I thought this thread may be helpful prior to the match to try to avoid some of the bad programs ie programs with unreasonable/unstable attendings and residents. I would like to try to avoid these programs if possible. I have had some pretty bad experiences with the University of Kentucky internal medicine department for example.

http://drslounge.studentdoctor.net/showthread.php?t=71396

:)

http://drslounge.studentdoctor.net/showthread.php?t=71396

:)

Am I missing something or are those surgery programs in the thread you posted?

Boston University has a malignant reputation in terms of treatment of residents, i.e. residents routinely get reamed out by attendings and made to feel that they don't deserve to practice at this "hardcore" inner city hospital . . . attendings are not honest in their evaluations i.e. remarks in evaluations don't have a correlation with reality and everyone in the IM department seems to walk around with a block of wood on their shoulder, it is the sort of hospital where you have to know the politics to do well, i.e. you will spend a lot of energy and times cateering to the emotional whims of some attendings and wondering why others constantly come down on you . . . not for the faint of heart! Most applicants would feel that life is too short for this type of bs, some residents apply knowing how bad it is basically to get a good fellowship (which may not materialize) or to have just to stay in boston for family reasons.

As a 4th year at BU, I'm having a bit of a hard time understanding where the idea that BU is this kind of "Hell on Earth" program, an idea which seems to be so prevalent around here. The program is hard, no doubt, but the faculty is very supportive of the residents and any issues I've heard of are few and far between. I've had this discussion with a lot of the interns and residents, and everyone is generally says the same thing about how the program isn't really as malignant as everyone outside the program believes. I'll admit that my experiences are somewhat limited, but after 2 years of clinical clerkships, I've not had any truly malignant interactions with any medicine faculty, and if the program were truly bad as everyone said, I would have thought this would be more apparent, even if the faculty were trying to "hide" it from the med students. For my part, I've had a lot of good experiences here, and I'm having a hard time deciding where to rank it in my top 3. My feeling is that a lot of these impressions are from many years ago, but the program has had a lot of changes and "malignant" wouldn't be one of the terms I would currently apply to the program.

I guess it depends on what type of learning and working environment you want in a residency. If all you know is old school northeastern IM programs like BU then yes it would appear that BU is just "tough" as you put it. However, there are so many more excellent IM programs that don't feel the need to harass their residents and a much more supportive of their residents than BU. The medicine residents I observed at BU appearred very stressed out and disatisfied with the program, some of the BU internal medicine attendings do have a condescending attitude toward students and residents (extremely so), so perhaps everyone sees a different part of the elephant as it were. When I select a residency program here is how I would rate BU for each category on a scale of 1 to 10 with 10 being excellent and 1 being poor:

A. Overall friendliness of faculty: 2 This is were BU can improve a lot as other hospitals I have been to have much nicer and approachable faculty, you will feel like you are walking on shards of glass with faculty at BU.

B. Teaching: 3 BU makes an effort to teach, but presentations are awful and attendings give vague answers and act dismissively towards students who keep up with their reading.

C. Location: 3while I guess that if you are into old crumbling brownstones and impossibly out of date streets that are too narrow to get anywhere then you would like the location, personally I wouldn't mind but I found the people who live around BU to be a bit pushy and boston is definitely not known for its hospitality.

D. Research 2 no secret here that BU's offerings in research are poor coordinated with the IM residency.

I think part of BU's problem is that they carry around the title of being an "academic" institution without really doing anything to improve themselves or their residency program, i.e. it is stagnated. Here is another IM program I rotated at (I won't say which one, but just to contrast with BU):


A. Overall friendliness of faculty: 9 I never felt harassed or pressured by the faculty and surprised how much a human being they made me feel like, rather than another face in the crowd.


B. Teaching: 9 EXCELLENT teaching, although a "community" program they didn't mess around with sloppy teaching practices and presented interesting cases.

C. Location: 8 a place where people just feel like being nice to each other, very friendly city as well.

D. Research 3 limited research options, but at least they were honest about this and said they did have residents working on various projects, but hey, with nice faculty and great teaching this program I would recommend to anyone over BU no question about it.

BU wants (needs) people to sort become accustomed to the BU way of doing things, and be weak minded, so that students/residents believe that being treated poorly is part of residency and life, but if you think independently you can find a lot of other excellent IM programs that will make your life easier and make you a more compassionate doctor in the end, to the BU 4th year, I would seriously consider rotating elsewhere (if it isn't too late) and consider a residency other than BU unless you know what you are getting yourself into, . . . you might be missing out on your dream program and not even know it! I just post this for those who DO care about how they are treated to a certain degree. While I didn't say bu was "Hell on Earth" I have seen scrawled in one resident area "THIS IS HELL" near a computer, so for a lot of residents it is . . .

I guess it depends on what type of learning and working environment you want in a residency. If all you know is old school northeastern IM programs like BU then yes it would appear that BU is just "tough" as you put it. However, there are so many more excellent IM programs that don't feel the need to harass their residents and a much more supportive of their residents than BU. The medicine residents I observed at BU appearred very stressed out and disatisfied with the program, some of the BU internal medicine attendings do have a condescending attitude toward students and residents (extremely so), so perhaps everyone sees a different part of the elephant as it were. When I select a residency program here is how I would rate BU for each category on a scale of 1 to 10 with 10 being excellent and 1 being poor:

A. Overall friendliness of faculty: 2 This is were BU can improve a lot as other hospitals I have been to have much nicer and approachable faculty, you will feel like you are walking on shards of glass with faculty at BU.

B. Teaching: 3 BU makes an effort to teach, but presentations are awful and attendings give vague answers and act dismissively towards students who keep up with their reading.

C. Location: 3while I guess that if you are into old crumbling brownstones and impossibly out of date streets that are too narrow to get anywhere then you would like the location, personally I wouldn't mind but I found the people who live around BU to be a bit pushy and boston is definitely not known for its hospitality.

D. Research 2 no secret here that BU's offerings in research are poor coordinated with the IM residency.

I think part of BU's problem is that they carry around the title of being an "academic" institution without really doing anything to improve themselves or their residency program, i.e. it is stagnated. Here is another IM program I rotated at (I won't say which one, but just to contrast with BU):


A. Overall friendliness of faculty: 9 I never felt harassed or pressured by the faculty and surprised how much a human being they made me feel like, rather than another face in the crowd.


B. Teaching: 9 EXCELLENT teaching, although a "community" program they didn't mess around with sloppy teaching practices and presented interesting cases.

C. Location: 8 a place where people just feel like being nice to each other, very friendly city as well.

D. Research 3 limited research options, but at least they were honest about this and said they did have residents working on various projects, but hey, with nice faculty and great teaching this program I would recommend to anyone over BU no question about it.

BU wants (needs) people to sort become accustomed to the BU way of doing things, and be weak minded, so that students/residents believe that being treated poorly is part of residency and life, but if you think independently you can find a lot of other excellent IM programs that will make your life easier and make you a more compassionate doctor in the end, to the BU 4th year, I would seriously consider rotating elsewhere (if it isn't too late) and consider a residency other than BU unless you know what you are getting yourself into, . . . you might be missing out on your dream program and not even know it! I just post this for those who DO care about how they are treated to a certain degree. While I didn't say bu was "Hell on Earth" I have seen scrawled in one resident area "THIS IS HELL" near a computer, so for a lot of residents it is . . .

To address your points in turn. When I said that BU is "tough", I meant that BU is the main hospital for the indigent and under served of Boston, and that there is going to be a concomitant amount of work associated with this patient population in terms of follow up and social work issues. However, the ancillary services and social work is excellent, and I've never noted any problems in getting patients placed in rehab or nursing care. For friendliness, I can't recall any medicine faculty being so bad as to leave a lasting impression. OB/Gyn, Peds, or Neuro, yeah, there may have been some issues, but that's not exactly a medicine issue, but on the medicine or medicine sub-specialty services I never had any problems (I had 2 LORs written by cardiologists). On my Advanced Acting Internship, I had 3 Attendings, and I didn't have any problems with any of them, and one of them wrote me another LOR. As for teaching, all the attendings were always willing to have attending rounds to go over important teaching points. In fact, there were a few times that I had to tell them a particular day wasn't good for teaching because there was too much AAI work to be done. As for location, the South End has greatly improved since the slum ridden days of the 1980's. It's become quite gentrified and there are a lot of trendy restaurants and artists's lofts within a 3 block radius of the hospital. I myself live in one of those run down brownstones which you describe. Aside from being "Boston expensive", it's a great place and I can't state any complaints with it. For research, there are a great number of residents doing research projects. You say it's "not a secret that research are poorly coordinated with the IM residency" but again the residents I've talked to say that they've made the contacts they've needed to in order to augment their CV for fellowship applications. As for the stagnation of the program, maybe that's been the case in the past, but there's a new program director who is also the chair of medicine, and there has been a lot of changes in the program within the last year, including a shakeup of the call schedule of the program. Dr. Coleman has been very responsive to the suggestions of the residents and there has been a lot of positive changes in the program. As for the "This is hell" being scrawled into the resident work area, I don't have any answer for that aside from that intern year sucks and when you're admitting patients at 2 AM, the world is a very bleak place, and people will choose to express their frustration in different ways. If you are a student at BU, or did a rotation at BU, I would be very interested to know who you worked with to give you such a poor impression of this program, because if you got a very different impression of the place than I have, I would be very interested to hear about it. Please PM me with your pertinent information.

