Mean and discouraging psych specialty advisor. What are your thoughts?

[voodoomagic]

By that measure someone with anxiety couldn’t do ANY job. Talk about stigmatized.. I tell ya’ people are not as open minded as they hope to be. Constantly judging etc., thinking they know what’s best for you.

Nobody knows your life experience like you do. Others might be able to put it in context for you but ultimately you are what YOU want to be.

If you want to do Psych, you’d probably be good at it.. However, if you have a problem of anxiety.. you may read the room too well, and psych may in fact become a load to bear.. can you detach yourself adequately from the problem you’re attempting to help someone navigate? If not.. then you have your answer.

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[doc111111]

Hi everyone,

I'm an MS3 at a top 30 allopathic school. I want to be a psychiatrist but my specialty advisor said something recently that hurt my feelings. I was involved in a process at my school called "feedforward." Essentially, students who are struggling in rotations are given special attention from the subsequent block director to check in with attendings to see if the issue has resolved. Long story short, I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student. I'm being treated for it now, but on my psych rotation, my block director was informed that "I tend to get flustered when anxious and that my interviews with patients go downhill subsequently." He later said to me in a private Zoom session “Psychiatry may not be a good fit for you if you’re not good at reading social cues and if anxiety gets in the way. Perhaps you shouldn’t even do clinical medicine and pursue pathology instead.” I sent an email back saying he hurt my feelings and wishing he would support me going forward. In response, I got this message....

Thanks for your email and I am sorry that my statement was challenging to hear and hurtful. I am supportive of you and your choice and will do all that I can to help you in the process of preparing for residency and through the process of applying. I do still think that reading social cues is an important aspect of psychiatric practice - however, I haven't had the sense in our interactions that this has been problematic and as we discussed anxiety or problems of attention can also lead to the perception of problems "reading the room." In any event, I am glad you are doing well and taking steps to care for yourself. While I want to be direct and honest when advising students, I never want to be hurtful, and I apologize given what I said has clearly weighed on you over these past couple of months.

My question to you all:

Do you think this guy is trying to be mean to me or is it legitimately just being frank? Sometimes, I sense in conversations that he may be biased towards me b/c I'm a struggling student. I feel I'm not on an equal playing field with other candidates as a result of this feedforward process. I'm worried b/c his opinion of students at this school holds weight at the residency program and I'm actually really interested in my home program. I feel like I kinda forced him to say he supports me but he did not go forward HIMSELF to say he does that and I subsequently am not sure if he truly supports me or not. What are your thoughts?

he commented concerns and yet said he would support you . i think you should
take that as a positive. as long ad thry work with you or explain reasons for their concerns or ways to improve it remains positive. you do have to be a bit tough though

 

[Lawpy]

By that measure someone with anxiety couldn’t do ANY job. Talk about stigmatized.. I tell ya’ people are not as open minded as they hope to be. Constantly judging etc., thinking they know what’s best for you.

Nobody knows your life experience like you do. Others might be able to put it in context for you but ultimately you are what YOU want to be.

If you want to do Psych, you’d probably be good at it.. However, if you have a problem of anxiety.. you may read the room too well, and psych may in fact become a load to bear.. can you detach yourself adequately from the problem you’re attempting to help someone navigate? If not.. then you have your answer.

Medicine is harsh to physicians with mental health problems. This is unfortunately the reality

 

[voodoomagic]

Medicine is harsh to physicians with mental health problems. This is unfortunately the reality

It is when your expectations are high. Read the reality (it’s a business), set your expectations accordingly and you won’t be disappointed. Life.. is harsh to individuals with mental health issues. Sports, Medicine.. Hospital Administrators, Politicians and their mega donors.. life is harsh. Just set your expectations low

 

[Eye-eye]

Based on the interactions, it sounds like this attending is really trying to help you. Yes, you got off on the wrong foot - the words "you hurt my feelings" are simply to stigmatized to not have them bring up some implicit bias, if nothing else, and this was on top of the comments he got from colleagues he trusts saying that you were too anxious and couldn't read social cues; you validated those points, unfortunately.

HOWEVER, that does not mean all is lost. The advice from your BF to try to repair that relationship is good, and you have plenty of time to do it. But don't inundate him with communications, trying to win him over. That can come off as needy, or in-your-face, or just make it obvious you're getting anxious or obsessive about this. He needs to see that you can get over that anxiety. That you can say "yup, that was a bad interaction. But I'm learning from it, and I can't change the past. I'm moving on." As someone who used to rub people the wrong way and burned down a couple bridges without even realizing it, I understand your concerns. But as someone who has rebuilt most of those bridges, I'm here to give you the hope that it is definitely possible. How you're going to win him back over is by:

1. Being mature, professional, and grateful in any interactions going forward. Don't manufacture these interactions. But as you have continued interactions through this feelforward thing, and I'm sure through preparing for residency apps, use these as opportunities to show that you've left that behind and are taking the advice to heart in moving forward.
1a. When going to him saying you still want to apply psych, if that is what you choose (and if you haven't already communicated this), thank him for his honesty. Apologize for reacting in the way that you did, instead saying you should have taken the comments to heart and used it to reflect instead of being reactive. State that you have spent a lot more time recently reflecting on yourself, what sort of person you want to be, and what field would both be best for you, and allow you to be the most effective and do the most good. And then state that after this consideration, you're still committed to psychiatry. That you know it may be a steep road for you, but want to take that on, and look forward to the growth that comes from examining and trying to address your faults. And state that as he had the courage to be so open and honest with you before, you would appreciate any continued advice from him which he may feel is appropriate, as you truly want to become aware of your limitations so that you can address them.

