Justianna's interest in compiling a Top 10 Plastics ranking makes me realize that I haven't seen a Top 10 General Surgery Residencies ranking - and it likely isn't the same as the Plastics list.

Since there are so many qualifications upon which to judge (research funding, fellowship placement, trauma volume, # apps received per year, etc), much of this could be comparing apples and oranges. So, let's just list by academic reputation (you can judge whatever that means).

Here's my starting pitch:
1)MGH
2)Hopkins
3)Southwestern

That's not a very deep or bold list, but it should do to start. Here are some others, but I'm not sure of the best order: Wash U, U Wash, Michigan, Duke, Baylor, NYU, Mayo. Also, what about: Brigham, BI-Deac, Yale, UCSF, Stanford, UCLA? Any suggestions??

I would toss out a couple of the names you submitted in your best of list including Mayo, Yale, Stanford, Baylor (houston), Wash U, U. of Wash., & Deac.

A few others that I feel would deserve more consideration in respect to academic circles include Pittsburgh, Minnesota, Vanderbilt, Emory, UAB, & Louisville

Also add Cinncinnatti and Wisconsin to the list of top programs by academic reputation

Dr. Oliver or anyone else: a little off topic but how hard is it to interview at Mayo? I still don't know how to determine what schools are really out of my league. I really would like to train in Surgery there. I'm interested in Mayo at Jacksonville which doesn't offer Sub-I's. Only the Rochester, MI site does and I'd prefer to stay in the south. What programs should I not even bother applying to being that I'm not AOA or in the top 10% of my class? :(

BeeGee,

the Mayo clinic (MN) is considerably less competative for general surgery residencies than you would assume. It has the reputation as a great place to be a patient, but a poor place to learn how to be a surgeon due to a very controlled environment without much indigent population or trauma experience. I do not know about the Scotsdale & Florida Mayo branches, but I would assume a lot of the same criticisms would apply (except that your not freezing to death 8 months a year :) )

[quote]Originally posted by droliver:
<strong>A few others that I feel would deserve more consideration in respect to academic circles include ... & Louisville</strong><hr></blockquote>

Hmmm....and WHY would you include UoL? ;)

Kimberli,

because we're an egotistical, elitist, malignant, know it all group of snobs :D (Kim, did I leave any adjectives out?)

I agree with your top 3 list maybe with a #4 being Vanderbilt. The rest are the rest although Stanford is supposedly good but I have nothing t base that on.

Hopkins, MGH, Southwestern, Vanderbilt

I would probably group them this way (in no specific order within groups) Keep in mind that this ranking is not a comment on the actual quality of the programs or the desirability of training there (particularly since some of the programs I'm listing didn't fill recently). Just my perceptions from informal discussions with students and residents. That being said, I would say that the vast majority of surgery programs can provide an adequate educational experience, find a good fit for you, don’t just go to the “name-brand” institution or you may be sorely disappointed.

Traditional Top Tier by reputation :
Mass General, Brigham, Johns Hopkins, Michigan, Duke, Pittsburgh, Wash U (St. Louis), UCSF

High second tier or first tier only in some fields: Baylor, UT-Southwestern, UCLA, U-Washington (Seattle), Penn, Colorado

Regional powerhouses (sought after, but seem to draw a more regional applicant pool or less well known outside of their region): Vanderbilt, Emory, Cincinnati, UCLA-Harbor, Oregon Health Sciences, Minnesota, Louisville, Rochester (NY), and probably the New York programs should go here too(Cornell, NYU, Mt. Sinai?)

Note: No purely community programs made this list, not because they aren’t good programs, but because if you want to create a prestige listing, they don’t get the same mentions. They probably should go on a different list, and I’m not familiar enough with the programs to really even hazard a guess. Heck, I don’t even have first hand knowledge of most of these programs!

Surg,

I really think you list captured a good hierarchy of most of the top programs. I think you might move Colorado & Univ. of Washington down a group, NYU up,& add UAB & Wake Forest to your third group, but overall a pretty thoughful assessment & pretty consistent with my own feelings on the academia prestige list. For quality of training, all bets are off though, as a # of community or state U. progams will turn out better trained surgeons just because their volumes are much higher & the competition with fellows is less.

