What is meant by "Malignant Residency Program"?

[Deferoxamine]

Terrible hours? Abusive to interns? Bullying and demeaning grown men into a pile of Kleenex and tampons? Bad leadership? Forcing residents into wanting to quit? Or just atypical cells invading beyond the basement membrane?

I can only guess what is meant when every 4th-year student and their mother mentions avoiding "malignant residency programs". Hopefully someone here can clarify.

Thx/adv.

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[turquoiseblue]

Terrible hours? Abusive to interns? Bullying and demeaning grown men into a pile of Kleenex and tampons? Bad leadership? Forcing residents into wanting to quit? Or just atypical cells invading beyond the basement membrane?

I can only guess what is meant when every 4th-year student and their mother mentions avoiding "malignant residency programs". Hopefully someone here can clarify.

Thx/adv.

its a program that tries to single you out... you may have a senior that doesn't like you and wants to ruin you, they make things up, spread rumors, tell all your other collegues, anything to get the PD to throw you out of the program in the end. it's what it is---malignant...meaning not trusting you that you'll turn out to be a good doctor, they just want you out even though you are a resident and still learning. i dont know why they expect you to be already at attending level during residency in some programs. some residents at some programs may already be done with residency in their own country so know everything already, making you, who just started look like you know absolutely nothing and make you seem incompetent in "comparison to your peers" when truly you are at your own level and compete with others in your own boat who aren't even present at the program and are elsewhere with their own level peers having a happier time. the malignant program starts calling you "not a good fit" and discriminate you for being different than their particular 'culture'...whereas the good ones feel like you fit in just fine.

it's like any job out there. i wish it would be considered more of a learning experience than just a job.

i may be wrong, but that's how i see it anyways.

 

[Law2Doc]

Terrible hours? Abusive to interns? Bullying and demeaning grown men into a pile of Kleenex and tampons? Bad leadership? Forcing residents into wanting to quit? Or just atypical cells invading beyond the basement membrane?

I can only guess what is meant when every 4th-year student and their mother mentions avoiding "malignant residency programs". Hopefully someone here can clarify.

Thx/adv.

I disagree with the prior poster insofar as he's suggesting that malignancy is in the eye of the beholder. It's not an individual perception kind of thing. If a program is malignant, most or all of the residents feel the brunt, not just one being "singled out". It's an objective standard. Basically it's a culture of abuse. Residents are in a very precarious position. There are rules governing how they may be treated but not a great deal they can do about enforcing these rules without jeopardizing their position or program as a whistle blower. They are the low person on the totem pole, and can be overworked, berated, scutted out, abused at the whims of the program, the attendings, the administration. So there are places that treat folks better or worse, based on this lack of control. Some places treat residents as the up-and-coming professionals they are and really try to emphasize the learning opportunities, others you will find attendings and residents having a very collegeal time always joking and residents covering for each other as long as the work gets done. Others programs see residents them as annoying little cogs in the hospital machine and treat them accordingly -- violating hour rules, seeing nothing wrong with berating people publicly, keeping them scutted out and not doing anything remotely educational. It is this latter that can fall into the malignant category. It's usually a culture that stems from the higher ups -- if the chairman or PD is a SOB, the chief residents will probably be act accordingly (s^&t flows downstream) and you will end up with a malignant program. So basically malignant is a culture which encompasses components of most of what you have mentioned in your initial paragraph (give or take the basement membranes). It's not a pleasant place to come to work. It doesn't have to be that way, but some places foster that culture, and there is very little a resident can do about it besides be a whistleblower/whiner, get him/herself kicked out of the program and maybe get the program in trouble. None of which are great options.

 

[gutonc]

Terrible hours? Abusive to interns? Bullying and demeaning grown men into a pile of Kleenex and tampons? Bad leadership? Forcing residents into wanting to quit? Or just atypical cells invading beyond the basement membrane?

I can only guess what is meant when every 4th-year student and their mother mentions avoiding "malignant residency programs". Hopefully someone here can clarify.

Thx/adv.

Yes. Some or all of the above. But generally, abusive/demeaning behavior with poor leadership and minimal concern for education and house staff well-being.

