Editor’s Note: Negative events experienced during an orthopedic chief residency year.
It was the beginning of my chief residency year in an inner-city hospital system. Overall, it had been a good summer for me. I performed many surgeries and the patients did well. But, I had one case that proved problematic.
I had done an ORIF on a patient with of an ankle fracture. Back then, chief residents could operate independently on call without an attending surgeon in the house. Patients in the city hospital, where the surgery was performed, were housed in large wards, sometimes quite a distance from the nurse’s station. My patient somehow got up out of bed the next day and walked around on the operated limb without crutches. The fixation, of course, fell apart. It was necessary to reoperate the case the next day with an attending present.
Unfortunately, the evaluation I received after my three-month rotation was “poor”. I was stunned as I had worked hard and except for the above-mentioned failed case, the trauma patients my team cared for did very well. With this in mind, I contacted the department chairman to discuss. It deeply mattered to me what my evaluation implied about my abilities. The chairman must have called the evaluating attending about this issue because, thereafter, that surgeon was overtly hostile toward me.
On a subsequent rotation in the spring, the surgeon mentioned above maintained his hostile stance. I was not spoken to, was given no cases to do and was largely ignored on rounds, during conferences and cases reviews. I had learned my lesson and did not report him again even though I clearly was being discriminated against. This adversely affected my training and ultimately the beginning of my career.
At the end of the final residency year and prior to graduation, all eight chief residents were given an oral examination. We were each placed in a room and an attending surgeon entered with radiographs and cases to discuss during the exam. Each resident had just one examiner. Just my luck, the attending described above walked into my room. Coincidence?
He brought with him radiographs from cases I remembered. These, in fact, were cases I was involved with the previous spring along with him! Oblivious to this, he asked questions about the patients and the radiographs. I know I got the answers right because I was involved in the discussions about these cases during daily rounds. My grade for the session was “Marginal Pass.” I never shared this injustice with anyone and just moved ahead to begin my career.
In an extraordinary turn of events, after I moved to another part of the country for my first job, the same attending called me. He asked if I was interested in returning to the residency program to do a “fellowship?” Of course, I declined. It later occurred to me why he had called.
After the unfortunate death of a young woman in a large city hospital, it was determined that the exhausted residents caring for her had many other patients to manage and no attending physician in the house for supervision. The young patient did not get the attention she needed overnight and she was dead by morning. The drug interaction that ultimately led to her death went unrecognized by those caring for her.
As a result of this tragedy, legislation was passed to limit residents’ work hours. In some cases, to meet the specified requirements, attending physicians were forced to help out by spending overnight hours in the hospital rather than at home when they were “on call”. This undoubtedly was why he wanted me back. He wanted me to take his shifts on call overnight in the hospital.
What did these events teach me? I let geography influence my choice of a residency program. In thinking back, when I interviewed at the site where I ultimately did my residency, the current residents did not seem happy. Even the chairman appeared unenthusiastic. Being one of the few women interviewing for an orthopedic residency in those days, I did not ask enough questions about why things were the way they were. I was just happy to be accepted into a program. In those days, many of the offers or residency slots took place outside of The Match.
As it turned out, I was later offered another residency slot at a more prestigious academic institution in another city. I wish I would have had the courage to make the change and train in the better program.
-
What can this teach others?
-
Don’t trust that you understand why things appear as they do. The residents I saw during my interview weren’t just tired, they were probably unhappy. Do more investigating and find out.
-
Watch your back. Not all those you meet are interested in your wellbeing and professional development.
-
Finally, go with your “gut”. If something does not feel right, it probably isn’t.
“You can observe a lot by just watching.” Yogi Berra