There are two very highly regarded community programs that I know: Baylor University (Dallas) & Carolinas Medical Center (charlotte). Both are very tough matches for lifestyle reasons & good reputations

RIO,
I could certainly agree with your assessment, the
NY programs fluctuate from year to year so some years it seems the hot one is Cornell, other years the hot one is NYU (especially for those that ever met Dr. Spencer) so I wasn't sure which to move up.

UAB seems to be the one with some buzz recently (which is a return to prominence considering that they were one of the few university programs that didn't fill a few years ago while Surgery was still popular, of course that was before Dr. Bland came to UAB)
Wake Forest I haven't heard much of, but that's probably because I'm not a Southerner :)

surg,

I tend to agree with your rankings with the modifications suggested by the other poster.

Are you a medical student or resident or...?

I would like to hear some more of your opinions on surgical training programs, esp. the ones you listed in your traditional top programs.

Thanks to all who reply.

I am a upper level resident so I'm just far enough out that you should take anything I say with a LARGE grain of salt since it generally represents a mix of my students', other students interviewing at my program's, fellow residents', and attendings' views, but, as I am getting farther and farther removed from the my own interviewing process what I post becomes more and more reliant on second hand info (things that people I think are reliable tell me), rather than first hand info (information that I learned at places that I visited, rotated at, went to school at, etc.)

As far as my views: As I said before, there are a plethora of training programs (230+ general surgery programs). For the most part any of them will be able to make you into a safe surgeon. The list I provided above are those that seem to be the ones most mentioned or sought after. I could give you a list of 40-50 more academic style programs that I don't think anyone would be ashamed to say they trained at right off the top of my head. Which you pick is a matter of a few things:
1) Decide on your goals: academic v. community v. unsure
2) Decide if you know what specialty in Gen Surg you may want (including the option of none at all)
3) Find a program that will get you the case load, the variety of patients, and the teaching that will turn you into a safe surgeon
4) Find a program full of people that you'd like to spend every waking hour with (because it will seem like you do, even in the most "benign" programs
5) Ideally, try to find a match between the program strengths and your interests (One thing I tell our students to keep in mind, particularly as they explore the middle of the second tier, is to ask themselves if there is a mentor there that they would model themselves after

How do you find out info?
1) Your advisor. If you have chosen wisely, they like you and will keep your best interests at heart.
2) Other attendings. See above
3) The residents at your program. They have very little to lose by telling you what they think
4) Students at other schools. Most students are pretty savvy about the programs in their region at least. Try to make friends on the interview trail to swap stories and compare notes. You'll be amazed how useful that is.
5) this board. I think most of us are willing to answer questions as best we can. It is much harder though to advise you well, since we don't know much about you (grades or personality) and where I might steer one student towards one program that I perceive is a good fit, I might discourage an equally "good" student because of fit issues (sometimes specialty interest, sometimes family issues, sometimes personality issues). Thus as far as specific programs personal characteristics, I think I'll stay out of that morass, but if you have questions as to their _perceived_ clinical strengths, I might give it a crack.

characteristics:

-applying nationwide (ie academic programs listed above)
-240 &lt; part I &lt; 260; non-aoa
-loves to operate; wants to be on max. end of RRC case load
-not affected by work hours or call schedule, but intense, focused work is desired over lots of B.S. work
-single
-dislikes whiners
-likes people who enjoy life to max with miniscule moments of free time that they have
-academic surgery with research is ultimate goal
-will research for 2+ years
-fellowship plans unknown due to unknown specialty desire due to hazy idea of specialty stereotypes
-likes a tightknit team rather than subcliques within a program

Any and all help about where and what I should do is appreciated.

Could someone here please comment on the strengths and weaknesses of U of Colorado, St Joseph Exempla (Denver), U of Nebraska, or Creighton gen surg programs? Any direct knowledge of these programs would help.

Is it true that sometimes a good LOR or two from nationally highly-respected surgeons can trump things like board scores?

Jen, I have had that same question for some time now.

jen628

This depends on just how low your board score is and what caliber of program you are applying to.
A great letter by someone that the selection committee knows and respects can go a long way to helping us form an impression of you and what you are like, however, the rest of that is up to you.
If I was forced to choose, I'd prefer someone with above average board scores with excellent letters over someone with excellent board scores and only average letters though so I guess there is some truth to your statement.

Keep in mind however, that at the most sought after programs, the ones that get in generally have good board scores AND good letters.

