Duke Reputation vs. Reality - malignant or not?

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Space Wrangler

Space Wrangler

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Hi Everyone,

I did not really see any relevant posts regarding my question that aren't completely outdated at this point, so I'm going to put it out there.

I'm considering Duke as my top choice for the match. I know that it has many strong points (which have been enumerated in other posts), but I won't get into that here. What I am interested in is the personality of the program. They have a reputation for being a bit hardcore/traditional/malignant, although I know that reputation often lags behind reality. What is life like as a Duke IM resident? Is it any more "malignant" than other top programs? Thanks for the help!
 
Space Wrangler said:
Hi Everyone,

I did not really see any relevant posts regarding my question that aren't completely outdated at this point, so I'm going to put it out there.

I'm considering Duke as my top choice for the match. I know that it has many strong points (which have been enumerated in other posts), but I won't get into that here. What I am interested in is the personality of the program. They have a reputation for being a bit hardcore/traditional/malignant, although I know that reputation often lags behind reality. What is life like as a Duke IM resident? Is it any more "malignant" than other top programs? Thanks for the help!
Click to expand...

BUMP

I have my Duke interview next week but I am in the exact position as the previous poster (possibly considering Duke as top choice due to location, reputation, etc.) and wanted to know how "malignant" the program is. I'll of course ask around while I'm at my interview, but I also wanted the SDN opinion.
 
Duke is a top-flight, tip of the spear, world-class medical center build on the backs of about 1000 residents and fellows, ground down to a nub. An alternative simile is like planet classes from "Star Trek". When I was there (not in IM), I gasped. Others, though, flourished in that environment.

Malignant? Only if you are lazy or not motivated, because the race never slows down, and the education continues apace - since they're always, always turning out new research, even though much of the faculty trained at Duke, there's no "inbreeding". The same criteria people use to describe "malignancy" are used for Duke residents to state why they love it there. In other words, either the residents and fellows are happy with the challenge, or they're masochists, with "folie à deux" x 500. It's not for the faint of heart.

At the same time, if you want to do fellowship, IM residency at Duke allows you to write your own ticket. By the very fact itself, when 38/40 match into fellowship, it's immaterial whether the other 2 didn't match or chose (Oh, the horror!) to go into general IM practice.

Two things (colored by what I said above): I said about Duke what Jim McMahon said about BYU - "best view of (Duke) was in the rear view mirror", and, just like when I went to military college - "wouldn't give it up for a million dollars, but wouldn't do it again for 10 million".
 
From what I remember from my interview and feedback from classmates and seniors, it really didn't feel like it was malignant - tough yes but not malignant. As the other poster said, you will have no problem writing your fellowship ticket (assuming you are going to do fine in the program). In the end, go there and see how it feels and and if you like the atmosphere, then go with it.
 
I had an interesting experience this week.. was flying up for an interview and got talking to the person next to me and he turned out to be an upper level IM resident at Duke. We had a good conversation about medicine and career goals and such and then I decided to go ahead and ask him about the "malignant" reputation that you always hear about when you talk about Duke IM. He said that he had heard the same exact thing from attendings and other faculty members when he was applying a few years back and was actually pretty nervous about it. He said he decided to go ahead and pick Duke because it catered to a specific track he was looking for and says he hasn't regretted it at all. Apparently, after the infamous match a few years ago where they did not fill all their spots, the program revamped a lot of 'sore spots' which mainly concerned duty hours and some bad apples in the faculty that residents repeatedly had negative experiences with. The resident said that he has worked hard but not over the work-hour limit, the atmosphere with the residents is collegial and faculty is supportive and not diminutive; most importantly, he said, they have been very helpful in carving out his non-traditional track and is definitely glad he picked Duke. I know it's one person's opinion but I truly felt like he was being 100% honest with me.
 
