Mean and discouraging psych specialty advisor. What are your thoughts?

[deleted445355]

---

Members don't see this ad.

Hi everyone,

I'm an MS3 at a top 30 allopathic school. I want to be a psychiatrist but my specialty advisor said something recently that hurt my feelings. I was involved in a process at my school called "feedforward." Essentially, students who are struggling in rotations are given special attention from the subsequent block director to check in with attendings to see if the issue has resolved. Long story short, I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student. I'm being treated for it now, but on my psych rotation, my block director was informed that "I tend to get flustered when anxious and that my interviews with patients go downhill subsequently." He later said to me in a private Zoom session “Psychiatry may not be a good fit for you if you’re not good at reading social cues and if anxiety gets in the way. Perhaps you shouldn’t even do clinical medicine and pursue pathology instead.” I sent an email back saying he hurt my feelings and wishing he would support me going forward. In response, I got this message....

Thanks for your email and I am sorry that my statement was challenging to hear and hurtful. I am supportive of you and your choice and will do all that I can to help you in the process of preparing for residency and through the process of applying. I do still think that reading social cues is an important aspect of psychiatric practice - however, I haven't had the sense in our interactions that this has been problematic and as we discussed anxiety or problems of attention can also lead to the perception of problems "reading the room." In any event, I am glad you are doing well and taking steps to care for yourself. While I want to be direct and honest when advising students, I never want to be hurtful, and I apologize given what I said has clearly weighed on you over these past couple of months.

My question to you all:

Do you think this guy is trying to be mean to me or is it legitimately just being frank? Sometimes, I sense in conversations that he may be biased towards me b/c I'm a struggling student. I feel I'm not on an equal playing field with other candidates as a result of this feedforward process. I'm worried b/c his opinion of students at this school holds weight at the residency program and I'm actually really interested in my home program. I feel like I kinda forced him to say he supports me but he did not go forward HIMSELF to say he does that and I subsequently am not sure if he truly supports me or not. What are your thoughts?

 

[Wordead]

Oh boy. You really need some thicker skin.

I have a lot of other things I'd like to say but I think you'd cry.

Take his criticism and do some soul searching.

 

[deleted445355]

Oh boy. You really need some thicker skin.

I have a lot of other things I'd like to say but I think you'd cry.

Take his criticism and do some soul searching.

I agree I need to develop thicker skin. Please let me know what you have to say. I appreciate the honesty.

 

[Lawpy]

That advice looks normal even though it's blunt. I feel like i'm missing something

 

[Dave1980]

they were not being "mean" they were being "honest".

you need to grow thicker skin as already mentioned. in the future i would never email someone you work with saying they hurt your feelings.

 

[Dave1980]

you also likley wont get into your home program if this advisor has a say.

 

[Chelsea FC]

Hi everyone,

I'm an MS3 at a top 30 allopathic school. I want to be a psychiatrist but my specialty advisor said something recently that hurt my feelings. I was involved in a process at my school called "feedforward." Essentially, students who are struggling in rotations are given special attention from the subsequent block director to check in with attendings to see if the issue has resolved. Long story short, I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student. I'm being treated for it now, but on my psych rotation, my block director was informed that "I tend to get flustered when anxious and that my interviews with patients go downhill subsequently." He later said to me in a private Zoom session “Psychiatry may not be a good fit for you if you’re not good at reading social cues and if anxiety gets in the way. Perhaps you shouldn’t even do clinical medicine and pursue pathology instead.” I sent an email back saying he hurt my feelings and wishing he would support me going forward. In response, I got this message....

Thanks for your email and I am sorry that my statement was challenging to hear and hurtful. I am supportive of you and your choice and will do all that I can to help you in the process of preparing for residency and through the process of applying. I do still think that reading social cues is an important aspect of psychiatric practice - however, I haven't had the sense in our interactions that this has been problematic and as we discussed anxiety or problems of attention can also lead to the perception of problems "reading the room." In any event, I am glad you are doing well and taking steps to care for yourself. While I want to be direct and honest when advising students, I never want to be hurtful, and I apologize given what I said has clearly weighed on you over these past couple of months.

My question to you all:

Do you think this guy is trying to be mean to me or is it legitimately just being frank? Sometimes, I sense in conversations that he may be biased towards me b/c I'm a struggling student. I feel I'm not on an equal playing field with other candidates as a result of this feedforward process. I'm worried b/c his opinion of students at this school holds weight at the residency program and I'm actually really interested in my home program. I feel like I kinda forced him to say he supports me but he did not go forward HIMSELF to say he does that and I subsequently am not sure if he truly supports me or not. What are your thoughts?

OP your feelings are valid. The initial comments would have hurt me as well, no one likes to hear that X field isnt a good match for them because of Y issues. But I wouldnt have emailed him and just suck it up and moved forward.

 

[hiiiiiiiiiii]

I’m sorry OP, but I’m going to be frank with you just like your advisor was. You need to let this go and move on. This is a normal interaction and much worse things will be said to you as you go through life.

 

[deleted445355]

I'm honestly truly confused as well. On most of our Zoom sessions, he says he "admires" me for personal qualities I have, yet gave this statement. I don't know what to make of things anymore...

 

[mrbreakfast]

So you block director brought negative feedback to your attention, attempted to give you advice (which is literally his job), and you rejected it; not only that, you told them you were rejecting it.

I feel like I kinda forced him to say he supports me but he did not go forward HIMSELF to say he does that and I subsequently am not sure if he truly supports me or not.

he says he "admires" me for personal qualities I have, yet gave this statement

You worry this person is being mean, but in reality this person is trying to be kind to you. The school wants all their students to match; part of that process involves being realistic with students. It is challenging to be critical of medical students who aren't doing well, and many people will give up once a student reacts poorly to criticism. Ironically, your reaction to his email kind of proves the block director's point.

