Malignant Programs

[nacholibre]

Any programs have a reputation of being really malignant? (I keep hearing this word and am not 100% sure what all it entails, but it doesn't sound happy)

Flip side....Are you at a program or know of a program that has a bad rep, but you think it shouldn't??

Do share!

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[DrBodacious]

Nacho -

I think anyone who is foolish enough to post negative comments about a specific program is inherently de-validating their comments. Enough people look at these sites that word travels quickly.

Most programs are going to have a portion of attendings that are demanding (or just a pain in the arse), but you usually learn a lot from those attendings, too.

 

[nacholibre]

I'm not trying to be a troll here...

I'm genuinely interested to know why giving an honest opinion anonymously would be a bad idea.

It seems to me that this discussion could only have the result of everyone being more informed. If someone knows that a program is known to have an issue, why not put it out there so that a) people know and are not caught off guard b)if anyone has a differing or more informed opinion they can correct any errors and c)programs with issues feel some motivation to change.

That being said, I understand and really appreciate the level of respect that exists between otolaryngologists. It's a rarity, but occasionally hinders those less informed people from getting all of the information.

All this being said, perhaps a better question would be: "What are some things I should look for / ask about while interviewing that may be suggestive of a malignant program?"

 

[resxn]

Best question you can ask a resident. "Knowing what you know now, if you had to do it all over again, would you want to come to this program?"

Next best question. "What would you change about this program if you could?"

If malignancy is a problem, you will know.

A chief resident told me in no uncertain terms, "I would not come back to this program and I would not recommend it to others because it is too malignant. They look for reasons to be retributive and hard. The attendings, in general, are not advocates of their residents. They are blamers of their residents."

While you can take that as the chief is a dork and cannot handle a residency, you will get a feel when you ask more than one resident what it's like. His comments were the harshest toward this program but it was consistent with less stark comments made by the other residents, so I did not rank that program high on my list. No point in me naming it's name because that was over 10 years ago now and there's a new chair.

 

[DoctwoB]

I'm not trying to be a troll here...

I'm genuinely interested to know why giving an honest opinion anonymously would be a bad idea.

Otolaryngology (and other surgical fields) are small communities with small residency programs. It would be difficult to post about your malignant program without being identifiable in any way, which could be detrimental to a resident. Even if someone has graduated, you'll still be seeing the same attendings at meetings and applying for fellowships and faculty positions with them.

 

[OtoHNS]

Best question you can ask a resident. "Knowing what you know now, if you had to do it all over again, would you want to come to this program?"

Next best question. "What would you change about this program if you could?"

If malignancy is a problem, you will know.

A chief resident told me in no uncertain terms, "I would not come back to this program and I would not recommend it to others because it is too malignant. They look for reasons to be retributive and hard. The attendings, in general, are not advocates of their residents. They are blamers of their residents."

While you can take that as the chief is a dork and cannot handle a residency, you will get a feel when you ask more than one resident what it's like. His comments were the harshest toward this program but it was consistent with less stark comments made by the other residents, so I did not rank that program high on my list. No point in me naming it's name because that was over 10 years ago now and there's a new chair.

Agree. Don't worry about it until you're interviewing. If a program is really that bad, it'll come out.

 

[neutropeniaboy]

Everything is relative.

A malignant program now would have run of the mill 10 years ago. Consequently, you're not going to find many attendings in our generation (Gen X) who are going to think that their programs are malignant. On the flip side, what I might say is a malignant program now might have been average 20 years ago.

Pay close attention during the interviews. Ignore issues of hours violation. While regulatory violations, I wouldn't put the program in the malignancy category if it is because a program is really busy. That's a good thing. If the attendings sell out the residents or the residents don't get along, those are the red flags. Don't discount top heavy programs either. Some of the best programs are top heavy.

Don't be a fool. You get 5 years to learn your trade. You can suck up the extra hours and a few verbal tirades.

 

[Daodejing]

Everything is relative.

Don't be a fool. You get 5 years to learn your trade. You can suck up the extra hours and a few verbal tirades.

Truer words have never been spoken

 

[StillChoosing]

You can suck up the extra hours and a few verbal tirades.

This should never be acceptable.

