Malignant Programs?

[pagemmapants]

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I'm in the middle of my CC in surgery and I've come to the conclusion that I unequivocally want to train in surgery but to a large degree am apprehensive about the surgical environment that I have witnessed. I don't want to spend my training competing with and getting cut down by my colleages, or being berated under the guise of "teaching" or the "Socratic method". I know that in some places this is simply "reality" or just "how it's done". . . and at least it's no longer "Decade with Dave" like it used to be here. . . but I gotta say, I don't think that sort of thing is necessary or conducive to a good training program.

So is there any way to find out classically malignant versus classically amicable residency programs? Are there any programs in particular that should be avoided unless you're a pachyderm and can handle that kind of malicious environment? Or is it less of a problem than I have been led to believe?

 

[smq123]

I'm in the middle of my CC in surgery and I've come to the conclusion that I unequivocally want to train in surgery but to a large degree am apprehensive about the surgical environment that I have witnessed. I don't want to spend my training competing with and getting cut down by my colleages, or being berated under the guise of "teaching" or the "Socratic method". I know that in some places this is simply "reality" or just "how it's done". . . and at least it's no longer "Decade with Dave" like it used to be here. . . but I gotta say, I don't think that sort of thing is necessary or conducive to a good training program.

So is there any way to find out classically malignant versus classically amicable residency programs? Are there any programs in particular that should be avoided unless you're a pachyderm and can handle that kind of malicious environment? Or is it less of a problem than I have been led to believe?

Have you considered some of the surgical sub-specialties? Things like urology and ENT are surgical in scope, but are traditionally less malignant and more relaxed than general surgery can be. I think that Kimberli Cox has mentioned that she was once scolded for not making surgery the ONLY focus of her life, but a lot of the guys in urology and oto are proud of the fact that they have other interests in their lives. [I just got off of ENT. Before every case, while they were setting up the room, practically each resident whipped out his cell phone and showed me pictures of his kids in their Halloween costumes.]

There probably are surgery programs that aren't that bad, but I think that a lot of people who are interested in surgery (but turned off by the lifestyle and the possibility of malignant coworkers) tend to forget the subspecialties.

 

[Winged Scapula]

As posted above, surgical subspecialties are famous for being less malignant across the board and may be a valid consideration for you and your future career.

Given where you are at, you've experienced the prototypical malignant surgery department (or so I hear from friends who are or who have trained there). Not every place is like that, nor does everyplace have an overwhelming atmosphere of malignancy. There were certain factions and parts of my residency that were but many parts that were not.

The best source of information is former residents. Most people posting here are not likely to be comfortable telling you that their program is malignant (look at how few responses icare4u got in asking what are good programs); they want to keep an air of anonymity. Many of the older or perhaps wiser posts realize that PDs and other people associated with programs are reading these forums. You want someone who is a rather recent grad of the program (not someone who trained there 15 years ago) and who can give you an idea of what they consider "malignant".

Remember that the term "malignant" means different things to different people. Some would consider working over 80 hrs per week as a malignant program, others see that as the cost of doing business, or rather an expected outcome. Being yelled at or humilated frequently? Most of us would consider that malignant, but it can be tempered by other positives about a program. UTSW for example has a pretty bad reputation, as does UCSD, but at least in the former, you are most likely to come out well-trained. So it depends on what you can take and what you figure the cost:benefit ratio is.

I wish there was a good source for this information - you can't really trust databases and it all comes down to the "feeling" you get when you interview (because you can't trust what people there will tell you...residents lie to applicants) and what former grads will tell you. The best source of information then is your interns who may have close friends at other programs, your younger faculty and med students at other programs (especially if they aren't applying to their home surgery program)...so talk to other candidates when you interview.

 

[doc02]

General surgery is malignant, but that doesn't mean that everything that everyone thinks is "malignant" actually is so. I've dealt with a lot of attendings people claimed were "malignant" and had no problem with them because I'm extremely detail-oriented and anal. The people who have the most problems with surgery are the ones who are more lax or don't really focus on pertinent issues. They get yelled at a lot and they generally attribute it to "this person is just malignant." Understand, I don't mean to defend malignant personalities because I fully agree that there are lots of surgeons with personality problems. I just mean to say that usually only an impartial third-party can really tell you if something was "fair" or "malignant." I mean, some people actually do stuff that, believe it or not, deserves getting yelled at.

 

[Pir8DeacDoc]

My friends who trained there confirm that it is the mecca for malignant surgery. A lot of the powerhouse programs in the South are purported to be malignant. I can't really confirm/deny this. My medical school was not overly malignant but would only be considered a powerhouse for primary care. Ask around as the time gets closer to apply. You will find someone there who is reasonable and you can discuss this further with.

 

[Blade28]

Sadly, one of the requirements for being a General Surgery resident these days, it seems, is possessing a thick skin.

Tough to find a truly 100% benign program that will train you well.

 

[Pir8DeacDoc]

Sadly, one of the requirements for being a General Surgery resident these days, it seems, is possessing a thick skin.

Tough to find a truly 100% benign program that will train you well.

