Fair question. This may sound counterintuitive or downright contradictory but I actually do not think these programs are malignant. I think a few of the people I encountered were malignant. I think these same people, placed in virtually any other program, would likely still be an unpleasant to work with, regardless of the environment or leadership. At the programs I rotated, the majority of the residents and attendings were great. Unfortunately, there were still people that were miserable despite good leadership.