Malignant Psychiatry Residency Programs

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inquiringmind1

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With everyone wanting to know as much information they can about residency programs for the match, why is there no mention of what programs are considered malignant? I think that is the question everyone would like to ask before committing 4 years ya? Naming a program and why there is a belief that program is malignant would be a great discussion.

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Nobody wants to burn bridges. Psychiatry is a small world, after all.

Plus what I think is malignant may not be to you. I interviewed at one program where an attending pontificated about the evils of immigration several years ago. I felt that created a malignant environment but some others didn't think so. The best thing is to go visit and observe carefully and listen to your instincts and get to know the senior residents. Finally, most psychiatry programs are not bad.
 
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What do you mean by malignant? When I think of malignant, I think of a program where most if not all the residents are objectively burnt out due to a culture of abuse. I don't think I interviewed at any, and I tried to probe pretty hard with the residents about violating hour rules, whether they personally experienced or witnessed their residents get berated publicly, or whether residents who left got fired or were forced to leave. I think psych residencies are much different than other specialties where those things are commonplace. However, my experience is limited to the mid- to top-tier programs on the coasts and midwest, so take my perspective with a grain/pile/pillar of salt.
 
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I think OP is probably referring to something like generally horrible atmosphere or regular violations like what was discussed in this thread:

https://forums.studentdoctor.net/th...-going-on-at-gwu-psych.1219777/#post-18094735

Not sure about all the details, but something like this would certainly raise concerns for me if I were looking at applying to a program like that.

That's definitely a PR nightmare. First GW expelled an undergrad for trying to commit suicide and then refused to let him back into his dorm to gather his belongings. Apparently the Dean personally delivered the note to that student while he was still on the psych ward.

Then the GW psych residency program fires a resident who had a new cancer diagnosis and was taking leave for it (whatever the reason being). Then the resident sues the residency program.

Whatever the facts may be, they pretty much have to fix their image since students are avoiding applying there. I know I avoided it when deciding which programs I would apply to, even though I would have loved to live in DC.
 
Some red flags: If you felt that you were mistreated during interviews, that interviewers were demeaning, asking for overly intrusive questions... residents seem guarded and scared to say anything critical about the program. If programs don't treat their applicants well, then you can bet that they treat their residents 10x worse.
 
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Some red flags: If you felt that you were mistreated during interviews, that interviewers were demeaning, asking for overly intrusive questions... residents seem guarded and scared to say anything critical about the program. If programs don't treat their applicants well, then you can bet that they treat their residents 10x worse.

I'd also suggest that programmes that initially come across as far too nice may also have something to hide. One programme I applied for was extremely keen to have me, despite initially being somewhat disorganised in getting back to me with an interview date. The next year, something like 7 out of their 8 first year trainees quit, and a few years later another batch of 6-7 who started out resigned en masse. Of that first batch, the sole survivor eventually transferred elsewhere after going through a period of protracted bullying not unlike what splik described in another thread where a group of attendings ganged up on an outspoken resident and closed ranks in the aftermath of a complaint.
 
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I'd also suggest that programmes that initially come across as far too nice may also have something to hide. One programme I applied for was extremely keen to have me, despite initially being somewhat disorganised in getting back to me with an interview date. The next year, something like 7 out of their 8 first year trainees quit, and a few years later another batch of 6-7 who started out resigned en masse. Of that first batch, the sole survivor eventually transferred elsewhere after going through a period of protracted bullying not unlike what splik described in another thread where a group of attendings ganged up on an outspoken resident and closed ranks in the aftermath of a complaint.

What program is this? If this is true, I don't see any reason to protect their image from prospective applicants.

Also, sometime programs are just really nice. Seems like a bad exercise to try and read into everything. There's a few bad programs out there, like the one you described and the GW program posted above, but for the most part psych residencies seem like overwhelmingly positive experiences.
 
never believe anyone who puts out crap about their lawsuit on the internet. it means they've already lost and trying to damage the reputation of the employer as much as possible (and apparently they've succeeded). we dont even know if this person even had cancer. malignant residents (see what i did there?) are much more common than malignant programs in psychiatry. i think the lesson is probably- never abandon a borderline, they can hurt you more.