2. Truly taking those thoughts to heart. In the time you have before your 4th year sub-i, take criticism to heart. If someone gives you only positive feedback, specifically ask "what could I do to make my performance even better?" NOT "IS THERE anything you think I need to work on," but "WHAT do I need to work on," or "WHAT COULD I BE DOING to keep improving or be more helpful to the team?" If you take their criticisms to heart and work on them, not only will you develop a thicker skin - your clinical and interpersonal skills will also improve, and you will likely see that in feedback over the course of time. Some changes you can make during a single rotation, or even a single day. Other things might be personality traits you struggle with for years. That's okay. Don't stress if you can't fix everything immediately - that's simply being human. Just keep on swimming, and don't avoid the upstream swimming that is trying to improve yourself as both a person, and a future physician.

If you can do that, I would be very surprised if your sub-i didn't reflect it. If you work with the same preceptors, they will see how much you've grown. Even if you don't, you'll make much better impressions on those you do work with. This will all get back to this attending one way or another. And while seeing someone who's always been naturally good apply to your program is always a good thing, you'd better believe that the person who takes hard criticism to heart and makes real change to improve from someone they have doubts about to someone they think would make a good resident is going to be more impressive. PDs, please correct me if I'm wrong in this thought. I also agree with others that sub-Is elsewhere can really be of benefit to you, but don't give up hope on your home program unnecessarily, either.

Trying to make those changes will also help in other ways. From here you can either say "screw you, you're wrong," to everyone who says something negative about you, and constantly feel insecure and inadequate; or you can say "okay, I'll work on that" or "I don't know what gave him/her that impression, but let me figure it out and work on the underlying problem." I promise you that if you can take the latter to heart, you'll be happier. You'll see improvement in yourself, and so will others. You'll have more positive interactions and less bad ones. You'll be more prepared for residency and your attending career, and be less stressed when things don't go your way.

I know what you heard was hard to hear. But you can choose to take it as a blessing. I've had several such "blessings" in my life, and can honestly say I'm glad for each one of them, regardless of how pissed off or despondent I was at the time. Now when I get criticism, I can evaluate it, take anything I can use to my advantage to heart, and use that which I think was off base at least as a means to know how to interact with the person going forward. Sometimes it's a them problem, sometimes it's a me problem, and more often than not, it's a bit of both. But that's life, and we can choose to learn from it and grow, or not.

Hopefully this has been somewhat helpful, and not just the mad ravings of a lunatic. As someone who's had to navigate some similarly tricky interpersonal situations in the past, I truly wish you the best, and am open to PMs if you want to chat in a less public forum.

 

[SurfingDoctor]

People should be so lucky to find other who gives realistic feedback... realizing most advisors give fluff advise that is meaningless and does no one any good.

 

[Candidate2017]

Your reaction is why many attendings give fake ego-stroking "feedback", pass students, and next thing you know, you're posting on SDN wondering why you didn't match when everyone said you were doing great. That's not really nice at all. However, the guy is going out of his way to help you with real feedback upon which you can use and improve yourself, but you focus on the butt hurt instead. Maybe he shouldn't have gone so far to say clinical medicine is not for you, or maybe he is justified.

In real world psychiatry, if you are terrible with patients and have poor social skills, negative feedback from patients may not be nice. It will be in the form of getting cursed at, assaulted, board complaints, lawsuits.

Anyway, take the feedback to heart, run with it, and improve yourself.

 

[AnkiDude22]

Hi everyone,

I'm an MS3 at a top 30 allopathic school. I want to be a psychiatrist but my specialty advisor said something recently that hurt my feelings. I was involved in a process at my school called "feedforward." Essentially, students who are struggling in rotations are given special attention from the subsequent block director to check in with attendings to see if the issue has resolved. Long story short, I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student. I'm being treated for it now, but on my psych rotation, my block director was informed that "I tend to get flustered when anxious and that my interviews with patients go downhill subsequently." He later said to me in a private Zoom session “Psychiatry may not be a good fit for you if you’re not good at reading social cues and if anxiety gets in the way. Perhaps you shouldn’t even do clinical medicine and pursue pathology instead.” I sent an email back saying he hurt my feelings and wishing he would support me going forward. In response, I got this message....

Thanks for your email and I am sorry that my statement was challenging to hear and hurtful. I am supportive of you and your choice and will do all that I can to help you in the process of preparing for residency and through the process of applying. I do still think that reading social cues is an important aspect of psychiatric practice - however, I haven't had the sense in our interactions that this has been problematic and as we discussed anxiety or problems of attention can also lead to the perception of problems "reading the room." In any event, I am glad you are doing well and taking steps to care for yourself. While I want to be direct and honest when advising students, I never want to be hurtful, and I apologize given what I said has clearly weighed on you over these past couple of months.

My question to you all:

Do you think this guy is trying to be mean to me or is it legitimately just being frank? Sometimes, I sense in conversations that he may be biased towards me b/c I'm a struggling student. I feel I'm not on an equal playing field with other candidates as a result of this feedforward process. I'm worried b/c his opinion of students at this school holds weight at the residency program and I'm actually really interested in my home program. I feel like I kinda forced him to say he supports me but he did not go forward HIMSELF to say he does that and I subsequently am not sure if he truly supports me or not. What are your thoughts?

He supports you, you can tell by the tone of this. You can do anything you put your mind too. No matter what you do you will land on your feet. Take good care of yourself.