I guess it depends on what team your are on for medicine, my teaching consisted of morning report waiting for an attending who was usually late, and then a lot of emphasis on how to present the patient, but then no really good discussion of diagnostic tests or management principles, believe me I have seen morning report run a lot better at other places, the attitude of the attending running report seemed to be that he felt he knew so much that he didn't bother to explain why this or that test was choosen etc . . . I have seen a similar display of such "excellent teaching" with interview applicants, one of whom had to correct what one of our attendings was saying! I.e. the applicant made a correct point about how the discussion between our resident and attending was making false assumptions, out attending tried to cover it up by saying, "Yes, I guess you could say that.", but it was obvious to everyone that our resident and attending had no read up on the case they were presenting. The noon conferences were not as good or memorable as they I have seen at other institutions at all, and I leave it at that. We were so busy on the wards that there wasn't anytime for "teaching at the bedside" I think one attending asked the causes of AG Metabolic acidosis and I rattled off mudpiles or something and he looked surprised I knew that, and well teaching was done for the rotation. There just isn't as much time to teach or to think at BU IM as there are at other places where you actually sit back and think about the next steps to take in the management. I have clinical experience at another hospital that is much more a safety net hospital for immigrants and poor people than BU and their placement/social work team is very efficient so this doesn't suck up the residents time, but still there is an underlying lack of efficiency at BU where simple things take hours to complete. Attending rounds can last from 9 am to 4 pm or later, at least on my team, and there isn't really teaching going on per se just an attending who tries it hard to make it look like the residents are incompetent and asks a couple odd medicine questions which no one answers. . .so I have seen residents try desperately to get out of "attending rounds" because there is just to much work to do and the attendings don't facilitate by rather are slow (I.e. go very slowly from room to room as in walking slowly and critiqueing residents daily in front of us students, ouch) and long-winded. Some residents just excuse themselves by saying that they need to get patient x to radiology and need to fill out some form and just never come back, I have seen residents utter a string of complaints about "attending rounds" when out of ear shot of the attending. At other places I have seen that the attendings are more focused and answer important management questions, not have a slow drawn out discussion about correcting the K of a patient with a second year resident who is already doing it correctly. At some institutions you can learn a lot by listening to discussion on the wards between residents and attendings, not so at bu, my daily thought was that I could be learning more by reading up in a book or article about my patients, because the were either not very much into teaching or simply weren't current with management principles and they themselves "learned by doing" and overly rely on consultants.

Until a couple years have elapsed and changes have been implemented (it appears things are in flux right now at this IM program) I would not recommend it at all to friends and obviously did not apply to BU IM at all.

"I thought this thread may be helpful prior to the match to try to avoid some of the bad programs ie programs with unreasonable/unstable attendings and residents. I would like to try to avoid these programs if possible. I have had some pretty bad experiences with the University of Kentucky internal medicine department for example."

I'm surprised/dismayed to here your comment re: UK Internal Med.

(a suspicious sort may wonder if making that aside was the whole point of your post ;))

While I can only speak to UK as having done medical school there (and therefore having done a 3rd year and a 4th year sub-I rotation there) I certainly wouldn't call it malignant! Now my basis for comparison is the 2 other programs that I've spent time at (both considered top tier programs, but also known to be "hard") so therefore take everything I say with a grain of salt. I assume you would anyway.

UK's schedule is definitely more aligned with old school academic programs--ie q4 overnight for a fair bit first year, with night float around only to do crosscover and take the heat off if there are a lot of admissions. And it's a pretty busy hospital, getting admissions from across the state and from an admission-happy ER. But their residents seem to enjoy their work, usually get to sleep a bit at night on call, and seem overall happy. And they also seem to like the PD as well.

But what I experienced personally the most, and impressed me to no end, was the quality attendings--lots of teaching, as good as if not better than I experienced elsewhere. Great people that care about the residents and care about making them great doctors. I can't imagine that would ever describe a malignant program...

"I thought this thread may be helpful prior to the match to try to avoid some of the bad programs ie programs with unreasonable/unstable attendings and residents. I would like to try to avoid these programs if possible. I have had some pretty bad experiences with the University of Kentucky internal medicine department for example."

I'm surprised/dismayed to here your comment re: UK Internal Med.

(a suspicious sort may wonder if making that aside was the whole point of your post ;))

While I can only speak to UK as having done medical school there (and therefore having done a 3rd year and a 4th year sub-I rotation there) I certainly wouldn't call it malignant! Now my basis for comparison is the 2 other programs that I've spent time at (both considered top tier programs, but also known to be "hard") so therefore take everything I say with a grain of salt. I assume you would anyway.

UK's schedule is definitely more aligned with old school academic programs--ie q4 overnight for a fair bit first year, with night float around only to do crosscover and take the heat off if there are a lot of admissions. And it's a pretty busy hospital, getting admissions from across the state and from an admission-happy ER. But their residents seem to enjoy their work, usually get to sleep a bit at night on call, and seem overall happy. And they also seem to like the PD as well.

But what I experienced personally the most, and impressed me to no end, was the quality attendings--lots of teaching, as good as if not better than I experienced elsewhere. Great people that care about the residents and care about making them great doctors. I can't imagine that would ever describe a malignant program...

Well I'm glad your experiences on your 2 rotations were good assuming you are who you claim to be as I wouldn't put anything past the people running the show at UK. I would strongly recommend against it if asked by a friend. As for "great attendings" I can only attest to my own experiences which in my mind more than qualify it as a malignant program. I completeley disagree with your entire last paragraph. I will give you that there are some really high quality people at UK like anywhere else. It's just that there are too many of the other kind and they are running the show in the IM program.

Well I'm glad your experiences on your 2 rotations were good assuming you are who you claim to be as I wouldn't put anything past the people running the show at UK. I would strongly recommend against it if asked by a friend. As for "great attendings" I can only attest to my own experiences which in my mind more than qualify it as a malignant program. I completeley disagree with your entire last paragraph. I will give you that there are some really high quality people at UK like anywhere else. It's just that there are too many of the other kind and they are running the show in the IM program.

Looks like I have finally found a post to which I am qualified to respond. I never took the trouble to register before, but I don't like the idea of my medical school institution taking criticism that probably no one closely associated with the program would offer. I completed medical school at the University of Kentucky and am now training in internal medicine. I must say, my experiences at this program as a medical student looking to enter internal medicine were very positive.

First of all, the people "running the show in the IM program" in Lexington, not unlike most other academic institutions, are the residents. UK certainly is a resident-driven program, offering significant autonomy and decision making to the interns and their upper-level residents. That being said, the attendings in the department (and I worked with quite a few of them) are by and large outstanding. Nearly all of them take time each day to formally teach their team and of course offer countless pearls throughout rounds. But, the most ridiculous aspect of the above post is the idea that the attendings could be malignant or abusive. The atmosphere of the IM program is one thing that I never heard fellow students or residents question. If anything, someone from another institution might consider the educational environment too laid-back or informal. Patient care, however, is taken quite seriously.

I cannot dismiss the possibility that someone could rotate through UK's IM department and have a bad month with a particular attending or resident, but from the collective experiences my friends and I had with the program, I do feel like it would be quite rare. And malignant or abusive - certainly not!

Looks like I have finally found a post to which I am qualified to respond. I never took the trouble to register before, but I don't like the idea of my medical school institution taking criticism that probably no one closely associated with the program would offer. I completed medical school at the University of Kentucky and am now training in internal medicine. I must say, my experiences at this program as a medical student looking to enter internal medicine were very positive.

First of all, the people "running the show in the IM program" in Lexington, not unlike most other academic institutions, are the residents. UK certainly is a resident-driven program, offering significant autonomy and decision making to the interns and their upper-level residents. That being said, the attendings in the department (and I worked with quite a few of them) are by and large outstanding. Nearly all of them take time each day to formally teach their team and of course offer countless pearls throughout rounds. But, the most ridiculous aspect of the above post is the idea that the attendings could be malignant or abusive. The atmosphere of the IM program is one thing that I never heard fellow students or residents question. If anything, someone from another institution might consider the educational environment too laid-back or informal. Patient care, however, is taken quite seriously.

I cannot dismiss the possibility that someone could rotate through UK's IM department and have a bad month with a particular attending or resident, but from the collective experiences my friends and I had with the program, I do feel like it would be quite rare. And malignant or abusive - certainly not!

I see. Like the "other" poster this is your first post because you never felt you "were qualified" to post anywhere else. One of the most common statements I've heard from residents is "It's always the same residents and nothing is ever done about it". Outright falsifications on evals by completely malignant Attendings/residents which seem to be based wholly on the decision of some moody attending on whether or not they like you. Another commonly heard sentiment expressed by residents about the bad residents "they spend their time abusing people rather than teaching those under them because they are insecure about their knowledge". It gets even worse than that.

Wow MedicineDoc--clearly you feel someone did you wrong at UK! I've never heard someone speak of the program with such vehemence! But I'd like to promise readers, after going back and talking to people at UK today, that this negative opinion seems to be in the minority. Again, everyone was shocked that someone viewed it as malignant--not that it's perfect, but such a description just seems out of left field! I encourage people to go and get other opinions as well, as I feel that they'll be overwhelmingly positive!