It's fair to be hurt by these comments, but you really have two options: take the advice to heart, do some soul-searching, and try to come up with a plan to improve on your weaknesses; alternatively, ignore it and just push forward.

 

[Mass Effect]

Hi everyone,

I'm an MS3 at a top 30 allopathic school. I want to be a psychiatrist but my specialty advisor said something recently that hurt my feelings. I was involved in a process at my school called "feedforward." Essentially, students who are struggling in rotations are given special attention from the subsequent block director to check in with attendings to see if the issue has resolved. Long story short, I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student. I'm being treated for it now, but on my psych rotation, my block director was informed that "I tend to get flustered when anxious and that my interviews with patients go downhill subsequently." He later said to me in a private Zoom session “Psychiatry may not be a good fit for you if you’re not good at reading social cues and if anxiety gets in the way. Perhaps you shouldn’t even do clinical medicine and pursue pathology instead.” I sent an email back saying he hurt my feelings and wishing he would support me going forward. In response, I got this message....

Thanks for your email and I am sorry that my statement was challenging to hear and hurtful. I am supportive of you and your choice and will do all that I can to help you in the process of preparing for residency and through the process of applying. I do still think that reading social cues is an important aspect of psychiatric practice - however, I haven't had the sense in our interactions that this has been problematic and as we discussed anxiety or problems of attention can also lead to the perception of problems "reading the room." In any event, I am glad you are doing well and taking steps to care for yourself. While I want to be direct and honest when advising students, I never want to be hurtful, and I apologize given what I said has clearly weighed on you over these past couple of months.

My question to you all:

Do you think this guy is trying to be mean to me or is it legitimately just being frank? Sometimes, I sense in conversations that he may be biased towards me b/c I'm a struggling student. I feel I'm not on an equal playing field with other candidates as a result of this feedforward process. I'm worried b/c his opinion of students at this school holds weight at the residency program and I'm actually really interested in my home program. I feel like I kinda forced him to say he supports me but he did not go forward HIMSELF to say he does that and I subsequently am not sure if he truly supports me or not. What are your thoughts?

He's a psychiatrist? I mean, he really should have more control over how he words things. I don't blame you for being hurt. BUT he is telling you the truth that if these are things you struggle with (social cues and inattention), it will hurt you as a psychiatrist. Psychiatry is a very challenging field because you don't rely on X-rays or lab work to get your diagnosis. You HAVE to be able to read your patient. Patients lie, they have no insight, or they just don't understand their behavior so you have to. That's a must. Otherwise, you'll get the diagnoses wrong. To provide an example, last month I had an adolescent male come to me for ADHD eval. He reported problems with attention, concentration, unable to tell me when it started but started in middle school he thought. Throughout our conversation, he kept stopping and then saying "what?" Clearly distracted. He kept staring at me and then again "what?" He kept saying "see it's my ADHD". No, it wasn't ADHD. He was having first break psychosis. He was thought blocked and the reason he was so distracted was because of auditory hallucinations.

There's more to the story but basically if you can't read cues and just take patients at their word in psychiatry, you WILL miss a lot (most?) things. So if this is where you struggle, then you should be approaching this attending with a "would you mind mentoring me" email asking for his advice on how to improve this so you can match psychiatry, not an email telling him he hurt your feelings. The latter won't really get you anywhere even if it makes you feel better. The former will make him think "wow, here's someone who wants to improve. Maybe we can fix this".

 

[Lawpy]

He's a psychiatrist? I mean, he really should have more control over how he words things. I don't blame you for being hurt. BUT he is telling you the truth that if these are things you struggle with (social cues and inattention), it will hurt you as a psychiatrist. Psychiatry is a very challenging field because you don't rely on X-rays or lab work to get your diagnosis. You HAVE to be able to read your patient. Patients lie, they have no insight, or they just don't understand their behavior so you have to. That's a must. Otherwise, you'll get the diagnoses wrong. To provide an example, last month I had an adolescent male come to me for ADHD eval. He reported problems with attention, concentration, unable to tell me when it started but started in middle school he thought. Throughout our conversation, he kept stopping and then saying "what?" Clearly distracted. He kept staring at me and then again "what?" He kept saying "see it's my ADHD". No, it wasn't ADHD. He was having first break psychosis. He was thought blocked and the reason he was so distracted was because of auditory hallucinations.

There's more to the story but basically if you can't read cues and just take patients at their word in psychiatry, you WILL miss a lot (most?) things. So if this is where you struggle, then you should be approaching this attending with a "would you mind mentoring me" email asking for his advice on how to improve this so you can match psychiatry, not an email telling him he hurt your feelings. The latter won't really get you anywhere even if it makes you feel better. The former will make him think "wow, here's someone who wants to improve. Maybe we can fix this".

This is an excellent approach and i fully recommend OP to follow this.

 

[futureapppsy2]

He's a psychiatrist? I mean, he really should have more control over how he words things.

Tbh, I've met so many psychologists/psychiatrists/masters-level therapists with consistently bad professional interpersonal skills that I'm not really taken back by it at this point (though I agree that the attending in the OP's post was being kind, especially in his--very kind--reply). That said, I don't think it's bad that the OP reached out to him--he didn't seem to mind, and it's important that people communicate, including communicating that something hurt them (within reason, of course). Even among professionals with doctorates, a lot of professional conflicts come down to people having their feelings hurt and poor communication around that, IMO, .

 

[Mass Effect]

Tbh, I've met so many psychologists/psychiatrists/masters-level therapists with consistently bad professional interpersonal skills that I'm not really taken back by it at this point (though I agree that the attending in the OP's post was being kind, especially in his--very kind--reply). That said, I don't think it's bad that the OP reached out to him--he didn't seem to mind, and it's important that people communicate, including communicating that something hurt them (within reason, of course). Even among professionals with doctorates, a lot of professional conflicts come down to people having their feelings hurt and poor communication around that, IMO, .

