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CanIMakeIt

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I have heard Duke is extremely malignant.

I keep hearing conflicting things about Duke. Anyone from Duke program cares to elaborate from personal experiences? But then as someone already said, definition of malignancy is different for diff people .... like beauty, in the eye of the beholder.. JMHO
 
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I know someone who went to Duke for med school and didn't like the atmosphere. I think it's definitely one of those intense academic medical centers with a high rank, that pushes the trainees hard. If you don't like that type of atmosphere, you might not like it there. There are multiple other hospitals that fall into this same category, i.e. Mass General, Hopkins, UCSF, Wash U, etc.
 

howelljolly

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It seems that top university program = malignant.

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

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

jdh71

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

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

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

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

jdh71

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It seems that top university program = malignant.

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

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

Plenty of laid back Uni programs
 

Bike on a Trek

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

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

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

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

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

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

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

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

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

CanIMakeIt

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

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

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

Hi Dragonfly99,

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

dragonfly99

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

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

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

I did residency there, and I would have to strongly disagree with you. I never went over 80 hours. The IMG issue is a result of a lack of US grads applying there, and infact the "worst" US Grad is ranked higher than the "best" IMG. The pd is a US grad herself. Maricopa is literally 2 miles away from good sam and three miles from st joes. True fellowship is difficult to get from there, but I got one so if you work you will get it. finally I have never seen an img get mistreated. My three years there on a daily basis tell me that.
 
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Duke resident here - felt compelled to clear up a number of misconceptions about the program. As a med student I too heard that duke was a malignant program - I decided to do a sub-I there and did not find any evidence of said malignancy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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



Dear Dr.ccccc

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



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



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

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

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



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



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

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



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



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



Yours sincerely,

Anonymous IM resident

SPUH


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

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

Dear Residents,

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

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

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

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

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

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

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

4. There were 196 delinquent charts last week.

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

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

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

Now I shall respond to the concerns in the letter.

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

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

Morning report:

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

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

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

In summary the MR will NOT change.

Elective Logs:

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

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

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

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

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

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

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

NK





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


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

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

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And to previous posters.

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

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

Including the previous post, some examples might be:

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

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

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

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

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

CanIMakeIt

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Howelljolly,

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

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

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

howelljolly

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Howelljolly,

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

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

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

Hernandez

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

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

But posting the email is pretty poor judgment.
 
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howelljolly

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

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

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

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

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


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

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

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

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

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

But posting the email is pretty poor judgment.

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

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

howelljolly

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

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

I agree.
 

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

Huh?

Am I reading the same email?

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

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

jdh71

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

Wrong.

No one is responsible for you, except for you.

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

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

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

Completely agreed.

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

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

I find the whole posting by the former resident just as immature, petty, and worse because they're trying to smear the PD's reputation behind an anonymous account on SDN by posting 1.5 year old emails presumably without letting the PD know. .
 
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dragonfly99

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

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

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


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

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

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

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

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I thought I would search SDN about this issue since it was a bit confusing to me to see “Student Mistreatment Policies” all over online at my university on the resident and medical school site. I’m assuming that the medical profession is somewhat notorious for mistreating of students or else they wouldn’t have to have these policies put in place. Why is it that students are mistreated in residencies or as interns? Is it a bureaucratic hierarchy of people that take pride in doing this, or is it meant to make people better doctors? What are some common things that define mistreatment that you or other training doctors you have known go through?
 
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snowbank

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I would disagree with some of the earlier posts about UMKC IM on this thread. While I wont say its as highly malignant as some of the other examples discussed here, I would say that they do make mountains out of molehills, and whatever impression one of the attendings has, it sticks. There are 2 hospitals residents rotate in - St. Luke's (private patients - uptight attendings, more malignant) and Truman (indigent, inpatient - much friendlier). I heard of 1 person in the last 3 years that was 'let go' (dont know details).
The comments about the PD are true, but a new PD came on recently, and I dont know much about the new PD. The earlier comments about the outlook of a program changing in 2-3 y is also true, but I would also say that '$hiT flows downhill' - and the culture follows from the top.
 

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I think a lot of programs will change over the next 1-2 years with the duty hour rules being changed.
 

theneh

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Univ. of Rochester is great when it comes to enforcing work hour rules.
 

omegaxx

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

I totally disagree about WashU. It's my home institution, and the medicine program has got to be one of the most benign of all the academic med centers. Good duty hour compliance, super chill and friendly faculty, very laid-back and happy residents, good lunch conference with yummy food... you name it. The intensity level is definitely very low.
 

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I totally disagree about WashU. It's my home institution, and the medicine program has got to be one of the most benign of all the academic med centers. Good duty hour compliance, super chill and friendly faculty, very laid-back and happy residents, good lunch conference with yummy food... you name it. The intensity level is definitely very low.

I would note the date of the post to which you replied. If you're not looking for a response or just trying to set the record straight, great. Otherwise, probably not a lot of traffic from the original participants around this thread.
 

omegaxx

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I would note the date of the post to which you replied. If you're not looking for a response or just trying to set the record straight, great. Otherwise, probably not a lot of traffic from the original participants around this thread.

Ooops, I totally missed the date. Sorry :p But sure, we can set the record straight: WashU's dept of medicine is awesome :luck:
 
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internal medicine: st mary medical in Long Beach fires a lot of people, heard same for Kaiser SF
 
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