 

[lockian]

Hey,
Feel free to PM me. I wasn’t in any kind of program like the feed forward one you mentioned, but I also dealt with similar feedback earlier on in my MS3 year, regarding getting anxious and missing social cues and being “awkward.” I too was gutted when I got it, and questioned whether I have what it takes to enter psychiatry. Now, I’m a practicing attending. Social anxiety and anxiety generally is very overcomable! What I would do now is put everything you can into improving on this. Get feedback on the spot, as detailed as you can, from everyone you work with. Talk to people about what works for them when they get stressed in a patient interaction. Practice with patients and practice with colleagues and practice with your friends. I found that trying specific behavioral strategies to get in the right mindset and loosen up really helps cut through the anxiety and let your genuine clinician self shine through. Improvement can impress people.

I cant say what the preceptor was thinking or will think with any kind of certainty, and it may be a futile exercise anyway. The best thing to do is going forward use this as a springboard. What helped me was to think, “well, their opinion of me can only go up from here.”

 

[Mass Effect]

By that measure someone with anxiety couldn’t do ANY job. Talk about stigmatized..

What?

 

[THEBACKANDFORTH]

Thanks everyone who has shared your thoughts. I really appreciate it. Several things..

1) I 'high passed' my psych rotation. I personally don't think I did as well as I had hoped due to aforementioned anxiety issues. It was also my first time exposure to psych interviews, and I found it drastically different from the rest of clinical medicine, which I was familiar with prior to med school.

2) After making efforts to address my anxiety, I've seen improvements in my performance after being on an SSRI and doing therapy for a little over a month now. I don't get nervous palpitations or knots in my stomach anymore. My oral presentations are stronger now. I feel if I get a psych preceptor and practice more, the combo with my psych therapy will definitely improve my performance when I do my 4th year psych electives. I believe I will be able to prove myself to this man later.

3) I asked my BF about this issue. He's a radiology fellow at a prestigious west coast university, soon to be attending, and one of the smartest and most insightful people I know. He said to me "No, this guy is not trying to be mean. He's just being honest. Reading social cues is important for the profession. He gave you a good email response back, but it's still unclear if he will truly support you b/c you essentially forced him to saying it rather him offering it. I would focus on working to change his opinion of you."

4) Should I take his email response back to me literally? I like to see the best in people, especially a person who is supposed to help medical students achieve their dreams, but am I being naive? My username is pink panda and I admit I've always had a sort of childhood innocence in me wanting to see the good in others, believe the purity of their intentions, and trust their words and actions are kind and wholesome? As much as third year has implanted seeds of doubt and cynicism and often makes me question the kindness and sincerity of others, I still try to see the good in people, as difficult as it can be most times. He said "I will do all that I can to help you" and I really want to believe this.

5) He only got hearsay from 2 attendings on my psych rotation who said I seemed to struggle with anxiety/attention issues, particularly with difficult patients. He did not observe my performance directly...

6) This man is the clerkship/block director for medical students. He's also the advisor for all students interested in psych. I will definitely have opportunities to interact and talk to him in the future and I was thinking I can better gauge his support if he perhaps he reiterates it later on or does actions that suggests he really does....

7) Am I really toast at my home program like everyone here says? I've become attached to this city and really want to train here. I plan to get 3 letters of rec from psych attendings at my school who have always believed in and supported me. They interview people and I'd think they'd go out of their way to advocate for me. You all make it sound like knowing him is a death sentence for matching at my home program.

So you all think he wasn't trying to be mean?

I think this last statement is quite naive. He was extremely thoughtful in his response.

Having two psychiatrist relay concerns about a student is significant, psychiatrists in general leave extremely supportive 5/5 evals. Psych rotations based purely on clinical evals are easy to honor. This psych obviously thought so, as he has advised many students and likely rarely gives this type of feedback. In this post, you appear to be seeking validation and ignoring advice to critically consider the feedback. That feedback was not a personal attack, but rather thoughtful.

It certainly is possible that anxiety caused your problems. But your responses here lean me more in the direction of believing you may be missing social cues. Psych requires an ability to connect with people, read people, cut through the lies and mistruths that people feed you. You need to really consider if you are able to do this. In interactions where you are not anxious, do you connect with people and see them for what they are? Do you intrinsically understand non-verbal communication? Are you intuitive?

 

[NickNaylor]

Your reaction is why many attendings give fake ego-stroking "feedback", pass students, and next thing you know, you're posting on SDN wondering why you didn't match when everyone said you were doing great. That's not really nice at all. However, the guy is going out of his way to help you with real feedback upon which you can use and improve yourself, but you focus on the butt hurt instead. Maybe he shouldn't have gone so far to say clinical medicine is not for you, or maybe he is justified.

In real world psychiatry, if you are terrible with patients and have poor social skills, negative feedback from patients may not be nice. It will be in the form of getting cursed at, assaulted, board complaints, lawsuits.

Anyway, take the feedback to heart, run with it, and improve yourself.

I would second this view. Here's the simple reality that medical students may not be aware of: it generally results in more work and stress for an attending to provide negative feedback. Having to deal with questions from the clerkship director if a student complains, dealing with re-grade requests, and generally having an uncomfortable or unpleasant interaction with a student when giving feedback is not something that anyone enjoys doing. The reality is that most academic physicians are getting paid less to do clinical work and are not given any meaningful remuneration for supervising trainees, especially medical students.

The "negative" feedback that I give students is often pretty gentle and not particularly hurtful - partially because students generally perform at an acceptable level, but also because the bar to reach for me to embark on the quest of providing very negative feedback is quite high. The simple truth is that it is simply easier to not provide negative feedback because it's one less thing on my plate that I have to deal with that takes away time from whatever other things I'd rather be doing instead. A student really has to do poorly for me to provide them with genuinely critical feedback because I know it's going to introduce a bunch of annoyances to me by doing so.

Thus, when you receive genuine, negative feedback, it likely means one of two things: 1) the attending simply doesn't care about the consequences of giving negative feedback and does so openly, and/or 2) your performance is genuinely not good and, despite the PITA that comes from providing negative feedback, the attending feels the need to provide it anyway.