BTW there has been a thread about a malignant program (GW is not what I would call malignant in any shape or form despite their gaffes and bad publicity) but one problem as mentioned above is that nowadays people seem to think everything is "malignant". I did have a programs to avoid thread but deleted it is in my old age thought it perhaps somewhat unwise.
 
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What program is this? If this is true, I don't see any reason to protect their image from prospective applicants.

Also, sometime programs are just really nice. Seems like a bad exercise to try and read into everything. There's a few bad programs out there, like the one you described and the GW program posted above, but for the most part psych residencies seem like overwhelmingly positive experiences.

The one I'm referring to is in Australia, so not really applicable for most of you here except to sympathise and demonstrate that there's evidence of bad places everywhere. I trained in a very nice environment, and at the time it was going through an significant overhaul with lots of positive changes lead from those at the top. However, a few years prior the reputation wasn't great in that trainees were getting shafted with all the busy jobs or oncall shifts - all that had been fixed by the time I started, so sometimes it's a matter of luck and about being in the right place at the right time.

In our system those from different services have quite a bit of shared teaching in the early years, so it's pretty obvious something is up when half-way through the year other doctors start enquiring about the conditions at your service and who to speak to about transferring. For the most part we don't have a lot of problems, and there are safeguards in that bad rotations can be stripped of their accreditation status which prevents trainees from being placed there.

Can't say I recall may cases going to lawsuits - the only one was a raging BPD (and not doing psychiatry). With psychiatry still being unpopular, those unhappy with their conditions have been able to cut their losses and get jobs elsewhere without too much fuss.
 
never believe anyone who puts out crap about their lawsuit on the internet. it means they've already lost and trying to damage the reputation of the employer as much as possible (and apparently they've succeeded). we dont even know if this person even had cancer. malignant residents (see what i did there?) are much more common than malignant programs in psychiatry. i think the lesson is probably- never abandon a borderline, they can hurt you more.

BTW there has been a thread about a malignant program (GW is not what I would call malignant in any shape or form despite their gaffes and bad publicity) but one problem as mentioned above is that nowadays people seem to think everything is "malignant". I did have a programs to avoid thread but deleted it is in my old age thought it perhaps somewhat unwise.

I'm not personally familiar with GW or the people involved in this case. I did read about the case from several sources and I believe the reason it gained so much traction and attention was because the resident wrote in to Pamela Wible about her situation. I'm sure there was more to the case than just her having cancer. From the sounds of it, it's likely she just wasn't able to perform her job adequately. Maybe the most troubling thing imo was that out of the dozens of articles I read the phrase "GW declined to comment on this incident" in almost every one of them.

I realize that there are likely far more malignant residents than malignant programs, but there are enough programs out there that a story like this should have been addressed properly. Not saying GW is definitely malignant or trying to bad-mouth anyone in particular, but as a prospective applicant the accusations and lack of response would certainly make me question their program.
 
I'm not personally familiar with GW or the people involved in this case. I did read about the case from several sources and I believe the reason it gained so much traction and attention was because the resident wrote in to Pamela Wible about her situation. I'm sure there was more to the case than just her having cancer. From the sounds of it, it's likely she just wasn't able to perform her job adequately. Maybe the most troubling thing imo was that out of the dozens of articles I read the phrase "GW declined to comment on this incident" in almost every one of them.

I realize that there are likely far more malignant residents than malignant programs, but there are enough programs out there that a story like this should have been addressed properly. Not saying GW is definitely malignant or trying to bad-mouth anyone in particular, but as a prospective applicant the accusations and lack of response would certainly make me question their program.

Depends on where the case was in litigation. If it was still in litigation, they didn't decline, they just couldn't legally comment.
 
