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  • Medical Trainees and Medical Training

  • By: Craig M. Johnson, D.O.

  • Scenario 1 of 4

    As the Vice-Chair of Education, you had welcomed the arrival of three new fellows into the 12-month, non–ACGME-accredited radiology fellowship training programs (in ultrasound, interventional radiology, and emergency radiology) at your institution. At the onset of the fellowship program, all of the fellows were eager and excited, having just successfully passed their oral boards in Louisville, Kentucky, and were ready to start their careers in radiology.

    However, 3 months into training at this busy hospital (where there has traditionally been no overnight attending call coverage), one of the fellows decided to resign for “personal reasons.” This resulted in redistribution of the clinical duties to the two remaining fellows, because the majority of the radiology group practice feels that working hard is a good part of the trainee experience, and “since we have all done it, we know that the best thing for a fellow is to stay busy and see and learn from as many good cases as possible.”

    You notice shortly thereafter that there has been a change in disposition of one of the remaining fellows. He had been very happy and energetic during the first couple of months of fellowship but more recently has exhibited a depressed affect and appears fatigued. You also notice that the level of his personal hygiene has changed (even on days when he is not on call), and some of the attending radiologists have commented that the quality of his work has decreased, although they feel that he is working very hard and learning a lot.

    You are concerned for this fellow’s health but see no signs of weight loss or coughing; he actually may have gained weight. You also do notice on a few occasions that the fellow is swallowing pills, but you never see the bottle. It also appears that the fellow attends few social functions, rarely interacts or socializes with people outside of work, and has not been seen with his family (contrary to their visible togetherness exhibited during orientation week).

    In discussion with colleagues, you have also heard about a few comments from referring physicians that he has recently “flown off the handle” when consulted for CT readings while on overnight call. Given all of this information, you want to find out what is going on with this fellow and help him out, but you don’t want to run the risk of offending him or provoking a confrontation.

    Question 1 of 4: On the basis of the available information and your familiarity with the process of medical training, what would be the least likely explanation for this fellow’s behavior? 


     Drug abuse. 





     Choice of wrong subspecialty. 



     Mental illness (such as anxiety or depression). 



     Marital difficulties



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