Sorry but no. You tell your friend they hurt your feelings. You tell your spouse they hurt your feelings. You tell your parents they hurt your feelings. You don't tell your boss (which is what this guy is) they hurt your feelings. That's just professional boundaries 101. When your boss gives you feedback, you take it and open the line of communications with anything EXCEPT "you hurt my feelings". You write to them and say you were caught off-guard, but want to improve. Or you say "I didn't catch myself doing that and would like to discuss it more". Or "This is the first time I've heard that feedback. May I ask why you feel that way?"

Telling your boss that feedback hurt your feelings only shows that you're too sensitive to handle criticism. Note I'm not saying you shouldn't get your feelings hurt. I'm saying that isn't how you communicate about your feelings being hurt.

 

[futureapppsy2]

Sorry but no. You tell your friend they hurt your feelings. You tell your spouse they hurt your feelings. You tell your parents they hurt your feelings. You don't tell your boss (which is what this guy is) they hurt your feelings. That's just professional boundaries 101. When your boss gives you feedback, you take it and open the line of communications with anything EXCEPT "you hurt my feelings". You write to them and say you were caught off-guard, but want to improve. Or you say "I didn't catch myself doing that and would like to discuss it more". Or "This is the first time I've heard that feedback. May I ask why you feel that way?"

Telling your boss that feedback hurt your feelings only shows that you're too sensitive to handle criticism. Note I'm not saying you shouldn't get your feelings hurt. I'm saying that isn't how you communicate about your feelings being hurt.

Oh, I agree 100%. I just meant that I don't think it was bad that the OP responded to his attending, though the wording could have been improved in that response.

 

[deleted445355]

Hi all,

I did not begin my response to him as "You hurt my feelings." I just said that to be concise in this post. I began my email saying I commended him as a block director for making my psychiatry rotation such a good experience for me and thanking him for spending so much time with the feedforward process. Then I did said he did hurt my feelings, but wished we had met for the first time under a more positive context and that everyone struggles at some point in their life and I have taken efforts to address my mental health issues and I hope opportunities in the future to show him my improvement over time.

The beauty of psychiatry is that people are more receptive to hearing your thoughts and feelings and subsequently care about them too.....

 

[Lawpy]

Hi all,

I did not begin my response to him as "You hurt my feelings." I just said that to be concise in this post. I began my email saying I commended him as a block director for making my psychiatry rotation such a good experience for me and thanking him for spending so much time with the feedforward process. Then I did said he did hurt my feelings, but wished we had met for the first time under a more positive context and that everyone struggles at some point in their life and I have taken efforts to address my mental health issues and I hope opportunities in the future to show him my improvement over time.

The beauty of psychiatry is that people are more receptive to hearing your thoughts and feelings and subsequently care about them too.....

The point is your adviser wasn't mean or rude. He's direct and honest. Yes having that type of feedback hurts but i'd look it as an opportunity to improve yourself and ask him for guidance.

 

[Chelsea FC]

For someone lecturing someone about not picking up social/emotional cues from people, im surprised he is so caught off guard that ur feelings were hurt when he basically told you that wouldnt cut it as a psych doc.

 

[deleted445355]

I was immediately hurt after he said that to me and ironically, he did not pick up social cues of my emotions in the moment b/c I guess I was good at hiding my feelings at the time? I even made a joke about my personality test saying I'm most suited for radiology even though I was in pain...

 

[djiboutiman]

I think he was just being honest with you, given the feedback he heard about you from other physicians. And that likely wasn’t an accurate representation of your skills given your anxiety, but that’s all he had to go on. I agree with the above poster who said you should ask for advice on how to improve. I think we all have a tendency to think people see us in a certain way. But I don’t think he sees you as less than just because of your “feedforward“ status.

All this being said, if I were you I’d make sure to do an away rotation in psychiatry, do the best you can, and secure some good letters of recommendation from the away rotation. You go to at least a somewhat prestigious medical school (given the ranking), so you’ll have an advantage in the match.

 

[Chelsea FC]

Yeah im gonna say it. Screw that guy he is an ass and doubt his comment was made in good faith. If so he would be way more thoughtful and careful with his response.

 

[Mass Effect]

The beauty of psychiatry is that people are more receptive to hearing your thoughts and feelings and subsequently care about them too.....

I'm a board-certified psychiatrist and I'm telling you no, this wasn't the way to handle it. What's done is done, but in the future, consider taking the advice I gave above.

 

[Mass Effect]

Yeah im gonna say it. Screw that guy he is an ass and doubt his comment was made in good faith. If so he would be way more thoughtful and careful with his response.

I mean, that's well and good until the OP doesn't match psych or even worse, does match psych and bombs during residency because feedback is thought of as "screw that guy". There is such a thing as using feedback to improve, no matter how it's delivered.

 

[deleted445355]

So you all think he wasn't trying to be mean?

 

[Chelsea FC]

I mean, that's well and good until the OP doesn't match psych or even worse, does match psych and bombs during residency because feedback is thought of as "screw that guy". There is such a thing as using feedback to improve, no matter how it's delivered.

You can use the feedback to improve while also saying screw that guy who is telling you don’t go into clinical medicine , especially knowing you have stuff going on and struggling clinically .. like he himself knew you have anxiety and this is how he wanted to talk about your issues. Total a*s. That doesn’t mean you can’t take some of his feedback and improve so when u are in the situation you be more mindful of your medical students.