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The terms "Malignant" and "psychiatry residency" programs are mutually exclusive. While some may have you work more than others, no program of which I am familiar is THAT bad, especially after intern year. Surgery, OBGYN, and some IM programs... yes; psychiatry absolutely NOT
 
The terms "Malignant" and "psychiatry residency" programs are mutually exclusive. While some may have you work more than others, no program of which I am familiar is THAT bad, especially after intern year. Surgery, OBGYN, and some IM programs... yes; psychiatry absolutely NOT

One of the many reasons I am choosing Psychiatry. Why on earth would you want to be around malignant personalities (yelling, cursing, abuse) for the rest of your career? Many Psychiatry programs want you to have balance in your life and encourage you to seek help if you are feeling burnt out.
 
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I bet there are programs out there that suck. Especially in a field that tends to attract people who arent super qualified or bright compared to other fields. Not saying psychiatrists arent smart, but lets be honest, it tends to get more of the bottom of the barrel than other fields due to it being non-competitive, which can foster some weird behavior.
 
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I think it depends what you mean by malignant. some people think working hard = malignant, which is not really the case. There are only a handful of programs in psych where people work worse hours than in say IM, but in general the hours are pretty good in psych programs particularly for senior residents. However medicine is toxic, particularly academic medicne. And psychiatry is full of personality disordered people, some of whom are sadists, bullies and psychopaths. More commonly you will have the fragile narcissistic and passive-aggressive types in psychiatry who are different kind of toxic. my program was not what I or anyone would call malignant in the slightest but I was certainly bullied and victimized. Sadly residents are in a position where they are easily oppressed, and most students and residents we get are too weak-willed or pathetic to rock the boat, which just makes things worse.
 
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I think it depends what you mean by malignant. some people think working hard = malignant, which is not really the case. There are only a handful of programs in psych where people work worse hours than in say IM, but in general the hours are pretty good in psych programs particularly for senior residents. However medicine is toxic, particularly academic medicne. And psychiatry is full of personality disordered people, some of whom are sadists, bullies and psychopaths. More commonly you will have the fragile narcissistic and passive-aggressive types in psychiatry who are different kind of toxic. my program was not what I or anyone would call malignant in the slightest but I was certainly bullied and victimized. Sadly residents are in a position where they are easily oppressed, and most students and residents we get are too weak-willed or pathetic to rock the boat, which just makes things worse.

I hope to sniff this out to the best of my ability during interviews. I will go to a lower ranked place if it meant I would enjoy being around my colleagues. I realize that you cannot erase this problem completely, but you can to some degree.
 
I think it depends what you mean by malignant. some people think working hard = malignant, which is not really the case. There are only a handful of programs in psych where people work worse hours than in say IM, but in general the hours are pretty good in psych programs particularly for senior residents. However medicine is toxic, particularly academic medicne. And psychiatry is full of personality disordered people, some of whom are sadists, bullies and psychopaths. More commonly you will have the fragile narcissistic and passive-aggressive types in psychiatry who are different kind of toxic. my program was not what I or anyone would call malignant in the slightest but I was certainly bullied and victimized. Sadly residents are in a position where they are easily oppressed, and most students and residents we get are too weak-willed or pathetic to rock the boat, which just makes things worse.

I think it's that as resident it's very difficult not to internalize the system. You are treated as a student, as part of a "class" and not as a working professional and are at the bottom of the hierarchy, and people end up behaving this way. I feel it's about setting your own limits and boundaries, how you carry yourself in professional matters, moreso than rocking the boat.
 
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I think it's that as resident it's very difficult not to internalize the system. You are treated as a student, as part of a "class" and not working professionals, and people end up behaving this way. I feel it's about setting your own limits and boundaries, how you carry yourself in professional matters, moreso than rocking the boat.

Setting boundaries often does rock the boat because your interests and self-directedness can be at odds with the program who wants complete control - thus malignancy.

It takes a good manager to recognize this, accept limitations and foster growth, development and independence. If either of these are missing, institutionalization sets in. Again, we're back to malignancy.
 
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Setting boundaries often does rock the boat because your interests and self-directedness can be at odds with the program who wants complete control - thus malignancy.

It takes a good manager to recognize this, accept limitations and foster growth, development and independence. If either of these are missing, institutionalization sets in. Again, we're back to malignancy.

This fits my formulation of malignant. The tolerance of professional individuation.

There can be no doubt that the whole of medicine is extremely hierarchical.

