Serious: Psychiatry Residency Programs to Steer Clear Of

[Auvelity]

What about the prematch programs? Are they malignant too?

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[MacDonaldTriad]

Not using disciplinary measures when indicated has its own collateral damage to patient care and resident quality of life and is ten times more prevalent than using discipline when it isn't appropriate.

 

[pbdoctor1]

Not using disciplinary measures when indicated has its own collateral damage to patient care and resident quality of life and is ten times more prevalent than using discipline when it isn't appropriate.

Great point and I believe everyone is in agreement about this and no one is denying this. There needs to be discipline that is judicious to anyone that is toxic or incompetent. The definition of judicious is a discussion in itself but it is not the main issue of concern.

Let me try and change the perspective with this logic when you flip this around. Sure it can be applied to residents. The bigger question is why are we not also disciplining and removing incompetent or abusive program directors or attendings? They are bad at managing and misusing their power with reckless punishment, silencing those who speak up, and teaching fear. Many see their harm as a much greater problem for ALL programs and a deeper issue.

What's perplexing and somewhat troubling for the community is the reluctance by training directors or attendings to acknowledge the abuse from colleagues from their response on SDN about malignant programs. Most are redirecting focus by blaming mostly residents. Worse there is a lack of any call to action to remove these PDs and attendings that repeatedly harass multiple residents. This makes some question what the real motivation is from the response by directors and attendings. We know residency is a vulnerable position and the abuse of power erodes trust and integrity of the training process. Are we ignoring or embracing it because they are colleagues? Shouldn't we speak out againt those PD and attendings who are overtly malignant?

“Bad men need nothing more to compass their ends, than that good men (or women) should look on and do nothing."


I think many SDN members feel concerned that the words and intent of good programs about themselves don't match why there is no real collective action by them to stop known abuse from malignant training directors. It may hint at a larger issue. There are private list serves, phone calls, and meetings and active communication between training directors. Some question if anyone is speaking out against what is going on? Why equate yourself with them? What if you inadvertently associate yourself with defending, protecting, or hiding the "Harvey Winstein" of medicine as your defend yourself?
The claim that it is too "hard" and complex to stop this it is simply not true. We discipline and punish "problem residents" all the time. You put it nicely by saying "this is a chronic issue that if neglected can decay into bad situations". Let's not neglect it because it has already.

This mirrors the societal changes of perceptions to abuses of power. In the past the majority of society felt uncomfortable talking about sexual harassment, gender inequality, and racial discrimination of minorities. Today we actively reject it and help protect against it. We can absolutely have accountability of abusive training directors but we don't. Without a response we see the expected misuse of power which reeks of willful ignorance, incompetence, harassment, or prejudicial and discriminatory behaviors. It matters that there is justice and decency in how we treat each other in ALL programs. It makes us all look bad if we don't.

We know the abuse and the degree of malignancy is egregious in some places. We need to reject it among our peers but we don't. It speaks volumes to trainees when we do nothing or that they see the same PD that repeatedly abuses or condones harassment. It appears as if we empathize with them as we defend ourselves. Worse it indirectly sends a message to applicants that all training programs do in fact condone harassment even if they say they don't. It's therefore rational to understand why some trainees are silent and internalize abuse. Harassment can happen to anyone in any residency good or bad. Applicants and trainees may not feel safe, even in good programs if they can't trust that ALL programs really want to help protect against abuse. I mean programs won't even stand up against extreme cases of harassment. Some even shut down any voices that speak up or open a dialogue. This is the core problem and why so may physicians burn out in ALL residencies.

Applicants therefore bear the burden of finding that information if we silence the discussion or don't actively prevent it from happening between colleagues in ALL residency programs. This doesn't even include the places with poor training, focus on work rather than education, or just plain disorganization. These problems are likely occurring in these "problem programs" and explains the burnout and malignant behaviors are overt reactions by leaders to try and hide it.

 

[Stagg737]

I want to add, that any program will give you good training and make you an excellent Psychiatrist if you have the right attitude.

I respectfully disagree. After talking to the senior residents at one program on the interview trail I was concerned about the education I'd receive there. After talking to alumni of the program irl and on here and hearing their comments on the program, I considered not ranking that program at all.

That being said, this was NOT a malignant program and the PD seemed like a great person (and residents and alumni agreed with that), there were just certain areas of psych where the training was significantly lacking (from what alumni told me). Won't derail the thread further, just wanted to point out that imo you need more than hard work and the right attitude to be an excellent psychiatrist.

 

[Mass Effect]

I am so confused by this thread. We're talking in circles and the bottom line is, abusive people suck, no matter if they're residents or PDs or attendings.

 

[pbdoctor1]

I am so confused by this thread. We're talking in circles and the bottom line is, abusive people suck, no matter if they're residents or PDs or attendings.

Well the confusion is because some who talk about being good/nice and needing to "discipline" abusive people are talking mainly about trainees but don't voice the same logic or passion towards program directors and faculty. One is powerless and punished, the other is not. The consequences also much greater. It's the concept of moral licensing or moral credentialing effect, a known cognitive bias.

This however influences a perception of false equivalence and confusion for applicants. Why do that? Why ignore the problem?

"Justice cannot be for one side alone, but must be for both." ~Eleanor Roosevelt

(Not referring to you of course and definitely not defending overtly abusive sucky residents or colleagues. 😉)

We don't need to relate or empathize with this guy:
"The truth is that parents are not really interested in justice. They just want quiet." ~Bill Cosby

 

[Mass Effect]

Well the confusion is because some who talk about being good/nice and needing to "discipline" abusive people are talking mainly about trainees but don't voice the same logic or passion towards program directors and faculty. One is powerless and punished, the other is not. The consequences also much greater. It's the concept of moral licensing or moral credentialing effect, a known cognitive bias.

This however influences a perception of false equivalence and confusion for applicants. Why do that? Why ignore the problem?

"Justice cannot be for one side alone, but must be for both." ~Eleanor Roosevelt

(Not referring to you of course and definitely not defending overtly abusive sucky residents or colleagues. 😉)

We don't need to relate or empathize with this guy:
"The truth is that parents are not really interested in justice. They just want quiet." ~Bill Cosby

I don't get the sense that anyone is ignoring the problem, but the emphasis is on residents because many feel there are more toxic residents in the world than there are PDs and attendings. Those toxic residents grow up to become toxic PDs, so cutting them off prior to them getting to that point is warranted to fight the overall problem.