Wow MedicineDoc--clearly you feel someone did you wrong at UK! I've never heard someone speak of the program with such vehemence! But I'd like to promise readers, after going back and talking to people at UK today, that this negative opinion seems to be in the minority. Again, everyone was shocked that someone viewed it as malignant--not that it's perfect, but such a description just seems out of left field! I encourage people to go and get other opinions as well, as I feel that they'll be overwhelmingly positive!

Yeah right.

I see. Like the "other" poster this is your first post because you never felt you "were qualified" to post anywhere else.

Not sure about the point of that little jab. If anything the fact that they were both inspired to start posting just so they could defend their program seems, to me, a positive.

Not sure about the point of that little jab. If anything the fact that they were both inspired to start posting just so they could defend their program seems, to me, a positive.

If the poster is claiming to be a student then he/she is not claiming to be in the program. How does the expression go about "walking a mile in someone's shoes". I am basically saying that I wouldn't put anything past some of the people in that program.

If the poster is claiming to be a student then he/she is not claiming to be in the program. I would love to spell it out even more clearly and one of these days I might.

I'd like to take you up on that, MedicineDoc, if you would be so kind. Rather than go on about UK's strengths and weaknesses from a personal standpoint, I will suffice it so briefly say that zeezee's understanding has been widely validated by residents as well as students that rotate through the department.

The sort of vitriol you evince is quite remarkable, given the general congenial atmosphere at UK.

And before you point it out with another ad hominem attack (instead of addressing the salient points of contention), this is indeed my first post, driven to defend a program I cherish. If my count is correct, your total may be the summation of the posts on this thread and the UK or UofL thread (which is simply a link to this one).

I'd like to take you up on that, MedicineDoc, if you would be so kind. Rather than go on about UK's strengths and weaknesses from a personal standpoint, I will suffice it so briefly say that zeezee's understanding has been widely validated by residents as well as students that rotate through the department.

The sort of vitriol you evince is quite remarkable, given the general congenial atmosphere at UK.

And before you point it out with another ad hominem attack (instead of addressing the salient points of contention), this is indeed my first post, driven to defend a program I cherish. If my count is correct, your total may be the summation of the posts on this thread and the UK or UofL thread (which is simply a link to this one).

I have simply stated my experiences and things I have heard again and again. I am skeptical of this post and the others. They sound the same to me as in the same poster. The words and cadence seem flowery and high handed as in coming from the same poster. I don't believe it. Other people are free to their own opinions.

I actually walked into my UK interview hearing the same type of things that you did MedicineDoc. In my limited experienced at UK that day, I found most of those things to be unfounded. I felt that I met a substantial number of residents that day and really didn't find anything to substantiate those rumors. The faculty members that I did interact didn't seem particularly of the malignant nature.

I'm not trying to invalidate your opinion; I understand that to each his/her own and indeed you can't know what it's like to be a resident at UK unless you have been a resident at UK. But as someone who has posted here for quite some time and has no stake in UK (I am an IMG and rotated in the East and West coasts, my post history could probably verify that), I felt compelled to post this to counter your skepticism towards less established posters.

At the same time, you too are a poster who recently registered with a very limited post history. While you choose to remain skeptical, it would be equally reasonable for others to be so as well and dismiss you as a proponent of a competing program seeking to tarnish UK's reputation. If true, then its unfortunate you've had this experience. I hope you're able to find a better fit.

I actually walked into my UK interview hearing the same type of things that you did MedicineDoc. In my limited experienced at UK that day, I found most of those things to be unfounded. I felt that I met a substantial number of residents that day and really didn't find anything to substantiate those rumors. The faculty members that I did interact didn't seem particularly of the malignant nature.

I'm not trying to invalidate your opinion; I understand that to each his/her own and indeed you can't know what it's like to be a resident at UK unless you have been a resident at UK. But as someone who has posted here for quite some time and has no stake in UK (I am an IMG and rotated in the East and West coasts, my post history could probably verify that), I felt compelled to post this to counter your skepticism towards less established posters.

At the same time, you too are a poster who recently registered with a very limited post history. While you choose to remain skeptical, it would be equally reasonable for others to be so as well and dismiss you as a proponent of a competing program seeking to tarnish UK's reputation. If true, then its unfortunate you've had this experience. I hope you're able to find a better fit.

Fine. I wish you good luck and no where near the experiences I have had if you wind up at UK. There are some very nice residents there and I hope they are the ones you mostly wind up having to deal with and warn you to be careful although I strongly recommend against going there in the first place.

I am skeptical of this post and the others. They sound the same to me as in the same poster.

Wait, you have this habit of using very cryptic language, so let me make sure I have this straight. In your world, it makes sense that someone would be so deeply impacted by your backhanded slight on an anonymous internet message board that they would feel compelled to create multiple new accounts on that board for the purpose of crafting the illusion that multiple UK residents were coming to the aid of the program?

.....just checking.....

:scared:

Wait, you have this habit of using very cryptic language, so let me make sure I have this straight. In your world, it makes sense that someone would be so deeply impacted by your backhanded slight on an anonymous internet message board that they would feel compelled to create multiple new accounts on that board for the purpose of crafting the illusion that multiple UK residents were coming to the aid of the program?

.....just checking.....

:scared:

Great. You got me. A zinger. Congratulations. As far as I can tell one poster claimed to be a resident. The others students (with one a former student and now a resident at another program in IM). Yourself advertising you are a student from St. Louis. I've already related my thoughts. I'm done with this thread. I hope you apply to and get accepted to the UK IM program.

who would want to live in kentucky? i've driven through the state and seen confederate flags on the backs of almost every truck i passed. no thanks!

who would want to live in kentucky? i've driven through the state and seen confederate flags on the backs of almost every truck i passed. no thanks!

I can tell you that you can count on hearing "Do you care to let me this or that?" at least 10 x a week. Instead of "Can I see the chart?", it's "Do you care to let me see the chart? Four extra words besides the many patients addicted to oxycontin or lortabs to remind you that you are surrounded with Eastern Kentuckians.

Although I only have the experiences of my interview day to tell me of BU, I came away with a positive impression. The residents that attended the dinner the night before seemed happy and the program seems responsive to residents, having implemented the first major change in their call schedule which will make it easier for us intern year, something some of the PGY-2s seemed a little miffed at since they had to go through a worse intern year than we will have. I forget the specific change in the call schedule.

The noon conference I attended was very well done, there was an ED attending at least one medicine attending, and an endocrinologist, and a nice discussion of diagnosis and clinical findings in the case presented, minute diagnostic points to distinguish diseases and key, if obscure, physical findings, with all of the attendings contributing important points. I did not get the chance to attend a morning report. The gastroenterologist who interviewed me was extremely nice and very genuine. Residents said that they soon got a lot of autonomy in treating patients, if attendings felt that it was justified.

While I did get the impression that the interns/residents worked hard and that it's a front-loaded program (this is actually one of the programs I was referring to in the other thread, amelia, thanks for your insights), I didn't feel it was "malignant" per se, but just a high volume program, so naturally people felt ground down at times. However, the new call system change is a significant improvement, the one conference I observed was really good, but not sure how applicable it is from amelia's posts, and they graduate very competent people, have good fellowship matching, interesting residents, and I think Boston would be a nice city to live in.

What would be the range of pricing from the most economical place to rent in a safe location within a reasonable distance of BU to more expensive. If I brought a car would I get stuck in traffic jams? If I didn't, would I have to spend a lot of time on the T going back and forth to work or just throughout Boston? Thanks for the good points everyone.

. . . having implemented the first major change in their call schedule which will make it easier for us intern year, something some of the PGY-2s seemed a little miffed at since they had to go through a worse intern year than we will have. I forget the specific change in the call schedule.

While I did get the impression that the interns/residents worked hard and that it's a front-loaded program (this is actually one of the programs I was referring to in the other thread, amelia, thanks for your insights), I didn't feel it was "malignant" per se, but just a high volume program, so naturally people felt ground down at times.

What would be the range of pricing from the most economical place to rent in a safe location within a reasonable distance of BU to more expensive. If I brought a car would I get stuck in traffic jams? If I didn't, would I have to spend a lot of time on the T going back and forth to work or just throughout Boston? Thanks for the good points everyone.

BU interviews well, but when you actually work long-term with their medicine attendings you may wish you went somewhere else. I think all IM programs try to put on the appearrance that they are not malignant, so it is good to talk to former residents who have more perspective on where BU IM residency fits in the grand scheme of things.

There are a lot of miffed residents at BUMC, not exactly because there are such a huge load of patients, but rather because BU attendings believe that residents have to suffer through a certain amount of harassment and education by intimidation during their stay. So be prepared to face some "old school" tactics which have died out at other places that treat their residents with more humanly. I think this lies at the heart of why so many consider BU IM to be such a malignant place. One resident I knew definitely would not have choosen BU's IM program if they had it to do again . . .

Boston is one of the worst cities to commute in, and the area around BUMC is horrible in terms of the traffic situation, i.e. old 2 or 4 lane traffic with people who drive worse than New Yorkers. Parking is very hard to come by, but I would recommend driving in 45 minutes to an hour each way each day to avoid living in the grimmy area around BUMC which always seems to have loud parties each fri, sat and sunday nights and there is always construction going on around there. Plus, I didn't feel very safe walking around at night there even though I lived only a couple of blocks away. Housing in Boston is one of the most expensive in the country as I think there is price-fixing by realtors to live in crumbling mice infested apartment buildings, so be prepared to live with a roomate during residency if you want some place more liveable during your stay in Boston.