Does anyone have the list of schools that require 7 years (2 being research) as opposed to five for gen surg?

btw, thanks surg.

Jen, Search for FREIDA ONLINE at <a href="http://www.ama-assn.org/ama/pub/category/2997.html" target="_blank">http://www.ama-assn.org/ama/pub/category/2997.html</a>
It is an excellent resource that will let you know if there is a mandatory 1 or 2 year research requirement during the residency. This is for every program in the nation that participates in the NRMP match.--BeeGEe

Hey, can someone comment on Ohio St. program. I know it was great once and was wondering how it is today?

Could someone compare contrast UPenn, Cornell, and UChicago? Esp. in terms of operative skill and broadness of training. This is what I have surmised....

My knowledge about Cornell sounds like it's easy, not much trauma or pediatric experience, but good placements in anything, even trauma or pediatrics. Surg onc is always been good here.

UPenn sounds like a killer program, lots of BS to deal with, especially in the junior years, and very thoracic heavy, though peds is awesome, of course.

UChicago seems young and possibly unstable with the current gen surg chief being recruited by everyone. Surg Onc seems strong here.

We just hired a recent grad of U. of Chicago for our trauma surgery staff after she finished her fellowship here & for what its worth she was very well trained coming from UC.

what about LSU? any thoughts?

Great topic, but how about for those of us not into the top programs? Can anyone list some of the programs that are good to train at, but are attainable for the more average student who actually would like to finish in 5 years without research years. Thanks

While I chose to go to one of those "top" programs, with research built in, I also looked at a number of other great programs that I thought I would have been more than happy to train at, would have received excellent surgical training, and allow you to finish in 5 years. Of those such places I interviewed at, my ranking would go something like this:

1./2. Utah and Wisconsin--not sure which I would put ahead of the other; they're quite similar (the chairman at Wisconsin trained at Utah); Utah wins the location battle hands-down, though
3. UT-Southwestern (not as competitive as previous posters have made it out to be)
4. UNC

The other programs I applied to were either 7-year or I didn't like enough to rank.

One of my best friends is a chief @ LSU-New Orleans & one of my ex-girlfriends finished there last year. Pretty solid program "in the trenches". One of Plastic Surgery fellows is from LSU-Shreport which is also a solid place I'm told.

I've had two friends who did fellowships @ Utah in recent years who think the program @ Utah is pretty weak (for what its worth). Sorry, LaCirujana.


UNC is usually a popular place among students on the interview circuit, but a lot of that is for the location rather than the program's reputation for great training. I think it actually is fairly competative for a spot there.

The South Carolina-Greenville, UT-Chatanooga, & Medical College of Georgia are programs that seem to turn out a lot of good people. I've had friends and acquaintances who really liked them.

I was really impressed a few years ago by the chair @ Med/ College of Wisconsin & the program they had going. You can do 6 months or so somewhere in England if you want to during the program. They did not fill a couple spots this past year in the match.

UT-Southwestern looked like a great program from the outside & as a rotator when I was a student. One of my former chiefs is a vascular fellow there now & thinks its good too. Unless things have really changed, this was a pretty competative place a few years ago but the landscape is different now I guess.

I would avoid the Univ. of Arkansas as they're changing chairmen

Mississippi has a lot of money from the tobacco settlements & have a lot of pathology running around there. Should be an ok place with all that.

Indiana has a wonderful rep. from some of our faculty, but I've heard very unfavorable reviews from some of our students who roatate there & two people who did recent fellowships there.

All anectdotal advice I know but here goes:

I have friends at:

UT-Knoxville -- loves it. Thinks it's strong. feels he will be able to match fellowships anywhere. speaks highly of the chairman

Texas A&M/Scott&White -- Surgical experience from day 1 to day 1825 is supposedly awesome. town sucks though

UT-SW -- my friend says it is extremely academic, old school, but not nearly as malignant as some would have you believe. he enjoys it but is not sure how comfortable he will be with bread and butter surgery

Univ of New Mexico -- a little "iffy" right now but enormous changes being made. financially, a little on the short end

Univ of Utah -- Fellow resident from there. He was not totally impressed with the overall strength of the program. Felt like lack of actual surgical hands on experience

Univ of Kansas-Wichita -- Really likes the early surgical experience and environment (large amount of GS). Worried about lack of pediatric/hepatic surgery.

