The "M" word

[LadyJubilee8_18]

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Whenever I talk to people about programs I'm considering, they seem to have heard that said program is "malignant". What does that really mean? For example, I was really impressed with Duke, but people warn me of how malignant the program is. Are the hours long? Attendings mean? Scut work? What programs are actually malignant, and what should really make applicants worry?

 

[Scaredshizzles]

Whenever I talk to people about programs I'm considering, they seem to have heard that said program is "malignant". What does that really mean? For example, I was really impressed with Duke, but people warn me of how malignant the program is. Are the hours long? Attendings mean? Scut work? What programs are actually malignant, and what should really make applicants worry?

There seems to be a correlation between malignancy and strong fellowship placement, lol.

 

[LadyJubilee8_18]

There seems to be a correlation between malignancy and strong fellowship placement, lol.

Thats also what I've noticed. Maybe there really isn't anything to worry about

 

[Scaredshizzles]

Thats also what I've noticed. Maybe there really isn't anything to worry about

Yea, I think one might as well go in with the attitude that I'm going to enjoy the hard work...Unless a program is actually having residents leave it, I wouldn't worry about a malignancy label too much, people like to complain, it is therapeutic.

 

[houstoncfh]

I think people mean different things when they say "malignant."

For instance: Some might think malignant might mean "poor ancillary services." I've heard on the trail about Columbia being a somewhat "malignant" program, and I think it might be because their ancillary services are less than stellar -- drawing blood yourself, having to transport the occasional pt to CT, etc. (This has purportedly gotten better over the last few years, btw).

Or it could mean: "busy." So a program where you take a bunch of overnight call and are constantly capped as opposed to a program where you have night float and occasionally win the game -- the former could be "malignant."

I think people worry that "malignant" means angry, bitter attendings and overworked, abused residents. Or a pyramidal program where you're competing with your fellow residents for next year's spots. I just haven't seen any programs that fit that description though.

There's another post either on here or the ERAS forum about what an imprecise term malignant is, and it's worth a read.

 

[Frugal Traveler]

Whenever I talk to people about programs I'm considering, they seem to have heard that said program is "malignant". What does that really mean? For example, I was really impressed with Duke, but people warn me of how malignant the program is. Are the hours long? Attendings mean? Scut work? What programs are actually malignant, and what should really make applicants worry?

Duke isn't malignant. You work hard and learn much just like any top 20 IM program with some exceptions (that are supposedly cush).

I think it is important to get a sense of the culture when you go to interview.
If you don't fit, you may feel alienated and hence dissatisfied. However, most programs have a culture that is broad-spectrum and would suit many applicants.

The best way to screen for malignancy is to find someone at the program from your school and have a heart-to-heart talk. Just ask what is up with the place, what have been the pros and cons, and get a sense of what type of person they are.

I can only think of a few programs that may not be universally friendly to a variety of applicants (and people know about these already).

 

[dragonfly99]

I think Duke IM got a rep. for being malignant for a variety of reasons. The main reason is/was probably that it's one of those high powered academic places where you just work really hard, particularly as an intern, and there are a lot of patients who are...well...really sick. Also, they used to make all the interns where short white coats, like med students, and white pants; this led to the perception that interns were looked down upon, and I think they've done away with this tradition. They also used to have a generally vague reputation of not having that "nice" of an atmosphere, which I assume meant that the attendings may have been harsh or pimped a lot...again, this tends to be a true of a lot of top 20ish programs, which honestly just have higher expectations of interns and residents in terms of knowledge base, and tend to foster a more competitive atmosphere.

 

[LadyJubilee8_18]

I think Duke IM got a rep. for being malignant for a variety of reasons. The main reason is/was probably that it's one of those high powered academic places where you just work really hard, particularly as an intern, and there are a lot of patients who are...well...really sick. Also, they used to make all the interns where short white coats, like med students, and white pants; this led to the perception that interns were looked down upon, and I think they've done away with this tradition. They also used to have a generally vague reputation of not having that "nice" of an atmosphere, which I assume meant that the attendings may have been harsh or pimped a lot...again, this tends to be a true of a lot of top 20ish programs, which honestly just have higher expectations of interns and residents in terms of knowledge base, and tend to foster a more competitive atmosphere.

Yeah, I definitely got the impression that the residents learn a lot and work hard, but not that they were unhappy. I didn't see anything wrong with it, and in fact I would prefer it that way. Probably because my home institution is also said to be "malignant" so I'm used to it. In any case, Duke is an awesome program.

 

[Phineus]

Yeah, I definitely got the impression that the residents learn a lot and work hard, but not that they were unhappy. I didn't see anything wrong with it, and in fact I would prefer it that way. Probably because my home institution is also said to be "malignant" so I'm used to it. In any case, Duke is an awesome program.

Interviewed there and asked specifically about this: the short-coat tradition is out; the long hours still exist, but that's one of the reasons you learn so much. I was very impressed with the program--the residents all seemed very happy and I never once sensed an iota of pompousness that I heard so much about. However, applicants I ran into on the trail that interviewed before me had a completely different view: ~4/4 all told me they felt the residents were unhappy and "something" was not right about the program. Again, not my experience at all.

 

[Scaredshizzles]

Interviewed there and asked specifically about this: the short-coat tradition is out; the long hours still exist, but that's one of the reasons you learn so much. I was very impressed with the program--the residents all seemed very happy and I never once sensed an iota of pompousness that I heard so much about. However, applicants I ran into on the trail that interviewed before me had a completely different view: ~4/4 all told me they felt the residents were unhappy and "something" was not right about the program. Again, not my experience at all.

This might be a cynical view, but I wouldn't necessarily trust everything fellow applicants will tell you. They might just want you to not rank Duke #1.

 

[applesbananas]

Interviewed there and asked specifically about this: the short-coat tradition is out; the long hours still exist, but that's one of the reasons you learn so much. I was very impressed with the program--the residents all seemed very happy and I never once sensed an iota of pompousness that I heard so much about. However, applicants I ran into on the trail that interviewed before me had a completely different view: ~4/4 all told me they felt the residents were unhappy and "something" was not right about the program. Again, not my experience at all.

Sounds like a good IV trail impression that you may want to expand on in another thread?? 😉

 

[ResidentMD]

Sounds like a good IV trail impression that you may want to expand on in another thread?? 😉

go applesbananas - actively recruiting 😉. I'm going to send you some of my reviews soon. Happy holidays 😉

 

[LadyJubilee8_18]

Sounds like a good IV trail impression that you may want to expand on in another thread?? 😉

LOL I wrote about my first one, but haven't written any since. I'll get on it too, don't worry.

 

[applesbananas]

go applesbananas - actively recruiting 😉. I'm going to send you some of my reviews soon. Happy holidays 😉

Haha...I miss Airee!