 

[DrBodacious]

This should never be acceptable.

Attendings have a difficult job. It sucked when I would get chewed out undeservingly (rarely), but it didn't take long to realize that: a) a well established attending has earned the right to not always be "fair," and b) who is to say that I wouldn't be more of a hard as after dealing with residents & academics for X # of years.

To put it another way: Everyone doesn't get a ribbon or gold star everyday of residency. Mistakes happen, and can have serious outcomes, or even if harmless they can have the potential for forming dangerous habits. The ends justify the means (to a large extent), when considering to goal of training surgeons, and the people who are capable of training them.

That being said, the chairman and program director manage quality control across the board. Patterns of abusive behavior are going to be acted on, and there are obvious lines that can't be crossed (racial/sexual harassment).

 

[StillChoosing]

"A well established attending" at a teaching hospital should be someone who respects learners.

 

[VisionaryTics]

"A well established attending" at a teaching hospital should be someone who respects learners.

I think confronting residents and pointing out shortcomings in an honest way demonstrates respect to the resident, the patient, and the profession.

 

[DoctwoB]

I think confronting residents and pointing out shortcomings in an honest way demonstrates respect to the resident, the patient, and the profession.

Of course. However that can be done in a lot of ways. Calmly pointing out areas for improvement during/after a case is very different from the screaming tirades with personal insults.

 

[VisionaryTics]

Of course. However that can be done in a lot of ways. Calmly pointing out areas for improvement during/after a case is very different from the screaming tirades with personal insults.

I don't think anyone is defending screaming or personal insults. But I see no problem with a tongue lashing.

 

[Pir8DeacDoc]

Why is a tongue lashing acceptable? We are all intelligent adults that in theory possess good communication skills. Attendings should have some self control. Would a tongue lashing be acceptable in a business setting? I've seen things happen in a hospital that would never fly in the real world. Don't kid yourself that we are the only people with stressful jobs.

I've been given stern words plenty of times that weren't tongue lashings. Intelligent people can articulate themselves easily and get the point across to other intelligent people without a tongue lashing. My chair would say " that's unacceptable". It got the point across.

 

[SouthernSurgeon]

I don't think anyone is defending screaming or personal insults. But I see no problem with a tongue lashing.

Lowly general surgeon here.

The days where anyone in medicine can get away with this sort of behavior are rapidly coming to an end.

It shouldn't be tolerated...but it doesn't particularly matter whether you think it's ok or not. Hospitals and medical schools are implementing zero tolerance policies with increasingly strict consequences. The old guard will shape up or get nailed.

 

[neutropeniaboy]

Let me clarify a few things.

A resident should never be allowed to make mistakes. Some mistakes have no consequences, but others have drastic consequences. So, mistakes are expected under my care, but they are never acceptable nor are they condoned.

My reference to the occasional verbal tirade was not to suggest that they were acceptable, rather I would not consider a program to be malignant if you experienced one.

Rarely is a tirade necessary, but I have often seen them and implemented them when a resident is way out of line, lazy or insubordinate.

If you think these tirades are things of the past, you're probably right. However, a few tirades does not a malignant program make.

Lastly, the definition of tirade is probably variable among the generations.

Some of you think that being a surgeon is like any other job with a normal work flow and a horizontal hierarchy. It's unlike any other job. A simple mistake can kill someone, and in an era where I see an increasing number of people say "I don't know, I'm just covering" or "I'll let the on call person handle that" or "I didn't get a chance to review this and that" a couple tirades are sometimes called for.

 

[DrBodacious]

It sounds like everyone has their own definition of verbal abuse, here.

When I read NPB's post sayng that it is worth while to put up with a few "verbal tirades" to get good training - I agree - certainly within what I had to put up with in residency. No one ever called me names, but tempers would raise and the attending sort of puts on a show where they make the resident look bad while showing them how to do something. I definately experienced unfair verbal criticism on an infrequent but regular basis, and more from certain attendings. Like "What are you doing?! Don't do that, your going to [insert ridiculous complication here]" when you are obviously just following suit.

Did it piss me off? Definately.

Why do I think this is okay?

1) I believe that the attendings I dealt with had earned some liberty to do what they want. Specifically, they were nationally recognized experts in their field who would allow me to have meaningful contributions to the care of their patients.

