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The Case of Dr. X. Background. Transfer from another program to your PGY2 year USMLE Step 1 & 2 scores 200 range “Highly recommended” with superior clinical competence, knowledge base, and maturity Chair Letter: Will excel in your program. First Rotation - Elective.

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  • Transfer from another program to your PGY2 year

  • USMLE Step 1 & 2 scores 200 range

  • “Highly recommended” with superior clinical competence, knowledge base, and maturity

  • Chair Letter: Will excel in your program

First rotation elective
First Rotation - Elective

  • Satisfactory, but presentation skills need improvement

  • Trouble organizing the case and coming up with differential diagnosis

Second rotation hematology oncology ward
Second Rotation – Hematology/Oncology Ward

Nursing concerns surface over his responses and reactions to calls and are reported to Chief Residents:

  • High K+ - didn’t respond readily

  • Febrile neutropenic patient, nurse identifies possible tunnel catheter skin infection – resident unconcerned, fellow had to initiate management

Second rotation hematology oncology ward cont d
Second Rotation – Hematology/Oncology Ward (cont’d)

  • Irregular heart rhythm detected in patient being transported to radiology after multiple failed LP attempts – “I am not concerned, he just got poked several times in his back”. Patient experiences oxygen desaturation after procedure!

Second rotation hematology oncology ward cont d1
Second Rotation – Hematology/Oncology Ward (cont’d)

  • GI fellow concerns about team performance regarding a patient with GI bleed

  • End-of-month evaluations from teaching attending and intern do not allude to significant concerns

  • Chief Residents counsel Dr. X: casual responses are inappropriate with regard to acuity of illness seen in this hospital

Fourth rotation night float
Fourth Rotation – Night Float

  • No problems reported by intern

  • Some residents on day teams expressed concern to Chief Residents regarding:

  • Aspects of judgment

  • Ability to prioritize patient problems

  • Breadth of differential diagnosis

Fifth rotation inpatient medicine
Fifth Rotation – Inpatient Medicine

  • Teaching attending evaluation: well-organized, team run well, added to quality of discussions about cases, sought feedback

Fifth rotation inpatient medicine cont d
Fifth Rotation – Inpatient Medicine (cont’d)

  • Intern evaluations:

  • Appeared to be self-motivated to learn more about medicine and demonstrated an interest in teaching.

  • Not especially strong at applying knowledge to clinical situations.

Fifth rotation inpatient medicine cont d1
Fifth Rotation – Inpatient Medicine (cont’d)

  • More interested in looking for “zebras” than delivering good basic care.

  • Had somewhat limited first-hand knowledge of our patients.

  • Don’t think he passes the basic test “would you want this person to provide care for one of your loved ones?”

Sixth rotation micu
Sixth Rotation - MICU

Attending comments during and after the month:

  • Dr. X had difficulty quickly assessing and implementing care on critically ill patients

  • At times sloppy with data gathering and reporting

  • Oral presentations poorly organized and often mumbles and does not engender confidence in the listener

Sixth rotation micu cont d
Sixth Rotation – MICU (cont’d)

  • Written communication often sloppy and illegible

  • Poor organizational skills, confusing presentations, make it difficult to follow his thought processes

  • Needs substantial work at presentation skills, formulating and expressing assessments and plans, learning a problem- and systems-oriented approach to patient care

Sixth rotation micu cont d1
Sixth Rotation – MICU (cont’d)

  • Earnest, hard-working, cares about patients

    Bottom line: We have serious concerns about his ability to function as a senior resident, and believe he should repeat the rotation