 

[deleted445355]

Hi guys,

Thanks for everyone who has taken time to give me advice and a fresh perspective on this issue. I really appreciate it. I agree that I need to improve my ability to take criticism, but I'm also human and have the right to experience emotions and right now, I'm still in a lot of pain. Most of you have not gone through what I had and perhaps you would feel the full set of emotions if you were in my shoes....

Third year has been a difficult and saddening year for me all around, dealing with mistreatment, and personal life stuff. I was interested in dermatology prior to falling in love with psych and have 10 papers in derm. It was disappointing to me to have everything happen to me the way it did b/c I had heavily invested my time and energy into another speciality and switched to psych b/c I truly felt like it was my calling.

I agree with my BF. Only my advisor knows what he meant when he said that and I do think being freely offered support vs. soliciting it in email asking for it is completely different and I can only do my best going forward while taking his advice to heart. To be completely honest, I'm envious of other students he has written letters for, make calls, and advocated for on the admissions committee.

I could wish to have been in the same shoes as they were......

 

[deleted1103055]

Do you think this guy is trying to be mean to me or is it legitimately just being frank? Sometimes, I sense in conversations that he may be biased towards me b/c I'm a struggling student. I feel I'm not on an equal playing field with other candidates as a result of this feedforward process. I'm worried b/c his opinion of students at this school holds weight at the residency program and I'm actually really interested in my home program. I feel like I kinda forced him to say he supports me but he did not go forward HIMSELF to say he does that and I subsequently am not sure if he truly supports me or not. What are your thoughts?

my thoughts went immediately to lectures delivered 15 years ago by Steve Jobs and Randy Pausch. Consider taking the time to watch these lectures which made quite a splash in their day. Perhaps you will come to appreciate and possibly thank your advisor.

Randy Pausch Last Lecture: Achieving Your Childhood Dreams 2007​

Steve Jobs' 2005 Stanford Commencement Address​

 

[ACSurgeon]

Hi guys,

Thanks for everyone who has taken time to give me advice and a fresh perspective on this issue. I really appreciate it. I agree that I need to improve my ability to take criticism, but I'm also human and have the right to experience emotions and right now, I'm still in a lot of pain. Most of you have not gone through what I had and perhaps you would feel the full set of emotions if you were in my shoes....

Third year has been a difficult and saddening year for me all around, dealing with mistreatment, and personal life stuff. I was interested in dermatology prior to falling in love with psych and have 10 papers in derm. It was disappointing to me to have everything happen to me the way it did b/c I had heavily invested my time and energy into another speciality and switched to psych b/c I truly felt like it was my calling.

I agree with my BF. Only my advisor knows what he meant when he said that and I do think being freely offered support vs. soliciting it in email asking for it is completely different and I can only do my best going forward while taking his advice to heart. To be completely honest, I'm envious of other students he has written letters for, make calls, and advocated for on the admissions committee.

I could wish to have been in the same shoes as they were......

We are all entitled to feeling whichever emotions. What we are not entitled to is having unlimited emotional support from those at the workplace. Family and friends keep your head straight when things get tough. Some coworkers will become good friends and be a good source of support. Otherwise. We all have a job to do and those around you want to do their and want you to do yours without letting personal things get in the way.

It seems like you’re very bright and can accomplish anything you want, with the right gamesmanship. You need to display confidence even if you’re not confident. You have to deal with your emotions and stress outside the patient encounter. We are human and there will always be some spillover but you have to find a way to overcome most of it. Seeing a professional will most likely help.

One thing from your posts is that you don’t seem to take feedback very well. Both because you hurt easy and because you have certain thoughts that are coming in the way. Your last post you’re telling everyone who posted here they haven’t experienced what you have and thus making their feedback less applicable. In reality, most people in medicine have been chewed out way worse than what you describe. Again, this would be a good time to be open/vulnerable with your immediate support circle to look for emotional support.

finally- you can turn things around and impress your attendings and match at your home program. Nonetheless, everyone going through the match has a very real chance of not matching at their number 1 program and must accept that reality. Even if all your attendings loved you and never uttered a word of negativity, you have to be prepared for the possibility of matching elsewhere. Otherwise, there’s a very really chance you’ll be disappointed come match day.

 

[Dave1980]

Hi guys,

Thanks for everyone who has taken time to give me advice and a fresh perspective on this issue. I really appreciate it. I agree that I need to improve my ability to take criticism, but I'm also human and have the right to experience emotions and right now, I'm still in a lot of pain. Most of you have not gone through what I had and perhaps you would feel the full set of emotions if you were in my shoes....

Third year has been a difficult and saddening year for me all around, dealing with mistreatment, and personal life stuff. I was interested in dermatology prior to falling in love with psych and have 10 papers in derm. It was disappointing to me to have everything happen to me the way it did b/c I had heavily invested my time and energy into another speciality and switched to psych b/c I truly felt like it was my calling.

I agree with my BF. Only my advisor knows what he meant when he said that and I do think being freely offered support vs. soliciting it in email asking for it is completely different and I can only do my best going forward while taking his advice to heart. To be completely honest, I'm envious of other students he has written letters for, make calls, and advocated for on the admissions committee.

I could wish to have been in the same shoes as they were......

Good luck in the future. Try not to be so defensive and don't make so many excuses for your failures.

 

[DJKitty]

Hi there,

You've already been given a lot of good advice on this thread, but I wanted to chip in and add my two cents as a psychiatrist and as someone who in the past had anxiety. I noticed in your last post that you express the view that things have happened/been done to you, which seems to reflect an external locus of control. Yes, you have anxiety, but you can't use it as an excuse. You need to take responsibility for the position that you are in now because you had at least some role in creating it. You have agency and self-efficacy and can work on improving your coping skills and developing an internal locus of control.