Everyone attending has their strengths and weaknesses. I kind of picture attendings in a role playing game with different skill attributes available: For example - Didactic teaching, surgical skill, teaching in the OR, genius/innovation, tireless work ethic, resident advocacy, multidiciplinary leadership, political advocacy. No one is perfect. I would rather work with someone who has 30 years of experience and is an expert in their field, even if they are a prick, compared to working with someone with questionable intellegence and experience and is respectful to me.

Instead of saying, "this attending made me feel bad, this is unacceptable," the smart question is, "what is their redeeming factor?"

2. Practically speaking, what are you going to do about i? In residency, you could whine about things constantly, but it doesn't get you anywhere. Whining to the program director should not be taken lightly.

3. This is unlikely to be widespread within any program in this day and age. As I mentioned before, most programs will have a couple people who are more demanding, but A way to make sure you avoid a malignant experience is to look at the variety of rotations.

4. Don't take things personally. If someone is being unfair with you, that is usually obvious to you, them and everyone around you. Focus on the learning points. If you keep your cool the attending just ends up making them self look bad for blowing up.

5. A good chairman and program director will keep things under control. All it takes is for the chairman to say "this is unacceptable" and people listen. People do get fired for lack of communication skiills.

6. This is a counterproductive thing to focus on as a MS4 in the match process. It is really not that big of a deal. Any interviewee who perseverates on finding out about malignant aspects in the program is going to show them selves in a negative light. Focus on the training opportunities available in the program.

 

[nacholibre]

I really don't think asking a question on SDN is perseveration. I am always amused to see how me asking one touchy question almost invariably ends up coming back to "this is not something you should be worried about" or i"f that's what you're focused on then you are not the right person for my program"

I agree with everything that has been said VERY much, and have really appreciated the insight into this situation that I hadn't considered, especially Bodacious' comment about it being a fair trade to get to work with experts in the field.

I do not agree with the claim that this is counterproductive as an MS4, just like I've argued in other threads about work hours restrictions, operative experience, location, etc. I am about to commit a majority of the next 5 years of my life to some place, and you can be sure that I am going to try find a situation where every detail, especially the culture of the program, work in favor of me learning best.

While I realize that I am in an incredibly competitive fight for a chance to become an ENT, and that I am probably no where nearly prepared enough for the task, I don't see this as a "be happy where ever you end up and in what ever situation you end up in." I have worked as hard as any other student I know to make myself a commodity to programs and as such, the programs that I have heard have a reputation of being malignant fall down or off of my list.

Anyone think this is a bad way to look at the situation?

 

[DrBodacious]

I really don't think asking a question on SDN is perseveration. I am always amused to see how me asking one touchy question almost invariably ends up coming back to "this is not something you should be worried about" or i"f that's what you're focused on then you are not the right person for my program"

I agree with everything that has been said VERY much, and have really appreciated the insight into this situation that I hadn't considered, especially Bodacious' comment about it being a fair trade to get to work with experts in the field.

I do not agree with the claim that this is counterproductive as an MS4, just like I've argued in other threads about work hours restrictions, operative experience, location, etc. I am about to commit a majority of the next 5 years of my life to some place, and you can be sure that I am going to try find a situation where every detail, especially the culture of the program, work in favor of me learning best.

While I realize that I am in an incredibly competitive fight for a chance to become an ENT, and that I am probably no where nearly prepared enough for the task, I don't see this as a "be happy where ever you end up and in what ever situation you end up in." I have worked as hard as any other student I know to make myself a commodity to programs and as such, the programs that I have heard have a reputation of being malignant fall down or off of my list.

Anyone think this is a bad way to look at the situation?

I don't think you are perseverating here, Nacho. It is smart to take the time to think through these issues and gain perspective before interview time. I was asking the same questions you were.

To explain my "counterproductive" statement: Interview day is where people attempt to judge your character and see if you are an ideal resident. Even though you want to know about the programs' characteristics, tread lightly when attendings and residents ask you "what questions do you have for me?" on interview day. I think it goes without saying that someone who is smart but entitled is very difficult to teach. That is the impression you want to avoid, and you risk making if you ask the wrong questions.