 

[pbdoctor1]

I don't get the sense that anyone is ignoring the problem, but the emphasis is on residents because many feel there are more toxic residents in the world than there are PDs and attendings. Those toxic residents grow up to become toxic PDs, so cutting them off prior to them getting to that point is warranted to fight the overall problem.

True but are we putting the cart before the horse? It's much more important that we prioritize the focus at the origin of harassment which comes from the top. We know that the years of trying to cut off toxic residents hasn't been effective in reducing this problem because we've made little attempt the other way around. Cutting off and eliminating toxic program directors and attendings is much more important and the core issue because trainees mirror this behavior. They produce malignant physicians and create environments that promote toxic behaviors because it feels normal to them. These behaviors proliferate at these programs and worse also spreads to other training directors and residency programs. This poses a risk for applicants who want to avoid these places and these people. Also it creates misery for unfortunate trainees who become traumatized by these difficult people. Inaction with regards to abusive behaviors and repeated harassment from toxic directors or faculty is beyond comprehension.

Confronting the root of the problem by removing toxic PDs or attendings would be more effective in the long run. Also it would change the sense of learned helplessness among trainees because when we enforce toxic behaviors at the top it signals to applicants and abusers that there is zero tolerance for harassment or outrageous behaviors of even PD and faculty during training. We shouldn't be creating trauma in residency because of inaction against harassment from the top. It's lacks introspective reasoning and looks bad. Creating depression (burnout), anxiety, PTSD, and suicidal ideation of future physicians should not be a part of any training program but it is happening as shown in the research on physician suicide and burnout. Paradoxically we don't recommend that our patients tolerate and internalize harassment but somehow tell applicants its ok and not to recognize this problem. It shouldn't mirror the Stanford prison experiment.

 

[Mass Effect]

True but are we putting the cart before the horse? It's much more important that we prioritize the focus at the origin of harassment which comes from the top. We know that the years of trying to cut off toxic residents hasn't been effective in reducing this problem because we've made little attempt the other way around. Cutting off and eliminating toxic program directors and attendings is much more important and the core issue because trainees mirror this behavior. They produce malignant physicians and create environments that promote toxic behaviors because it feels normal to them. These behaviors proliferate at these programs and worse also spreads to other training directors and residency programs. This poses a risk for applicants who want to avoid these places and these people. Also it creates misery for unfortunate trainees who become traumatized by these difficult people. Inaction with regards to abusive behaviors and repeated harassment from toxic directors or faculty is beyond comprehension.

Confronting the root of the problem by removing toxic PDs or attendings would be more effective in the long run. Also it would change the sense of learned helplessness among trainees because when we enforce toxic behaviors at the top it signals to applicants and abusers that there is zero tolerance for harassment or outrageous behaviors of even PD and faculty during training. We shouldn't be creating trauma in residency because of inaction against harassment from the top. It's lacks introspective reasoning and looks bad. Creating depression (burnout), anxiety, PTSD, and suicidal ideation of future physicians should not be a part of any training program but it is happening as shown in the research on physician suicide and burnout. Paradoxically we don't recommend that our patients tolerate and internalize harassment but somehow tell applicants its ok and not to recognize this problem. It shouldn't mirror the Stanford prison experiment.

You're severely underestimating the dramatic AND traumatic impact of a toxic resident on a program. A malignant or severely personality disordered resident can terrorize his/her colleagues with as much damage as any PD. At least the PD is bound by institution-specific due process. A toxic resident can wreak havoc and instill fear in all the other residents before the PD even catches wind of it and I would bet those residents have been responsible for inspiring thoughts of suicide or even attempted or completed suicides among those they've harassed and terrorized.

 

[MacDonaldTriad]

Someone has some baggage

 

[Monocles]

You're severely underestimating the dramatic AND traumatic impact of a toxic resident on a program. A malignant or severely personality disordered resident can terrorize his/her colleagues with as much damage as any PD. At least the PD is bound by institution-specific due process. A toxic resident can wreak havoc and instill fear in all the other residents before the PD even catches wind of it and I would bet those residents have been responsible for inspiring thoughts of suicide or even attempted or completed suicides among those they've harassed and terrorized.

Sorry I missed the earlier parts of the discussion. When you say residents terrorising people do you mean like years below them (ex: senior harassing juniors) or do you mean co-residents of the same year??

 

[MedMan80]

I suppose it can go both ways, but a resident is more easily accountable to termination than a PD I would say and plenty more residents get the axe than PD's do.

 

[deleted736562]

Unless you're a chief which you're very unlikely to be if you're malignant, residents don't have authority over each other. Yes, they might create trouble but it is an entirely different dynamic than a malignant attending who supervises you or a PD. Come on. The comparison is a bit ridiculous.

 

[MedMan80]

Unless you're a chief which you're very unlikely to be if you're malignant, residents don't have authority over each other. Yes, they might create trouble but it is an entirely different dynamic than a malignant attending who supervises you or a PD. Come on. The comparison is a bit ridiculous.

Agreed, I think with the prior responses some PD's/APD's were showing their colors!

 

[Mass Effect]

Sorry I missed the earlier parts of the discussion. When you say residents terrorising people do you mean like years below them (ex: senior harassing juniors) or do you mean co-residents of the same year??

Both.

Unless you're a chief which you're very unlikely to be if you're malignant, residents don't have authority over each other. Yes, they might create trouble but it is an entirely different dynamic than a malignant attending who supervises you or a PD. Come on. The comparison is a bit ridiculous.

What exactly is ridiculous about it? Believe me, once you see this happen, you'll never forget that it does and can happen. You don't have to have "authority" over each other in order to bully others. If authority was the pre-requisite, then there would be no such thing as high school bullying by peers, would there? Bullies grow up and some of them make it past the med school weeding process and wreak havoc wherever they can. To suggest otherwise is naive.

 

[deleted736562]

Both.



What exactly is ridiculous about it? Believe me, once you see this happen, you'll never forget that it does and can happen. You don't have to have "authority" over each other in order to bully others. If authority was the pre-requisite, then there would be no such thing as high school bullying by peers, would there? Bullies grow up and some of them make it past the med school weaning process and wreak havoc wherever they can. To suggest otherwise is naive.

We all have dealt with the bullying/problematic colleague. By the time we reach residency most of us know how to set proper boundaries. For most of psychiatry residency (at least in my experience) residents work more or less independently from each other, under supervision of an attending, whether inpatient or outpatient.

It's just an entirely different level/dynamic than what occurs with someone who actually has authority over you and can abuse it. So yeah, I don't think there are any valid parallels there.

 

[NYC4Life]

AVOID Staten Island University Hospital psychiatry residency. It's a malignant program.