 

[thedrjojo]

I disagree with the prior poster insofar as he's suggesting that malignancy is in the eye of the beholder. It's not an individual perception kind of thing. If a program is malignant, most or all of the residents feel the brunt, not just one being "singled out". It's an objective standard. Basically it's a culture of abuse. Residents are in a very precarious position. There are rules governing how they may be treated but not a great deal they can do about enforcing these rules without jeopardizing their position or program as a whistle blower. They are the low person on the totem pole, and can be overworked, berated, scutted out, abused at the whims of the program, the attendings, the administration. So there are places that treat folks better or worse, based on this lack of control. Some places treat residents as the up-and-coming professionals they are and really try to emphasize the learning opportunities, others you will find attendings and residents having a very collegeal time always joking and residents covering for each other as long as the work gets done. Others programs see residents them as annoying little cogs in the hospital machine and treat them accordingly -- violating hour rules, seeing nothing wrong with berating people publicly, keeping them scutted out and not doing anything remotely educational. It is this latter that can fall into the malignant category. It's usually a culture that stems from the higher ups -- if the chairman or PD is a SOB, the chief residents will probably be act accordingly (s^&t flows downstream) and you will end up with a malignant program. So basically malignant is a culture which encompasses components of most of what you have mentioned in your initial paragraph (give or take the basement membranes). It's not a pleasant place to come to work. It doesn't have to be that way, but some places foster that culture, and there is very little a resident can do about it besides be a whistleblower/whiner, get him/herself kicked out of the program and maybe get the program in trouble. None of which are great options.

Spot on.

 

[pillowhead]

A distinct lack of trust between residents (often fostered by administration), residents and attendings, and residents and administration.

An attitude from attendings and administration that places more emphasis on your getting scutwork done rather than getting an education while simultaneously giving you no realistic assistance in getting that scutwork done (realizing that a reasonable amount of scutwork is entirely normal during residency).

Frequent and severe work hour violations with no interest in fixing the problem while often actually blaming the resident for being lazy and inefficient.

Public berating of residents and criticizing of residents to other residents. Kicking residents while they're down rather than having constructive ways of helping them improve.

There is no one thing that makes a program malignant. The presence of scutwork, hard work, and long hours do not by themselves make a program malignant. Those three terms would definitely have described my intern program, but the chief residents, administration, and attendings of said program were very concerned with my development as a physician, had an open door policy if residents had a problem or concern that needed addressing, and other residents were very supportive of each other. A malignant program is one where you wake up every day just not wanting to go to work....and not because the hours or long or the work is hard. Your coworkers and bosses make a program malignant, not necessarily the workload.

 

[turquoiseblue]

A distinct lack of trust between residents (often fostered by administration), residents and attendings, and residents and administration.

An attitude from attendings and administration that places more emphasis on your getting scutwork done rather than getting an education while simultaneously giving you no realistic assistance in getting that scutwork done (realizing that a reasonable amount of scutwork is entirely normal during residency).

Frequent and severe work hour violations with no interest in fixing the problem while often actually blaming the resident for being lazy and inefficient.

Public berating of residents and criticizing of residents to other residents. Kicking residents while they're down rather than having constructive ways of helping them improve.

There is no one thing that makes a program malignant. The presence of scutwork, hard work, and long hours do not by themselves make a program malignant. Those three terms would definitely have described my intern program, but the chief residents, administration, and attendings of said program were very concerned with my development as a physician, had an open door policy if residents had a problem or concern that needed addressing, and other residents were very supportive of each other. A malignant program is one where you wake up every day just not wanting to go to work....and not because the hours or long or the work is hard. Your coworkers and bosses make a program malignant, not necessarily the workload.

I agree. all in all a malignant program would be described as a really horrible stressful place to work where there are a lot of co-worker attitudes that make your life difficult, with threats from the staff (eg. nurses, attendings, residents, interns, etc) that can make you live in fear, regardless of if you are doing a good job, where you dread going to work every day. I've experienced one before...it was a nightmare.

it's just a general awful demeanor of a program or even the PD itself that makes you miserable and in disbelief. there is a website malignantresidency.com that shows programs to avoid that have been malignant in terms of getting rid of their own residents. that is also a sign of malignancy as they don't have the patience with their residents and rather get rid of them.