I had concern about this as well, until I visited and talked with people who go there. I felt like it was the most friendly interview visit I've had so far. They didn't have this elitist east-coast mentality that I noticed from other top programs (I'm from the Midwest). It felt like a rigorous, but happy institution. A second year there from my school was surprised to have ended up there, but absolutely loves the program. As of right now, they are #1 on my rank list so hopefully my gut is not wrong! 🙂
 
I am a Pulm/CC fellow at Duke and I don't think the program is malignant at all!! The residents that rotate through the MICU are on q3 24 hour call and are always happy and seem to be having a good time. Yes they are tired and worn out but that is what residency is about. They have pretty decent schedules and we are always worried about making sure they don't go over hours. The chiefs bring the on call residents Pizza every friday night! I mean how could that be malignant!!!??? If you are lucky enough to get in here (like me :laugh:) then you will love it. Just plan on working hard, learning a lot and being surrounded by world class attendings!

PM me with any more questions. I am happy to help!
 
Thanks a lot for the helpful information! You all pretty much confirmed my own impression of the Duke program - mainly that you work hard but get a lot out of it. I am not worried about putting in hours, I just wanted to make sure that it is a positive culture, that people enjoy working together, and that resident-attending relationships are supportive. I think that I am definitely going to keep Duke #1!
 
The definition of "malignancy" in residency is definitely changing. A malignant program used to be one where the residents were actually verbally abused (sometimes physically abused), where your well-being as a person was completely disregarded, where nobody gave a **** about you, where your education was an afterthought, etc.
It really doesn't seem like places like that truly exist anymore. I'm positive somebody will jump in here to correct me, but I've now met dozens of residents and fellows from the traditional "malignant" programs (like Duke, like UTSW) and none of them report anything like that happening to them. I've never actually met somebody who went through a malignant training process in the last decade. It's just something you hear about, third-hand, like Bigfoot.
Now, a "malignant" program seems to be any place that actually pushes you to the 80hr limit, has anything more frequent than q4 call, any place where the residents are tired, etc. The program I'm at now, doing my fellowship, has an IM program that I would consider cushy. They complain like mad if they start to approach 80 hours, they complain that the place is becoming "malignant." Nobody seems to have perspective on this anymore.
[/old man rant]

edit: with the caveat that this is only in reference to IM, as I have no good concept of what other fields (e.g. surgery) are going through these days
 
Last edited:
VJWDO said:
I am a Pulm/CC fellow at Duke and I don't think the program is malignant at all!!
Click to expand...

Not for IM, but specific for Pulm/CC are several of the biggest *******s I met there (in the whole place): Wahidi, number 1 with a bullet, Shofer, and the "Zaas-hole" - I didn't even make that one up. Snide and condescending, insulting, and not helpful. That is opposite, say, PSK, who is in your face, but clear - very much so - on why you are wrong, and what you can do to fix it. Vic Tapson is one of the 3 smartest people in the entire medical center (which is saying something).

Now, granted, it may completely have been wholly or mostly my fault for being weak and off-service, but, still - why stop at professional, when you can layer some snark and criticism on top?
 
Sounds like some rough experiences. If you don't mind, could you provide some examples of what you went through? Just trying to figure out where on the spectrum of snide, condescending, etc. things may fall.
 
Apollyon said:
Not for IM, but specific for Pulm/CC are several of the biggest *******s I met there (in the whole place): Wahidi, number 1 with a bullet, Shofer, and the "Zaas-hole" - I didn't even make that one up. Snide and condescending, insulting, and not helpful. That is opposite, say, PSK, who is in your face, but clear - very much so - on why you are wrong, and what you can do to fix it. Vic Tapson is one of the 3 smartest people in the entire medical center (which is saying something).

Now, granted, it may completely have been wholly or mostly my fault for being weak and off-service, but, still - why stop at professional, when you can layer some snark and criticism on top?
Click to expand...

I have to completely disagree with you. Every single person you named has been wonderful to work with and are some of the best teachers I have ever had. I can see where you may have had problems as you apparently have a major personality deficit and complete lack of professionalism.

To those of you reading this thread I would take Apollyon's words with a grain of salt as he obviously had some personal issues.
 