 

[deleted445355]

On my psych rotation, one of the attendings who worked with me directly said "I can see you being a psychiatrist." She was super nice, knew I had issues going on, and showed me a lot of compassion and humanity in spite of all of it. Definitely asking her for a letter of rec. As for this guy, he's blunt and that's fine, but over the several Zoom sessions I have spoken to him, I did get a feeling that he didn't like me and said stuff to try to make me feel bad. Hate to say this... It's a bummer b/c I actually really like my home program. I'm sure my other letter writers from my school would advocate for me.

I understand the importance of taking feedback, but I'm honestly just very sad about this whole situation. I feel like I'm not on an equal playing field with other students at my school, simply b/c I was involved with feedforward and struggled with mental health issues that became apparent on my rotations.

 

[Chelsea FC]

On my psych rotation, one of the attendings who worked with me directly said "I can see you being a psychiatrist." She was super nice, knew I had issues going on, and showed me a lot of compassion and humanity in spite of all of it. Definitely asking her for a letter of rec. As for this guy, he's blunt and that's fine, but over the several Zoom sessions I have spoken to him, I did get a feeling that he didn't like me and said stuff to try to make me feel bad. Hate to say this... It's a bummer b/c I actually really like my home program. I'm sure my other letter writers from my school would advocate for me.

I understand the importance of taking feedback, but I'm honestly just very sad about this whole situation. I feel like I'm not on an equal playing field with other students at my school, simply b/c I was involved with feedforward and struggled with mental health issues that became apparent on my rotations.

Struggled pre-clinically, had mental Heath issues appearing out of nowhere in medical school. Still forcing myself out that line to get my MD. Screw the haters and go get that bag. Slowly get stronger and be the better version of yourself. You will become a better teacher from knowing how much of a struggle it all was.

 

[NickNaylor]

This all seems like a perfectly reasonable interaction. I'm an academic psychiatrist and supervise medical students and residents. Paying attention to social cues and "reading the room" are critically important skills to the work, and if you struggle in this regard then, yes, it's something that you should be aware of and should weigh in your decision to pursue the field. These are hard things to teach because a lot of "reading the room" is situational, intuitive, and very difficult to extrapolate from a example interactions.

I thought your advisor's response to your concerns were completely reasonable. Responding to negative feedback with some kind of statement implying that the feedback was delivered in a way that was hurtful to you is not a good take unless the statements are patently unprofessional and disrespectful. The comment about not pursuing clinical medicine was a bit harsh and not something that I would've said, but providing negative feedback that you don't like is not unprofessional nor disrespectful.

It sounds like the supervisor is giving you valid feedback. What you choose to do with that is up to you. When it comes to negative feedback, it's very easy to be defensive and disagree. Very few people do things intentionally bad, so negative feedback is often very easy to defend against. Sometimes the negative feedback may seem baseless. That said, there is almost always something valuable that you can gleam from it. Put your feelings aside and figure out where your supervisor is coming from and why he/she felt the need to provide you with that feedback, even if you disagree. Then work on whatever "kernel of truth" you feel like is buried in that feedback.

Your responses in this thread paint a portrait of someone who cannot tolerate negative feedback and are unable to find something valuable in it when given. That's something that might be worth reflecting on and trying to understand, because whether or not you're going to go into psychiatry, you're definitely going to be receiving critical feedback in the future, and I can almost guarantee that complaining that it was "mean" won't yield the same response that you received from this supervisor.

 

[Dave1980]

I did get a feeling that he didn't like me and said stuff to try to make me feel bad.

Sorry but this sounds a little pathetic. This isn't preschool. This is medical school and honest feedback should be listened to and internalized not rejected because it makes you feel bad.

I understand the importance of taking feedback

You didn;t do well this time. hopefully next time you can take honest feedback better

 

[GoSpursGo]

On my psych rotation, one of the attendings who worked with me directly said "I can see you being a psychiatrist." She was super nice, knew I had issues going on, and showed me a lot of compassion and humanity in spite of all of it. Definitely asking her for a letter of rec. As for this guy, he's blunt and that's fine, but over the several Zoom sessions I have spoken to him, I did get a feeling that he didn't like me and said stuff to try to make me feel bad. Hate to say this... It's a bummer b/c I actually really like my home program. I'm sure my other letter writers from my school would advocate for me.

I understand the importance of taking feedback, but I'm honestly just very sad about this whole situation. I feel like I'm not on an equal playing field with other students at my school, simply b/c I was involved with feedforward and struggled with mental health issues that became apparent on my rotations.

I'm going to echo what other attendings have told you--his feed back was not disrespectful, it was negative. Those are not the same thing. It is also entirely normal to get disparate feedback on your rotations from different attendings because some of them are going to see you on good days, and some of them are going to see you on bad days. You have to take all of the feedback and synthesize it.

Him saying that psychiatry might not be a good field for you is also valid feedback that you should consider. You don't have to AGREE with it, but you should at least consider why you are receiving that feedback and decide whether it is valid.

Finally, you also need to be realistic. All the attendings in the world saying nice things to your face isn't going to help you. If he doesn't think you're going to make a good psychiatrist, he may "support" you in terms of wishing you well and not actively trying to sabotage your application at other programs, but he will not tell your home program that you would be a good fit. If his word carries weight, that could very well sink you at your home program. So you need to be realistic about whether your application is competitive for psychiatry at other programs. At the end of the day, not everyone gets to be in their preferred specialty, or in their preferred program.

 

[Mass Effect]

I understand the importance of taking feedback, but I'm honestly just very sad about this whole situation. I feel like I'm not on an equal playing field with other students at my school, simply b/c I was involved with feedforward and struggled with mental health issues that became apparent on my rotations.

I'm going to say something that you're likely going to think is mean, but I promise you I am not saying it to hurt your feelings. I feel bad for you, I really do. But I think you need to hear honesty rather than validation or else you're going to be heartbroken in the match and residency.

