Skip to Main Content

Winning the Residency Lottery

December 14, 2019
by Mark David Siegel

Hi everyone: They say lottery winners quickly lose perspective on their newfound fortunes and, if they don’t acknowledge their luck sometimes, they’ll squander their riches. As Program Director, I’m in the same position, so today I want to acknowledge my own good fortune.

Last Thursday, we had our fall Clinical Competency Committee meeting. As most of you know, the ACGME requires all residencies to have a CCC, which is charged with reviewing every trainee’s performance twice a year. At our meetings, we review everyone’s milestones in six competencies: medical knowledge, patient care, interpersonal and communication skills, practice-based learning and improvement, professionalism, and systems-based practice. The goal is for all residents to show they’re ready for independent practice by the end of training. One-hundred thirty-eight residents, two minutes allotted for each.

The day is long and intense. We start at 7:30 AM and finish at 4 PM. The APDs are there, the Chiefs come through, inpatient faculty join us, and clinic preceptors appear to discuss their residents. We use MedHub evaluations and faculty reports to generate scores. To keep us fueled, Brett brings in three meals from Panera- coffee, breakfast sandwiches, quiche, fruit, sandwiches, soup, salads, water, more coffee, cookies, hot chocolate, and coffee cake (the latter was the culinary highlight of my day).

Here's the bottom line: everyone is on track for promotion or graduation. As always, there were occasional hiccups, and we did have to mark a few residents down in some areas. For example:

  • Deficient inbox management, particularly failure to respond promptly to results, refill prescriptions, and answer staff messages (Patient care and Professionalism)
  • Very low ITE scores- particularly under the 30th percentile (Medical Knowledge)
  • Failure to respond to emails from program leadership (Professionalism)
  • Erratic communication with nursing staff (Patient Care, Interpersonal and Communication Skills, Systems-Based Practice)
  • Public venting (Professionalism)
  • Resistance to feedback (Practice-based Learning and Improvement)

None of these issues were common and I’m sure each will be addressed effectively. If you have an area to improve, your APD will be in touch.

It was much more common for us to mark trainees up for exceptional performance, often to near-aspirational or aspirational levels. For example:

  • Extraordinary teaching
  • Special contributions to the residency, such as committee membership, leading conferences, promoting wellness, and advocating for program improvement.
  • Aspirational fund of knowledge, particularly ITE scores above the 90th percentile
  • Special efforts to help patients
  • Role modeling teamwork, collaboration, and effective communication with colleagues and staff.

As the long day drew to a close and darkness descended outside the windows at the VA, we finally reached the end and couldn’t help but reflect on our good fortune. You are an incredibly talented, committed and accomplished group. You’re inspiring and, for that reason, on the behalf of the faculty, I want to take this moment to acknowledge how privileged we are to work with you. We’ve definitely won the residency lottery.

Enjoy your Sunday, everyone,


Submitted by Mark David Siegel on December 15, 2019