We all experience different challenges in life, but we can't use these challenges as an excuse for poor performance at work and in other social settings. Uncontrolled anxiety in a psychiatrist can be quite dangerous, especially if you are dealing with patients who are agitated and escalating their behaviors towards violence. You have to be in control of the situation and not freeze/panic due to your own mental health issues. Even if you are feeling anxious, you need to be able to regulate your emotions in such a way that your anxiety is not visible to others (patients and colleagues).

Good luck with your residency pursuits.

 

[guytakingboards]

Hi guys,

Thanks for everyone who has taken time to give me advice and a fresh perspective on this issue. I really appreciate it. I agree that I need to improve my ability to take criticism, but I'm also human and have the right to experience emotions and right now, I'm still in a lot of pain. Most of you have not gone through what I had and perhaps you would feel the full set of emotions if you were in my shoes....

Third year has been a difficult and saddening year for me all around, dealing with mistreatment, and personal life stuff. I was interested in dermatology prior to falling in love with psych and have 10 papers in derm. It was disappointing to me to have everything happen to me the way it did b/c I had heavily invested my time and energy into another speciality and switched to psych b/c I truly felt like it was my calling.

I agree with my BF. Only my advisor knows what he meant when he said that and I do think being freely offered support vs. soliciting it in email asking for it is completely different and I can only do my best going forward while taking his advice to heart. To be completely honest, I'm envious of other students he has written letters for, make calls, and advocated for on the admissions committee.

I could wish to have been in the same shoes as they were......

This similarly seems like a situation where you're not reading the room. You asked a group of strangers if that guy was being mean to you. They for the most part all said no. Now you're saying the forum doesn't understand you, which was not the point.

You need thicker skin/better coping skills to succeed in medicine. Life throws alot more at people than a bad eval.

 

[Dral]

My intent is not to be accusatory, but to be helpful. OP, please take a quick look at this and try to apply it to your situation. Pay particular attention to the words/arrows on the left side.

 

[Lawpy]

This similarly seems like a situation where you're not reading the room. You asked a group of strangers if that guy was being mean to you. They for the most part all said no. Now you're saying the forum doesn't understand you, which was not the point.

You need thicker skin/better coping skills to succeed in medicine. Life throws alot more at people than a bad eval.

SDN basically went blunter than the adviser with OP proving the adviser's point.

 

[deleted1103055]

This all seems like a perfectly reasonable interaction. I'm an academic psychiatrist and supervise medical students and residents. .....

Your responses in this thread paint a portrait of someone who cannot tolerate negative feedback and are unable to find something valuable in it when given. That's something that might be worth reflecting on and trying to understand, because whether or not you're going to go into psychiatry, you're definitely going to be receiving critical feedback in the future, and I can almost guarantee that complaining that it was "mean" won't yield the same response that you received from this supervisor.

Since you're an academic psychiatrist, I'd be curious to know what you thought of Jonathan Haidt's argument re: the coddling of the American mind and setting up a generation for failure. The Coddling of the American Mind - Book

The 2015 article published in The Atlantic was eyeopening:

How Trigger Warnings Are Hurting Mental Health on Campus

College students are increasingly demanding protection from words and ideas they don’t like. Here’s why that’s disastrous for education.

www.theatlantic.com

 

[Osminog]

It’s perfectly normal to feel upset after receiving negative feedback. If someone in a position of authority told me that my social deficits potentially disqualify me from successfully practicing clinical medicine, my feelings would be hurt too.

Accept the feedback as one person’s opinion. It’s not a life-defining, career-limiting label that you have to thoughtlessly accept. Continue improving your clinical skills, repairing your deficits, and caring for your mental health. Do whatever you need to do to better yourself as a future physician, and when the time comes, hopefully your dreams will be in reach.

 

[voodoomagic]

Since you're an academic psychiatrist, I'd be curious to know what you thought of Jonathan Haidt's argument re: the coddling of the American mind and setting up a generation for failure. The Coddling of the American Mind - Book

The 2015 article published in The Atlantic was eyeopening:

How Trigger Warnings Are Hurting Mental Health on Campus

College students are increasingly demanding protection from words and ideas they don’t like. Here’s why that’s disastrous for education.

www.theatlantic.com

I think you’re referring to the wrong generation without you stating which generation you are referring to. Future generations haven’t been coddled- they’ve been robbed, their planet on the verge. Stop reading.. and start thinking.

 

[deleted1100659]

medical school students are often faced with 300k+ plus, beaten down emotionally, rarely acknlowdged, and put into a highly competitive environment. Definitely not coddled, in regards to med students. Its an emotionally taxing experience, then you finally finish and stare at that huge number that is your student loan debt, and eagerly await empty promises of student debt reform.

 

[spottedpothos]

I think you’re referring to the wrong generation without you stating which generation you are referring to. Future generations haven’t been coddled- they’ve been robbed, their planet on the verge. Stop reading.. and start thinking.

Did you read the book?

 

[Mass Effect]

medical school students are often faced with 300k+ plus, beaten down emotionally, rarely acknlowdged, and put into a highly competitive environment. Definitely not coddled, in regards to med students. Its an emotionally taxing experience, then you finally finish and stare at that huge number that is your student loan debt, and eagerly await empty promises of student debt reform.

I don't think anyone said med students are coddled.