But how you self-formulate within these steep, vertical structures is also just as important. Whether you see yourself as a victim or being bullied is also important. I found increased degrees of internal freedom by trying to understand machiavellian principles as operational software. Thinking of it, like... Human Beings socialize like this... Which removes the egocentric burden. And allows one to ... as Skikima says... negotiate personal boundaries.

And this is from someone who had to adopt this philosophy or I would end up a taxidermic specimen on the wall of an authoritarian overseer.

In short. Medicine is...at it's core... malignant towards the individual aspirant, plebe, initiate, squire, novice, and apprentice.

Programs just vary by workload and degree of mentorship and educational opportunities.

The potential for tyranny is very much the territory of relational dynamics with a PD or attending.

And you could find yourself in a malignant situation at any program.
 
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A 600 question personality survey of a potential PD, should be public access information .... in #Nasrudin'sWorld
 
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Also. My limited experience tells me that east coast big league academic programs are steeper more intense hierarchies. And are distinctly more malignant in character.

But ... I mention it... only because I'm curious what other people think about that phenomenon.
 
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never believe anyone who puts out crap about their lawsuit on the internet. it means they've already lost and trying to damage the reputation of the employer as much as possible
i agree this is often the case, but i'm sure there are plenty of situations where the former employee has been done dirty

malignant residents...are much more common than malignant programs in psychiatry.
definitely- most attendings are on cruise control and laid back and it's the residents that are hard-nosed (was guilty of being this was occasionally myself)

remember that gravity has the tendency to pull fecal material toward the center of the Earth
 
What do you mean by malignant? When I think of malignant, I think of a program where most if not all the residents are objectively burnt out due to a culture of abuse. I don't think I interviewed at any, and I tried to probe pretty hard with the residents about violating hour rules, whether they personally experienced or witnessed their residents get berated publicly, or whether residents who left got fired or were forced to leave. I think psych residencies are much different than other specialties where those things are commonplace. However, my experience is limited to the mid- to top-tier programs on the coasts and midwest, so take my perspective with a grain/pile/pillar of salt.

Well there was just an article about the GW psychiatry residency discriminating and kicking out a resident with cancer...that's on the coasts....scratch that one out.
 
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Well there was just an article about the GW psychiatry residency discriminating and kicking out a resident with cancer...that's on the coasts....scratch that one out.
sigh... GW is a reasonable program if you want to be in DC. it is not malignant. DC doesn't really have any great programs but it is a fine program and I know plenty of people who have done just well for themselves training there. also how do you even know said resident even had cancer?
as you will see from her extremely pink website, Dr. Waggel is now in private practice.
 
I'm not personally familiar with GW or the people involved in this case. I did read about the case from several sources and I believe the reason it gained so much traction and attention was because the resident wrote in to Pamela Wible about her situation. I'm sure there was more to the case than just her having cancer. From the sounds of it, it's likely she just wasn't able to perform her job adequately. Maybe the most troubling thing imo was that out of the dozens of articles I read the phrase "GW declined to comment on this incident" in almost every one of them.

I realize that there are likely far more malignant residents than malignant programs, but there are enough programs out there that a story like this should have been addressed properly. Not saying GW is definitely malignant or trying to bad-mouth anyone in particular, but as a prospective applicant the accusations and lack of response would certainly make me question their program.

GW can't comment on the allegations because they would open themselves up to further legal liability. They already got sued. They could get sued on additional causes of action of libel if they made public allegations against the resident. Regarding more bad residents than bad programs, I think you're mistaking. The system stinks, it stinks bad and there's a lot of effort being put into hiding the stench without addressing the underlying rot. People getting forced out of employment for medical reasons is a common occurrence and huge discrimination problem. Although it is protected by law, these laws are commonly not enforced. In addition, in workaholic , pro-business societies like the US, there exist toxic dynamics , values and incentives that encourage blaming the victim (employee) instead of punishing discrimination by the employer.
 
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[QUOTE=" I did have a programs to avoid thread but deleted it is in my old age thought it perhaps somewhat unwise.[/QUOTE]

As an applicant, I think it is great this is something you put together (even if it is kept private now).

