Malignant Preceptors

[EmilKraepelin55]

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Hey everyone, was curious about something:

So I have my two IM rotations coming up, one outpatient and one hybrid (both in and out) but the hybrid is still considered “outpatient.” My school scheduled this long ago, but calls me a few days prior to the start of my first IM rotation to tell me they want me to switch preceptors so I can get a purely inpatient rotation. I’m like, yes I absolutely need this. However, they say that the available preceptor for the upcoming block who does pure inpatient IM is a malignancy I have heard awful things about. I told them no, because I understand myself and know that I learn better without having a malignant personality break me down time and again. They agreed to my objection, but it left me conflicted. Would it have been better to accept the malignancy in favor of a pure inpatient IM experience, or do what I did? I honestly feel like I made the right call given what I know about this preceptor, but I would be interested in anyone’s thoughts on the matter.

 

[MakeLifeHappen13]

Life is too short to suffer a miserable person for an entire month if it can be avoided. You will get all the inpatient medicine you can handle during residency. Don't sweat it.

 

[qwertythrowaway]

what one person considers "malignant" varies quite a bit.
there were sites with terrible reviews from prior students where I had an excellent experience, and vice versa.

if it were me, i'd be trying to do more inpatient rotations regardless of preceptor reputation. inpatient IM is where i learned to string together a coherent presentation, write a lot of notes, and do basic physical exams/work-ups. it helped set my foundation for the rest of my clerkships. you can definitely learn IM from a hybrid/outpatient model...but if you can get an inpatient experience, i'd go for it.

you're gonna make a lot of mistakes during third year. you will inevitably be yelled at, ignored, and work with crummy people. the point is to learn as much as you can. if you think you will learn more at the inpatient site, go there. if not, do the other thing

 

[deleted480308]

Hey everyone, was curious about something:

So I have my two IM rotations coming up, one outpatient and one hybrid (both in and out) but the hybrid is still considered “outpatient.” My school scheduled this long ago, but calls me a few days prior to the start of my first IM rotation to tell me they want me to switch preceptors so I can get a purely inpatient rotation. I’m like, yes I absolutely need this. However, they say that the available preceptor for the upcoming block who does pure inpatient IM is a malignancy I have heard awful things about. I told them no, because I understand myself and know that I learn better without having a malignant personality break me down time and again. They agreed to my objection, but it left me conflicted. Would it have been better to accept the malignancy in favor of a pure inpatient IM experience, or do what I did? I honestly feel like I made the right call given what I know about this preceptor, but I would be interested in anyone’s thoughts on the matter.

I think you overuse the word “malignant “. It’s a cliche with no meaning, specifically what did this individual do allegedly?

 

[EmilKraepelin55]

I think you overuse the word “malignant “. It’s a cliche with no meaning, specifically what did this individual do allegedly?

This person is primarily known to be a sort of Jekyll/Hyde personality who explodes and berates students, threatening to throw them off service sometimes for even the smallest perceived slights I.e. someone didn’t bring their phone the first day of the rotation so they could access the UTD app, so he threatened their expulsion from his service and verbally destroyed them in front of the nursing staff who claims “he is not usually this way.”

 

[deleted480308]

This person is primarily known to be a sort of Jekyll/Hyde personality who explodes and berates students, threatening to throw them off service sometimes for even the smallest perceived slights I.e. someone didn’t bring their phone the first day of the rotation so they could access the UTD app, so he threatened their expulsion from his service and verbally destroyed them in front of the nursing staff who claims “he is not usually this way.”

But does the school actually punish these students? Does the doc actually stop teaching these residents? Are you unable to bring your phone (a med student or resident should have a phone)?

you need to learn to navigate these people. Not that it’s ok for them to act like that but you play the cards you are dealt. Emotionally ignore them and get what you need out of them which is access to patients. Learn their triggers and work around them.

 

[NontradCA]

what one person considers "malignant" varies quite a bit.
there were sites with terrible reviews from prior students where I had an excellent experience, and vice versa.

if it were me, i'd be trying to do more inpatient rotations regardless of preceptor reputation. inpatient IM is where i learned to string together a coherent presentation, write a lot of notes, and do basic physical exams/work-ups. it helped set my foundation for the rest of my clerkships. you can definitely learn IM from a hybrid/outpatient model...but if you can get an inpatient experience, i'd go for it.

you're gonna make a lot of mistakes during third year. you will inevitably be yelled at, ignored, and work with crummy people. the point is to learn as much as you can. if you think you will learn more at the inpatient site, go there. if not, do the other thing

If you’re thinking about doing IM as a specialty I’d say absolutely do it, because the chances are high you’re going to run into similar people in the future. It’s better to learn how to deal with them now as a student than as an intern. If you feel like you’re being treated unfairly or disrespected then tell them about it. It’s only a limited interaction and you could be making a difference for future students.