 

[dragonfly99]

People mean different things when they say, "malignant" and I would say that it is a somewhat subjective judgment. I'm sure there are places that pretty much anyone would agree are malignant, and then there are others where some people would feel strongly that a place IS malignant while others would argue strongly that it is not...

 

[Law2Doc]

People mean different things when they say, "malignant" and I would say that it is a somewhat subjective judgment. I'm sure there are places that pretty much anyone would agree are malignant, and then there are others where some people would feel strongly that a place IS malignant while others would argue strongly that it is not...

Sure there are gray area programs that straddle the border, with some finding it malignant and others not, but the term "malignant" when used to describe a program generally is meant as a more objective standard. If one person finds it a malignant situation, that does not make it a malignant program. If most of the residents find it malignant, then that is a very different story and it falls squarely into this "malignant program" category. As such, it is an objective standard. There are programs like this. And it usually is a cultural thing, not a perception thing. And it generally comes from the top down, with SOBs in charge fostering such culture. There are programs like this in every field. And word of mouth is such that people going into these fields quickly find out which programs these are. Nobody is talking about the single resident who whines. There are whiners at every program. We are talking about a cultural pattern of abuse.

 

[Deferoxamine]

Appreciating all the quick responses in here. Thanks for the clarification, everyone. When stuck in the la-la-land that is medical school (particularly MS3), I guess it's pretty easy to forget that residency programs are probably very much like companies and businesses - some run like clockwork, some have happy employees, some are miserable, some have pathetic leadership, some pit their employees against each other because the headperson gets off on conflict, etc. Good to know.

 

[FutureInternist]

Appreciating all the quick responses in here. Thanks for the clarification, everyone. When stuck in the la-la-land that is medical school (particularly MS3), I guess it's pretty easy to forget that residency programs are probably very much like companies and businesses - some run like clockwork, some have happy employees, some are miserable, some have pathetic leadership, some pit their employees against each other because the headperson gets off on conflict, etc. Good to know.

Actually is much more like high school, with rumors, cliques, the "cool" residents who can get away with stuff while the rest have to follow all the rules....but since you are in med school now, you probably know how that goes

 

[Deferoxamine]

Necro bump.

And important discussion can be had here between now and Match Day, as many of us are in the process of interviewing at programs and making sure we aren't missing any warning signs at the places we love.

Any other tips, input, advice?

 

[Winged Scapula]

Necro bump.

And important discussion can be had here between now and Match Day, as many of us are in the process of interviewing at programs and making sure we aren't missing any warning signs at the places we love.

Any other tips, input, advice?

While it may not define malignancy, IMHO one warning sign is how many residents turn up for the dinner the night before. One SDNer was staying with me and reported that only 3 residents (from a moderate sized program) showed. This reflects poorly and either generally means that they are overworked and too tired to come or don't feel that they can support their program (in this case, it may also mean that because the PC scheduled the dinner at some out of the way restaurant that the residents simply didn't want to drive that far - giving them the benefit of the doubt).

 

[Deferoxamine]

While it may not define malignancy, IMHO one warning sign is how many residents turn up for the dinner the night before. One SDNer was staying with me and reported that only 3 residents (from a moderate sized program) showed. This reflects poorly and either generally means that they are overworked and too tired to come or don't feel that they can support their program (in this case, it may also mean that because the PC scheduled the dinner at some out of the way restaurant that the residents simply didn't want to drive that far - giving them the benefit of the doubt).

Well I thought so too, but at many places, the program only allows say 5 or 10 residents to sign up per session, or that they all take turns or something because the program doesn't want to pay for 30 free dinners on top of what it costs to feed the applicants.

 

[Winged Scapula]

Well I thought so too, but at many places, the program only allows say 5 or 10 residents to sign up per session, or that they all take turns or something because the program doesn't want to pay for 30 free dinners on top of what it costs to feed the applicants.

Huh...perhaps that's true at very large programs. Can't say I've seen that at average sized surgery programs and after polling my friends, they say the same.