 

[Stagg737]

We all have dealt with the bullying/problematic colleague. By the time we reach residency most of us know how to set proper boundaries. For most of psychiatry residency (at least in my experience) residents work more or less independently from each other, under supervision of an attending, whether inpatient or outpatient.

It's just an entirely different level/dynamic than what occurs with someone who actually has authority over you and can abuse it. So yeah, I don't think there are any valid parallels there.

We work "independently" at my program, but on our actual inpt psych rotations it's not uncommon to have 3-4 residents in the same room at once or be working on the same unit. My program doesn't seem to have these kind of issues, but the opportunities are there.

 

[deleted736562]

We work "independently" at my program, but on our actual inpt psych rotations it's not uncommon to have 3-4 residents in the same room at once or be working on the same unit. My program doesn't seem to have these kind of issues, but the opportunities are there.

Sure, the kind of problems people face in every workplace. There will always be someone who's "off" and who's problematic. The difference is that, being colleagues, you have space to set your boundaries and I may wager it would be a learning opportunity to learn to deal with these kind of situations.

Add authority to the equation, and you are in a completely different ball game.

 

[Mass Effect]

We all have dealt with the bullying/problematic colleague. By the time we reach residency most of us know how to set proper boundaries. For most of psychiatry residency (at least in my experience) residents work more or less independently from each other, under supervision of an attending, whether inpatient or outpatient.

It's just an entirely different level/dynamic than what occurs with someone who actually has authority over you and can abuse it. So yeah, I don't think there are any valid parallels there.

You'll see the parallel if/when you witness it. Believe me, it's just as traumatic to the people involved and just as problematic to the program as a whole. At least the PD is bound by due process, GME, and some kind of promotions committee. Not so for a resident. Often in these cases, others don't speak up for fear of retaliation or getting a colleague into trouble.

As for residents working together, this is not true of all programs. In my experience, residents in the same class work very closely together, on the inpatient unit, on CL, and even in outpatient if they run a group together or are paired up for family therapy, etc. They also supervise junior residents and work directly with them on call shifts and night float, so there is plenty of opportunity for bullying. It's easy to say set boundaries until you actually deal with someone like this for the first time and you're forced to work with them.

 

[deleted736562]

You'll see the parallel if/when you witness it. Believe me, it's just as traumatic to the people involved and just as problematic to the program as a whole. At least the PD is bound by due process, GME, and some kind of promotions committee. Not so for a resident. Often in these cases, others don't speak up for fear of retaliation or getting a colleague into trouble.

As for residents working together, this is not true of all programs. In my experience, residents in the same class work very closely together, on the inpatient unit, on CL, and even in outpatient if they run a group together or are paired up for family therapy, etc. They also supervise junior residents and work directly with them on call shifts and night float, so there is plenty of opportunity for bullying. It's easy to say set boundaries until you actually deal with someone like this for the first time and you're forced to work with them.

Not sure why you allow yourself to condescendingly infer what is or what isn't my experience. Almost every program has its share of the one or two problem residents everyone will deal with. it doesn't come anywhere close as dealing with the "problem attending". i have worked with both. the very sense of authority and privilege the attending status brings, nevermind a pd, drowns your inner and outer voice. I really don't know how you can so easily dismiss the authority factor in here, unless you're coming in with your own agenda... let's make it about the residents. and yes there will be a lot of resident interaction, but for the most part you're working with attendings, you're evaluated by attendings...etc

BTW the bullying never stops. I've seen my share of attending-attending bullying and messed up dynamics. I wouldn't compare it when it's coming from a superior who literally can control the future of all of your career.

Anyway not arguing this further.

 

[Mass Effect]

Not sure why you allow yourself to condescendingly infer what is or what isn't my experience. Almost every program has its share of the one or two problem residents everyone will deal with. it doesn't come anywhere close as dealing with the "problem attending". i have worked with both. the very sense of authority and privilege the attending status brings, nevermind a pd, drowns your inner and outer voice. I really don't know how you can so easily dismiss the authority factor in here, unless you're coming in with your own agenda... let's make it about the residents. and yes there will be a lot of resident interaction, but for the most part you're working with attendings, you're evaluated by attendings...etc

Anyway not arguing this further.

You criticize my post for inferring your experience, yet accuse me of having an agenda? That's hilarious. My only agenda is to offer a very real and troubling factor in a very skewed thread that is full of slanted propaganda. It's easy to blame attendings and PDs because of the authority factor while pretending that troubled residents can't cause the exact same psychological damage in other residents. That's called having an agenda, not my balanced posts in this thread. As I said about 20 days ago, no matter the role, abusive people suck. They don't suck less just because they're a resident.

 

[deleted736562]

They don't suck less just because they're a resident.

They certainly suck a lot more when they are in a position of authority and power. Do we have to spell that out? Those abusive residents btw are a 100% more awful when they are torturing a student. And yes I've seen that too, and it evokes the same feelings when attendings do it to residents.

I don't think anyone's point here is that attendings are more abusive than any other population or that attendings are big ole evil bunch. It's about the issues inherent in a system that make this kind of abuse possible, how they disempower certain populations and what to do empower the weaklings to stand up to abuse of authority. The "residents do it to each other" is certainly very left field....at best.

 

[Mass Effect]

They certainly suck a lot more when they are in a position of authority and power. Do we have to spell that out? Those abusive residents btw are a 100% more awful when they are torturing a student. And yes I've seen that too, and it evokes the same feelings when attendings do it to residents.

I don't think anyone's point here is that attendings are more abusive than any other population or that attendings are big ole evil bunch. It's about the issues inherent in a system that make this kind of abuse possible, how they disempower certain populations and what to do empower the weaklings to stand up to abuse of authority. The "residents do it to each other" is certainly very left field....at best.

If you follow and comprehend the thread, it isn't at all left field. It fits in perfectly well and is incredibly relevant to the point of the thread. Abuse in medicine comes in ALL forms and while power differential is a factor, lateral abuse is not harmless by any means and in some cases, can cause just as much harm as abuse coming from someone in a position of authority. Also, while it's your experience that abuse sucks a lot more coming from someone of authority, don't discount the experience of others who've been on the receiving end of lateral abuse.

 

[deleted736562]

If you follow and comprehend the thread, it isn't at all left field. It fits in perfectly well and is incredibly relevant to the point of the thread. Abuse in medicine comes in ALL forms and while power differential is a factor, lateral abuse is not harmless by any means and in some cases, can cause just as much harm as abuse coming from someone in a position of authority. Also, while it's your experience that abuse sucks a lot more coming from someone of authority, don't discount the experience of others who've been on the receiving end of lateral abuse.

