Performance Improvement Plans: How to Succeed When on a PIP
You just learned that you are being put on a PIP. A flood of emotions and thoughts erupt. Now what? One of RWBC's most important tasks is to support residents through their PIPs. We have over 10 years of experience doing so and have learned a lot in that time about choices residents make that led to success and that led to dismissal. This topic page combines that evidence base with some literature that is available to give you very specific guidance.
For some perspective, as one program director who has worked with residents on PIPs explained to RWBC, "A PIP is a part of the educational process.
It is important to take it
seriously, but it is also important not to be
overly discouraged or worried. A PIP is NOT reportable to the state or future employers. A PIP that results in improvement is a WIN-WIN for you, and for your program; however, if you fail to improve as expected, you may be at risk for more serious consequences. It's important to approach your PIP with the right attitude & proper support- in order to maximize your potential for success."
Take your time reading and considering this guidance. Attending to this supports your success with your PIP.
1. First, breathe. Seriously, just breathe. You've been hit with a major stressor and your physiology has likely responded accordingly. Before attempting to do anything with this experience, learn how to breathe to calm yourself. Mindful breathing is a powerful way to do that.
2. Do not make any major decisions about anything right now. What you just learned will first be processed through your emotional mind. We make our worst decisions when we are in or emotional minds. Here's a link to a short introduction to this concept.
https://www.youtube.com/watch?v=xNY0AAUtH3g&t=28s
3. Accept your emotions. We experience events first through our emotional minds. That's normal. Identify your emotions about being on a PIP. Name them. They all have a right to be there. Having those emotions will not stop you from succeeding with your PIP. Trying to suppress your emotions will risk your wellbeing which can affect your success. You have a right to all your emotions about this.
4. Identify your negative thoughts. Closely related to your emotions will be thoughts about being on a PIP. If some of those thoughts become Automatic
Negative
Thoughts for you (ANTs) then they will likely become obstacles to your success. Here are some examples of ANTs related to being on a PIP: This is stupid, I don't have these problems! It's not fair. They're just out to get me. This is horrible, now I'll never be a physician. I can't handle this. This is so humiliating I can't tell anyone. Monitor your automatic negative thoughts regarding the PIP. When you notice yourself having an ANT, stop, breath, and firmly talk back to it with a Positive Alternative Thought (PAT), such as: Other residents have been on PIPs and succeeded. I will too. It is what it is and I will handle it. It is embarrassing to be on a PIP and I will handle it directly and effectively. I don't like this and I will learn and succeed with it. Deliberately make a list of Positive Alternative Thoughts. Write them down. Take a photo of them and put it in your Favorites Album on your phone. Look at it often. Here is a guide for changing ANTs
https://www.youtube.com/watch?v=m2zRA5zCA6M&t=29s
5. Write your PIP Mission Statement. As your emotional mind settles, your logical/rational mind will speak up and help you consider how to handle the PIP. Before you get into the details of doing the PIP, consider how you want to BE and act during the PIP. Write that down as a mission statement. Take a photo of that and put it into your Favorites Album on your phone. Refer to your mission statement often. It is your foundation for how you will manage this experience.
6. Tell trusted others. Let people you trust and who know you well know that you are on a PIP. Do not do your PIP alone. No one is meant to do that and doing it alone lowers the success rate for residents. Ask for their support. If they quickly jump to giving advice, ask them to hold off on that for a bit as for now you most need their support as you make your way through your initial reactions to the PIP.
7. Engage stress reduction tools. A PIP is a uniquely stressful experience in residency and it deserves dedicated attention to tools that will help cope with that stress. Here is a link to a summary of those tools. Especially look at the Pushing Away, Hearing and Activities tools.
8. Practice emotion shifts. It is likely that during the work day your thoughts and emotions will wander back to your PIP. That's normal. When that happens, first be kind to yourself when you notice it ("Yeah, there are those thoughts and feelings again. That's ok I can handle it.") Then do an Emotion Shift. Here is the link to Emotion Shifts on the RWBC website
https://www.marshfieldclinic.org/education/residents-and-fellows/well-being-committee/well-being-topics/quality-of-life/emotion-shift
9. Don't give up. Don't let your emotional mind or automatic negative thoughts fool you into thinking it is hopeless and you're going to fail. Don't get fooled into thinking there is nothing else in life, or in medicine, or for any career if you don't succeed. Admit that you may not be able to imagine an alternative future; however that does not mean there aren't alternatives that would be meaningful. Considering the fact that alternatives exist does not mean you are giving up.
10. Consult with RWBC. When you were given your PIP it included a recommendation that you consult with RWBC. The Division of Education does that as our evidence base indicates that residents who engage RWBC during their PIPS have a higher success rate with their PIPs. Consult us now, here is the email link to get it started
https://www.marshfieldclinic.org/education/residents-and-fellows/well-being-committee/Consult-with-us
You will make it through this and we are here for you.