 

[gutonc]

Huh...perhaps that's true at very large programs. Can't say I've seen that at average sized surgery programs and after polling my friends, they say the same.

I think it's probably more true at programs with 100+ residents than those with a few per year. My program would have 20-30 interviewees at a time and 8-10 residents at the dinner which I think is a good ratio.

I went to an interview dinner at Dartmouth where it seemed that every resident who wasn't on call was at the dinner. They outnumbered the interviewees by ~3:1.

On the one hand, it was cool to get to meet almost all of the residents and see (instead of just hear about) how they all really got along well. On the other hand, they mostly just wanted to hang out with each other and get drunk on the bosses nickel.

 

[dragonfly99]

LOL...there's nothing else to do in Hanover...except ski.

 

[gutonc]

LOL...there's nothing else to do in Hanover...except ski.

Which, besides getting drunk, was about the only other thing they wanted to talk about. Don't get me wrong, I'm more than cool with both, but maybe not the best way to sell a program.

 

[Holderlin]

So why don't we start a list to help curious posters avoid notorious residency programs. The thread title is perfect for searches.

From what I've heard, Duke and Johns Hopkins definitely fall into this category.

 

[ModerateMouse]

So why don't we start a list to help curious posters avoid notorious residency programs. The thread title is perfect for searches.

From what I've heard, Duke and Johns Hopkins definitely fall into this category.

I think that someone started a thread about this a while ago (I don't remember if it got locked . . .).

 

[Law2Doc]

So why don't we start a list to help curious posters avoid notorious residency programs. The thread title is perfect for searches.

From what I've heard, Duke and Johns Hopkins definitely fall into this category.

Um no, it doesn't work that way. Whether someplace is benign or malignant varies by specialty within each hospital. You can't assert that an entire hospital system is malignant throughout all of its programs (and suggest that is "definitely" the case, no less)- It is very program specific. Meaning a given hospital might be known as having a malignant surgery program, a middle of the road OBGYN program, but actually be quite benign in IM, and a joy to work at in EM, etc. So no you cannot ever simply say XYZ hospital is malignant -- you will never be accurate for all the programs within. The places you mentioned may be malignant in some specialties and the best places to end up in other specialties, and you do people a disservice suggesting that as a hospital system these are bad places. Maligning all programs within a single hospital system is pretty unreasonable unless you have a whole lot more data to back up these statements. I suspect you are basing this on hearsay about very specific specialties.

That you don't know this suggests to me that you aren't the right person to be calling out specific programs.

 

[Winged Scapula]

I think that someone started a thread about this a while ago (I don't remember if it got locked . . .).

Yes, because the problem is, as L2D notes, is that it invariably degenerates into hearsay and broad stroke brushings of entire hospitals/programs/states, etc as BAD places to do residency.

There are a million sad stories out there and these types of threads draw out all the disgruntled former residents who offer personal experiences (which can be helpful) and assume that their reality matches everyone elses (which is not always the case).

In addition, what may be "malignant" to one person may not be to another. We've had SDNers claim programs were malignant because they worked long hours. Is it? Not in my book, but YMMV.

 

[alwaysaangel]

That you don't know this suggests to me that you aren't the right person to be calling out specific programs.

That poster hasn't even APPLIED to medical school yet so yeah...

 

[BlueBanana]

I went to Duke for medical school and am now a medicine resident at a different place. Malignancy at Duke was discussed occasionally. Which programs are? What does that term mean?

I feel like the term is often misused as others have said. I have a friend whose significant other was a medicine fellow at UNC and said it was so malignant since he worked tons of hours. UNC is a great program and I've almost never heard it described in those terms. They've had a night float system for a long time. What she was describing just sounded like a very busy rotation in residency.

The two programs at Duke commonly discussed are surgery and medicine. Ob I've heard is actually a fairly nice program among ob programs.

Surgery and Medicine there both have long histories with great leaders. But a lot has changed since Drs. Stead and Sabastine.