 

[CantFindMeNowAdcoms]

Since you're an academic psychiatrist, I'd be curious to know what you thought of Jonathan Haidt's argument re: the coddling of the American mind and setting up a generation for failure. The Coddling of the American Mind - Book

The 2015 article published in The Atlantic was eyeopening:

How Trigger Warnings Are Hurting Mental Health on Campus

College students are increasingly demanding protection from words and ideas they don’t like. Here’s why that’s disastrous for education.

www.theatlantic.com

I found this article interesting. Thank you for sharing. I’d also be interested in an academic psychiatrist’s thoughts on the subject.

 

[Eye-eye]

Hi guys,

Thanks for everyone who has taken time to give me advice and a fresh perspective on this issue. I really appreciate it. I agree that I need to improve my ability to take criticism, but I'm also human and have the right to experience emotions and right now, I'm still in a lot of pain. Most of you have not gone through what I had and perhaps you would feel the full set of emotions if you were in my shoes....

Third year has been a difficult and saddening year for me all around, dealing with mistreatment, and personal life stuff. I was interested in dermatology prior to falling in love with psych and have 10 papers in derm. It was disappointing to me to have everything happen to me the way it did b/c I had heavily invested my time and energy into another speciality and switched to psych b/c I truly felt like it was my calling.

I agree with my BF. Only my advisor knows what he meant when he said that and I do think being freely offered support vs. soliciting it in email asking for it is completely different and I can only do my best going forward while taking his advice to heart. To be completely honest, I'm envious of other students he has written letters for, make calls, and advocated for on the admissions committee.

I could wish to have been in the same shoes as they were......

So a few thoughts in response to this:

The vast majority of people on here are clearly trying to help you (and even the most blunt of them, saying "good luck then," are probably trying to help as well, in the form of building thicker skin and showing you how much you need to grow in this regard to make it in most medical settings). If I can make a stupid-sounding analogy, the thing that came to mind was a scene from LOTR: The Fellowship of the Ring, when Gandalf, imposing fear and authority, states boldly to a brainwashed Bilbo, "Do not take me for some conjurer of cheap tricks. I am not trying to rob you. I am trying to help you." Take these posts as similarly saying, with the authority of experience and consensus, "Do not take me for some untested naif. I am not trying to wound you. I am trying to help you." Yes, it can sound a little harsh. But we are truly trying to help you by confronting you with reality.

Absolutely nobody on this thread said you don't have the right to experience your emotions; many of these comments express empathy with your pain and state how normal that is for you to feel. We know you feel that way, and that you have to feel that way right now in order to confront the issue and push forward. Vehemently coming back to say that you have the right to experience that expresses a victim mentality - or better put, an external locus of control, as @DJKitty noted. This is the root of the issue! I think just about everyone has struggled with this, and many good people have lost the battle. Not only does it make you sound like you enjoy making excuses or playing the victim, but it also is what's making you miserable! I know that when I've let myself think, "why do I have to go through this," "can't they just let me go home," "why is he being so mean to me," etc, etc, that I feel horrible. Similarly, I feel like **** when I allow myself to envy someone else's life (and remember, they have their own **** - you just don't know what it is.) But I've had moments when I realized I was thinking that way and consciously reminded myself, our thoughts determine our lives (there's a great book by the same title, for anyone interested, especially of the religious persuasion). And I consciously made the effort to change my way of thinking. To say, I can either take this as a burden or as a blessing, a way to grow and learn - which is a pretty huge gift, when you think about it. To remember that I chose this career knowing it would be really freaking hard, and that I chose it for a good reason, that is still extremely valid, and honestly that I have it pretty easy compared to the people working their assess off for meager pay, without satisfaction in their work or a realistic chance to really move up the ladder, trying to provide for a family hand-to-mouth and worried about how they can possibly keep it up enough to survive. This is the frameshift you need to make.

As a couple others have indicated here, we've all gone through ****. I didn't match this past cycle. In the past, I was told once by the person whose advice I most respected that he was very worried about me at a time in my life when I thought I was doing everything right and things were finally going the right direction. There are other examples, but we've all lived life and gone through some difficult experiences. I've been devastated multiple times in my life, and you bet your ass I had a right to feel those emotions and feel a lot of pain. But whether it took days or years, I grew from each of those experiences, and am honestly grateful for them. I'm grateful I didn't match this year. Think about that. That's not possible without a huge frameshift. I'm happier now, not even knowing what specialty I'm going to end up in - if I have a real shot in the specialty of my choice or not - than when I was certain I was going to match in my desired specialty. You can come out of this not only stronger, but also happier. But not if you take all of this as abuse or as a burden. We all have to grow as humans. But believe me, this kind of growth will pay so many dividends for your happiness and life satisfaction in the future.

The victim mentality kills, and I don't mean that metaphorically. I've gone through a lot of depression in my life, and if I didn't fight against the external locus of control mentality, there's a real chance I wouldn't be standing here. Just brace yourself - when you come to this thread for advice, or go to someone for feedback, remember that it WILL be hard to hear, and it WILL feel like we're attacking you. And remind yourself that it's harder to say these things than to say "you're okay, you're doing great," and that we wouldn't be bothering if we weren't truly trying to help you. That it's in YOUR control to take the advice to heart, painful though it is, and say "Okay. That's tough to hear, but I will work on that. And it's better to know that I need to work on it than not to know."

And remember, we're not trying to hurt you. We're trying to help you.

 

[sloop]

5) He only got hearsay from 2 attendings on my psych rotation who said I seemed to struggle with anxiety/attention issues, particularly with difficult patients. He did not observe my performance directly...

I think this point was possibly a response to my earlier question. Given this explanation, I think that the feedback you received was harsh but likely valid.

He’s the clerkship director, so he’s probably getting a lot of feedback about your performance from the other faculty. He’s relaying problems with your performance honestly. I don’t know if I would personally convey things the way he did, but I also don’t know what he heard from trusted colleagues about your performance.