You are not on an equal playing field at your home program. Your first post said this: "Long story short, I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student."

Interpersonal issues is a huge red flag in psychiatry. It sucks, but when the specialty is 90% talking and working with others, if you can't do that, it's akin to a surgeon who can't cut. If a surgery candidate suffered a broken wrist so he/she couldn't cut during their rotation, how would the program rank them? Likely they wouldn't, because regardless of the reason, the surgeon could not perform appropriately and they couldn't see how good a surgeon he is. They just couldn't evaluate that part of him. For you, they couldn't evaluate you being a superstar psychiatrist because other things got in the way. I understand anxiety may have been part of it for you and you're now receiving treatment which I think is great, but your home program may be out of reach at this time for the same reason surgery at the institution would be out for the surgeon with a broken wrist. Hopefully with treatment, things have improved. Do a bunch of aways and impress the hell out of other programs if you want psych.

 

[Member10billion]

So you all think he wasn't trying to be mean?

I agree with the above posts regarding honesty and feedback reception.

I do have to add that if this attending was trying to be mean to you, who cares! People are mean and you need to learn to ignore them. Not everyone will support you in all your endeavors. If they do, great! Listen to what you want and what helps you. I've said it before and I'll say it again; it is way easier to say no than to take time to help someone out.

Personally, I do not put much stock into advisors and mentors. I'll listen on how to improve and appreciate their time, but I certainly do not limit myself based on what someone else said. If I listened to all the negative advice, I wouldn't have even graduated high school!

 

[Dral]

Not everyone gives constructive feedback only all the time. He could have framed it differently, but I don't think he was trying to be mean.

Geez, when I was in school, I got ripped apart by a research advisor where they told me they were giving me a D for the rotation. Eh, I just decided to move on and focus on the people who were more understanding and helpful (after reflecting and trying to understand what happened). I would suggest you do the same and try to reflect on what he said, but not take it too much to heart.

 

[Chelsea FC]

I'm going to say something that you're likely going to think is mean, but I promise you I am not saying it to hurt your feelings. I feel bad for you, I really do. But I think you need to hear honesty rather than validation or else you're going to be heartbroken in the match and residency.

You are not on an equal playing field at your home program. Your first post said this: "Long story short, I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student."

Interpersonal issues is a huge red flag in psychiatry. It sucks, but when the specialty is 90% talking and working with others, if

this is 100% reason why schools are full of **** when they say you should be forthcoming with mental health struggles and it won’t affect your standing when it comes to matching in house. We preach wellness but are the first to turn our backs on any doc that display any attributes this field view as weakness

 

[NotAProgDirector]

You mentioned that "I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student." The main issue here is that you had a poor performance. You can blame it on your anxiety -- and it's quite possible that's the reason. But regardless, they are evaluating you on your performance. The evaluation rubric won't change because of personal issues. Ultimately, what you need to do is get your anxiety under control and then show them that your performance has improved. That will make all the difference. Otherwise, all we have is your opinion that your performance will improve.

It's very common to get very negative feedback from some faculty, and then fine feedback from others. I see this regularly in a residency program. There are lots of reasons -- your performance varying is one possibility. Some faculty are more honest than others. I've had faculty have this exact interaction with learners -- they give them negative feedback, they are accused of being petty / mean / biased / etc. Ultimately they decide not to given negative feedback even to poor performers to avoid all the hassle it causes. It's also possible that others have given you negative feedback in a more subtle way, and you fail to pick up on it -- you see it as all positive. This would map to the concern that you have trouble "reading the room".

An example -- I was working with a 4th year SubI a few years ago. Our assignments on Hosp Med are only 1 week long, so I try to give feedback early. She was absolutely terrible -- disorganization and inefficiency were the biggest two issues (it was difficult to assess her fund of knowledge due to this). I sat down with her after day 2 to review. I used the classic "feedback sandwich" -- told her the things that I thought she was doing well (interpersonal connections with her patients), then talked about the troubles (inefficiency and disorganization making it difficult to get the day's work done), that she was behind where other SubI's would be, and finished with that I enjoyed working with her. Asked if there was anything I could do to help, which she declined.

What happened? Nothing. The next day was exactly the same. So I sat down with her again, asked her about our feedback session the day prior. She told me that she was doing great with interpersonal skills and that I liked working with her. She seemed to completely miss all of my concerns (which time-wise were the biggest piece). So I reframed the conversation. I repeated what I told her the day beforehand, but this time I added that her current performance was consistent with a failing grade from me. I explained that other people may pass her, and she could easily pass the rotation. But my opinion was that her performance fell well below the standards I set for my SubI's. Just so we're clear, I've failed only one SubI in my entire career -- it's not like I'm some jerk that just fails people for fun.

This time, there were tears. But there also was a discussion that she felt she wasn't doing as well as everyone else, yet no one had told her so. Looking back at my first conversation, that's exactly what I thought I was telling her -- but I didn't say "you're failing" because I didn't want to hurt her feelings. But it's exactly what needed to be said.

I worked with her intensively the next few days. By the end of the week, she had a passing performance. She submitted an eval of me that wasn't all that positive. Yet, later that year after she matched, she reached back out and thanked me -- she said she couldn't see the problem and blamed me for being mean, yet after that conv she was able to ask for more honest feedback (something I helped her with) and found that it really was a problem, and she was able to work on it.

I can't say if you're in the same position. All we have is your side of the story. But I think you're looking at this the wrong way. You seem to be asking whether this person hurt your feelings on purpose -- to be mean. It's much more likely that they are being honest to help you, and that a side effect of that is that your feelings were hurt. You need to get beyond this.