BU interviews well, but when you actually work long-term with their medicine attendings you may wish you went somewhere else. I think all IM programs try to put on the appearrance that they are not malignant, so it is good to talk to former residents who have more perspective on where BU IM residency fits in the grand scheme of things.

There are a lot of miffed residents at BUMC, not exactly because there are such a huge load of patients, but rather because BU attendings believe that residents have to suffer through a certain amount of harassment and education by intimidation during their stay. So be prepared to face some "old school" tactics which have died out at other places that treat their residents with more humanly. I think this lies at the heart of why so many consider BU IM to be such a malignant place. One resident I knew definitely would not have choosen BU's IM program if they had it to do again . . .

Boston is one of the worst cities to commute in, and the area around BUMC is horrible in terms of the traffic situation, i.e. old 2 or 4 lane traffic with people who drive worse than New Yorkers. Parking is very hard to come by, but I would recommend driving in 45 minutes to an hour each way each day to avoid living in the grimmy area around BUMC which always seems to have loud parties each fri, sat and sunday nights and there is always construction going on around there. Plus, I didn't feel very safe walking around at night there even though I lived only a couple of blocks away. Housing in Boston is one of the most expensive in the country as I think there is price-fixing by realtors to live in crumbling mice infested apartment buildings, so be prepared to live with a roomate during residency if you want some place more liveable during your stay in Boston.

I was surprised to hear about how malignant BU is percieved to be from people outside the program, as it wasn't something which came across to me during during med school. As such, I took the last week to specifically get in touch with the interns and residents which I had worked with during my clinical rotations in IM. The unequivocal response I got from the 8 people I talked to was the BU wasn't malignant in the sense of residents at each others throats, and constant bickering and grievances with the faculty. Even one resident I talked to who said that he might rank BU lower if he had to do it again said that his problems weren't with malignancy in the program. Moreso, the problems I have heard about the program fall into 2 categories. 1) Nursing and logistical support can be aggravating at times and 2) The amount of support the residents get for their fellowship applications varies significantly from department to department (Cards applicants report having trouble getting the necessary support from the department, while GI applicants get an extraordinary amount of support from their department and match incredibly well, and fellowships applications are complicated by how there's no elective time during intern year, so making contacts takes a lot of initiative on your part). So yeah, the program isn't perfect, but it's not the people who are malignant. As for Boston, yeah it's expensive, yeah the traffic sucks, yeah the South End isn't Cambridge, but that's not exactly a secret, and for my part the South End has improved significantly in the 4 years I've been here and has become an up and coming area.

edit.

Just deleted both BU and UK from the "programs selected" section of my ERAS.

Life is too short to spend 3 years at a @#$# place.

Keep the feedback coming.

viostorm, remember to take what you see here with a grain of salt. it's an anonymous message board. i wouldn't necessarily take someone else's word on a program. if you are really interested in a program, you should check it out for yourself. you can get a sense of how happy residents are during the interview/ preinterview function. are there alot of residents at the preinterview dinner? do they seem to like each other? do you get along with the residents you meet? i wouldn't necessarily drop bu from your list.

viostorm, remember to take what you see here with a grain of salt. it's an anonymous message board. i wouldn't necessarily take someone else's word on a program. if you are really interested in a program, you should check it out for yourself. you can get a sense of how happy residents are during the interview/ preinterview function. are there alot of residents at the preinterview dinner? do they seem to like each other? do you get along with the residents you meet? i wouldn't necessarily drop bu from your list.

I think that is all excellent advice. I'll try and find the drunkest resident at the dinner to get the deets. :D

The word on the street is interviews are a load of @#$@, have a close friend that interviewed, thought they matched at a great non-malignant program and then now are suffering through hell ... completely lied to on the interview.

Both BU and UK are mid-tier, and there are plenty of non-malignant programs with good reviews on par with them and I wasn't really sold on either, but I did want to investigate both.

I am willing to answer any questions about the program as honestly as I can from my experiences with it. It turned into a real nightmare the kind you can only get from attendings with huge egos who don't give a crap about a measly intern much less helping them to become a good doctor or providing a good working environment. I did have good experiences on my infectious disease, cardiology, and VA rotations with only 1 good UK internal medicine rotation. The 1 good UK IM rotations was good mostly because it was with an older attending with good knowledge base that was simply put a nice guy. The program isn't run by him and I'm pretty sure he will probably retire soon as he didn't really like his situation there from what I could tell. There is a malignant core to the program that includes both some upper levels and the attendings with the highest appointments within the program. There are some really nice upper levels but the ones that are bad are so bad that it's ridiculous. I think they are allowed to be that way because of the core of the program which consists of some pretty self absorbed a-holes some of whom I know from my own experience aren't above lying on evals or elsewhere if they get you in their gun sights for some reason. Also work hour violations occur regularly and can be extreme. If it happens they will try to blame it on you after they dumped all scut on you and claim they didn't know about it. So you get nailed either way and you find yourself trying to hide the amount of time you are in the hospital. The facilities are dirty and old. For example, the Er smells like an armpit and the morning report room always has yesterdays lunch all over the floor in the old school house desk style seating with the tiny little desks sliding all over the incredibly dirty floor. There is a ton of construction going on but it won't be finished or usable for years. I have a pretty good feel for the whole program if you're interested in knowing more but I don't really want to go into the gory details mostly because I would like to leave it behind me.

I think "malignant" is often in the eye of the beholder. Some people can stand supercilious attendings as long as their work hours are controlled and there is night float. I personally didn't mind taking overnight 30 hour call too much, but couldn't have tolerated crappy teaching and have little tolerance for aggressive/antagonistic personality types.

I agree that the interview day doesn't tell you much. Programs try HARD to hide any faults, just like YOU would try hard to hide any faults on your application. It's the game. Ideally it would be best to find out about a program from a friend, or a recent graduate of your med school. That is the only way you might get an honest assessment.

As for KU, I interviewed there for one of the medicine fellowships, and it seemed O.K. The only thing was that I got a weird vibe from the fellowship "chief fellow", who I know was a KU product (med school and residency). I felt she was not very friendly and seemed to assume that I must be obnoxious and self-centered, perhaps since I came from a better known medicine program. This was before we even really conversed, so I don't think it could have been anything I said. The faculty seemed pretty cool (at least in the division where I interviewed).

One thing to keep in mind on these threads is that atmospheres at residency programs can change quite a bit in even 2-3 years.

For what it's worth, I have heard that Duke is malignant, and they didn't fill their internship class last year. I have heard Hopkins might be kind of bad too...but that could be just because it's really intense. Word is that Mass General is less friendly than some of the other "Harvard" hospitals. Again, these assessments may be out of date.

Some might say my residency was malignant because we had long work hours, but also we had good teaching so to me that kind of balanced it out. Choosing a residency is an imprecise science...hard to get the straight dope until you are already there!

Call me vindicative but I am really not ready to just let go what happened to me at UK. I am happy where I am now and have plenty of time to study and become the Doctor I always envisoned myself to be but I still can't let go the mistreatment and outright BS I had to undergo at UK. Take it for what it's worth but I just had to bump this thread prior to finalization of program selections. I will be happy to elaborate if anyone is interested.

Maricopa Medical Center in Phoenix is a malignant program. Each class is at least 75% IMG and the attendings tend to abuse them knowing they settled on going there. When I was there, they continuously violated the 80 hour rule and the didactics were poor. It's just a run down and depressed program in a bad part of the city with a prison built in the hospital. It was just depressing. They worked long hours. The program director doesn't seem to care about recruiting U.S. grads and just targets anyone with a high board score regardless of their social and clinical skills.

St. Josephs program in Phoenix was malignant in terms of structure and scutwork. They lost their accreditation a few years ago and not much has changed despite the change in program director. The prelims outnumbered the categoricals with regards to the intern class which is sad, and all the categoricals were IMGs except one. The program director acted as if he didn't care about his categoricals and spent most of his time with the prelims because they were all U.S. grads going into competitive fields. The prelims seem like they run that program and the program director seems as if its his intent to recruit the best prelims and settle on IMGs with high board scores and weak social and clinical skills. I couldn't even understand some of the residents because their English was so poor and I spent 3 summers in China. Very disorganized and confusing system and the nurses wouldn't help with anything. They have no fellowships either

Maricopa Medical Center in Phoenix is a malignant program. Each class is at least 75% IMG and the attendings tend to abuse them knowing they settled on going there. When I was there, they continuously violated the 80 hour rule and the didactics were poor. It's just a run down and depressed program in a bad part of the city with a prison built in the hospital. It was just depressing. They worked long hours. The program director doesn't seem to care about recruiting U.S. grads and just targets anyone with a high board score regardless of their social and clinical skills. I thought St. Josephs program in Phoenix was malignant in terms of hours and scutwork. They lost their accreditation a few years ago and not much has changed despite the change in program director

Don't have any info one or the other about the malignancy of Maricopa Medical Center, but if you want to do a fellowship post internal medicine residency this isn't the place to go to.

Don't have any info one or the other about the malignancy of Maricopa Medical Center, but if you want to do a fellowship post internal medicine residency this isn't the place to go to.

