Resident In Difficulty
USAFP Small Group Exercise
Take Home Points
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Act swiftly to investigate and remediate a problem
Document, document, document – a simple MFR is often all you need
Focus on meeting requirements, not on illness or disability
Use the above the line / below the line model as your guide
Follow your program’s due process policy
Integration Task – Cases
Read and discuss the cases in your small group.
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Is the conduct:
Above the line (resident prerogative) or is it below the line (program prerogative).
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What course of action would you take at this point?
Appoint a spokesperson and be prepared to share your findings with the larger group.
Resident In Difficulty Cases
Faculty Development Session
1. Dr. A. is a second year resident who transferred into your program a few months ago from a
transitional internship. The head nurse in the clinic calls you to complain that Dr. A. has been
showing up 15-20 minutes late for clinic recently.
Part II: You talk with Dr. A. She denies that she has been late to clinic and does not
understand where this information is coming from. What will you do at this point?
2. Dr. E. is a resident who is early in his 3rd year. He has been slow in clinic in the past, but recently
the nurses have been complaining that he is still in clinic at 5pm and they have to stay late to assist
him. You look for Dr. E and find that he is not in his office—he is still in clinic. Then you notice
he has 37 open records in AHLTA, some dating back as far as 3 months.
Part II: When you meet with him, Dr. E. admits that he has a problem with time management
and asks for help in improving this shortcoming. He agrees to get the charts completed within 2
weeks.
3. Dr. L. is an intern, late in the academic year. She appears to be doing well when you see her, but
more than one of her classmates tell you they are concerned that she is very depressed and that she
may kill herself. They feel that she should not go home alone. They have been letting her sleep at
their houses to make sure that she is not alone. Her performance has been ok up to now.
Part II: You meet with her and she agrees that she is depressed asks for your help.
4. Dr. L. above, has been admitted to the inpatient psych ward. As a result she has missed most of her
current rotation. Her performance prior to her admission was clearly below expectations and she
will be marked as failing the rotation. When you visit her, she asks that you overlook her failure of
the rotation, which she attributes to her depression. She wants you to adjust her rotation schedule
so that it will be less stressful for her over the next few months.
5. Dr C. is an intern who scored in the 2nd percentile on the composite score of his in-training exam
this year. The results have just come back and you are deciding how to handle this problem.
Generally residents who score below the 20th percentile on the composite score do not pass the
board certification exam.
Part II: You meet with Dr. C. and he explains that he is simply a “poor test taker”. He is
doing well on his rotations and feels he is on par with his peers.
6. Dr. R. is doing well and liked by staff and residents. The residency coordinator pulls you aside
and complains that she constantly has to remind Dr. R. to attend to administrative tasks. If she
continues to nag him, he will eventually get the administrative items completed. She is sick of it.
Part II: You talk to resident R. and he agrees that he is sometimes the last one to get some
admin things completed. He states that his patients love him, he is passing all of his rotations
and he just doesn’t have time to complete the “stupid busy-work admin stuff”. Your residency
coordinator calls you while you are talking to Dr. R., to inform you that he is 3 weeks away
from the end of his 2nd year and does not have a medical license. Dr. R. blames the state he
applied to for being slow to process his request. You later find out that he had not even taken
part III of the USMLE boards.