What does it mean when a residency program is “malignant”?

[stickgirl390]

On wards right now, and I keep hearing residents throw this term around when referring to different programs they were considering. What does it mean/imply when a residency program is described as “malignant”? How is this notion gathered from Sub-Is/interviews?

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[QuizzicalApe]

"malignant" programs are termed thus if they're run by a pack of remorseless jackholes that abuse, overwork, and otherwise purposely or inadvertently torment their residents

 

[deleted480308]

On wards right now, and I keep hearing residents throw this term around when referring to different programs they were considering. What does it mean/imply when a residency program is described as “malignant”? How is this notion gathered from Sub-Is/interviews?

Much like “professionalism” is a phrase admins everywhere use as a kitchen sink term for “anything we don’t want you to do”...... the trainee universe has started the now almost meaningless phrase “malignant” to mean “something there really bothered me”

if someone doesn’t give a very specific complaint I would ignore claims of malignancy on an anonymous forum.

 

[LunaOri]

In a malignant program, there is an atmosphere of fear. The residents are in constant competition with each other, and the seniors do not support the juniors. The residents, especially the juniors, are used to do scut work, and there is minimal teaching by attendings and senior residents. There's a lot of verbal abuse and belittling. Blame and shame are the name of the game.

 

[M&L]

So how do we find out if it is malignant ?

 

[QuizzicalApe]

So how do we find out if it is malignant ?

Essentially only word of mouth or from current residents. The term is definitely overused, though. If someone tells you a program is malignant they should be prepared to explain why.

 

[M&L]

Essentially only word of mouth or from current residents. The term is definitely overused, though. If someone tells you a program is malignant they should be prepared to explain why.

thank you!

 

[boolin_1]

I remember reading about some name/shame posts about 'malignant' programs and it was mainly about the interview food tasting like **** lol

 

[LunaOri]

I don't think there are very many truly malignant programs anymore--this was more common in the days before work-hour restrictions.

 

[ciestar]

I don't think there are very many truly malignant programs anymore--this was more common in the days before work-hour restrictions.

It still happens... residents being told to fudge their numbers to keep them under even when theyre not.

Two programs my program rotate with are apparently like this.

 

[Angus Avagadro]

I hear this term a lot. I believe a malignant program is one where residents leave for other programs. I agree they are rare. Life as a resident is hard and the length of work hours unpredictable. Many frustrated residents vent and refer to their program as malignant. Residency is not school. Residents are there to work and learn the mechanism of medicine and patient care. This is why they get paid. Actual teaching may consist of morning report, a noon conference, and some bedside comments by the Senior or Attending. The rest is work, and lots of it. Residents must sharpen their efficiency so they can function as attendings. If you cant generate enough RVU's to pay for your compensation package, the employer will not renew your contract. Then you are selling your house and moving. Auditions are a great way to get a feel for the culture at a program and to determine if it might be a good fit for you.

 

[longhaul3]

It varies by specialty. The least malignant program in my specialty would be the most malignant program in 50% of other specialties. We all have our own different cultures.

There are some truly malignant programs out there though, even by surgery standards. Constant beatings, seniors who won't speak to or make eye contact with interns, attendings who pitch a fit when their cases are covered by anyone but a chief, etc.

 

[Neopolymath]

When the lady in the cafeteria isn't nice to me back in the morning

 

[scoopdaboop]

It varies by specialty. The least malignant program in my specialty would be the most malignant program in 50% of other specialties. We all have our own different cultures.

There are some truly malignant programs out there though, even by surgery standards. Constant beatings, seniors who won't speak to or make eye contact with interns, attendings who pitch a fit when their cases are covered by anyone but a chief, etc.

That's so stupid. It's sad, but comical knowing that there are people who do stuff like this. If I was an intern and the seniors don't even want to make eye contact, I'm gonna challenge them to a 1 on 1.

 

[Mad Jack]

On wards right now, and I keep hearing residents throw this term around when referring to different programs they were considering. What does it mean/imply when a residency program is described as “malignant”? How is this notion gathered from Sub-Is/interviews?

It means the program has any number of things that induce resident misery. Sometimes this is excess work, sometimes it is toxic resident culture, sometimes it is nightmarish admin. Like cancer, it comes in many stripes. You usually have to get a feel for it during interviews unless residents warn you. Ask about whether residents are happy, how supportive administration is, etc to determine this as well as possible

 

[longhaul3]

That's so stupid. It's sad, but comical knowing that there are people who do stuff like this. If I was an intern and the seniors don't even want to make eye contact, I'm gonna challenge them to a 1 on 1.