 

[thumbz]

Ehhh this preceptor sounds like a pile of trash. Will you have an opportunity to do a wards based IM rotation, either as an MS3/4 or as a SubI? If yes, dump this rotation. If not, and you want to match IM, you need an inpatient rotation (and absolutely try to get a wards based one) or you'll have a much harder time matching.

When it comes to IM and what we look at (I sit on a residency ADCOM) - Wards IM >>>>>>>> Preceptor inpatient > Preceptor outpatient

When I interviewed every larger program asked me during interviews if I did a wards based IM rotation, and now that I sit on an ADCOM we ask every DO who applies if their IM rotation was wards based (as in with a teaching program and resident team) as so many of the DO schools don't have this as a standard. As every DO student knows the rotations can be super hit or miss and an "inpatient IM rotation" may actually be 2 hours a day of shadowing a doc eat in the doc's lounge followed by self directed learning chill time

 

[Osteosaur]

Ehhh this preceptor sounds like a pile of trash. Will you have an opportunity to do a wards based IM rotation, either as an MS3/4 or as a SubI? If yes, dump this rotation. If not, and you want to match IM, you need an inpatient rotation (and absolutely try to get a wards based one) or you'll have a much harder time matching.

When it comes to IM and what we look at (I sit on a residency ADCOM) - Wards IM >>>>>>>> Preceptor inpatient > Preceptor outpatient

When I interviewed every larger program asked me during interviews if I did a wards based IM rotation, and now that I sit on an ADCOM we ask every DO who applies if their IM rotation was wards based (as in with a teaching program and resident team) as so many of the DO schools don't have this as a standard. As every DO student knows the rotations can be super hit or miss and an "inpatient IM rotation" may actually be 2 hours a day of shadowing a doc eat in the doc's lounge followed by self directed learning chill time

How do you verify the quality of their inpatient experience? Evals?

 

[EmilKraepelin55]

Ehhh this preceptor sounds like a pile of trash. Will you have an opportunity to do a wards based IM rotation, either as an MS3/4 or as a SubI? If yes, dump this rotation. If not, and you want to match IM, you need an inpatient rotation (and absolutely try to get a wards based one) or you'll have a much harder time matching.

When it comes to IM and what we look at (I sit on a residency ADCOM) - Wards IM >>>>>>>> Preceptor inpatient > Preceptor outpatient

When I interviewed every larger program asked me during interviews if I did a wards based IM rotation, and now that I sit on an ADCOM we ask every DO who applies if their IM rotation was wards based (as in with a teaching program and resident team) as so many of the DO schools don't have this as a standard. As every DO student knows the rotations can be super hit or miss and an "inpatient IM rotation" may actually be 2 hours a day of shadowing a doc eat in the doc's lounge followed by self directed learning chill time

Sadly, my school doesn’t really have this “wards-based” type of inpatient IM rotation. I mean, there is one FM residency at my hospital but that’s about it. Otherwise, it’s preceptor based. My current interests are primarily neurology/psych and maybe IM, so I will see what I can do to at least get 1 or 2 inpatient preceptor experiences if not get a subI in a wards scenario. Sucks to be at a new DO school man.

 

[EmilKraepelin55]

And I definitely hear those of you saying I should learn how to deal with these types of people, but my question is if you knew a bullet was coming at you early enough that you can dodge It then wouldn’t you? I am trying to hold off on saying yes here because we may be able to work something else out with another inpatient preceptor who may become available. I place a lot of value on my mental health, and I believe given my past that if I had a trash personality for a preceptor I probably would end up learning minimally anyways along with persistent mental health ramifications afterwards.

 

[deleted898021]

Ehhh this preceptor sounds like a pile of trash. Will you have an opportunity to do a wards based IM rotation, either as an MS3/4 or as a SubI? If yes, dump this rotation. If not, and you want to match IM, you need an inpatient rotation (and absolutely try to get a wards based one) or you'll have a much harder time matching.

When it comes to IM and what we look at (I sit on a residency ADCOM) - Wards IM >>>>>>>> Preceptor inpatient > Preceptor outpatient

When I interviewed every larger program asked me during interviews if I did a wards based IM rotation, and now that I sit on an ADCOM we ask every DO who applies if their IM rotation was wards based (as in with a teaching program and resident team) as so many of the DO schools don't have this as a standard. As every DO student knows the rotations can be super hit or miss and an "inpatient IM rotation" may actually be 2 hours a day of shadowing a doc eat in the doc's lounge followed by self directed learning chill time

Pre covid I don’t understand how this could be a problem though? Because surely almost everyone interested in IM would get an inpatient wards based IM SUB-I their 4th year?