Neither is St. Joes

. . . I am really not ready to just let go what happened to me at UK. I am happy where I am now and have plenty of time to study and become the Doctor I always envisoned myself to be but I still can't let go the mistreatment and outright BS I had to undergo at UK. Take it for what it's worth but I just had to bump this thread prior to finalization of program selections. I will be happy to elaborate if anyone is interested.

Wow, that pretty much sums up how I still feel about BU. It is hard to "let go" when somebody has such a bad experience (I am astounded that others who have experienced the faculty at Boston Medical Center in the internal medicine department can feel anything other than at least a suspicion that the faculty don't care about teaching if not confirmation of outright harassment.)

I am so happy that I also am able to pursue becoming the doctor I always wanted to be away from the shear malignancy of BU. In a way doing clinical work at BUMC is like russian roulette, i.e. you may get a really bad team to work with or you may have an OK experience, the place is that large, and large enough not to take individual complaints seriously apparently.

I still keep in contact with happenings at BUMC, including the internal medicine department. I recently received information that seems to confirm that administration at BUMC are still hell bent on allowing attendings to treat medical students and residents however they like to my dismay. I was floored and still shocked to a certain degree, i.e. it wold be nice to see that they have changed. Even so, the information made me conclude that BUMC is even more malignant than when I was there . . .

I almost don't care what happens at BUMC these days, but sure, if someone out there reads this and asks the right questions during interview there or applies to some better places then maybe people who care about having an optimal work environment for residency will be saved a lot of abuse. In the end, unfortunately, somebody has to be stuck there I guess, but maybe at least this information, if they read it, will help them to understand that abuse is so woven into the Boston University Medical Center system that they won't pull their hair out trying to understand the malignancy of the place.

I think that malignant internal medicine residency programs like BU and UK should be outed so that medical students applying for medicine residency at these places should realize that they have a choice, and if they wanted to be treated in a respectful and civilized manner they should realize that there are better options available than BU and UK for most applicants.

I feel that MedicineDoc's posts are accurate as going to a malignant place will make anyone want to pull out their hair years later if they are unfortunate enough to be exposed to the worst of the worst faculty at these places. Many years later I still wake up in the early morning hours having nightmares about being humiliated on service.

In the end my one prayer was that I wouldn't be humiliated anymore and just wanted it to be done with the place, . . .

If you don't like education via humiliation don't go to Boston University's Internal Medicine Residency Program!

Keep them coming. Think of how much crap you can spare other people who are now beginning to potentially enter into a bad situation.

Has anyone heard anything about the UMKC program in kansas city, MO? I have an interview there but I want to know if it is a malignant program.

Has anyone heard anything about the UMKC program in kansas city, MO? I have an interview there but I want to know if it is a malignant program.
It is one of the most benign programs around. Very supportive PD and staff. Designed to benefit the residents. Call schedules are mild with night float. Average 60-65 hours per week. Best board scores in the region including Univ of Missouri and KU.

Did you interview there or do you have a friend that is a resident there? How do u know about the program?

It is one of the most benign programs around. Very supportive PD and staff. Designed to benefit the residents. Call schedules are mild with night float. Average 60-65 hours per week. Best board scores in the region including Univ of Missouri and KU.

Maricopa Medical Center in Phoenix is a malignant program. Each class is at least 75% IMG and the attendings tend to abuse them knowing they settled on going there. When I was there, they continuously violated the 80 hour rule and the didactics were poor. It's just a run down and depressed program in a bad part of the city with a prison built in the hospital. It was just depressing. They worked long hours. The program director doesn't seem to care about recruiting U.S. grads and just targets anyone with a high board score regardless of their social and clinical skills.



I heard it was not so malignant from someone who rotated there as a student, but that they did work alot of hours. He felt the PD was very nice.

I was invited to interview there, and was told they did not do a residency dinner the night before??

1. please know that I am biased in that I am the Director of Academic Affairs at St. Joseph's in Phoenix.
2. I have not looked at SDN in 4 years and thought I'd look around.
3. Opinions on student experiences can vary considerably for a host of reasons...
4. I would never refute an individual students perception of a rotation experience...but
5. I want to correct the statement that "St. Joseph's lost their accreditation a few years back..." This simply did not happen...yes, we were on 'thin ice' for two years...but NEVER on probation or lost accreditation...the last St. Joseph's program on ACGME probation was over 20 years ago (and not Medicine)...
6. Programs do change and evolve ...we have a new Program Director...and we have hired 7 new faculty ...I know it is difficult to keep up with local changes and rumors...

The MATCH is a paradoxical phenomenon...combined with a short 3 year residency a program's educational personality can change very quickly for the better (and for the worse!)...

I wish you all the best "educational fit" for your optimal learning style...that is what is most important in your career evolution...

Charles Daschbach MD
St. Joseph's Dept. of Academic Affairs

at my program I was on call yesterday and apparently I have to be on call AGAIN friday. talk about malignant...!

at my program I was on call yesterday and apparently I have to be on call AGAIN friday. talk about malignant...!


Are you serious? Q4 call is pretty standard for many programs. Please explain how/why this is malignant.

At some point, everyone is likely to think that his/her own program is malignant. This is such a subjective thing that it's hard to rate unless you've experienced other programs first-hand.

Are you serious? Q4 call is pretty standard for many programs. Please explain how/why this is malignant.


um. That was sarcasm;)

thank god somebody got it...

thank god somebody got it...

I guess I didn't think it was that funny, or sarcastic. Sorry.

uh, definitely sarcastic. welcome 2 sdn

I have heard Duke is extremely malignant.

I have heard Duke is extremely malignant.

I keep hearing conflicting things about Duke. Anyone from Duke program cares to elaborate from personal experiences? But then as someone already said, definition of malignancy is different for diff people .... like beauty, in the eye of the beholder.. JMHO

I know someone who went to Duke for med school and didn't like the atmosphere. I think it's definitely one of those intense academic medical centers with a high rank, that pushes the trainees hard. If you don't like that type of atmosphere, you might not like it there. There are multiple other hospitals that fall into this same category, i.e. Mass General, Hopkins, UCSF, Wash U, etc.

It seems that top university program = malignant.

Unfortunately the pressure-cooker education method does nothing for me, I thrive in a supportive team-player environment. Expect me to do well, and leave me be... I'll do just fine. Breathe down my neck, even with good intentions, I'll lose focus.

But I want to get into a university program.... what to do...what to do...:confused:

I know someone who went to Duke for med school and didn't like the atmosphere. I think it's definitely one of those intense academic medical centers with a high rank, that pushes the trainees hard. If you don't like that type of atmosphere, you might not like it there. There are multiple other hospitals that fall into this same category, i.e. Mass General, Hopkins, UCSF, Wash U, etc.

Yup. They take a certain type . . . the type that tends to like that kind of environment.

When I was sending out my app last year, I remember distinctly thinking about how much I hated those gunner a-holes when I was on rotations in school, and realizing that it was only my ego that was interested in an "intense" and "prestigious" program because I didn't want to spend three years with those SAME a-holes every day.

And don't hate, I'm not . . . really . . . I'm sure gunners are nice people too, the world takes all kinds. Its just not my bag baby.

It seems that top university program = malignant.

Unfortunately the pressure-cooker education method does nothing for me, I thrive in a supportive team-player environment. Expect me to do well, and leave me be... I'll do just fine. Breathe down my neck, even with good intentions, I'll lose focus.

But I want to get into a university program.... what to do...what to do...:confused:

Plenty of laid back Uni programs

....one of those intense academic medical centers with a high rank, that pushes the trainees hard. If you don't like that type of atmosphere, you might not like it there. There are multiple other hospitals that fall into this same category, i.e. Mass General, Hopkins, UCSF, Wash U, etc.

This is a reasonable response. But, shouldn't everyone WANT to go to a program that tries to get every student and houseofficer to perform to the level of their abilities, and then "pushes" them to see if they can go a little further (I prefer the word "coach" to "push")? Isn't this all about students, residents, and fellows trying to reach their potential and testing their limits to figure out what they are capable of? You don't need to be malicious about pushing people and "push" does not equal "malignant"; I know of no program that really systematically desires to have their trainees suffer. I'm convinced that "malignancy" results from a poor fit with the program, making the label not particularly helpful.

You have a point.
However, it is just untrue that there aren't any malignant programs.
There are programs that just may have a program director, chief resident or department chair who is hard to get along with and treats other people poorly. I do believe that hospitals/medical centers and sometimes even individual departments have a "culture" and sometimes it is not a positive one. Yes, some trainees don't like to be "pushed" but some programs ARE abusive. I don't think that throwing surgical instruments, yelling at students and/or house staff on the wards (not in a code situation or situation of incompetence/irresponsible behavior), making students do pushups on the wards, swearing at trainees, or a litany of other behaviors are acceptable. I have seen or heard first hand of all these at well reputed academic medical centers.

Some programs have a high rate of dismissing and/or formally disciplining trainees, and/or of having trainees leave the program. In general I would recommend applicants to avoid these programs. It is suggestive of malignancy in the program...not proof, but suggestive.

Also, some places have poor ancillary support and a workload so heavy that trainees have little time for study, etc. (this latter situation doesn't apply to most high rung university programs, but there are certainly programs out there like that, many of which take FMG's who had little or no other choice of where to to IM or fp residency).

