In all likelihood, this will happen to you.
A page, an email, a text will request that you report to the program director’s office to have a conversation about a complaint against you. You are terrified, offended, maybe irritated. As you leave rounds to walk to the office, your adrenaline pumps. Your hands are sweaty, and you are a bit nauseous and lightheaded. Your heart rate increases. It is unimaginable that someone has complained about your behavior.
You understand your role as an advocate for your patient, and that is what you have been doing for 70 to 80 hours a week with little rest and little appreciation. While walking to the program director’s (PD) office, I hope that this message reaches you: residents do not arrive in training with a fixed capacity to perform. The point of residency is to grow, a process that requires an open mindset. Feedback on your behavior is not a grade or a hearing on your crimes. Criticism does not mean you are failing. Your intelligence, compassion and commitment is — probably — not being called into question. Rather, you are actively performing a new role that requires you to learn to speak and behave in a manner defined by the culture of the institution and profession that you are joining.
Seated at a desk is your PD with a printed-out complaint. It may have been emailed from the overnight ED attending, a nurse on the floor, the vascular surgery fellow that was rude to you on call, the clinic manager, or even a patient. More concerning, the complaint may have come from the institutional anonymous patient safety reporting system that is run by the human resources department.
The complaint entails the reporter’s perception that you were rude, disrespectful, short-tempered, inconsiderate, sexist, racist, insensitive, pushy and/or basically wrong — although hopefully not all those things at once. You are outraged, then defensive, and go through stages of explaining, to bargaining, to becoming defensive again, blaming the reporter even if you don’t exactly know who it is. Finally, you’re just baffled and — to put it bluntly — slightly pissed off. You are probably not listening to your PD, who is trying to patiently explain how your behavior has been perceived by someone else on the team. You don’t agree with the report or the PD. You know you are trying hard, working hard, and doing the right thing for your patients.
As your PD, I need you to take a deep breath. You are in a training program. I, your PD, am aware that you are still learning how to do this job. I do not expect you to be perfect. You are not perfect, and you are not yet fully formed as a physician. You are in the program to learn new skills that are unfamiliar and difficult. Your performance is continuously under subjective evaluation, but actual feedback opportunities will only intermittently arise. Your perception of the events is important, and as PD, I want to understand your version of the events in question. What I have learned in my time as PD is that you will likely need to adopt a new way of looking at your growth and development, one that is not about praise for high test scores or good grades. If the report says you were rude, chances are that the person you spoke to felt you were rude. Own that, think it over and figure out to communicate the same information in a different tone of voice or word choice next time. Consider apologizing. If the complaint is that you were offensive, racist, sexist, or ageist, you were perceived as being offensive. You gave offense, but that is not a catastrophe. Your PD wants to help you.
In the culture in which you are working, that behavior is unacceptable and cannot continue. You need to internalize this and work on changing your behavior. If you put a patient, another worker, or even yourself in an unsafe situation, you need to go back and analyze the process. This is quality improvement. An unsafe situation is not okay, but it can be improved. As a trainee, you actually get credit for initiating quality improvement, and you have just been given a project.
Listen to this feedback. The criticism you have received was delivered by someone with the same altruistic goals that motivate you to be a good doctor: excellent patient care, patient and staff safety, interprofessional collegiality, and so much more. If you can recognize that the other person cares just as deeply about medicine as you do, you may have found someone who is willing to engage in your growth. Take the opportunity to really learn more about yourself through this brief glimpse of how others see you in action as a doctor. If what you hear is unflattering or embarrassing, you are fortunate to have learned this is the protective setting in which you can work to develop into the physician that you want to be. It is absolutely normal to feel threatened or insecure at this point. Take a moment to reflect, do something for yourself to relax, and build your equanimity.
Residency is a long and difficult road along which you will learn new things about yourself and grow as part of the process.
Practical Wellness: Perspectives from a Program Director
A program director’s perspectives on practical wellness in residency and how graduate medical education leadership can facilitate housestaff resiliency and self-advocacy.
Image source: Curves by Rosmarie Voegti licensed under CC BY 2.0.
Attending Physician Guest Writer
Geisel School of Medicine at Dartmouth
Dr. Ronan is an associate professor of neurology and medicine at the Geisel School of Medicine and is the program director of the Dartmouth-Hitchcock Neurology Residency.
Practical Wellness: Perspectives from a Program Director
A program director's perspectives on practical wellness in residency and how graduate medical education leadership can facilitate housestaff resiliency and self-advocacy.