Whether or not you still have a shot at your home program, I have no idea. Does the clerkship director still have a negative impression of you? If so, that’s obviously not good. It also depends on how engaged the clerkship director is with your department. Some clerkship directors work very closely with the residency program while others don’t. Either way, he’ll probably be asked about your performance but it’s hard to know how much weight it will carry. It is probably safe to say it will carry some weight but beyond that, hard to tell. The other factor is, honestly, what program it is. This gets complicated, though, and isn’t always super predictable. Less well-known, community programs may struggle more with recruitment. As a result, they may get weaker applicants and they might give you a shot as a “known entity.” Better programs get a lot of very competitive applicants but some of those same programs also have a habit of taking several residents a year from their own medical school.

I think you can feel out your own chances at your home program and can still apply, but don’t put all your eggs in that basket.

 

[acstylin]

Person in authority: You need to work on some skills and improve your ability to do X.

Med student: Oh man. I’m really glad you told me this. I actually thought I was good at that but you’re telling me this for a reason and it’s important to believe you. What is something you could recommend me doing so I can be better at recognizing when I’m making this mistake and how have you seen people turn this around?

-Med student goes and intentionally makes those changes and shows massive improvement using the exact advice the Person in Authority gave them. Person in Authority recognizes this seeing fantastic potential in a student to take feedback and instruction and recommends student for their program.

Would you rather have a trainee who is coachable and humble or the naturally gifted individual who won’t take your advice? You were gifted the opportunity of a lifetime to showcase your ability to take criticism, improve, and bounce back better than ever. You could have shown this person what you’re made of and how bad you want a spot in their program. It is unfortunate that you did not jump at this opportunity. Take this as a learning experience and promise yourself that you will attack your weaknesses in the future. Can you have hurt feelings? Of course. We all do. The most successful people in this world are not the ones that never get their feelings hurt. They are the ones who do something positive about it.

 

[zekintha]

I think it's unfortunate that this guy gave you that feedback without clear direct observation of your interactions with patients. That being said, I agree with everyone who has said that he probably wasn't trying to be mean and he was honestly trying to give you feedback as @NotAProgDirector gave a great example of above. This is a great opportunity to take advantage of the time you have left as an MS4 and proactively seek out feedback from your direct preceptors as well as this person (and your psych resident program director if you can get clinical facetime with them), and really iteratively get more feedback every 2-3 days (hey, rotations are short in the scheme of things) and demonstrate improvement in the specific skills you agree to work on with your preceptor over those 2-3 days. I recently had a med student impress me with the amount of feedback that he sought out -- he was average-ish when he started, nothing special, but he really stood out to me over the short 1.5 weeks I worked with him because I could see the improvement by the next day on anything we had discussed.

Hopefully, if you are able to stick to this strategy, you can overcome the faux pas of how you responded to the feedback in your email (the response should have been acknowledging your struggles, potentially with explanation of circumstances though you *need* to make sure you don't seem like you're making excuses or solely blaming external factors, and then asking for mentorship/feedback/guidance moving forward) and maybe stay at your home institution for residency. Remember, the key to being ranked highly in match is being someone that the people in the program (faculty and residents) want to have as a colleague: someone who will pull their weight and is enjoyable to work with.

As an aside, for what it's worth, I had two classmates who were also told by psych attendings that they should consider a field without significant patient interaction, and they are both doing great in IM/peds fields. I also personally received anonymous negative feedback from a resident on my first MS3 rotation, and after nursing my hurt feelings on my own (again, agree with everyone who says it's okay to feel how you feel -- we're all human, of course!), I approached the rotation director to ask if he could clarify the feedback and how I could improve; he told me he didn't have any concerns about my performance but gave me some pointers on how not to land myself in hot water with anyone else. We all get negative feedback at some point (or at many points) in our medical careers given the sheer number of preceptors and patients we interact with, and you can't please everyone, but always ask yourself (whether it's negative feedback or an adverse patient event) if there was anything you could have done differently (sometimes there isn't) and try to learn from it.

 

[Styrene]

Very ironic. And a very interesting back-and-forth.

All that notwithstanding, wouldn't the most productive course of action be to honestly appraise his advice from a practical standpoint? To look deeply into why you responded in the way that you did? To examine why the central question that arises in you is one of whether he likes you?

If these are things one cannot do, psychiatry may not be the best choice. But social weaknesses or whatever can be remedied.

I've also never heard anyone speak of reading social cues as necessary for psychiatry. That "skill" is important but not necessary for all medicine, most jobs, life in general. Perhaps less so in psychiatry given a significant proportion of psychiatric patients behave in deranged ways that are not interpreted using innate or common sense notions (ie inferring from "I behaved in X way in Y scenario for reason Z" that "Patient A is behaving in B way now because of reason Z").

 

[Ganon]

Very ironic. And a very interesting back-and-forth.

All that notwithstanding, wouldn't the most productive course of action be to honestly appraise his advice from a practical standpoint? To look deeply into why you responded in the way that you did? To examine why the central question that arises in you is one of whether he likes you?

If these are things one cannot do, psychiatry may not be the best choice. But social weaknesses or whatever can be remedied.

I've also never heard anyone speak of reading social cues as necessary for psychiatry. That "skill" is important but not necessary for all medicine, most jobs, life in general. Perhaps less so in psychiatry given a significant proportion of psychiatric patients behave in deranged ways that are not interpreted using innate or common sense notions (ie inferring from "I behaved in X way in Y scenario for reason Z" that "Patient A is behaving in B way now because of reason Z").