I am less fearful of "malignant" programs than I am of ending up somewhere with relatively poor educational experience (whether it be poor quality supervision or most of your time spent doing social work duties and not seeing patients). Programs that do the bare minimum to keep accreditation. I think this is an artifact of the fact that, as an applicant, I am new to this ball game and I am fearful I am not assessing programs based on the right metrics. This is compounded by the fact that I know programs put on their best face interview days. I am trying to tell myself if it seems too good to be true, it probably is.
 
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Unfortunately outside of having close friends in psychiatry residency, it can be hard to get the "inside scoop" on programs (ex: notoriously pathological attendings, brutal work hours/environments, adversarial administrations, etc).

I think a lot of it is sort of trusting your gut feeling. Most questions you ask residents is kind of pointless because during interview season residents are required to give the "correct" answer. ("Of course everyone is super happy here! Our didactics are great! Call is such a wonderful learning experience! We feel super supported by our administration!" etc etc or else otherwise residents heads' are on the chopping block :p)

Maybe better questions would be to ask:

- What changes would you make to the program? or
- What do you hope could be different here?

Also

- What sort of support services are given to residents here? Ex is there individual therapy, MH treatment for residents, etc

Or

- If you could go back in time and tell your M4 self about this current program, what would you list as the pros and cons?

And watch their subtle microexpressions. If you see them shed a single tear, run! :rofl:

EDIT: Maybe another idea is to seek out the really grumpy/disheveled looking residents, because those people are more likely to give an honest response.
 
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sigh... GW is a reasonable program if you want to be in DC. it is not malignant. DC doesn't really have any great programs but it is a fine program and I know plenty of people who have done just well for themselves training there. also how do you even know said resident even had cancer?
as you will see from her extremely pink website, Dr. Waggel is now in private practice.

Not even St. Elizabeth's? I thought that was the oldest Psych hospital.
 
Unfortunately outside of having close friends in psychiatry residency, it can be hard to get the "inside scoop" on programs (ex: notoriously pathological attendings, brutal work hours/environments, adversarial administrations, etc).

This is what scares me. I have friends from the previous graduating classes at my school who are psych residents. One of them is trying to transfer due to problems in the curriculum/"administration drama" (her words) that I would never have guessed in a million years were issues going off of interview day. Mentors from my home program also mentioned these problems to me (it's in our region). I hope this is the only program on my list that there is a mismatch between smiley interview day and the day to day of residency. I should add, my#1 and #3 programs I have two friends at who absolutely love their programs.

But thank you for the insight! I wish I thought to ask these questions during interviews...
 
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never believe anyone who puts out crap about their lawsuit on the internet. it means they've already lost and trying to damage the reputation of the employer as much as possible (and apparently they've succeeded).
See "Gu, Eugene". There may not be a lawsuit yet, but it's coming.

I think it's that as resident it's very difficult not to internalize the system.

This is certainly true, but it doesn't necessarily mean malignancy. Certain elements of institutional culture are handed down and residents tend to embody those for both good and ill. You see that happening when you get two different programs cross-covering a single hospital. One of my internal med rotations was like that where you had Program A: "Sure, I'll gladly let you sign out early and do your orders for you despite the fact I'm the night coverage resident and don't know jack about your patient" and Program B: "That page came in at 4:59. It's your f-cking problem, bro."

(I preferred the culture of program B)
 
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I thought this guy is becoming more and more irrelevant.

He still has a ton of followers, including many doctors who believe him despite the fact his case has more red flags than a Soviet parade.

He's as good a case as any about why you should be skeptical of rumors about the malignancy of any particular program. I had a resident my year quit the program. He had some serious problems with his performance, to put it mildly, and was on the path to being fired before he left. Of course for like the next two years there were people on this forum whispering about serious problems in our program because we landed a guy who had serious interpersonal problems.
 
i think the lesson is probably- never abandon a borderline, they can hurt you more

That lesson better applies to a predominantly narcissistic personality type organized at the borderline level. DSM isn't very dimensionally flexible when it comes to PD diagnoses, but even with what we got they're hardly ever applied well so I can't blame 'em.