Some of the concern may be around fixing the problem. If you had a medical knowledge problem, that can be "easily" fixed -- you can study and learn more. If you had an organizational problem, that can be less easily fixed -- there are ways to learn to become organized although some people seem to have organizational difficulties that are harder to compensate for. If your problem is EQ -- i.e. "reading the room" -- these are very difficult to fix. It is very difficult to teach people how to do this. Hopefully it's all your anxiety at play and getting that under control will help.

Last, I think there may be some disagreement about what the term "support your application" means. If you're asking whether this person is going to write you a letter stating that you're the best student they have ever had, call programs on your behalf, etc -- then no, they will not be doing that. What they will do is help answer your questions and help keep you moving forward.

 

[NickNaylor]

this is 100% reason why schools are full of **** when they say you should be forthcoming with mental health struggles and it won’t affect your standing when it comes to matching in house. We preach wellness but are the first to turn our backs on any doc that display any attributes this field view as weakness

I'm not sure that that's the case. I think what schools mean is that mental health issues need to be addressed, and in that sense you should be "forthcoming" about them. Being "forthcoming" about mental health concerns while on the job is absolutely not the right time or place to bring up those concerns. Those concerns are for your psychiatrist and/or therapist; if your academic performance begins to be affected, then perhaps those concerns are also for your dean.

The simple reality is that if mental health concerns are getting in the way of your performance, that's a problem. I don't think that's the system "turning our backs" on those students or physicians. It's a simple problem of not being able to perform at a minimum standard necessary to do the work that you are learning to do. The example of the broken wrist provided above is an excellent, non-mental health related corollary. If a student has an anxiety disorder, that's none of my business until it affects their ability to perform the clinical work of a student. At which point it still isn't really my business, but it will certainly affect how I perceive them as a clinician because that's what I'm there to do. I don't rate students poorly because of whatever issues they may or may not be dealing with at the time. I rate students poorly because they are unable to do the work that they are there to do.

I have treated multiple trainees - including medical students and residents - on both the inpatient psychiatric unit and on our ECT service. By all accounts, those trainees do exceptionally well when they are feeling well. But it's a problem if you're psychotically manic and can't interact appropriately with patients or colleagues or so depressed that you just don't show up for work - not because the the mental health issues are inherently problems, but because the mental health issues are getting in the way of fulfilling the obligations of your work. @NotAProgDirector highlights this in his/her post above.

Certainly mental health continues to be stigmatized in medicine and elsewhere. But my experience in academic medicine has been that, as long as you're able to do your work as a physician or soon-to-be physician, the overwhelming majority of people aren't going to hold whatever mental health issues you might have against you. And in those cases when your academic performance suffers due to mental health issues, there are many supports and avenues in place to get students feeling well and back in their programs. Perhaps this is just my institution, but this was my impression at my medical school as well, which was a different institution than where I did my residency training and am currently on faculty.

 

[Dral]

To expand on above, if an individual is perceived as not a good fit or even unfit to perform duties as a student, that is that evaluator's experience with that person. While yes, there are some evaluators that may be unfair, what is expected of the evaluator in the case where they know nothing else of the clinical work of that individual other than when they were experiencing issues? "I didn't think this person performed up to the standards I hold as an A+ student, but I'm to assume they are an A+ student because they admitted they were experiencing anxiety/depression on their rotation so I'll assume they are A+ even though they didn't show me that". That can't really be how it works.

If someone has clinically diagnosed anxiety and is getting it under control, then request a leave of absence. Again, that's like breaking a bone or being ill in another way and needing time off to recover/improve.

If someone has anxiety as part of their personality...well again, I'm sure the evaluator can empathize, but they can't necessarily give a stellar eval for that person if they honestly felt it caused the learner to be a less than a stellar performer on that rotation.

We can think of subpar performance in the following ways:
Subpar intentionally and subpar unintentially (fails to fulfill basic responsibilities and is not good on the job interactions/organization)
Good intentions, but subpar unintentially (Shows up and means to do well, but falls short on certain intangibles such as interactions and organizational skills)
Subpar intentions but good unintentially (Doesn't fulfill responsibilities, but can shine and do well when they are actually performing responsibilities)
Good intentions and good unintentially (shows up and fulfills responsibilities as well as performs naturally well/interacts well)

It's easy to give negative feedback to those who objectively don't even intend to do well (The person who doesn't even show up). The difficulty comes in when people do well and try hard in terms of fulfilling their responsibilities, but they have certain 'unintentional' qualities that make their performance subpar. While negative feedback on these latter characteristics is not easy to hear about, it is often times important to address. I have seen people intend to go into fellowships and certain training that just makes me think they must possess no self awareness. While I may not know the whole story, I feel it's poor form as an educator to let those people move on with a pat on the back and an A grade. They don't need to be ripped a new one, but they should be made aware somehow. If that has to be reflected in evals, then it should hopefully be delivered in the most amicable way possible.

In the case of OP, if after some introspection, they can choose to say to themselves "You know what...this evaluator experienced my performance when it was suboptimal. Now that I am getting things under control I know I am better than that and can be good at what I intend to do. So I'm going to hear what they say, but who they saw is not who I really am". They could also say "This evaluator was right. Maybe I'm not a good fit for psych." Hopefully that's not the case.

 

[futureapppsy2]

So you all think he wasn't trying to be mean?

Nope.

 

[sloop]

I am also a psychiatrist and I find myself torn. I think a lot of this depends on what the psychiatrist was basing his criticisms on.

I might have misinterpreted something but it sounded like the psychiatrist may have told OP that they shouldn’t be a psychiatrist based on an explanation of a difficulty that was relayed to them before having the opportunity to observe OP on the rotation. If that is the case, I think that the criticism is probably unfair and unduly harsh. I think it is kind of a dick move to tell an anxious person that they’re not cut out for the field before even observing them on the rotation.

If, on the other hand, this is feedback based on observed performance, I think it may be completely valid.