We should address all kinds of abuse. No one would argue with that. I certainly am not discounting anyone's experience. I'm all for a culture that exposes and breaks down lateral and hierarchical abuse. At the end of the day, all subjective experience is worth the same.

Can't we address the systematic issues that make abuse of authority possible AS WELL AS addressing lateral abuse? In that sense, how is this thread "propaganda" if it tries to specifically address hierarchical abuse and what to do about it? Are we denying those issues exist? My impression is actually that the latter was brought up to discount/whitewash the former.

 

[Mass Effect]

We should address all kinds of abuse. No one would argue with that. I certainly am not discounting anyone's experience. I'm all for a culture that exposes and breaks down lateral and hierarchical abuse. At the end of the day, all subjective experience is worth the same.

Can't we address the systematic issues that make abuse of authority possible AS WELL AS addressing lateral abuse? In that sense, how is this thread "propaganda" if it tries to specifically address hierarchical abuse and what to do about it? Are we denying those issues exist? My impression is actually that the latter was brought up to discount/whitewash the former.

I think you should probably go back to page 1 of this thread and read it with the goal of understanding why the discussion about toxic residents is necessary. The argument made is that residents in trouble have no recourse because of the power differential and therefore the problem is malignant PDs. It is not irrelevant or manipulative to the thread for some of us to point out that many times, when a resident is in trouble, it's because he/she is the toxic one in the situation, not the PD. This is pretty basic.

Not a single person in this thread stated that we can't address the abuse by some PDs and attendings. What people said was that putting all the emphasis on the PDs and attendings while ignoring the problems these toxic residents bring to the situation is short-sighted and does nothing to rid the field of medicine of abuse as lateral abuse is just as damaging.

 

[calvnandhobbs68]

I think you should probably go back to page 1 of this thread and read it with the goal of understanding why the discussion about toxic residents is necessary. The argument made is that residents in trouble have no recourse because of the power differential and therefore the problem is malignant PDs. It is not irrelevant or manipulative to the thread for some of us to point out that many times, when a resident is in trouble, it's because he/she is the toxic one in the situation, not the PD. This is pretty basic.

Not a single person in this thread stated that we can't address the abuse by some PDs and attendings. What people said was that putting all the emphasis on the PDs and attendings while ignoring the problems these toxic residents bring to the situation is short-sighted and does nothing to rid the field of medicine of abuse as lateral abuse is just as damaging.

There's a difference between dealing with a co-worker who's being a d*ck and a boss who's being a d*ck.

I don't get why you're missing that point here.

 

[Mass Effect]

There's a difference between dealing with a co-worker who's being a d*ck and a boss who's being a d*ck.

I don't get why you're missing that point here.

Why do you think my disagreement with that statement is me missing the point? It isn't, in any way, shape, or form. The psychological ramifications of a boss being a dick can be identical to the psychological ramifications of a co-worker being a dick. If that wasn't the case, then we wouldn't have so many teen suicides due to peer abuse/bullying. Toxic residents wreak havoc on the entire program and they also hold some authority over junior residents and medical students in terms of evaluations. This is where the problems start. Malignant PDs didn't just become malignant overnight. They were once malignant residents too.

 

[Shufflin]

 

[PsychApp777]

AVOID Staten Island University Hospital psychiatry residency. It's a malignant program.

Can you please elaborate on that? What about it is malignant? Thanks.

 

[yanks26dmb]

AVOID Staten Island University Hospital psychiatry residency. It's a malignant program.

I interviewed here, didn't get that vibe at all..but maybe you know something I don't. Any reason for saying that?

 

[pbdoctor1]

Why do you think my disagreement with that statement is me missing the point? It isn't, in any way, shape, or form. The psychological ramifications of a boss being a dick can be identical to the psychological ramifications of a co-worker being a dick. If that wasn't the case, then we wouldn't have so many teen suicides due to peer abuse/bullying. Toxic residents wreak havoc on the entire program and they also hold some authority over junior residents and medical students in terms of evaluations. This is where the problems start. Malignant PDs didn't just become malignant overnight. They were once malignant residents too.

The community hopes you and others are coming to this discussion without an agenda and genuine intent to act on solutions to resolve malignant programs (which I believe you are given your personal conflict on this issue). The discomfort and automatic resistance and defense is due to cognitive dissonance.

It include:

• You’re presented with irrefutable evidence and information that goes against beliefs you hold with a deep conviction (e.g. political or religious beliefs)
• You’re fully committed to the belief and have taken action that is difficult to undo (e.g. you have a leadership role in medicine, a gang, a political party or a religion)
• You act in a way that directly conflicts with your strongest beliefs and values
• You’re forced to do something you don’t want to do

The solutions:

• Change your beliefs (which isn’t always easy especially if the belief is a long held personal, political, or religious belief, if it relates to your self-image, or if it might cause the collapse of an entire web of mutually-supporting beliefs)
• Change your behavior to align with your beliefs (“I’m better than this. No more junk food or smoking!”)
• Ignore, justify, rationalize, or trivialize the contradiction/incompatibility (“Who cares?” “It isn’t that bad” “It’s not a big deal” “Nobody’s perfect”)
• Compartmentalize
• Add new thoughts, change perspectives and the way you think about it (“I’m eating junk food now but I’ll work out later)
• Try to convince yourself that there is no contradiction
• Be indifferent to the contradiction that is inducing the mental stress
• Avoid, ignore, or deny any information which might conflict or contradict what you believe and cause cognitive dissonance.

(I copied the above from online)

Irrespective of personal feelings or self defense, physician suicides and burnout are symptoms associated to a serious crisis. Medicine trains us to trust and respect those in power, even under harassment. It reinforces cognitive dissonance and compartmentalization to avoid narcissistic injury. We all despise it but accept it, until trust is eroded when a director or attending violates personal and professional boundaries. It has left some to be traumatized and burn out from this mental conflict. The solution requires critical thinking to nudge the community to do what's right. A starting point can begin by removing the same toxic training directors or programs. It's a very low bar to start from. We can inspire positive and just leadership for residents and applicants when we hold the bar higher for ourselves.

The normalization of this problem with cognitive dissonance is harmful for trainees leading to unintended consequences. Applicants know that because we aren't trying to fix this problem our dialogue both good and bad are the only means to help them avoid toxic directors and programs. We don’t need another suicide to inspire us to act instead of doing nothing. We do not need comforting rationalizations or “thoughts and prayers” but acts of real leadership.