As far as malignant programs.... Well I'd probably wager that the community programs matching lots of IMGs is the set that contains all the places that are truly malignant, yet that shouldn't be globalized in the least. It's also not very useful, because it's rare people will match at a low-tier program who isn't qualified enough to go to a reputable University-affiliated residency. There's some selection bias there too, although there are problem residents that get into great programs too. A lot of "malignant" designations are about the resident-program fit more than anything. Even at top places, some people will have experiences that will feel like malignancy, and even some of those stories are hard to justify as appropriate on behalf of the program. Still, one bad experience doesn't have to color your residency. It can have a lot of gravity, though. At my program, we had a resident who was discriminated against due to some regular adjustment to resident life and 1 unfortunate mistake, but she graduated and improved and found herself with plenty of allies although never able to completely overcome the unfounded reputation. That can be pretty crushing for people who really want to do well. One other resident was intentionally blowing off duties and did not care about the program's attempts to fix it, eventually taking a child fellowship fast track instead of being canned. He should have been canned at least after PGY-2, but his experience also shows how reputable programs can float along problem residents. These 2 cases are fairly unusual. There are occasionally residents who burn out and quit or transfer than have malignant experiences at good programs. Sometimes that's just a bad cultural or life fit, too.
 
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Somewhat related: Did that GW lawsuit ever get close to trial? It started a couple years ago and these types of things usually take a while.
 
Maybe another idea is to seek out the really grumpy/disheveled looking residents, because those people are more likely to give an honest response.
FWIW I would hope no one would seek out the residents at my program that would be likely to tell you "negative" things because the "negative" things actually tell you far more about their (in)abilities than they do about the program. There are certainly things worth saying to prospective trainees, but only one person has trouble leaving work at a reasonable hour...
 
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Unless you are a very small program, there will be times when someone is unhappy, and if you are a large program someone is unhappy most of the time. If a lot of people are unhappy about a few specific things in a program, this will be seen in the ACGME survey, and program evaluations committee reports, the resident evaluation of program.....
 
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That lesson better applies to a predominantly narcissistic personality type organized at the borderline level. DSM isn't very dimensionally flexible when it comes to PD diagnoses, but even with what we got they're hardly ever applied well so I can't blame 'em.

As far as malignant programs.... Well I'd probably wager that the community programs matching lots of IMGs is the set that contains all the places that are truly malignant, yet that shouldn't be globalized in the least. It's also not very useful, because it's rare people will match at a low-tier program who isn't qualified enough to go to a reputable University-affiliated residency. There's some selection bias there too, although there are problem residents that get into great programs too. A lot of "malignant" designations are about the resident-program fit more than anything. Even at top places, some people will have experiences that will feel like malignancy, and even some of those stories are hard to justify as appropriate on behalf of the program. Still, one bad experience doesn't have to color your residency. It can have a lot of gravity, though. At my program, we had a resident who was discriminated against due to some regular adjustment to resident life and 1 unfortunate mistake, but she graduated and improved and found herself with plenty of allies although never able to completely overcome the unfounded reputation. That can be pretty crushing for people who really want to do well. One other resident was intentionally blowing off duties and did not care about the program's attempts to fix it, eventually taking a child fellowship fast track instead of being canned. He should have been canned at least after PGY-2, but his experience also shows how reputable programs can float along problem residents. These 2 cases are fairly unusual. There are occasionally residents who burn out and quit or transfer than have malignant experiences at good programs. Sometimes that's just a bad cultural or life fit, too.

There's also the sort of malignancy that is common across the board and that is inherent to the system. Essentially the hierarchy, the politics and how little power residents have from the moments they sign up in the match, having to pay insane amounts of $$ for what essentially are job applications, to graduation date. I think that's malignancy in its own right that allows the worse kind to occur.
 
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I've totally revised my perspective since piping in on this thread. A much more common problem is personality disordered residents who shouldn't be physicians but who will graduate residency.

Such that. Whatever you might hear on the media about an oppressed resident. think again. it's likely they're the problem.

For a program to slide into malignant, slave driving, work camps, takes a lot. And even then. That's probably just because they're functioning like a lot of the industrial psych jobs out there. And the residents are just getting used as rx'ing cogs more than it is a personally threatening problem of a PD with a PD.
 