 

[thumbz]

How do you verify the quality of their inpatient experience? Evals?

Sadly the evals are useless - I had a fellow med student who had an IM inpatient preceptor rotation where he worked 1 day. Otherwise his preceptor gave him "time off to interview". His eval said something along the lines of "best med student I ever worked with, functioned like a resident on the wards".

So I just ask them to describe it in the interview, and ask them probing questions depending on how they describe it. Questions like "did you work with a resident team, how many patients were you following on average" etc

 

[thumbz]

Pre covid I don’t understand how this could be a problem though? Because surely almost everyone interested in IM would get an inpatient wards based IM SUB-I their 4th year?

You would be shocked - I've seen students with no inpatient experience try to match IM.

 

[NontradCA]

Sadly, my school doesn’t really have this “wards-based” type of inpatient IM rotation. I mean, there is one FM residency at my hospital but that’s about it. Otherwise, it’s preceptor based. My current interests are primarily neurology/psych and maybe IM, so I will see what I can do to at least get 1 or 2 inpatient preceptor experiences if not get a subI in a wards scenario. Sucks to be at a new DO school man.

In general you’re going to find far less toxic personalities in psychiatry than neuro or IM. You’re not going to need inpatient medicine experience for a psychiatry sub I if it’s not consults, but certainly will for neurology and IM.

 

[Candidate2017]

This person is primarily known to be a sort of Jekyll/Hyde personality who explodes and berates students, threatening to throw them off service sometimes for even the smallest perceived slights I.e. someone didn’t bring their phone the first day of the rotation so they could access the UTD app, so he threatened their expulsion from his service and verbally destroyed them in front of the nursing staff who claims “he is not usually this way.”

Well yeah, the med student is out of line but IM has a fair share of attendings prone to tantrums, which are not ok. He should've eloquently destroyed the med student like this:

 

[getfat]

available preceptor for the upcoming block who does pure inpatient IM is a malignancy I have heard awful things about.

I understand the importance of inpatient experience but if the person is truly toxic (won't teach, talks talks down to you) then I would pass on the experience.

Most of your learning during third year is made outside of the hospital anyway.

 

[FrkyBgStok]

what one person considers "malignant" varies quite a bit.

this statement is very important. my favorite attending in residency was almost unanimously hated by the rest of my class because he was direct, not fluffy, and he expected the best from everyone. and the more people spoke poorly about how he "flipped out over the smallest slight" and the more I saw him expect me to bring my A game which caused me to bring my A game, the more I wanted to be like this attending.

personally, I would choose the inpatient experience. In your training, you will likely deal with people much worse and not be able to get away from it. Or worse, have to deal with it for 3 years. might as well learn how to deal with them now and bring your A game every day. Your personalities might click (not a dig on you, but you never know).

 

[Neopolymath]

this statement is very important. my favorite attending in residency was almost unanimously hated by the rest of my class because he was direct, not fluffy, and he expected the best from everyone. and the more people spoke poorly about how he "flipped out over the smallest slight" and the more I saw him expect me to bring my A game which caused me to bring my A game, the more I wanted to be like this attending.

personally, I would choose the inpatient experience. In your training, you will likely deal with people much worse and not be able to get away from it. Or worse, have to deal with it for 3 years. might as well learn how to deal with them now and bring your A game every day. Your personalities might click (not a dig on you, but you never know).

Agree. It's important to point out that healthcare, and particularly med school, is filled with people saying "OMG Dr. X YELLED at Susie" but that didn't happen in the slightest. I witnessed this repeatedly as a bystander.

I'm not saying OP isn't in fact dealing with an actual malignant personality but one has to consider the source and decide the probability of it being true for themselves because we can't do that unfortunately. Good luck to OP, regardless.

 

[NontradCA]

If you’re thinking about doing IM as a specialty I’d say absolutely do it, because the chances are high you’re going to run into similar people in the future. It’s better to learn how to deal with them now as a student than as an intern. If you feel like you’re being treated unfairly or disrespected then tell them about it. It’s only a limited interaction and you could be making a difference for future students.

Also to clarify I meant tell the actual preceptor about it. I think medical students are quick to jump to rumors, c/to school, or just hold things in. People would be surprised as to how receptive “malignant” preceptors are to negative feedback.

 

[Giovanotto]

Agree. It's important to point out that healthcare, and particularly med school, is filled with people saying "OMG Dr. X YELLED at Susie" but that didn't happen in the slightest. I witnessed this repeatedly as a bystander.

I'm not saying OP isn't in fact dealing with an actual malignant personality but one has to consider the source and decide the probability of it being true for themselves because we can't do that unfortunately. Good luck to OP, regardless.

this so much. I cringe when I see this happen.