"A tragedy is the imitation of an action that is serious and also, as having magnitude, complete in itself ... with incidents arousing pity and fear, where with to accomplish its catharsis of such emotions." — Aristotle

Happy Holidays!

 

[Mass Effect]

The community hopes you and others are coming to this discussion without an agenda and genuine intent to act on solutions to resolve malignant programs (which I believe you are given your personal conflict on this issue)

I have no agenda. I do have biases based on personal experience, as do you as evident by your posts. We ALL have biases to some degree. It's not a bad thing. They influence us and shape our views about things. Based on my experience, I feel I can 100% see both sides and understand both sides. However, this particular thread is tilted beyond belief to one side and it runs the risk of ignoring the other side of the issue, which is just as important and just as prevalent (if not more so).

The discomfort and automatic resistance and defense is due to cognitive dissonance.

It include:

• You’re presented with irrefutable evidence and information that goes against beliefs you hold with a deep conviction (e.g. political or religious beliefs)
• You’re fully committed to the belief and have taken action that is difficult to undo (e.g. you have a leadership role in medicine, a gang, a political party or a religion)
• You act in a way that directly conflicts with your strongest beliefs and values
• You’re forced to do something you don’t want to do

The solutions:

• Change your beliefs (which isn’t always easy especially if the belief is a long held personal, political, or religious belief, if it relates to your self-image, or if it might cause the collapse of an entire web of mutually-supporting beliefs)
• Change your behavior to align with your beliefs (“I’m better than this. No more junk food or smoking!”)
• Ignore, justify, rationalize, or trivialize the contradiction/incompatibility (“Who cares?” “It isn’t that bad” “It’s not a big deal” “Nobody’s perfect”)
• Compartmentalize
• Add new thoughts, change perspectives and the way you think about it (“I’m eating junk food now but I’ll work out later)
• Try to convince yourself that there is no contradiction
• Be indifferent to the contradiction that is inducing the mental stress
• Avoid, ignore, or deny any information which might conflict or contradict what you believe and cause cognitive dissonance.

(I copied the above from online)

No need for the lesson. I'm pretty well-versed in mental health and understand what cognitive dissonance is.

Irrespective of personal feelings or self defense, physician suicides and burnout are symptoms associated to a serious crisis. Medicine trains us to trust and respect those in power, even under harassment

It also teaches us not to complain or snitch on our colleagues. The AMA's code of ethics allows and encourages us to come forward, but there's an unspoken code of silence among medical trainees that allows toxic personalities to rise through the ranks and eventually become attendings. What happens is these residents are eventually terminated (like Eugene Gu) and they say they were harassed or bullied. In many cases, their insight is so impaired that they come up with asinine reasons for their dismissal (like that resident who claims she was fired for having cancer when in court documents, it's quite clear she was fired for not doing her job).

It reinforces cognitive dissonance and compartmentalization to avoid narcissistic injury. We all despise it but accept it, until trust is eroded when a director or attending violates personal and professional boundaries. It has left some to be traumatized and burn out from this mental conflict. The solution requires critical thinking to nudge the community to do what's right. A starting point can begin by removing the same toxic training directors or programs. It's a very low bar to start from. We can inspire positive and just leadership for residents and applicants when we hold the bar higher for ourselves.

I never argued that toxic training directors shouldn't be training directors and that they do more harm than good when it comes to resident well-being. Where we seem to disagree is in the prevalence and seriousness of toxic residents and the appropriate response to them. A toxic training director was once a toxic resident. The more we allow toxic residents to graduate in this system, the more toxic training directors we turn out. It begins in residency (or med school). That's your starting point. Who knows how many fellow residents you may help by reigning in a toxic colleague? If we truly investigated all the bullying that goes on in medicine, I bet you'd find plenty of cases where the bullying was done by a fellow resident and not an attending.

The normalization of this problem with cognitive dissonance is harmful for trainees leading to unintended consequences

Agreed. Bullying of any kind should never be tolerated. It doesn't matter who's doing the bullying.

We don’t need another suicide to inspire us to act instead of doing nothing. We do not need comforting rationalizations or “thoughts and prayers” but acts of real leadership

You're right, but we also can't be myopic and I feel like a lot of posts in this thread are. The problem is not solely with those in administration. It's with ALL of medicine. If people can't treat peers with respect, there's no way they will treat subordinates with respect.

 

[deleted736562]

I don't really think the problem is the occasional "toxic" resident or attending (that term is very relative btw). The whole system is toxic and we do an excellent job at accepting, normalizing and internalizing. We are almost brainwashed to do so.

It doesn't help that residency is only 4 years so people are aware that they will exist the system, but the system stays. The whole thing is so pathologic that we in the medical field do become myopic how crazy our training is without some serious LEGAL guarantees to prevent workplace abuse ; guarantees that the defenders of the system chose to ignore. I think at the core of the issue is a realization that isn't about particular individuals but about a system in place. Some people are obviously invested in the status quo which makes change so difficult.

 

[Mass Effect]

I agree that the problem is primarily the system because it allows the bullies (whether residents, PDs, or attendings) to thrive. I don't know of a single person who defends the system or is invested in the status quo, even the bullies we're discussing. I think most people recognize that removing abuse from medicine means systemic changes at all levels and zero tolerance for abusive behavior, even in medical school.

 

[deleted736562]

I agree that the problem is primarily the system because it allows the bullies (whether residents, PDs, or attendings) to thrive. I don't know of a single person who defends the system or is invested in the status quo, even the bullies we're discussing. I think most people recognize that removing abuse from medicine means systemic changes at all levels and zero tolerance for abusive behavior, even in medical school.

Clearly the AMA and ACGME, hospital administrators and essentially the people that run the system are invested in it and uphold the status quo. It was the AMA and ACGME who lobbied for giving residency training an "exception" in the law so as not to be considered a primarily employed position when suits were filed against the match process for breaking antitrust laws. The core of the problem imo is the way residency training is sort of in limbo; somewhere in between a salaried employee position and apparenticiship. This is reflected in the match process all the way to multiple ways antitrust laws are breached. It's quite unique to the US btw in the west (some countries do run their own forms of slave labour for medical trainees), but most Western countries with strong tradition for protecting workers would never run a system like that one. It essentially gives a major upperhand to the employers and strips workers of much needed power and ability to negotiate and bargain.

Or course there are multiple other factors that allow abuse to seep in, but I think this is one of the major ones.