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For a program to slide into malignant, slave driving, work camps, takes a lot. And even then. That's probably just because their functioning like a lot of the industrial psych jobs out there. And the residents are just getting used as rx'ing cogs more than it is a personally threatening problem of a PD with a PD.

And for some psych residents, working a few weeks of 50-65 hours feels like slave labor as compared to the 40-50 they are used to.
 
Something that our surgery resident colleagues might abhor.

Right. Exactly. The migration of cultural expectations to the millennial worldview and the drama of social media around this or that program or event pertaining to it, makes for a muddled field of information. I don't know what to tell anyone. When I talk to applicants I tell them about agency, resilience, and making the program what they want and how to get what they want out of training. I don't try to t sell my program. I try to sell them the to tools to be the best resident they can be under any circumstances.
 
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I've totally revised my perspective since piping in on this thread. A much more common problem is personality disordered residents who shouldn't be physicians but who will graduate residency.

Such that. Whatever you might hear on the media about an oppressed resident. think again. it's likely they're the problem.

For a program to slide into malignant, slave driving, work camps, takes a lot. And even then. That's probably just because they're functioning like a lot of the industrial psych jobs out there. And the residents are just getting used as rx'ing cogs more than it is a personally threatening problem of a PD with a PD.

This, this, and this. Program Director should have a name change. I suggest "transference sponge".
 
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More commonly you will have the fragile narcissistic and passive-aggressive types in psychiatry who are different kind of toxic. my program was not what I or anyone would call malignant in the slightest but I was certainly bullied and victimized. Sadly residents are in a position where they are easily oppressed, and most students and residents we get are too weak-willed or pathetic to rock the boat, which just makes things worse.
Setting boundaries often does rock the boat because your interests and self-directedness can be at odds with the program who wants complete control - thus malignancy.
This is what scares me. I have friends from the previous graduating classes at my school who are psych residents. One of them is trying to transfer due to problems in the curriculum/"administration drama" (her words) that I would never have guessed in a million years were issues going off of interview day. Mentors from my home program also mentioned these problems to me (it's in our region). I hope this is the only program on my list that there is a mismatch between smiley interview day and the day to day of residency. I should add, my#1 and #3 programs I have two friends at who absolutely love their programs.

But thank you for the insight! I wish I thought to ask these questions during interviews...

I'm in a program that fits these definitions of malignant. My work week is twenty-five hours (not counting an hour plus commute each way to most sites)? This program's educational experience is limited to scribing for attendings and reading books. I wasn't allowed to start medication on my patients until the last three months of my second year, which was all inpatient. At that main rotation site of hours, there were eight total patients in July of this year; but there were SEVEN residents and THREE attendings. The last three months of my second year taught me all I know about inpatient psychiatry because I could start any medication I wanted; I was seeing up to forty patients a day. The volume wasn't the malignant part. Not learning to be a psychiatrist is the malignant part. The program is run by former residents who weren't able to function outside the program. I'm not getting bullied or victimized; I'm getting burnt out from boredom.

Residents have advocated for years about making changes in the program, but the administration isn't interested; when we advocate, they punish by removing well-liked rotation sites or extending hours of work without adding any educational value. The program fulfills the ACGME checklist and coaches residents what to say on the ACGME surveys (we have three meetings this week about this). Most of the residents in the program feel powerless to change anything because we've exhausted all the usual avenues to advocate for ourselves; the program director has very real power over us and can likely end our careers before they really begin; the rest don't care because they barely have to work (or even go to work) and get to become attendings. There are at least six residents leaving this year and two others who tried to leave but failed due to geographic restrictions. That many residents leaving doesn't affect the program because it'll always fill.

I think it's that as resident it's very difficult not to internalize the system. You are treated as a student, as part of a "class" and not as a working professional and are at the bottom of the hierarchy, and people end up behaving this way. I feel it's about setting your own limits and boundaries, how you carry yourself in professional matters, moreso than rocking the boat.

I try and do this, but I'm concerned that it's not enough.
 
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