How to deal with a Malignant Residency Program Director



Dealing with a malignant residency program director is not an easy task especially if you were the target all the time. With the new ACGME residency regulations, I don't think that the term malignant PDs apply much, however, this term is still widely used among troubled residents and/or in troubled programs.


Although in many cases it turn out that the resident is not efficient enough to meet the program expectations, however I will take the resident side in this post and guide you on how to deal with the situation in the safest manners. Yes, I still think that there are directors out there that are not benign!


1- Face the problem. This is your future and nobody is concerned about it more than you. Open your ears to every single comment you receive from your director or faculty and work on improving yourself in that domain even if you will spend couple of hours extra in the afternoon. Try to come up with a standard way to pre-round on your patients to be ready for the presentation. Come early to the ward, yes, the earliest you can. Manage living in the same neighborhood your institution is. (I used to live across the street!).


2- Seek for help. In general, every resident should have a mentor to evaluate and help throughout the residency. This will work as a 3rd party feedback for you on how you are functioning and how you can improve your reputation. Most of the times it work as a shield from the anger waves you receive from your PD, if any.


3- Peer to peer. Don't bring up the word malignant director to any colleague, they might spread the news and ruin your residency. Sit with your close friends or those who are considered the top in your residency and  try to figure out how they manage their day.


4- Don't argue. This is very important. Some directors get offended easily even if you didn't mean to. Let them say and comment whatever they want. They can't fire you if they don't have enough evidence to support their decision. Just let it go.


5- Take initiative to present yourself to the other seniors in the program by presenting cases and journal articles whenever you have a chance. You can communicate with the chief residents to see how they can help you get these spots. This way you will have some positive feedback from different levels enough to ease your directors anger.


6- Many of the new residents, especially the IMGs in busy programs will suffer from stress even without knowing that it is the origin of their trouble. You may try this book as  a start: The Mayo Clinic Guide to Stress-Free Living