Good luck with that. It's unfortunate but where it exists, it just is what it is.

 

[TeddyBoomBoom]

It’s such horse ****. I’m not talking about hard work, ****ty hours, knowing your place on the totem pole - that’s just residency. I’m talking about taking treating residents terribly only because everyone knows they have no recourse. To me, it not helpful to anyone, and just suggests poor character for those who act like that. I have no skin in the game - I’ve never felt like my own leadership was toxic, but I’ve seen it in other programs and it suuuuuuucks.

 

[Goro]

It means the program has any number of things that induce resident misery. Sometimes this is excess work, sometimes it is toxic resident culture, sometimes it is nightmarish admin. Like cancer, it comes in many stripes. You usually have to get a feel for it during interviews unless residents warn you. Ask about whether residents are happy, how supportive administration is, etc to determine this as well as possible

I just remembered a Clinical Dean telling me that a hint that a program is toxic is a if it's a competitive specialty, say, Derm, that has slots left over after the Match, and is not in some rural backwater.

 

[longhaul3]

I just remembered a Clinical Dean telling me that a hint that a program is toxic is a if it's a competitive specialty, say, Derm, that has slots left over after the Match, and is not in some rural backwater.

Those are really rare. They are probably most often malignant programs, but it's not a reliable way to pick out a malignant program.

There were zero unfilled positions in the neurosurgery match this past year. There are lots of malignant neurosurgery programs.

 

[Goro]

Those are really rare. They are probably most often malignant programs, but it's not a reliable way to pick out a malignant program.

There were zero unfilled positions in the neurosurgery match this past year. There are lots of malignant neurosurgery programs.

That's why I called it a hint!

 

[redpointmd]

Malignant means that there is an disproportionate amount of service vs educational requirements, residents don't get support from residency administration for non-clinical goals, seniors bully and belittle juniors and often dump work on them. Truly malignant programs are horrible, offer less quality training and lead to higher amounts of burnout and dissatisfaction.

Ways to look out for them: are there a ton of residents at the interview dinner from all years of the program? Do they seem happy? Obviously you can't ask if malignant, but ask if there is protected time for education, if there is support for residents to pursue non-clinical accomplishments (research, conferences, global health, etc), ask about an issue they had that residency administration helped them sort out. Read between the lines and judge based on how they answer these questions.

 

[NickNaylor]

I agree with @choppadocta's definition above: a "malignant" program has an imbalance in the service (i.e., your clinical work) and educational (i.e., activities with a focus on teaching you how to be a physician) missions for residents. The description of "malignant" also often includes an implicit descriptor of the culture: program administration may minimize or completely ignore resident feedback about the program, program leadership may not support the residents within the program (which can manifest in a variety of ways), and the residents themselves may not be supportive of one another, something that may or may not be supported by a program. In typical use, though, "malignant" can mean any number of things, from true abuse of residents and completely inappropriate behavior on the part of program leadership to "I don't like what my program is doing, therefore it's malignant."

I agree with taking a description of a program as "malignant" with a grain of salt. Anyone who makes this claim should, as @QuizzicalApe says, be able to explain why. Frankly, for many residents, residency is the first real job that they have ever had, and a lot of complaints about residency essentially boil down to being an employee for a large organization. Residency is not the same thing as college, medical school, etc., and what is expected of you is much different as an employed physician - even as a trainee - than as a student. This transition comes with some growing pains, and what some residents consider "malignant" is, instead, a reality of working in a large organization.

My residency program was quite possibly the most benign program in the world, and even then a small number of residents would complain that the program was "malignant." Perhaps not-so-coincidentally, the same residents that complained the loudest and made these claims were also often the ones that caused the most problems for the program in ways that often boiled down to simple unprofessional behavior (e.g., buying plane tickets and booking hotels to take 1+ week off on a busy inpatient service without talking to anyone about it first, then getting upset because they didn't follow clearly defined procedures for requesting and receiving vacation time - as a chief, I actually had a resident demand that the program should reimburse him/her for the flights that he/she would now no longer be able to take, lol). I would simply say that there are two sides to every complaint of a program being "malignant," and you should do your best to get as much information as you can from current/former residents, program leadership, etc. about concerns that residents might express to see what the real deal is.