I think surgery is a pretty tough program where you will work hard and are expected to be great. The chief residents have to stand in front of the whole department to discuss mistakes made during M and M. But there are some very good attendings there who care for their patients and trainees. I've heard some rumors about bad things there but don't have personal experience where people did unethical or unfair things. There was a resident notorious for demeaning students but she was sent to anger management.

Medicine's mascot is the Marine. They also have high expectations. I saw a lot of changes in the last few years. Gone are the short white coats and some of the old school ways. They are also developing a hospitalist program which seems good. I think some of the upper levels learn more from the specialists rounding on gen med. But the hospitalists tend to have more time to teach as they are not doing research and trying to keep as many balls in the air. And both are on Gen med.

I am happier and have a nicer life being in residency not at Duke but I know many of my classmates were happy to stay. It is an intense place. I saw public humiliation at times. But the grand rounds and noon conferences are excellent. And much of the intensity is about taking very good care of your patients. I think it's not for everyone. There is more joking on rounds and more invites to my attendings houses where I'm at. But sometimes I miss Duke and the Duke Marines.

I think there are programs with different attitudes you have to know yourself enough to know where you'll do well and pray the match treats you well. But going through Duke would make you an excellent physician although it might be a tough ride at times.

 

[Law2Doc]

I went to Duke for medical school and am now a medicine resident at a different place. Malignancy at Duke was fairly commonly discussed. Which programs are? What does that term mean?

I feel like the term is often misused as others have said. I have a friend whose significant other was a medicine fellow at UNC and said it was so malignant since he worked tons of hours. UNC is a great program and I've almost never heard it described in those terms. They've had a night float system for a long time. What she was describing just sounded like a very busy rotation in residency.

The two programs at Duke commonly discussed are surgery and medicine. Ob I've heard is actually a fairly nice program among ob programs.

Surgery and Medicine there both have long histories with great leaders. But a lot has changed since Drs. Stead and Sabastine.

I think surgery is a pretty tough program where you will work hard and are expected to be great. The chief residents have to stand in front of the whole department to discuss mistakes made during M and M. But there are some very good attendings there who care for their patients and trainees. I've heard some rumors about bad things there but don't have personal experience where people did unethical or unfair things. There was a resident notorious for demeaning students but she was sent to anger management.

Medicine's mascot is the Marine. They also have high expectations. I saw a lot of changes in the last few years. Gone are the short white coats and some of the old school ways. They are also developing a hospitalist program which seems good. I think some of the upper levels learn more from the specialists rounding on gen med. But the hospitalists tend to have more time to teach as they are not doing research and trying to keep as many balls in the air. And both are on Gen med.

I am happier and have a nicer life being in residency not at Duke but I know many of my classmates were happy to stay. It is an intense place. I saw public humiliation at times. But the grand rounds and noon conferences are excellent. And much of the intensity is about taking very good care of your patients. I think it's not for everyone. There is more joking on rounds and more invites to my attendings houses where I'm at. But sometimes I miss Duke and the Duke Marines.

I think there are programs with different attitudes you have to know yourself enough to know where you'll do well and pray the match treats you well. But going through Duke would make you an excellent physician although it might be a tough ride at times.

As mentioned above, simply having long hours doesn't rise to the level of malignancy. Some programs have tainted reputations (perhaps deservedly) because of a publicly known inability to get within the 80 hour limit in the first few years of that restriction, but that doesn't necessarily make them malignant programs.

As far as the chiefs being on the spot for M&M, that is actually the traditional model for surgery, dating back to the early 1900s, and I don't know that that really factors into a program being considered malignant. Most people suggest that this traditional approach to M&M provides for very good learning, (ie it makes it very hard to not learn from your mistakes) and there has long been a culture in the field of "owning up" to one's mistakes which goes along with the swagger and bravado of being a surgeon. I suspect few in the field would push to eliminate this tradition, or suggest this as a real reason their program is "malignant".

Malignancy is an ongoing culture of abuse, and it's pervasive througout the program, so it's not a single person's viewpoint. There is always someone not keeping afloat who whines about malignancy, but in a program of a dozen people where only one is shouting "malignant", I would suggest that the program is probably a pretty good one. In a program of a dozen where ten are shouting malignant, I would probably take the other view.