 

[deleted445355]

Thanks everyone who has shared your thoughts. I really appreciate it. Several things..

1) I 'high passed' my psych rotation. I personally don't think I did as well as I had hoped due to aforementioned anxiety issues. It was also my first time exposure to psych interviews, and I found it drastically different from the rest of clinical medicine, which I was familiar with prior to med school.

2) After making efforts to address my anxiety, I've seen improvements in my performance after being on an SSRI and doing therapy for a little over a month now. I don't get nervous palpitations or knots in my stomach anymore. My oral presentations are stronger now. I feel if I get a psych preceptor and practice more, the combo with my psych therapy will definitely improve my performance when I do my 4th year psych electives. I believe I will be able to prove myself to this man later.

3) I asked my BF about this issue. He's a radiology fellow at a prestigious west coast university, soon to be attending, and one of the smartest and most insightful people I know. He said to me "No, this guy is not trying to be mean. He's just being honest. Reading social cues is important for the profession. He gave you a good email response back, but it's still unclear if he will truly support you b/c you essentially forced him to saying it rather him offering it. I would focus on working to change his opinion of you."

4) Should I take his email response back to me literally? I like to see the best in people, especially a person who is supposed to help medical students achieve their dreams, but am I being naive? My username is pink panda and I admit I've always had a sort of childhood innocence in me wanting to see the good in others, believe the purity of their intentions, and trust their words and actions are kind and wholesome? As much as third year has implanted seeds of doubt and cynicism and often makes me question the kindness and sincerity of others, I still try to see the good in people, as difficult as it can be most times. He said "I will do all that I can to help you" and I really want to believe this.

5) He only got hearsay from 2 attendings on my psych rotation who said I seemed to struggle with anxiety/attention issues, particularly with difficult patients. He did not observe my performance directly...

6) This man is the clerkship/block director for medical students. He's also the advisor for all students interested in psych. I will definitely have opportunities to interact and talk to him in the future and I was thinking I can better gauge his support if he perhaps he reiterates it later on or does actions that suggests he really does....

7) Am I really toast at my home program like everyone here says? I've become attached to this city and really want to train here. I plan to get 3 letters of rec from psych attendings at my school who have always believed in and supported me. They interview people and I'd think they'd go out of their way to advocate for me. You all make it sound like knowing him is a death sentence for matching at my home program.

 

[mrbreakfast]

He said "I will do all that I can to help you" and I really want to believe this.

There is zero reason to think this person won't try to help you. His advice to you was already an attempt to help, but it's literally his job to help you whether or not he thinks you'll be an amazing psychiatrist. I wouldn't worry about it.

Am I really toast at my home program like everyone here says?

How about instead focusing on this: "I didn't do as well as I had hoped during my clerkship, so I'm going to do everything I can to absolutely smash my M4 rotation and prove the doubters wrong."


Confidence with patients comes with time; you get better the more "reps" you take. I don't know a ton about psychiatry, but in neurology we very often have to tell people, or their families, very bad news. No one expects medical students to be amazing at that from day one, and some people are innately better than others. However, all good physicians are have good bedside manner (in my opinion) and you can learn through osmosis and emulation.

I admit I've always had a sort of childhood innocence in me wanting to see the good in others, believe the purity of their intentions, and trust their words and actions are kind and wholesome

Just a warning, an overly idealistic outlook is a recipe for burnout in residency.

 

[Mass Effect]

this is 100% reason why schools are full of **** when they say you should be forthcoming with mental health struggles and it won’t affect your standing when it comes to matching in house. We preach wellness but are the first to turn our backs on any doc that display any attributes this field view as weakness

You completely missed the point of my post. My entire point was that the mental health struggle didn't matter. Replace anxiety with broken wrist. If the poster had a broken wrist that caused interpersonal problems, that would hurt her in psych. It isn't about having the broken wrist, it's about the interpersonal problems.

 

[thepoopologist]

You need to understand yourself and how you respond to different interactions before you're able to communicate therapeutically with others.
Its not about your mental health struggles, its about being aware of them and being able to adjust your response accordingly so you don't disintegrate at the slightest remark. Your mental health is your mental health, and you need to take care of it, however pointing out your anxiety will not help you win the game.
The other possibility is he is mean in a passive aggressive sense and sees your anxiety as weakness and is mentally tearing you limb by limb, however if you're at a top 30 school I assume you're being given the benefit of the doubt, and even if this theory is true, the point is to not let him or anyone destroy you.

 

[Bobblehead]

Home field advantage to residency matching involves the existing faculty and staff knowing in part that they're training a near-peer who might eventually become a colleague. In that context having interpersonal problems bodes poorly for being ranked to match. If it's between choosing someone matching from outside who is equivalent on paper and someone known by the home program to not do well around certain parts of the established population it might be better to pick the unknown quantity. The MS4 performance will be crucial to changing that perception. Fixating on people being "mean" and "discouraging" is going to simply validate their initial assessment.

 

[GoSpursGo]

4) Should I take his email response back to me literally? I like to see the best in people, especially a person who is supposed to help medical students achieve their dreams, but am I being naive? My username is pink panda and I admit I've always had a sort of childhood innocence in me wanting to see the good in others, believe the purity of their intentions, and trust their words and actions are kind and wholesome? As much as third year has implanted seeds of doubt and cynicism and often makes me question the kindness and sincerity of others, I still try to see the good in people, as difficult as it can be most times. He said "I will do all that I can to help you" and I really want to believe this.

7) Am I really toast at my home program like everyone here says? I've become attached to this city and really want to train here. I plan to get 3 letters of rec from psych attendings at my school who have always believed in and supported me. They interview people and I'd think they'd go out of their way to advocate for me. You all make it sound like knowing him is a death sentence for matching at my home program.