You have a point.
However, it is just untrue that there aren't any malignant programs.
There are programs that just may have a program director, chief resident or department chair who is hard to get along with and treats other people poorly. I do believe that hospitals/medical centers and sometimes even individual departments have a "culture" and sometimes it is not a positive one. Yes, some trainees don't like to be "pushed" but some programs ARE abusive. I don't think that throwing surgical instruments, yelling at students and/or house staff on the wards (not in a code situation or situation of incompetence/irresponsible behavior), making students do pushups on the wards, swearing at trainees, or a litany of other behaviors are acceptable. I have seen or heard first hand of all these at well reputed academic medical centers.

Some programs have a high rate of dismissing and/or formally disciplining trainees, and/or of having trainees leave the program. In general I would recommend applicants to avoid these programs. It is suggestive of malignancy in the program...not proof, but suggestive.

Also, some places have poor ancillary support and a workload so heavy that trainees have little time for study, etc. (this latter situation doesn't apply to most high rung university programs, but there are certainly programs out there like that, many of which take FMG's who had little or no other choice of where to to IM or fp residency).

You've done a nice job of giving examples of things that could happen that you want to avoid, and you've mostly done it without resorting to the word "malignant" as a generalization. I think the number of programs though, where such behaviors run through the entire gamut of personalities, must be very few and far between (probably much fewer than the number of places that get labeled as malignant, as if that captures the entire truth about a place). I would avoid asking residents if they think their program is "malignant." I think the most relevant information to seek from residents is where they ranked their program in the match, and if they had to do it over again would they rank it higher or lower (and why?). But, you need to ask a few residents to make sure you are getting consistent responses. Other than that, trust your gut. If a place is systematically doing malicious things to their trainees, you'll figure it out pretty quickly--you can't hide that.

You have a point.
However, it is just untrue that there aren't any malignant programs.
There are programs that just may have a program director, chief resident or department chair who is hard to get along with and treats other people poorly. I do believe that hospitals/medical centers and sometimes even individual departments have a "culture" and sometimes it is not a positive one. Yes, some trainees don't like to be "pushed" but some programs ARE abusive. I don't think that throwing surgical instruments, yelling at students and/or house staff on the wards (not in a code situation or situation of incompetence/irresponsible behavior), making students do pushups on the wards, swearing at trainees, or a litany of other behaviors are acceptable. I have seen or heard first hand of all these at well reputed academic medical centers.

Some programs have a high rate of dismissing and/or formally disciplining trainees, and/or of having trainees leave the program. In general I would recommend applicants to avoid these programs. It is suggestive of malignancy in the program...not proof, but suggestive.

Also, some places have poor ancillary support and a workload so heavy that trainees have little time for study, etc. (this latter situation doesn't apply to most high rung university programs, but there are certainly programs out there like that, many of which take FMG's who had little or no other choice of where to to IM or fp residency).

Hi Dragonfly99,

Can you please name some of the programs where you have heard of or observed above mentioned behaviors....Thanks.

I'm not going to because things can change a lot in 3-5 years at a particular place, and I don't think it would be fair to generalize about a place based on stuff that happened several years ago. You can pretty much assume that behavior like that happens at a lot of the top 20ish type of medicine and surgical residencies, though, since those are the ones that tend to have more of the Type A attendings, fellows and residents, as well as med students. The poor ancillary services/mucho scut work thing is more characteristic of impoverished city hospitals - you can usually pick out those programs because they are filled up with FMG's. That says nothing bad about the FMG's...it's just a symbol of how that residency may not be super desirable.

Maricopa Medical Center in Phoenix is a malignant program. Each class is at least 75% IMG and the attendings tend to abuse them knowing they settled on going there. When I was there, they continuously violated the 80 hour rule and the didactics were poor. It's just a run down and depressed program in a bad part of the city with a prison built in the hospital. It was just depressing. They worked long hours. The program director doesn't seem to care about recruiting U.S. grads and just targets anyone with a high board score regardless of their social and clinical skills.

St. Josephs program in Phoenix was malignant in terms of structure and scutwork. They lost their accreditation a few years ago and not much has changed despite the change in program director. The prelims outnumbered the categoricals with regards to the intern class which is sad, and all the categoricals were IMGs except one. The program director acted as if he didn't care about his categoricals and spent most of his time with the prelims because they were all U.S. grads going into competitive fields. The prelims seem like they run that program and the program director seems as if its his intent to recruit the best prelims and settle on IMGs with high board scores and weak social and clinical skills. I couldn't even understand some of the residents because their English was so poor and I spent 3 summers in China. Very disorganized and confusing system and the nurses wouldn't help with anything. They have no fellowships either

I did residency there, and I would have to strongly disagree with you. I never went over 80 hours. The IMG issue is a result of a lack of US grads applying there, and infact the "worst" US Grad is ranked higher than the "best" IMG. The pd is a US grad herself. Maricopa is literally 2 miles away from good sam and three miles from st joes. True fellowship is difficult to get from there, but I got one so if you work you will get it. finally I have never seen an img get mistreated. My three years there on a daily basis tell me that.

Duke resident here - felt compelled to clear up a number of misconceptions about the program. As a med student I too heard that duke was a malignant program - I decided to do a sub-I there and did not find any evidence of said malignancy.

As a resident, I certainly don't feel like the program is malignant. This is the South after all, so people tend to be nicer in general. I've found most of the attendings to be really laid back and the younger attendings in particular are pretty easy to be on a first name basis with. The program director is very receptive to our concerns and has instituted a number of changes in response to our suggestions. And most importantly, there's definitely a strong camaraderie amongst the house-staff.

On the interview trail, I actually did not think any of the major university programs I visited were malignant. Most residents seemed to get along pretty well with each other, and fellowships could be attained from most of the programs. On the other hand, no other program offered evening sign outs with the chiefs or daily critical appraisal of evidence on gen med like Duke did. And the level of autonomy on sub-specialty services seemed unparalleled except for a couple of other programs in the country.

So I think the program has been a great fit for me. Maybe its not the best fit for everyone, but its best to find that out for yourself rather than base your opinion on what the program might have been like in the '80s or '90s.

Extremely malignant program.
A sadist PD with an extremely bad attitude towards residents. Sarcasm galore in morning reports where residents are verbally abused & told things like " you may end up getting a divorce but you will learn medicine"-PD.

The faculty is mostly recruited from ex-residents either from SPUH or from UMDNJ-RWJ whose part this program has been in the past. They will not speak up aginst the PD or his malpracticies.

Several residents have either left or have been asked to leave for trivial issues or for trumped up charges because they spoke up against the PD or some of the ex-Chief Residents.

Several faculty have left since this program's inception because the PD's arrogant & boorish behaviour.

The program secretary is in cahoots with the higher up & acts extremely snobbish.

The assistant-PD has not personality of her own & tows the PDs line. She has her eyes set on his chair when he quits.

The program tends to make tall claims, but has achieved little since starting. No fellowships have started yet despite the PD having promised to start them in 2005. You will be told how they are getting a Pulm or Sleep fellowship with JFK soon or a GI fellowship with UMDNJ-RWJ (who will not recruit an FMG to their program).

The PD has practised racism against FMG (surprising as he is an FMG himself). There are ACP articles about him when he was a PD in UMDNJ-RWJ, about how he worked to make that program IMG free. Now that he is running a community program, he recruits the FMGs and then makes them work in his sweatshop, taking verbal liberties with them when addressing them. So do a lot of the faculty, the program coordinator & the senior nursing staff.

He has fired numerous FMGs & at least 1 AMG (who left medicine altogether). Most of them went on to other University programs & are now in fellowships. Surprising, since his program have produced fellows that one could count on less than 3 fingers.

There is no support to a person's fellowship application & the PD REFUSES to write LORs if the resident is not in his good books (brown-noses him or his cronies).

He is said to have gone after some residents who left his program in a slanderous way & tried to report them to state boards or their new PDs, ABIM & ECFMG, usually to no effect.

Be careful if you intend to step into this minefield.
Here is a sample of the PD's email showing how malicious the inside workings of the program are. This was in response to an ANONYMOUS email sent to the PD by a serving resident of the program:


From: Resident SPUH [mailto:xxxxxxx]
Sent: Monday, April 02, 2007 1:44 PM
To: xxxxxxxxxx
(xxxxxxxxxx)Subject: Confidential: Resident issues that are never discussed



Dear Dr.ccccc

You are a man whom I consider to be my mentor and father-figure, I have deep
respect for you and that is the reason I am sending you this email. I know
that you will do all you can in your power to help us residents. Our program
has all the elements to become the very best however, there are still many
issues that scar our residency. You always say that "this is your program"
then why is it that every single resident is unhappy.



Problem 1: The unhappiness has nothing to do with work and work hours,
everyone works very hard everyday to provide the best patient care. We work
everyday with fervor and enthusiasm but there is no appreciation for our
work. We only get the raw end of the stick. A single mistake on part of a
resident mars all the work he/she has ever done. Every order we write, there
is a fear that it might be on the projector and we will face public
humiliation. The fear that we are constantly being watched and scrutinized
adds immense stress and fear.



Problem 2: Everyday only the simplest and least complicated cases are
presented in morning report, we never get to engage in a discussion of
interesting or complicated cases because of fear of sitting in the "hot
seat". The residents do not provide astute differentials and this decreases
the interest of the whole exercise. Even with so much emphasis on morning
report, the educational experience and learning is limited. After talking
amongst lot of residents and seeing morning report at other programs, we had
a few suggestions:

1. We should use the white board during morning report to discuss the
differential of the chief complaints.

2. Shift the focus from the detail of history asked to actual discussion of
a case in terms of management which would give us a feel of approaching a
patient and in the process realise our shortcomings on history/physical and
order sheet. Our objective is to learn from your experience and knowledge.
We feel that a healthy discussion would stimulate our brains to think wider
and more objectively.