VJWDO said:
I have to completely disagree with you. Every single person you named has been wonderful to work with and are some of the best teachers I have ever had. I can see where you may have had problems as you apparently have a major personality deficit and complete lack of professionalism.

To those of you reading this thread I would take Apollyon's words with a grain of salt as he obviously had some personal issues.
Click to expand...

Good job. I have a "lack of professionalism" and a "personality deficit". I "obviously" had some "personal issues". Yeah, you can clearly deduce that, from ONE single sentence, even as I pointed out others who were good. In other words, maybe you should recapitulate the meaning of those words before you use them again.

I sent an itemized list by PM to one student. I would testify to it in court - not embellished. As I was in the MICU 7 years ago, times may have changed. Maybe you look at it through rose-colored glasses. It's only slightly ironic that, of the people I mentioned, they happen to be, to you, "some of the best teachers" you've ever had. Really? Coincidentally? The very ones I mentioned are the best? What if I'd said Mark Steele or Claude Pianditosi or Joe Govert? Would you, again, say they were "some of the best teachers"? Would you say that any faculty I mentioned were "some of the best teachers"? That stretches credibility, and makes you sound like you're not objective.

So, even though I qualified my answer, you still personally insult me, and draw conclusions without basis in fact (and, if you read, as I said, I didn't even make up the "Zaas-hole" name - so is that other people with "personality deficits" and "complete lacks of professionalism"?).

And a "complete lack of professionalism" isn't a one-liner on the internet - that would be showing up naked, cursing, blaspheming, and telling the patients they're all going to die, whether they are or not. Maybe you need to adjust your criticism filter a bit. But, then again, you, apparently, are drinking the Kool-Aid, so you have at it. Your pulmonary skills, if you complete fellowship, should be second to none. Critical care, not so much. At least you weren't a Duke IM resident (since DO residents are NOT WELCOME at Duke), because, when I was there, they were afraid of procedures, and their skills (or lack of same) showed that.
 
Apollyon, would you mind sending me the PM that you mentioned previously? I would be curious to hear your opinion as well
 
Apollyon said:
Good job. I have a "lack of professionalism" and a "personality deficit". I "obviously" had some "personal issues". Yeah, you can clearly deduce that, from ONE single sentence, even as I pointed out others who were good. In other words, maybe you should recapitulate the meaning of those words before you use them again.

I sent an itemized list by PM to one student. I would testify to it in court - not embellished. As I was in the MICU 7 years ago, times may have changed. Maybe you look at it through rose-colored glasses. It's only slightly ironic that, of the people I mentioned, they happen to be, to you, "some of the best teachers" you've ever had. Really? Coincidentally? The very ones I mentioned are the best? What if I'd said Mark Steele or Claude Pianditosi or Joe Govert? Would you, again, say they were "some of the best teachers"? Would you say that any faculty I mentioned were "some of the best teachers"? That stretches credibility, and makes you sound like you're not objective.

So, even though I qualified my answer, you still personally insult me, and draw conclusions without basis in fact (and, if you read, as I said, I didn't even make up the "Zaas-hole" name - so is that other people with "personality deficits" and "complete lacks of professionalism"?).

And a "complete lack of professionalism" isn't a one-liner on the internet - that would be showing up naked, cursing, blaspheming, and telling the patients they're all going to die, whether they are or not. Maybe you need to adjust your criticism filter a bit. But, then again, you, apparently, are drinking the Kool-Aid, so you have at it. Your pulmonary skills, if you complete fellowship, should be second to none. Critical care, not so much. At least you weren't a Duke IM resident (since DO residents are NOT WELCOME at Duke), because, when I was there, they were afraid of procedures, and their skills (or lack of same) showed that.
Click to expand...


Nice Rant.