 

[BlueBanana]

I also think a less known program might be just as malignant if not more malignant than a place like Hopkins or Duke since they are so well known and so many watch them. A struggling small program could be much less supportive than a place like Hopkins since Hopkins has so many resources and many possible mentors who could shield residents from problems.

 

[BlueBanana]

Thanks for correcting me although I can think of other examples where Duke surgery has traditions which are more intense or may be considered malignant. I'm not saying that I think it's malignant. I'm just saying there are things unique to Duke that are more intense. But again you don't go to Duke surgery to have people tell you how great you are but so that you can have the swagger of being a Duke trained surgeon afterwards.

 

[Resuscitator]

"Malignant residency programs" is a term created by a group of unmatched/low-scored/....applicants who are trying to discourage other peoples from applying to certain programs to have some advantage in these programs in case they were ranked in the match. There is nothing so called malignant, most programs follow ACGME rules and they apply the standards on all when speaking about already match applicants. Beaware of these individuals, apply whereever you think you have a chance, don't loose any.

 

[Droopy Snoopy]

"Malignant residency programs" is a term created by a group of unmatched/low-scored/....applicants who are trying to discourage other peoples from applying to certain programs to have some advantage in these programs in case they were ranked in the match. There is nothing so called malignant, most programs follow ACGME rules and they apply the standards on all when speaking about already match applicants. Beaware of these individuals, apply whereever you think you have a chance, don't loose any.

Yeah, and what about the other ones? Although that last half-sentence is generally sound advice, the idea of malignant residency programs being a vast bottom-quartile conspiracy theory is incredibly stupid.

 

[BlueBanana]

I think there are definitely different personalities of programs. Some are friendlier and some are more intense. Some programs are more "call your upper level with any questions" and others are more "call me if you're weak".

Some people misuse the term malignant to describe the more intense places. But they mean hard core, more rough schedules rather than abusive.

That said deciding when you're looking for a program what kind of personality a program has and where you want to go is important.

I think you learn on your own AND from mentoring and some programs put you out there earlier and more frequently than others.

I think finding the right fit for you is the thing to do.

 

[Holderlin]

Um no, it doesn't work that way. Whether someplace is benign or malignant varies by specialty within each hospital. You can't assert that an entire hospital system is malignant throughout all of its programs (and suggest that is "definitely" the case, no less)- It is very program specific. Meaning a given hospital might be known as having a malignant surgery program, a middle of the road OBGYN program, but actually be quite benign in IM, and a joy to work at in EM, etc. So no you cannot ever simply say XYZ hospital is malignant -- you will never be accurate for all the programs within. The places you mentioned may be malignant in some specialties and the best places to end up in other specialties, and you do people a disservice suggesting that as a hospital system these are bad places. Maligning all programs within a single hospital system is pretty unreasonable unless you have a whole lot more data to back up these statements. I suspect you are basing this on hearsay about very specific specialties.

That you don't know this suggests to me that you aren't the right person to be calling out specific programs.

Fine it was surgery.

Nice treatise BTW. I wouldn't have guessed you went to law school.

*EDIT* It was based on countless testimonials of varying objectivity, no doubt, but the sheer number of compaints/horror stories I think makes it hard to question the notion that there's something especially tortorous about these two programs. But things change of course.....

 

[Holderlin]

That poster hasn't even APPLIED to medical school yet so yeah...

Aw C'mon. I can still read, and I have a PhD, at least.

So I guess I am a Doctor. Just not a cool one.

 

[Droopy Snoopy]

Fine it was surgery.

Nice treatise BTW. I wouldn't have guessed you went to law school.

*EDIT* It was based on countless testimonials of varying objectivity, no doubt, but the sheer number of compaints/horror stories I think makes it hard to question the notion that there's something especially tortorous about these two programs. But things change of course.....

You still don't seem to comprehend the difference between the Johns Hopkins' Department of General Surgery and Johns Hopkins the ginormous healthcare system. It's a good thing you make up for your ignorance with humility though, or else people would think you're a huge tool.