Problem 3: We appreciate and acknowledge your effort to improve the
electives. There is a responsibility of both the resident and the preceptor
to make the time meaningful. It our endeavor to put in our best and learn
because this education forms the basis of our professional career. What we
request of you is to trust us. The fear of loosing credit for a rotation
takes away the enthusiasm and charm of learning. Electives are now perceived
as jail-time. The concept of threat to make residents work adds stress and
burden to our work and creates an atmosphere of rebellion. All you had to do
is just ask us to be more responsible and we would have responded.



Problem 4: Elective logs were started as a part of monitoring the residents
and to enhance the learning. The concept is excellent in the inception
however, the realisation of the goal is not achieved. Please do not take it
in the wrong way but writing logs is not possible in real time. Most of the
electives we see 4-5 patients everyday and on clinic days we may see up to
10 or more. On an average it takes 30 min to write for a single patient.
Here is what happens: most electives we get free by 5 PM then spend 1-2
hours reading Harrissons for board review. Around 7PM, we head back home and
then after a very quick dinner start work on logs for 2-3 hours. In these
2-3 hours we are able to finish only 3-4 patients. Clinic days we get free
after 6PM and there is less time and enormous number of patients. What
happens is that by the weekend we have a backlog of 10-15 patients and the
whole weekend is spent writing up logs. Logs have become a painful chore and
decreased learning in the elective to a bare minimum. Every one's goal is to
finish logs, all day the only discussion is how many logs do we have left.
There is no more time to pick and read Harrison's. Reading of textbook is
longer done. It also has a immense effect on our personal lives as we find
no time for ourselves or our family during electives.

Our suggestion: We are evaluated by a pre and post test. Logs should be
modified so that we pick the most interesting case for the day and write
notes on it making a total of 5 well researched cases a week. This will give
us time to actually read and concentrate and make meaningful patient logs
which will benefit us much more. Please consider this because there is an
extreme mental stress associated with this exercise esp. when it comes with
the fear that we might not get credit for our work. Also, there was a
mention that there is plan to start this exercise on MTS floors and ICU,
even the thought of doing it is scary. Please please do not start them it
will create a situation which will not be humanely possible to manage.



LAST PROBLEM: This is singularly the most important of all problems. "Every
one shouts at us" Nobody is polite to the residents, we are humiliated and
our self respect is shattered. Our chief is extremely impolite, she shows no
concern for resident issues and does not provide any cushion. She shouts at
residents and her message to us is that we are worthless. This kind of
behaviour is unwarranted, all of us are colleagues and there should be a
code of professional conduct. We are treated like inmates with her being a
jailer. Every small event is made a big issue and new rules are made
everyday. This adds to the confusion and chaos.



Every resident in under extreme stress and nobody appreciates the program.
Nobody has the courage to speak in residency council meetings because of the
fear that they might be singled out and eventually be expelled. There is a
depression amongst residents. The one thing our program lacks is resident
happiness. None of the residents endorse or recommend this program to
juniors and medical students. I have sincerely written this email to you so
you can address these issues. You are like our father who takes care of his
children in the best possible manner. We are not bad, every one works to win
your appreciation and respect. Give us the chance....



Yours sincerely,

Anonymous IM resident

SPUH


From: Kxxxxxxxx
Sent: Thu 4/5/2007 4:33 PM
Cc: [names removed]

Subject: FW: Confidential: Resident issues that are never discussed

Dear Residents,

I received this anonymous email a few days ago. It is regrettable that one
has to resort to this method when I have always welcomed all of you to come
in and talk to me. I am not sure if this a majority or a minority view. It
really does not matter if only one of you has these feelings.

Before I write my response to the letter I like you to keep the following
FACTS in mind.

1. 10 out of 19 PGY1, 8 out of 13 PGY2, and 7 out of 11 PGY3 residents
FAILED the in - training examination. Two PGY 3 residents scored below the
11th percentile. Four PGY 2 residents scored below the 13th percentile. Five
PGY1 residents scored below the 13th percentile. Lay people would do better.

There are residents who did extremely well. If I put a PGY 1 resident who
scored the 98th percentile with a PGY 3 resident who scored 11th percentile
- Is it fair to the PGY 1 resident?

What do you think happens to patients when a team consists of a PGY 3 and
PGY1 residents who score 11th and 5th percentile respectively?

2. During the last OSCE only four out of ten residents passed the station.

3. Majority of residents failed the last elective post tests. What would
happen if there were no logs?

4. There were 196 delinquent charts last week.

5. In spite of all efforts we continue to fail the counter signature
requirements (by the joint commission)

6. Last week 10 residents were absent in the board review. 17 residents were
absent in the morning report. 9 residents were absent in the noon
conference. 4 residents were absent in grand rounds.

7. This academic year 37 residents have called in sick. Epidemiologically
this is not possible.

Now I shall respond to the concerns in the letter.

It is not true that your work is not appreciated. It is true that you are
watched. It is not true that I do not trust you. However my trust is always
accompanied by VARIFICATION (trust and verify)

We are dealing with lives of other people. The program spends enormous
amount of money and other resources to support you.

Morning report:

The MR is a unique American tool for the department chair to monitor quality
of care. In most institutions it has degenerated into a quasi grand rounds
type of activity and has been handed over to the CR. It is not my role to
entertain you during the MR. When a patient with HTN and hyperlipemia comes
in with chest pain and has a 20 mm difference of BP in both arms and the
patient is given heparin - what do you expect me to do?

Our MR is attended by at least 12 faculty and they all contribute. Show me
one program in the country where there is so much participation from the
faculty. The letter states that we do not discuss complicated cases because
of fear. This is untrue. Is Wegner's granulomatosis complicated enough?

The letter demands dispensing with history and physical and focusing on
management. If you believe that you have learnt all elements of H & P, why
so many failed in the OSCE?

In summary the MR will NOT change.

Elective Logs:

The program leadership adopted the concept of PORTFOLIOS for the residents.
Portfolios demonstrate your efforts. They stimulate innovation and
imagination. Recently we added the patient logs during electives. The
purpose is to stimulate you to form good habits of looking up. It enhances
scholarship. We have just started this and we learn as we go along. I am
perfectly willing to modify the requirements after we get some experience.

The letter describes the log as "a painful chore ". This is pathetic and
shameful and does not appreciate the intent behind it.

In summary the logs will stay and will be modified as we review them.

I am deeply disturbed about the perception of a harsh environment. The
program is committed to utmost professionalism at all times by everyone. I
am aware of infractions in this regard and I am truly sorry for it. You have
my word that no such behavior will be tolerated in the future. I ask you to
report to me directly if you ever feel insulted by anyone in this
institution. I am instituting an anonymous evaluation system for the program
director, the associate program directors, the chief resident and the
residency office staff. You will be able to evaluate our performance every
quarter.

I particularly object to the statement that no resident recommends this
program to medical students. This is simply not true. During the recruitment
at least nine of you came to see me to recommend your friends for residency.

Finally, it is my responsibility to monitor high quality patient care and as
a byproduct facilitate a robust education program. I learnt a long time ago
that students and residents will perform at the level of expectations. I
will not preside over a program where even one resident will fail the
boards. I cannot and will not dumb down the process so that some of you will
be comfortable with ignorance.

I invite all to come and see me and discuss further. Thank you,

NK





Here are some links showing the anti-FMG prejudices of the PD before he left the UMDNJ-RWJ & moved over to SPUH & the response from some practising FMG physicians to it:


http://www.acpinternist.org/archives/1998/02/change.htm

http://www.acpinternist.org/archives/1998/05/letters.htm

And to previous posters.

Malignancy is NOT in the eye of the beholder. This is why it is called a "malignant program" and no a bad, unsupportive, too liberal, too conservative, gunnerish, too-laid-back... whatever program. Yes, some programs are not a good fit for an individual resident, and this goes for each individual, and is "in the eye of the beholder".

Malignancy, both in neoplasm, and in medical education is objective, and has some signs, which is what the OP is asking about. When you are at your interview, everyone is on their best behavior, and you may not know about a malignancy. How? Because some of these are glaring signs that would send anyone running, and so they are hidden from the interviewees.

Including the previous post, some examples might be:

1. displaying the mistakes on a resident's progress note in morning report
2. an attending who regularly rips out resident's progress notes from the chart, along with the other doctors and nurses notes on that same sheet of paper.
3. as a reisdent is writing on a chart and discussing what he thinks he should do for a patient, the attending gets angry, the attending (often) grabs the chart from their hands an flings it down the hall.
4. An attending who forces residents to do pushups while on rounds.

So, point is, yes there are subjective good and bad programs for an indvidual, but there are also objectively malignant programs... and that's what we are talking about.

Please keep in mind that it is generally regarded as poor taste to post emails without permission and it's even more so to leave the names of all the recipients in the post. I've removed the individual names for their privacy.

Please keep in mind that it is generally regarded as poor taste to post emails without permission and it's even more so to leave the names of all the recipients in the post. I've removed the individual names for their privacy.

woah, somebody kept the names on there? Even with that poor judgment, i have to say the PD's letter was one of the worst things i've ever read from a PD. What a malignant dick.

