Welcome to “Ask the Program Director,” a column from MedPage Today where your most pressing questions about residency — from the application process to life as a resident — are asked and answered. Want to submit a question? Comment below or email perspectives@medpagetoday.com.
Dear residency program director,
While I thought my second year of residency would be easier than the first, I now find myself facing a big interpersonal challenge: One of the OB attendings is incredibly discouraging and rude. While he acts this way toward all the trainees, it feels especially targeted at me — despite positive evaluations from all my other attendings. The attending frequently tells us that everyone in our program is lacking in skill, knowledge, and commitment, and not ready to progress to the next level. At times, he won’t let us do procedures that we have done countless times before, saying we’re not ready.
If this were coupled with specific and actionable feedback or teaching, that would be another story. But it’s not constructive, just discouraging, and frankly, insulting. I’m worried this will affect my reputation and evaluations, and my ability to advance long-term. It’s definitely lowering my morale and confidence. I don’t want to be a tattle-tail or complainer by going to program leadership, but I’m not sure what to do.
Dear applicant:
This is a fantastic question that I imagine many trainees, unfortunately, have to face on a daily basis in their residency programs. First off, please know you are not alone and I also had to deal with a difficult attending during my training years.
Dealing with difficult people and personalities will be a challenge you will face not only during training, but inevitably for the rest of your career. Being in the healthcare field means collaborating with peers, bosses, teams, and multiple different personality types. And being able to successfully navigate these relationships and tricky encounters leads to enhanced understanding, solidarity, and resilience. So, I’m glad you’re asking about this now.
The first piece of advice I can offer is to take a step back and reframe this as an opportunity to learn. The actions of your attending are likely more a reflection on him/her and less about you, given all the positive evaluations from your other attendings. With that said, even difficult attendings have valuable knowledge and skills to offer. Even if their teaching style remains suboptimal, try and hone in on positive teaching points you can learn from them. Try and understand why they feel the way they do. Where might this feedback that everyone in the program is lacking in skill and knowledge be coming from?
When attendings make such remarks, they are likely comparing a set of residents to other residents they have taught in the past who they viewed as more motivated, initiative-taking, or knowledgeable. Consider whether it’s worth speaking to the attending and requesting more precise feedback about how you can improve. Asking specific questions could provide more clarity on how to progress, and will also show your “difficult” attending that you have a sincere desire to learn.
You may be surprised to find that this attending opens up to you when you’re one-on-one, or begins to perceive you differently, so long as you maintain a high level of professionalism.
When dealing with such attendings, and all healthcare personnel for that matter, use polite and professional language at all times and avoid reacting emotionally or defensively. Remember, your goal is to be the strongest and most competent trainee who will make a positive impact on your patients and your healthcare team.
It’s also important to remember that there is a difference between constructive criticism and inappropriate behavior. If your attending crosses professional boundaries by using insulting language and demeaning behavior geared specifically toward you, then it may be worthwhile to seek guidance from your chief resident. This can be especially helpful if you do not want to contact administration or your program director, as you indicated. Chief residents are a great source of information and are always your first line of defense and advocacy, particularly with tricky situations like this.
If you feel that going to your chief resident may not lead to a positive outcome, then consider talking to trusted colleagues or mentors, or escalating the issue to your program director and graduate medical office. After all, it is their job to deal with and handle these situations judiciously. This would not be the first time your program director or graduate medical office heard a claim like this.
Finally, keep in mind that this one attending’s treatment toward you is unlikely to affect your reputation, and these situations shouldn’t diminish your confidence in your abilities. You have received positive evaluations from all your other attendings, and there is a reason for that! As medical professionals, we seek perfection and approval from everyone, but this is not how reality works. Even the greatest professionals of all time will be criticized by others from time to time.
Remember to always be kind to yourself, especially in a profession that demands so much from you. By focusing on professionalism, empathy, and self-awareness, you can navigate the challenges of dealing with a difficult attending while simultaneously achieving your goal of becoming an ob/gyn.
Are you a medical student or resident? Please comment below or email us at perspectives@medpagetoday.com with other questions you’d like to have answered by a residency program director.
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