I'm clearly not as knowledgeable about this as you are Blade. But, I just don't agree with that. Somehow we think that the abuse and having thick skin somehow "trains" us better. I guess it depends what you mean by being trained well but I think there are plenty of good programs with good training that aren't malignant. The problem is that many of the bigger named places like Duke, Emory, etc are malignant. But that doesn't mean they are the only option for good training.

 

[Blade28]

I'm clearly not as knowledgeable about this as you are Blade. But, I just don't agree with that. Somehow we think that the abuse and having thick skin somehow "trains" us better. I guess it depends what you mean by being trained well but I think there are plenty of good programs with good training that aren't malignant.

Slight misunderstanding here - I meant that the majority of programs that are at least decent are usually pretty tough. Maybe not malignant to the reputations of places like Duke, NYU, UCSD, etc. But tough nonetheless.

I do agree that there are some good benign programs out there, but they're in the minority, unfortunately.

 

[lord_jeebus]

I knew UCSD wasn't the greatest place to be a surgical resident, but I had no idea how infamous we were! Fascinating.

 

[Castro Viejo]

Slight misunderstanding here - I meant that the majority of programs that are at least decent are usually pretty tough. Maybe not malignant to the reputations of places like Duke, NYU, UCSD, etc. But tough nonetheless.

NYU? Really?

It's not THAT bad.

 

[gasnewby]

I knew UCSD wasn't the greatest place to be a surgical resident, but I had no idea how infamous we were! Fascinating.

now don't everybody flame me, but what the ucsd anesthesia guys told me is that the surgery program is weak. not through any fault of the residents, but that in the last few years the surgery attendings have made money a priority over education. so they don't usually let the residents do much because they are more interested in volume.

 

[Blade28]

I knew UCSD wasn't the greatest place to be a surgical resident, but I had no idea how infamous we were! Fascinating.

My alma mater. 🙁

 

[Winged Scapula]

I knew UCSD wasn't the greatest place to be a surgical resident, but I had no idea how infamous we were! Fascinating.

You are very infamous!

So much so that an extremely arrogant classmate of mine, who used to argue that you HAD to be arrogant to be a surgeon, that he had been TOLD it was desirable (so he amped up his baseline arrogance), was chastened by his audition elective at UCSD. Suffice it to say they hated him, he hated them, and now he's an EM physician.

 

[Winged Scapula]

now don't everybody flame me, but what the ucsd anesthesia guys told me is that the surgery program is weak. not through any fault of the residents, but that in the last few years the surgery attendings have made money a priority over education. so they don't usually let the residents do much because they are more interested in volume.

This unfortunately is happening at a lot of surgery programs. Whether its a fear over malpractice or public condemnation, residents do not generally have the independence that they had just a few years ago in many programs.

 

[SLUser11]

I do agree that there are some good benign programs out there, but they're in the minority, unfortunately.

I can think of one, but I'm biased.

 

[blz]

NYU? Really?

It's not THAT bad.

There seems to be an air of malignancy at Tisch, but pretty benign at VA/Bellevue.

 

[quagmire]

as a resident of one of the programs mentioned in this thread has having a nationwide reputation of malignancy balanced by good training I'd like to say that there is a significant difference from the way a program is perceived and the way it actually is.

before i interviewed i also had heard of the malignancy of my program. in fact the only reason i interviewed there was because my sister lived in the same city. but after interviewing and ultimately matching there I have come to realize that the word on the street is completely off the mark.

it's a new age and surgery and the stuff you could get away with in the earlier days (yelling, throwing stuff, and just being an ass) you can't get away with anymore....and for good reason.

so i implore people to really look at a program and look at the way the residents interact with the faculty. is it a cordial and even jovial environment, or do you see the residents walking around on pins and needles and in extreme reverence for their attendings? don't mistake working hard for a hard working environment.

those are my two cents...i personally enjoy the residents and faculty in my program and i have found that all rumours and reputations are undeserved.

 

[Scrubbed In]

I'm a current resident at UCSD, and I can tell you that it's not malignant here. All the residents (with the exception of one or two) are nice people to work with in the hospital, and cool people to hang out with outside the hospital. A couple of attendings can be tough at times, but are usually justified in their criticisms.

Dr Cox...as far as your classmate who rotated at UCSD, sounds like we did the surgery world a favor. 🙂

 

[icare4u]

:

 

[icare4u]

as a resident of one of the programs mentioned in this thread has having a nationwide reputation of malignancy balanced by good training I'd like to say that there is a significant difference from the way a program is perceived and the way it actually is.

before i interviewed i also had heard of the malignancy of my program. in fact the only reason i interviewed there was because my sister lived in the same city. but after interviewing and ultimately matching there I have come to realize that the word on the street is completely off the mark.

it's a new age and surgery and the stuff you could get away with in the earlier days (yelling, throwing stuff, and just being an ass) you can't get away with anymore....and for good reason.

so i implore people to really look at a program and look at the way the residents interact with the faculty. is it a cordial and even jovial environment, or do you see the residents walking around on pins and needles and in extreme reverence for their attendings? don't mistake working hard for a hard working environment.

those are my two cents...i personally enjoy the residents and faculty in my program and i have found that all rumours and reputations are undeserved.

ummm, quagmire, do you mind telling us where you are?

 

[melunman]

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