Yes I would consider most of the Duke Pulm/CC department attendings outstanding educators and some of the best teachers I have ever had including all the individuals you have mentioned. I have completed training at various less desirable locations around the country (as you pointed out I am a DO so we have to make do) and feel blessed to be given the opportunity to train at Duke. You call that drinking the kool-aid and I call it taking advantage of an excellent training program and moving on instead of perpetuating a 7 year long grudge. Have things changed in 7 years? I would think so, what institution hasn't?

I "personally insulted" you the same way you "personally insulted" some very fine attendings BY NAME on a public forum. That is where I take issue with your professionalism. I will apologize for the personality deficit remark as I do not presume to know anything about your personality. Your actions however I do not condone and would definitely declare to be unprofessional. My "criticism filter" is right where I want it to be.

And if you think lack of professionalism is defined by going to the extremes mentioned in your post then I rest my case.

I too would love to see the incriminating yet incredibly true information that you would swear to in a court of law...but doubt you would send it to me. Feel free to prove me wrong.

I digress and will no longer pollute this forum with childish arguments. If anyone wishes to have a CURRENT review of Duke from a person closely working with CURRENT IM residents then feel free to ask me any questions or PM me.
 
Having gotten more information, and having been PM'd by 4 or 5 people, I can safely say that the culture has changed in the Duke MICU from half a decade ago. I said what I thought above - that what is thought by some to be malignant is actually what others seek, so, no harm, no foul, so that, if you can take the heat, you won't get burned, and the sore spot of the MICU should not now be a deal-breaker. And, for the lurkers, if you got a Duke IM interview, by no means not rank them due to what I told you. This is unsolicited, so I am telling you the truth. It DID suck, but it is objectively better.
 
No, and I am posting from my phone so it's difficult to see clearly the thread. The 4 or 5 are applicants. The Duke Mafia did not come out of the woodwork (although those MFers are EVERYWHERE). I did not intend to confuse. If someone tried to intimidate or influence me by PM, do you really think that I would "dummy up" (as Archie Bunker would have said)? What could they do to me? Dignity is long gone.
 
Apollyon said:
No, and I am posting from my phone so it's difficult to see clearly the thread. The 4 or 5 are applicants. The Duke Mafia did not come out of the woodwork (although those MFers are EVERYWHERE). I did not intend to confuse. If someone tried to intimidate or influence me by PM, do you really think that I would "dummy up" (as Archie Bunker would have said)? What could they do to me? Dignity is long gone.
Click to expand...

I know that feel. 😀
 
Apollyon said:
No, and I am posting from my phone so it's difficult to see clearly the thread. The 4 or 5 are applicants. The Duke Mafia did not come out of the woodwork (although those MFers are EVERYWHERE). I did not intend to confuse. If someone tried to intimidate or influence me by PM, do you really think that I would "dummy up" (as Archie Bunker would have said)? What could they do to me? Dignity is long gone.
Click to expand...

What I want to know is how you removed your post? It makes the possibility of Duke Mafia more plausible. HAHA. :laugh:
 
VJWDO said:
What I want to know is how you removed your post? It makes the possibility of Duke Mafia more plausible. HAHA. :laugh:
Click to expand...

Nah, I just deleted it for civility. Honestly, the Duke Mafia is more into psychological warfare. They'll guilt you into submission, and make you think that you're worse than a genocidal murderer. It's very insidious!
 
In a world of many prominent IM programs shifting to some ratio of 3+1, 4+1 or 6+2, etc. etc. It seems like Duke doesn't emphasize the idea of outpatient continuity clinic. Depending on the rotation it looks like a resident doesn't have any clinic, and others one may attend-but not every week.

Can anyone comment on the outpatient training at Duke and if there is any potential for them to switching over to a X+Y rotation schedule? Does the lack of a more regular ambulatory exposure makes it a more rigorous program with more time on inpatient. Thoughts?
 
To be honest from what I have seen Duke is not the place people come to for outpatient IM. They come here with the goal to match into top specialty programs. I know nothing about their outpatient experience but I have heard numerous residents say that while it is good training their inpatient training is by far more vigorous. Hope that helps.
 
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