 

[pbdoctor1]

I agree that the problem is primarily the system because it allows the bullies (whether residents, PDs, or attendings) to thrive. I don't know of a single person who defends the system or is invested in the status quo, even the bullies we're discussing. I think most people recognize that removing abuse from medicine means systemic changes at all levels and zero tolerance for abusive behavior, even in medical school.

Agreed, a multi level approach to change the system should be encouraged to change the status quo. We should not be distracted from the systemic problem and not forget to address the failures of repeated bullying in specific programs. By removing those abusive directors we can also remove the basis of learned bullying. Our discussions can provide more transparency such that maladaptive behavior doesn't get taught and learned.

A plausible reason why current methods of focusing on "toxic" residents hasn't worked in reducing abuse is that malignant programs that threaten residents are not interested in reducing abusive behavior. They appear to be focused on keeping trainees to obey and selectively choosing which behaviors are acceptable, even if it means abusing medical students or other residents. Applicants want to avoid these programs because it breeds abusive behaviors. They continue to train more bullies because the subjective response by the PD is more discriminatory rather than an objective or empathic reasoning. They may even protect malignant residents who "play the game".

Clearly the AMA and ACGME, hospital administrators and essentially the people that run the system are invested in it and uphold the status quo. It was the AMA and ACGME who lobbied for giving residency training an "exception" in the law so as not to be considered a primarily employed position when suits were filed against the match process for breaking antitrust laws. The core of the problem imo is the way residency training is sort of in limbo; somewhere in between a salaried employee position and apparenticiship. This is reflected in the match process all the way to multiple ways antitrust laws are breached. It's quite unique to the US btw in the west (some countries do run their own forms of slave labour for medical trainees), but most Western countries with strong tradition for protecting workers would never run a system like that one. It essentially gives a major upperhand to the employers and strips workers of much needed power and ability to negotiate and bargain.

Or course there are multiple other factors that allow abuse to seep in, but I think this is one of the major ones.

You both really hit the nail on the head with this statement. There are people who are too lazy to engage in normative management or don't want systemic change because it benefits themselves since they built the system to have near authoritarian power. You can't claim to be nice and decent when you reinforce the system to be disproportionately and dangerously skewed or ignore continued pathological behaviors of colleagues then claim to be the sole fair arbiters to sort out "bad" residents. It's likely the reason why there is minimal enforcement up top. The result of trying to maintain this level of status quo has become so dire that the consequences are causing systemic harm with burnout and suicide occurring in more and more programs, forcing residents and medical students to accept the current system and ignore problems. It is becoming inhumane and egregious to blindly accept repeated bullying in some places given this known massive power differential.

There is a level of personal responsibility that needs to first be addressed beyond near insurmountable systemic problems. We can improve the system by targeting low hanging fruits beginning with educating applicants about malignant programs and then actively removing malignant PD, attending physicians, residents who misappropriate their power. Serious pathologies are being passed down because the system allows programs directors to ignore, protect, or collaborate with known incompetent or abusive PDs thereby allow bullying to thrive as long as it maintains the status quo. We don't want training programs to collude or tolerate this behavior as it trickles down to residents and medical students. We should be encouraging physicians to work together and hold a higher bar for training directors and demand professional accountability should anyone misuse this coveted privilege and abuse their power. This is a simple and necessary step to improve behaviors and systemic change that is decent and builds in critical thinking not dogma.

 

[Mass Effect]

Agreed, a multi level approach to change the system should be encouraged to change the status quo. We should not be distracted from the systemic problem and not forget to address the failures of repeated bullying in specific programs. By removing those abusive directors we can also remove the basis of learned bullying. Our discussions can provide more transparency such that maladaptive behavior doesn't get taught and learned.

Agreed.

A plausible reason why current methods of focusing on "toxic" residents hasn't worked in reducing abuse is that malignant programs that threaten residents are not interested in reducing abusive behavior

I'm not sure what you mean by threaten residents. If you mean telling toxic residents they're putting their jobs at risk due to their toxic behavior, I don't really consider that threatening or abusive. It is possible a toxic resident and a toxic PD could co-exist at a program and that kind of set-up has the potential for pure chaos.

They appear to be focused on keeping trainees to obey and selectively choosing which behaviors are acceptable, even if it means abusing medical students or other residents

I'm sure that might be the case at some programs, but I think there are some behaviors that are universally unacceptable and the argument that others are doing something else wrong doesn't really fly. It's like a drunk driver claiming they shouldn't get arrested because others shoplifted and didn't get caught if I'm understanding you correctly.

I don't know what you mean by the last part of your statement "even if it means abusing medical students or other residents"? Do you mean the PD is abusing medical students and other residents?

Applicants want to avoid these programs because it breeds abusive behaviors. They continue to train more bullies because the subjective response by the PD is more discriminatory rather than an objective or empathic reasoning. They may even protect malignant residents who "play the game".

If the residents "play the game" what makes them malignant? My definition of playing the game is doing everything right in order to fly under the radar so I don't understand.

There is a level of personal responsibility that needs to first be addressed beyond near insurmountable systemic problems. We can improve the system by targeting low hanging fruits beginning with educating applicants about malignant programs and then actively removing malignant PD, attending physicians, residents who misappropriate their power

I don't have a problem with this in theory, but I wouldn't begin by educating applicants. I'd begin by filing complaints against malignant programs first and foremost. I think targeting applicants has the potential to backfire and make the resident issuing the warning look like someone who has an ax to grind with the program.

 

[pbdoctor1]

I'm not sure what you mean by threaten residents. If you mean telling toxic residents they're putting their jobs at risk due to their toxic behavior, I don't really consider that threatening or abusive. It is possible a toxic resident and a toxic PD could co-exist at a program and that kind of set-up has the potential for pure chaos.

This happens more often than it sounds like in terms of a toxic PD working with a toxic resident to ensure fear. I mention "threaten" as in malignant programs often scare all their residents by placing many of them "on the radar" and having a history of multiple terminations and retaliations. These are repeated patterns of behaviors indicative of problems in the program that go beyond a resident's behavior. It's about conformity and obedience in spite of a toxic environment and less so about reducing abusive behaviors of an individual resident. These programs are "training" this type of bullying behavior in order to graduate and thus the cycle continues because the environment tends to be toxic. When you draft laws and policies that allow for overwhelming power to be potentially abused and it often does occur.

I'm sure that might be the case at some programs, but I think there are some behaviors that are universally unacceptable and the argument that others are doing something else wrong doesn't really fly. It's like a drunk driver claiming they shouldn't get arrested because others shoplifted and didn't get caught if I'm understanding you correctly.