 

[Holderlin]

You still don't seem to comprehend the difference between the Johns Hopkins' Department of General Surgery and Johns Hopkins the ginormous healthcare system. It's a good thing you make up for your ignorance with humility though, or else people would think you're a huge tool.

Are you serious? Yeah I just can't comprehend the difference between those two things.

Is it really that insulting for me to post about programs with bad reputations? It's no secret really, in fact there was a widely publicized scandal at Hopkins which I'm sure all of you are familiar with. I'm really sorry I didn't specify the department of surgery in my first post. Both those programs are widely discussed as being demanding if not brutal(malignant?).

I'm so very sorry.

And what's with the cancer metaphor? I can understand why people would get annoyed by people throwing that word around.

 

[Samoa]

Your coworkers and bosses make a program malignant, not necessarily the workload.

This is probably the best summary I've seen. There are places where the workload is heavy, but everyone is generally happy and the inevitable issues that arise when people work in groups are handled appropriately and without drama. Then there are other places where the workload is not nearly so heavy, but where a (usually small) number of people make everyone else's life miserable.

In fact, the chairman could be the nicest person ever, and it could be a junior faculty member or senior resident whose bad behavior is tolerated for some reason, that creates a malignant experience for the people below them in the heirarchy.

I guess it's pretty easy to forget that residency programs are probably very much like companies and businesses - some run like clockwork, some have happy employees, some are miserable, some have pathetic leadership, some pit their employees against each other because the headperson gets off on conflict, etc.

Actually is much more like high school, with rumors, cliques, the "cool" residents who can get away with stuff while the rest have to follow all the rules....but since you are in med school now, you probably know how that goes

FYI, companies and businesses are much like high school. The sad fact is, you never really graduate from high school. But as an adult, you have the option to leave the school where you get picked on, and go someplace else. So people tend to gravitate toward places where they're treated decently, or at least compensated in some fashion for being treated poorly.

So the thing that really sucks about a malignant program is the lack of a reasonable option to leave it for a less malignant one.

 

[MD forever]

Thank you for the above discussion and input.
Can somebody put it together to come up with agreed criteria to classify malignant programs? and list them out!
Is the term malignant programs "permanent" never change?. Can this change by change in time, conditions, leadership, personals.etc?
Having list for those programs, will it help them see their problem and hence try to fix it?. Can this list help candidates to avoid them and escape the trap?
Will the number of residents being fired from same program and those on probation count as a criterion for defining malignancy of a program?
I will be pleased if a Program Director give us his input.
Thank you

 

[Law2Doc]

...
Is the term malignant programs "permanent" never change?. Can this change by change in time, conditions, leadership, personals.etc?
Having list for those programs, will it help them see their problem and hence try to fix it?. Can this list help candidates to avoid them and escape the trap?
Will the number of residents being fired from same program and those on probation count as a criterion for defining malignancy of a program?
I will be pleased if a Program Director give us his input.
Thank you

Since malignancy tends to be personnel driven, it can change over time as personnel change. But culture change in either direction is a slow process. I don't think the number of residents fired is determinative -- a program can have 0-1 firing over many years and be malignant. Malignancy is really something faced by those who endure, not those who flame out. Also In many cases residents who are let go are let go after failing to remediate, so it's often a symptom of a bad fit more than a malignant program cleaning house. You will come across plenty of residents who just don't "get it" in terms of expectations in residency, and continue to make the same blunders after countless warnings.

 

[45408]

I think surgery is a pretty tough program where you will work hard and are expected to be great. The chief residents have to stand in front of the whole department to discuss mistakes made during M and M.

That's pretty common. The surgery department at my med school did that, and we do it at my residency program too.

 

[Buzz Me]

That's pretty common. The surgery department at my med school did that, and we do it at my residency program too.

That isn't what everyone else does at M&M?

 

[Smurfette]

That isn't what everyone else does at M&M?

+1

Whenever a non-chief had to present an M&M, it was HIGHLY unusual. Chiefs were expected to report and prepare M&Ms for complications on their own service. It was EXCEEDING rare for an attending to present an M&M.

 

[MD forever]

Is there any similarities between "malignant programs" and Bullying (behavior/ attitude)?.