Howelljolly,

I guess that's what I meant ... some people call some programs malignant because it didn't fith their personality/style/whatever and they in turn term those programs as malignant. I have heard of such cases that you described at various institutes but never witnessed them myself ... and I totally agree with your previous post....

"Unfortunately the pressure-cooker education method does nothing for me, I thrive in a supportive team-player environment. Expect me to do well, and leave me be... I'll do just fine. Breathe down my neck, even with good intentions, I'll lose focus.
But I want to get into a university program.... what to do...what to do... "

coz I am the same way and I don't want to end up at a malignant program either.

Howelljolly,

I guess that's what I meant ... some people call some programs malignant because it didn't fith their personality/style/whatever and they in turn term those programs as malignant. I have heard of such cases that you described at various institutes but never witnessed them myself ... and I totally agree with your previous post....

coz I am the same way and I don't want to end up at a malignant program either.

Yep, malignancy is fairly objective. I'd think you can get a pretty good idea if you fit with the residents, and if the amount of formal teaching vs. clinical work is good by you. You probably need to be quite observant to pick out a malignant program. But even a gunnerish, high pressure program, where residents are happy, wouldn't be ideal for me.... and Im not sure how to pick those out.

i have to say the PD's letter was one of the worst things i've ever read from a PD. What a malignant dick.

I dunno. To me, it seems that the PD is explaining his tough love didactics. While not diplomatic, to me it seemed more firm.

But posting the email is pretty poor judgment.

I dunno. To me, it seems that the PD is explaining his tough love didactics. While not diplomatic, to me it seemed more firm.

I was put off by that initial listing of the poor academic and clinical performance, and the lack of attendance.

He states that he learned that students and residents perform at the level of expectations. But what does that mean, and what is he doing to apply that idea? From what I see, the PD calls his residents pathetic and shameful, and posts their mistakes in morning report, not to show what he expects of them, rather to show them what he thinks the are

thats my take on this sort of thing.

well it will soon be rank list time and hopefully we will all make the right choice for ourselves.

The PD sounds like a prick based on the way he wrote the email. That being said, his actual objective evidence of how the residents performed sounds like there are serious problems with the house staff. Both the residents and the PD make it sound like a bad place to be.

The PD sounds like a prick based on the way he wrote the email. That being said, his actual objective evidence of how the residents performed sounds like there are serious problems with the house staff. Both the residents and the PD make it sound like a bad place to be.


Just to let everyone know, all the residents being talked about in this program were FMGs. As you can see from the date, this was from back in 2007. All of the PGY 3s & I mean ALL are board certified in internal medicine today after attempting the ABIM test in their 1st go,regardless of the performance being quoted here. This is just a very formal letter written by that prick head to all residents. One has to be actually present to believe what he says when he & his cronies verbally lamblasts residents in morning rounds or when on service.
As far as the "taste"/ethics of posting emails here.....all future residents need to know the truth of what is going on in some of these dungheap programs. There is nothing more overt than smelling the fetid odor from this horse's mouth.
My advice.......just avoid this program. This guy is a crook, a manipulator & a liar. He plays with you in the interview & then plays with your future when you join up his program. This is advice from someone who has worked with him & was hounded out of his program very unfairly. I can post emails from some senior program faculty from this very program to show they disagreed with this joker completely & supported me in moving on. Luckily, I managed to move on & am now a fellow in an interventional program thanks to their support. Such luck doesnt come to everyone.
If anyone doesnt believe in this, go ahead & join this program. Then write back here in an year about your experiences.

Keep in mind guys, we welcome bringing complaints about programs, but do not do so with an account created simply to do that and complain in an articulate and respectful manner. Creating second accounts simply to bash a program will not be tolerated.

Did you interview there or do you have a friend that is a resident there? How do u know about the program?

I have had multiple friends who have gone through their program. Very resident oriented. PD very supportive and makes changes to improve work hours so that there is better quality outside of work for residents. Highly recommended.

I dunno. To me, it seems that the PD is explaining his tough love didactics. While not diplomatic, to me it seemed more firm.

But posting the email is pretty poor judgment.

1. 10 out of 19 PGY1, 8 out of 13 PGY2, and 7 out of 11 PGY3 residents
FAILED the in - training examination. Two PGY 3 residents scored below the
11th percentile. Four PGY 2 residents scored below the 13th percentile. Five
PGY1 residents scored below the 13th percentile. Lay people would do better.

This is how Captain Dickwad starts his email. By humiliating his residents, and showing them that he thinks they are total losers. "lay people would do better?". How is that instructive? It's meant to demean, not instruct. I mean, it is mainly his failure that his residents aren't performing. He picked them, he's in charge of them getting to morning report (mostly), having enough time to learn, etc. If most of the residents are doing well, and a few aren't, then its likely the resident's problem. If most people aren't doing well, then it's likely the program's problem.

1. 10 out of 19 PGY1, 8 out of 13 PGY2, and 7 out of 11 PGY3 residents
FAILED the in - training examination. Two PGY 3 residents scored below the
11th percentile. Four PGY 2 residents scored below the 13th percentile. Five
PGY1 residents scored below the 13th percentile. Lay people would do better.

This is how Captain Dickwad starts his email. By humiliating his residents, and showing them that he thinks they are total losers. "lay people would do better?". How is that instructive? It's meant to demean, not instruct. I mean, it is mainly his failure that his residents aren't performing. He picked them, he's in charge of them getting to morning report (mostly), having enough time to learn, etc. If most of the residents are doing well, and a few aren't, then its likely the resident's problem. If most people aren't doing well, then it's likely the program's problem.

I agree.

woah, somebody kept the names on there? Even with that poor judgment, i have to say the PD's letter was one of the worst things i've ever read from a PD. What a malignant dick.

Huh?

Am I reading the same email?

I didn't get "malignant dick" at all - nor did I find it hard or undiplomatic.

It sounds like a PD responding quite rationally to the complaints of "sour grapes". If we were trying to make a case that this PD is a jackass, we failed.

This is how Captain Dickwad starts his email. By humiliating his residents, and showing them that he thinks they are total losers. "lay people would do better?". How is that instructive? It's meant to demean, not instruct. I mean, it is mainly his failure that his residents aren't performing. He picked them, he's in charge of them getting to morning report (mostly), having enough time to learn, etc. If most of the residents are doing well, and a few aren't, then its likely the resident's problem. If most people aren't doing well, then it's likely the program's problem.

Wrong.

No one is responsible for you, except for you.

Morning report, ground rounds, noon conference, rounding, etc . . . are all opportunities for you to actively learn. They are not spoon feeding sessions.

I agree that the reply email makes the program director look like an A #1 jerk. Although the original complaint email was unprofessional also, IMHO, with that many residents having academic problems it definitely reflects poorly on the program. The fact that the PD replied in the manner he did makes him look defensive, petty and antagonistic, not to mention rude and condescending and immature.

The fact that the PD replied in the manner he did makes him look defensive, petty and antagonistic,

Completely agreed.


It's meant to demean, not instruct. I mean, it is mainly his failure that his residents aren't performing.

I grew up with the old school tough love/drill instructor type of father, so to me this isn't that shocking and doesn't come across as harsh to me as I know many would take it. It's very defensive to start off as he did, and without a doubt it would seem to imply that the program has some deficiencies, but the original email seemed to be complaining about many of the things he had implemented.

I find the whole posting by the former resident just as immature, petty, and worse because they're trying to smear the PD's reputation behind an anonymous account on SDN by posting 1.5 year old emails presumably without letting the PD know. .

Oh yes, I agree that the original posting comes across poorly also (on the part of the former resident).

I only meant that if the PD wants to be seen as a serious professional, then even if he is frustrated he shouldn't resort to demeaning the residensts (as a group) in response to an anonymous email.

I can tell you that you can count on hearing "Do you care to let me this or that?" at least 10 x a week. Instead of "Can I see the chart?", it's "Do you care to let me see the chart? Four extra words besides the many patients addicted to oxycontin or lortabs to remind you that you are surrounded with Eastern Kentuckians.


No doubt the patients in inner city Los Angeles or Houston have less incidences of drug abuse. :rolleyes:

No doubt the patients in inner city Los Angeles or Houston have less incidences of drug abuse. :rolleyes:
You're right there are drug seekers everywhere. In fact there are quite where I am now. I will tell you that my experiences were so intolerable that it colored just about every experience that I had in Lexington. I can't even hear the word Lexington without feeling some of the old sense of being powerless in front of some of the worst examples of a-holes in charge who I would have quickly cut down to size if they hadn't been in a position of power over me. In their minds I was nothing. Not worth teaching. Not worth showing respect to. Nothing. These were dorks. They could not exist in such a capacity outside a highly artificial environment. I am truly happy now. Leaving despite their threats and outright lies was the best decision I ever made. I thank God for getting me out of that mess. I no longer grind my teeth at night.

BU wants (needs) people to sort become accustomed to the BU way of doing things, and be weak minded, so that students/residents believe that being treated poorly is part of residency and life, . . .This sounds like learned helplessness (Seligman). The same principle applies to cases of abuse--especially under the umbrella of domestic abuse/violence.

Since there are new threads inquiring about this subject maybe we could keep them together for a better reference source.