Before looking at the profile to the left I thought to myself, "Found the psych resident"

(Good perspective all the more)

 

[Mass Effect]

I've also never heard anyone speak of reading social cues as necessary for psychiatry. That "skill" is important but not necessary for all medicine, most jobs, life in general. Perhaps less so in psychiatry given a significant proportion of psychiatric patients behave in deranged ways that are not interpreted using innate or common sense notions (ie inferring from "I behaved in X way in Y scenario for reason Z" that "Patient A is behaving in B way now because of reason Z").

Your statements are factually inaccurate. First, a significant proportion of psych patients do not behave in "deranged" ways. In fact, the majority of patients with mental illness have depression, anxiety, PTSD, and a multitude of other disorders that would not be classified as "deranged" nor would result in behavior that is "deranged". Next, reading social cues is at the core of studying human behavior. It is very much an important skill especially in psychiatry.

 

[Styrene]

Your statements are factually inaccurate. First, a significant proportion of psych patients do not behave in "deranged" ways. In fact, the majority of psych patients with mental illness have depression, anxiety, PTSD, and a multitude of other disorders that would not be classified as "deranged" nor would result in behavior that is "deranged". So that's just plain wrong. Next, reading social cues is at the core of studying human behavior. Why you would think it doesn't apply in psychiatry is perplexing.

My apologies if the intended meaning and received meaning were different.

You concluded that a significant proportion of psych patients don't behave in deranged ways by arguing that a majority of psych patients have disorders not classified as deranged. Significant as I use it does not mean most or majority. I can see how that may be misinterpreted.

You questioned why I think reading social cues does not apply to psychiatry. I state that it is an important skill in all of medicine, which includes psychiatry.

You implied that reading social cues is at the core of studying human behavior and thus is important in psychiatry. I'd counter that by saying that the systematic study of human behavior, rather than the reading of social cues, is a major focus of the social sciences, which includes psychology. Psychiatry does use the conclusions of psychology, but the clinical practice of psychiatry is not the study of human behavior. Rather, it's an objective analysis and categorization of it.

Anyway, the point was that reading of social cues is important but not necessary in psychiatry because objective examination and analysis of behavior and thought within a refined nosological framework of mental disorders is the standard. Reading social cues can certainly make that process easier in certain situations.

What I will say is that kind, socially skilled psychiatrists are subjectively more pleasant (patients and probably everyone else in the world like them better). Whether there is a difference in outcomes, I'm not sure. Even still, this sort of alliance-building, supportive interaction with patients is explicitly taught during psychiatry residency.

Thank you for the engaging response.

 

[Mass Effect]

My apologies if the intended meaning and received meaning were different.

You concluded that a significant proportion of psych patients don't behave in deranged ways by arguing that a majority of psych patients have disorders not classified as deranged. Significant as I use it does not mean most or majority. I can see how that may be misinterpreted.

I guess it depends on how you're using the term "deranged" which is a term I tend not to use to describe our patients. It also depends on your practice, inpatient vs outpatient. But I have never thought this to be a significant part of practicing psychiatry.

You questioned why I think reading social cues does not apply to psychiatry. I state that it is an important skill in all of medicine, which includes psychiatry.

What you said was: "I've also never heard anyone speak of reading social cues as necessary for psychiatry. That "skill" is important but not necessary for all medicine, most jobs, life in general. Perhaps less so in psychiatry"...

Both "important but not necessary" and "less so in psychiatry" are inaccurate. That's what I'm objecting to.

You implied that reading social cues is at the core of studying human behavior and thus is important in psychiatry. I'd counter that by saying that the systematic study of human behavior, rather than the reading of social cues, is a major focus of the social sciences, which includes psychology. Psychiatry does use the conclusions of psychology, but the clinical practice of psychiatry is not the study of human behavior. Rather, it's an objective analysis and categorization of it.

What? I'm confused by the "rather than". Are you saying that the reading of social cues is not a part of the systematic study of human behavior? The clinical practice of psychiatry most certainly is the study of human behavior. Every time you see a patient, you are doing a mental status exam. You are not just categorizing your patients. I mean, you could, but you'd be a crappy psychiatrist if you did. You have to understand your patients and picking up on their social cues and understanding their social cues is one of the main components. I think you have a bit of an inaccurate view of psychiatry, possibly because you're very early in your training.

Anyway, the point was that reading of social cues is important but not necessary in psychiatry because objective examination and analysis of behavior and thought within a refined nosological framework of mental disorders is the standard.

What do you think an objective exam is in psychiatry? Do you think that if I'm sitting with a patient and he won't look me in the eye, that isn't part of the objective exam? Or if I tell the patient the appointment is over and get up and he begins a new story, that isn't important to my overall formulation of the patient? You are aware that picking up on social cues is the diagnostic criteria for some DSM disorders, right? How do you think you're going to observe a deficiency in social cues if you yourself don't pick up on social cues? I think your perception of psychiatry is inaccurate.

Reading social cues can certainly make that process easier in certain situations.

What I will say is that kind, socially skilled psychiatrists are subjectively more pleasant (patients and probably everyone else in the world like them better). Whether there is a difference in outcomes, I'm not sure. Even still, this sort of alliance-building, supportive interaction with patients is explicitly taught during psychiatry residency.

Thank you for the engaging response.

This isn't part of alliance-building or supportive interaction with patients. That isn't what social cues is about. Social cues is what helps differentiate between certain disorders, it's what we mean when we write for the mental status exam that the patient exhibited inappropriate laughter or that tearfulness was not appropriate to conversation, it's what helps us diagnose autism or a nonverbal learning disorder or a personality disorder or a neurocognitive disorder or PSA or even prodromal schizophrenia, depression, or social anxiety. Response to social cues is one of the most important things to notice in your patient. If you don't notice your own struggles with it, that can be a big problem, especially in psychiatry.