I'll address the two points that were actual questions.

"I will do all I can to help you" does not mean he's going to give a positive review if he doesn't honestly believe it. He's not going to go out of his way to hurt you, and will attest to the positive attributes he sees, but if asked about his honest opinion he's going to give it. It is good that you still have some time to improve his perception of you before you apply. Whether you are toast probably depends on how strongly his opinion is weighted and whether you can change that opinion by the time you apply.

 

[deleted1100659]

Attending psychiatrist here.

1. The guy actually seems somewhat genuine, I don't think his goal was to be rude. He seems fairly invested in your success.

2. To those that say have thicker skin, it is important to remember that emotional resilience is built upon many factors. Social anxiety disorder for example, the key factor is fear of being ridiculed/judged by others. If someone presents to the clinic with that complaint, I do not think my response would be "have thicker skin", lol.

3. You will continue to grow and evolve while in medical school and this continues in residency. I developed resilience/strength with time, and didn't have near the fortitude I have now when i first started out, back in the day. However, there will be times when people are rude (not talking about this time specifically) or just completely mean/vindictive. I think it would be helpful to find ways to manage this sort of thing when it happens, so you don't go down the rabbit hole of trying to predict how others perceive you, and letting that thought drive you crazy.

 

[deleted445355]

Attending psychiatrist here.

1. The guy actually seems somewhat genuine, I don't think his goal was to be rude. He seems fairly invested in your success.

2. To those that say have thicker skin, it is important to remember that emotional resilience is built upon many factors. Social anxiety disorder for example, the key factor is fear of being ridiculed/judged by others. If someone presents to the clinic with that complaint, I do not think my response would be "have thicker skin", lol.

3. You will continue to grow and evolve while in medical school and this continues in residency. I developed resilience/strength with time, and didn't have near the fortitude I have now when i first started out, back in the day. However, there will be times when people are rude (not talking about this time specifically) or just completely mean/vindictive. I think it would be helpful to find ways to manage this sort of thing when it happens, so you don't go down the rabbit hole of trying to predict how others perceive you, and letting that thought drive you crazy.

I agree. This guy has spent more time with me combined than all other block directors for feedforward process. He’s said “He’s invested in me now and if could keep him updated on my mental health.” My best friend from med school had small group with him and said he’s nice. He ends all his emails to me with “All the best” too.

He ended up extending feedforward to help me in further blocks and I think it was definitely made with kind intentions. Overall this guy goes out of this way for his students, more so that other block directors/specialty advisors I’ve met and interacted with.

“In the end, I want this to be helpful to you and to provide some support to help avoid concerns down the road - I want you to do well on the more intensive blocks. As is stated by Dr. X below, you have a number of strengths - but anxiety vs attention vs reading the room do at moments seem to get in your way.”

 

[Mass Effect]

Attending psychiatrist here.

2. To those that say have thicker skin, it is important to remember that emotional resilience is built upon many factors. Social anxiety disorder for example, the key factor is fear of being ridiculed/judged by others. If someone presents to the clinic with that complaint, I do not think my response would be "have thicker skin", lol.

As a psychiatrist as well, I have to say that to be fair, this isn't a clinic and we are not her psychiatrists. I wouldn't say "have thicker skin", but I would say on this forum where she is voluntarily seeking advice, she didn't handle any of this well and needs to work on that. I don't think it's out of line to be truthful and even blunt about that.

 

[Lawpy]

As a psychiatrist as well, I have to say that to be fair, this isn't a clinic and we are not her psychiatrists. I wouldn't say "have thicker skin", but I would say on this forum where she is voluntarily seeking advice, she didn't handle any of this well and needs to work on that. I don't think it's out of line to be truthful and even blunt about that.

Sad to say, i'm realizing the adviser is even more justified in providing the comments he did, even though they're blunt and direct

 

[voodoomagic]

Hi everyone,

I'm an MS3 at a top 30 allopathic school. I want to be a psychiatrist but my specialty advisor said something recently that hurt my feelings. I was involved in a process at my school called "feedforward." Essentially, students who are struggling in rotations are given special attention from the subsequent block director to check in with attendings to see if the issue has resolved. Long story short, I've had some interpersonal and mental health problems this year, specifically anxiety that impacted my ability to perform as a student. I'm being treated for it now, but on my psych rotation, my block director was informed that "I tend to get flustered when anxious and that my interviews with patients go downhill subsequently." He later said to me in a private Zoom session “Psychiatry may not be a good fit for you if you’re not good at reading social cues and if anxiety gets in the way. Perhaps you shouldn’t even do clinical medicine and pursue pathology instead.” I sent an email back saying he hurt my feelings and wishing he would support me going forward. In response, I got this message....

Thanks for your email and I am sorry that my statement was challenging to hear and hurtful. I am supportive of you and your choice and will do all that I can to help you in the process of preparing for residency and through the process of applying. I do still think that reading social cues is an important aspect of psychiatric practice - however, I haven't had the sense in our interactions that this has been problematic and as we discussed anxiety or problems of attention can also lead to the perception of problems "reading the room." In any event, I am glad you are doing well and taking steps to care for yourself. While I want to be direct and honest when advising students, I never want to be hurtful, and I apologize given what I said has clearly weighed on you over these past couple of months.

My question to you all:

Do you think this guy is trying to be mean to me or is it legitimately just being frank? Sometimes, I sense in conversations that he may be biased towards me b/c I'm a struggling student. I feel I'm not on an equal playing field with other candidates as a result of this feedforward process. I'm worried b/c his opinion of students at this school holds weight at the residency program and I'm actually really interested in my home program. I feel like I kinda forced him to say he supports me but he did not go forward HIMSELF to say he does that and I subsequently am not sure if he truly supports me or not. What are your thoughts?