Not defending blatantly toxic residents and they should and have been accountable but realistically its completely subjective and enforcement is solely up to how much it bothers PD. Hence, you can be toxic but sneaky and be ok.

I don't know what you mean by the last part of your statement "even if it means abusing medical students or other residents"? Do you mean the PD is abusing medical students and other residents?

I mean that a malignant program allows or encourages this type of behavior by a resident as they choose fit. It's a subjective process when a program defines a "problem resident" haphazardly. Often times this malignancy behavior is copied from the faculty or PD and translates downward to lower level residents or medical students.

If the residents "play the game" what makes them malignant? My definition of playing the game is doing everything right in order to fly under the radar so I don't understand.

Residents who "play the game" are hiding behaviors or worse tolerating a problem within the residency. Programs may also be selecting and training sociopathic behaviors this way because of mirroring effects by those in power. It's why toxic residents can complete residencies when they "fly under the radar".

We should be trying to change their thoughts process with support and education instead of forcing changes or obedience temporarily.

I don't have a problem with this in theory, but I wouldn't begin by educating applicants. I'd begin by filing complaints against malignant programs first and foremost. I think targeting applicants has the potential to backfire and make the resident issuing the warning look like someone who has an ax to grind with the program.

This method has been the status quo for years and the result has been retaliation, lack of oversight, and little to no enforcement of malignant program directors and attendings. We know that malignant programs persist and blatantly abuse despite other programs directors knowing this. Helping applicants avoid these programs is the least that can be done at this point to encourage accountability on abusive program directors and faculty and doing what's right.

The concern is that by refusing to get rid of incompetent or abusive PDs who treat residents and applicants as disposable commodities and setup rules and policies that are ripe for abuse, it creates a mentality of the disposable physicians in medicine, as we are beginning to see with increasing burnout and suicides. By focusing on the short term appeasement of administrators and focusing on money by setting up rules that encourage these abusive behaviors, we have lost our vision or ethical values in training future clinicians. The unintended long term consequence of this is the ever increasing burnout and suicides among all physicians.

 

[BearsBeetsBattlestar]

AVOID Staten Island University Hospital psychiatry residency. It's a malignant program.

Hi! Could you please elaborate on that?

 

[foreverbull]

This is an interesting discussion to me as an outsider (psychologist). Any place in which we are dependent on others to receive training for licensure and/or are in professional limbo puts us in a very vulnerable power position, generally-speaking.

Being from another field, I’m curious to hear from folks in here: how widespread is abuse, exploitation, harassment, etc. during residency? Is this just a few bad apple sites or somewhat common?

 

[liquidshadow22]

Why the ACGME Survey Falls Short in Identifying the Truth About Trainee Dissatisfaction

 

[Amygdarya]

This is an interesting discussion to me as an outsider (psychologist). Any place in which we are dependent on others to receive training for licensure and/or are in professional limbo puts us in a very vulnerable power position, generally-speaking.

Being from another field, I’m curious to hear from folks in here: how widespread is abuse, exploitation, harassment, etc. during residency? Is this just a few bad apple sites or somewhat common?

Depends on the specialty and individual residency. Eg., psychiatry residencies on average tend to be less malignant than most other specialties (particularly surgical ones). I don't think there's objective data on the prevalence of abuse etc for obvious reasons, but from my purely anecdotal and subjective understanding of it, it's a "bad apple" situation in psychiatry and more of a pervasive "culture" in, say, OBGYN and general surgery.

 

[Anon nonA]

AVOID Staten Island University Hospital psychiatry residency. It's a malignant program.

Unfortunately, this appears to be true. Look at this recent review on Scutwork.com:

Link: Staten Island University Hospital - Northwell Health (formerly NSLIJHS) | Scutwork by Student Doctor Network