 

[gutonc]

+1

Whenever a non-chief had to present an M&M, it was HIGHLY unusual. Chiefs were expected to report and prepare M&Ms for complications on their own service. It was EXCEEDING rare for an attending to present an M&M.

Wow...we got 2 mods and a 7+yr member to respond to a 1yo necrobump.

 

[Smurfette]

Might wanna make that three mods, since you also posted.

 

[dragonfly99]

Is there any similarities between "malignant programs" and Bullying (behavior/ attitude)?.

I would say yes...and that your comment is perceptive. Residency and medical school are special in the sense that trainees can't just "quit" and go somewhere else...except in fairly rare cases. People not getting along (for various reasons) with coworkers or bosses or people getting fired for various (merited/or or unmerited) reasons happens in the "real world" of companies, businesses, etc. In residency and med school the situation is different because there is a big power differential between the trainees and the people above them. This creates a situation where there is a potential for abuse. Luckily, most docs are decent people and it's usually kind of a benign dictatorship, if you will...but not always.

 

[45408]

That isn't what everyone else does at M&M?

I think the surprising factor for other departments is even having an M&M...

Having M&M was a pretty infrequent event at the medicine department at my med school, and I didn't go to any M&Ms in any other departments (either they didn't have them, or they were that infrequent). Nobody else has them every week, in any specialty I rotated in for med school.

Wow...we got 2 mods and a 7+yr member to respond to a 1yo necrobump.

I noticed it just had some interesting discussion.

 

[Substance]

There should be objective ways to measure program malignancy. Things like board pass rates, duty hours violations, frequency of resident terminations and remediations, teaching conference frequencies, etc. Stuff that's measurable.

 

[Section8Doc]

For those of you interested, you CAN fight back against an abusive Residency program and/or colleagues:

These are tried and true methods I figured I would share of making your superiors/colleagues lives a living nightmare, possibly costing them their jobs.

Quite a few attendings on Chiefs in a speciality is on the payroll of, and receiving honoraria from, a Pharmaceutical company. One well-placed anonymous call to FDA DDMAC reporting "possible off-label" marketing and speaking will put a hit in their pocket. A DDMAC warning letter to a physician does not do well for their career advancement.

Many any older residents or attendings WANT to get in good with Pharma, but most hospitals or centers discourage this with policies prohibiting reps soliciting. Grab your colleagues business card and make sure a Pharma Rep gets it, and follows up with a call specific for them. Sit back and watch the fireworks. As a corollary to this, get your local rep to recommend your colleague to a Pharma company's Speakers Bureau

Probably my favorite: OSHA violations. We all know there are millions in any given place. There is anonymous reporting, so do the honorable and lawful thing, and report them all.

Lastly, we have the good old DEA. When everything else fails, it is a great fallback option to help trigger an inspection into accounting for any and all narcotics. We all know every last dose and microliter is not accounted for.

 

[Buzz Me]

Having M&M was a pretty infrequent event at the medicine department at my med school, and I didn't go to any M&Ms in any other departments (either they didn't have them, or they were that infrequent). Nobody else has them every week, in any specialty I rotated in for med school.

I don't understand...so you don't review at least the interesting complications/deaths and try to learn from them?

How are people held accountable?

 

[wannabeOBGYN]

I think the surprising factor for other departments is even having an M&M...

Having M&M was a pretty infrequent event at the medicine department at my med school, and I didn't go to any M&Ms in any other departments (either they didn't have them, or they were that infrequent). Nobody else has them every week, in any specialty I rotated in for med school.

I spent my third year at a small hospital with 30-40 residents and we only had M&M once, presented by a chief resident. Also, I did an elective earlier this year at an OB/GYN program that had M&M, and it was being presented by a PGY3.

 

[Substance]

I don't understand...so you don't review at least the interesting complications/deaths and try to learn from them?

How are people held accountable?

Perhaps the M&M ritual is disappearing in all but the most prominent of institutions due to legal matters. Openly taking ownership of errors in an official M&M conference likely constitutes admission of culpability and can be used in a court of law - though this is all guesswork. Can anyone here with legal experience clear this up for me?