Copy and pasted from site:
Review:
Posted 12/14/18
Overall Program Rating 1/5
SUMMARY
The quote in the title is verbatim from the end of a mandatory-attendance meeting in mid-December 2018 held by the Manager of G.M.E. and Academic Affairs and the V.P. of Med Education at S.I.U.H. All four classes, including two chief residents, from PGY1-PGY4 were in attendance; no administration or residency faculty were present. The supposed purpose of the meeting was to discuss the resident's "anonymous" online survey about "wellness"--which was also mandatory and completed several months earlier. It didn't take long before the residents opened up. After an hour of hearing the residents unload on the program director/chair (yes, it's the same person) and criticize the program for its many weaknesses, the Manager of GME exclaimed, aware that we're nearing the end of recruitment season, "So you guys are REALLY GOOD at lying to applicants!" Because I've spent time with applicants, corresponded with them over email and text, and have gone to recruitment dinners, the GME manager's comments hit me. I can't lie to applicants. I was lied to myself! DRAWBACKS: The administration/leadership doesn't have the skills to run a robust residency. The administration is failing in its obligations regarding medical education. The residents are the workforce for the hospital. The teaching sucks. We don't have a E.M.R. for the outpatient department. Inpatient experience sucks. Weak geriatric psychiatry experience. Weak child inpatient experience. Weak neurology experience. The seniors complain there is inadequate psychotherapy supervision during outpatient years (because there is no dedicated outpatient supervisor--the three outpatient clinic attendings see their own heavy caseload AND have to find time to supervise when they can. One PGY4 said that 10 patients were seen on one day and that only once case had supervision ). WOULD I REAPPLY: Hell no. I regret coming here. While I like the clinical faculty on an individual level, this is a bad place for training. GRADUATES: The program is new and has graduated two classes of four residents each. INQUIRIES BY APPLICANTS: Yes, please by all means contact me. Do not buy the hype on the website or from the P.D. or from overly-chirpy residents who praise the program. An audio recording of the December meeting featuring the comments of the residents exists. Do not judge the residency based on where graduates go or do.
MY SCHEDULE
Your first year will be spent between "off-service" rotations, i.e., internal medicine, general pediatrics, E.D., and psychiatry. The medicine experience is awful. You feel unsafe being "the doctor". The senior IM residents that you're working with on IM are overwhelmed by their own long lists of patients and have literally told me, when I could reach them during call duty, "Don't call me unless your patient is dying." The weekend call for IM is dangerous for patients but also residents. Handoffs by medicine residents are inadequate. The medicine residents are good people but they're in a hospital that demands that we speed up care, and unfortunately, this means that they don't really know their patients, and that when we come onto their service, it's just a mill. Forget the bio-psycho-social model. The Case managers have so much power in this hospital. They and other bean counters put pressure on medicine attendings and residents to churn patients out. On service, our days are long and our schedule has changed thanks in part to the after hours call schedule. We. Were. Not. Told. About. This. When. Being. Recruited. So that Northwell does not have to pay attendings for overnight call, administrators in the Northwell system in its brilliance (sarcasm) brought in telepsychiatrists which are based out of either Manhattan or Long Island. To cover the E.D. between the late afternoon and late evening hours, SIUH residents have been tasked with call-duty. This has essentially DOUBLED our call duty hours and worsened the quality of life for residents. There's no quality teaching during this time. Also, the overnight telepsych doctors complain to our program director if they are handed off more than 2 patients, and then our P.D. comes down on us, complaining that we're being too inefficient, instead of telling the telepsych people to screw off. Plus (no surprise to you readers): on new-innovations, many residents lie about duty hours. ELECTIVES: I would like to put together an elective and get it approved while here, but I'm not optimistic. Talking with the PGY4s, whose requests for electives were denied, I may have to just suck it up.
MY LEARNING EXPERIENCE
TEACHING: The attendings on the C.L. service, especially Dr. Shaikh and Dr. Segun, do teach when they can, but the service is busy. I and other residents enjoy working with the medical students who rotate with us. DIDACTICS: Most of the learning is self-driven. At the meeting, the senior residents especially the PGY4 class complained that the quality of the didactic sessions has deteriorated over the years. One said that the Friday 1-3 P.M. lectures aren't held most of the time especially now during recruitment/interview season. The didactic schedule posted online is fake and inaccurate. The title of the lectures posted on new-innovations is also not accurate. Residents have been asking for years for the powerpoints and readings to be posted beforehand, for the topics of the lectures/didactics to be posted beforehand, but the program is too disorganized for this to happen. A MAJOR problem, and this was pointed out by the V.P of Med Education at the meeting, is that the leadership doesn't have the skills. The V.P. of Med Education said that the former chairman Dr. Joffe who started the residency program, didn't have the skills to put together a curriculum. Since Dr. Joffe died, the program director also became chair and is stretched too thin. The P.D./Chair has contradictory roles: to increase productivity of the department -- R.V.Us, relative value units (profit for the hospital), by demanding more "efficiency" and output from workers -- but also (unfortunately?) has an obligation for training psychiatry residents, and managing the department which he does poorly -- and insists on more "scholarly activity" and in promoting a false image of the department. He insists on delegating nothing and micromanaging everything. More and more demands are placed on residents without consulting us about our schedules. It's a hierarchical, top-down structure, with an over-emphasis on authority, the over-usage of punishments and threats--a recipe for disaster, worker unhappiness, paranoia, fatigue, burnout, and bad patient outcomes. CONFERENCES: Grand rounds have been worthless.
MY LIFE AND ENVIRONMENT
PHYSICAL ENVIRONMENT OF WORK AREA: as pointed out repeatedly by the residents during the meeting, there is inadequate space to complete work (including privacy when we are trying to obtain Protected Health Information or collateral on the phone). At the north side, where we do the vast majority of the work on the consultation service, we share a crowded call room with THREE C.L. attendings. There is no on-site, in-hospital separate, dedicated "resident room" for work at north. We use these wireless spectra handsets but the service throughout the hospital is patchy and even non-existent in entire parts of the hospital. Wifi? What is wifi? There is no wifi in many parts of the hospital especially the outpatient building where we have lectures and meetings. CAMARADERIE: Among residents, good. Between attendings and residents: as pointed out during the meeting, sometimes antagonistic. You should know: every month there is a C.C.C. meeting where several faculty members meet in a room and/or call in to "discuss" the residents. In an ideal world, the residents would receive face-to-face feedback. However, what happens is that many of the participating attendings, who may not have even recently worked with the residents being discussed, end up piling on and slandering the residents. This meeting is not attended by the chairman/program director but is attended by the program coordinator who works closely with the P.D., and she takes notes, being careful not to attribute who said what. Then when the P.D. meets with residents one-on-one, the P.D. then conveys these defamatory remarks, creating a sense of paranoia and making the resident feel stupid and unprofessional. Good residents have been brought to tears by this humiliation. It's "crazy-making." LIFE OUTSIDE WORK: Yes, I have one, you should too. But don't come here.

 

[Monocles]

Unfortunately, this appears to be true. Look at this recent review on Scutwork.com:

Link: Staten Island University Hospital - Northwell Health (formerly NSLIJHS) | Scutwork by Student Doctor Network

Yikes! Those poor residents. :'(

On the other hand scutwork.com is amazing. I'm enjoying all these juicy deets hahahaha.

 

[uhmocksuhsillen]

Well that sounds like the definition of malignant. Would be very curious to hear the programs take on all of that.

 

[Mass Effect]

This is an interesting discussion to me as an outsider (psychologist). Any place in which we are dependent on others to receive training for licensure and/or are in professional limbo puts us in a very vulnerable power position, generally-speaking.

Being from another field, I’m curious to hear from folks in here: how widespread is abuse, exploitation, harassment, etc. during residency? Is this just a few bad apple sites or somewhat common?

It can be common, particularly in other fields. There are some malignant psychiatry programs too, although those are more rare, imo. I think the most important thing to keep in mind is that many residents who are terminated lack insight into the reason for termination, so it's easy to make it about abuse, exploitation, and harassment. We've seen it time and time again here on SDN, particularly in the general residency forum, where someone can post that they had to remediate one rotation 3 times, were put on probation twice, had to repeat another rotation, and finally missed a shift, and they still blame abuse and harassment for the cause of his/her termination.

Also important is that abuse and harassment can come from a co-resident just as easily as from those in charge. There can be malignant personalities in residency and sometimes, they're your peers. I remember one of my attendings telling me he went through residency with a resident his class was certain was a sociopath. He was 10ish years out of residency when he told me this story and she was on trial for murder. Those types of people do exist in training and many of them are the bullies you hear about (surgery and OB/Gyn is notorious for peer-to-peer bullying). It doesn't always come from the top.

 

[Amygdarya]

There is also a cross-specialty peer bullying, eg. ED residents bullying psychiatry consult residents into not getting psychiatric patients proper care. Don't get me started 😡

 

[XannyBarz]

There is also a cross-specialty peer bullying, eg. ED residents bullying psychiatry consult residents into not getting psychiatric patients proper care. Don't get me started 😡

i feel like Id probably tell another resident to SMD if they were being difficult. gonna have to watch those icare reports

 

[Mass Effect]

i feel like Id probably tell another resident to SMD if they were being difficult. gonna have to watch those icare reports

Except that that kind of thing is likely to get YOU in trouble, whether fair or not.