Oregon Health Sciences -- I haven't spoken to my friend from there in a while. Overall, it appears to have a good chairman with a large surgical base. I'll try to contact him and see if he can give me the pros/cons

Univ of Wisconsin -- Overall pretty strong program. Lots of pathology. A little bit of a beat-down, plus it's in Wisconsin


More later

I'll second the good reviews I've heard for UT-Knoxville & Scott & White. I think an important thing to consider about some of these third tier (I don't know what else to call them) places in the smaller places is that most of them will lack fellows & will offer some oppurtunities to do a lot of vascular, orthopedic, thoracic, urologic, minor pediatric, and even gynecologic cases that you might not get @ the larger places. These can be valuable skills if you practice outside of metropolitan areas. You will prob. be at some disadvantage for some of the more competative fellowships coming from these places though.

One of my fellow chiefs went to Wichita for med school & actually transferred there for his pgy-2 year for personal reasons. He ended up coming back here for his pgy-3+ years because he thought there was a big drop-off in quality in training for what its worth.

I think OHSU is pretty competative due to location (Portland) & prob. does not meet fourthyear's list of programs that might be reachable without stellar class rank,etc.... I think there have been some pretty nasty comments about it in the review section of scutwork.com if I remember right

A few more comments:

Rob--I think you have Medical College of Wisconsin and Univ. of Wisconsin a little muddled--Dr. Rikkers is the chairman of University of Wisconsin, they filled in the match last year, and the England program is through UofW. I don't know anything about MCW.

OHSU is NOT competitive. I was not terribly impressed by the program there. They do have a new chairman (John Hunter--also a Utah trained guy, by the way, most recently from Emory), who I think will be making some favorable changes, but in the meantime, about the only thing the program really has going for it is location. They take 10 categorical residents/year and they are spread out over 6 hospitals--very little support, kind of a bizzarre program director, and just a generally weird vibe about the place.

U. New Mexico--on probation. 'Nuff said.

For what it's worth, I'm curious as to who you guys know from Utah--I know one of the recent vascular fellows was from Louisville--nice guy, but pretty bitter about Hiram ("Fire 'em") Polk and the overall malignancy of the program there. The residents (and 4th year med students, for that matter) at Utah get tons of hands-on experience (from day one--none of this "interns don't operate" garbage), although I will admit that there is a paucity of upper-level cases at the University hospital--the private hospital is where most of the Whipples, liver resections, etc., occur. I would guess that the fellows didn't spend any time at the private or pediatric hospital. Most of the people from my class (and the one ahead of mine) who left Utah, left pretty bitter about a number of things, so I can imagine they don't have the nicest things to say--I left, but for very different reasons, and think pretty highly of the program (obviously).

L.C.

No, I think I spoke correctly about MCW both not filling & having a rotation available in the UK (http://www.mcw.edu/surgery/gs-rotations.html). I just remember being very impressed with the chairman, Dr. Henry Pitt & the beautiful Froeterdt Clinic facilities way back when I interviewed. I never interviewed in Madison & don't know much about it other some historical things that have come from the research labs there.

That would be change re. OHSU not being very competative recently. Dr. Hunter is a laparoscopic God though & was very popular @ Emory. I did not realize he was @ OHSU now.

My friend whom you met @ Utah was pretty fried @ the end of his residency & really got beat on as a junior resident. He was an absolute stud technically & otherwise by the end of his chief year & he was recruited to come back as faculty (I think he's gone back to TX to do private practice). Personally, I've had a blast 85% of the way thru my training & it really would never occur to me to call this place malignant. There are always some personalities that you have to tread lightly around, but that's true everywhere.

As an aside, my Father did his fellowship @ Utah in the early 70's when I was 2-3:cool:

It sounds like you're pretty happy where you are (wherever that is). Enjoy it, it goes by so fast

Froeterdt? Not a very beautiful name..

From what I understand, there are quite a few programs that have been placed on probation. I don't think that should be a deterrant to considering a program. If anything, it might even be a bonus. You know that program has an incentive to improve.

how can I find out which programs are on probation? I'd rather NOT go to one b/c you risk the program being closed while you are there, having to scramble into another residency mid-training, including the hassle of moving. So anyone have a link to a list of these programs?

Originally posted by droliver


No, I think I spoke correctly about MCW both not filling & having a rotation available in the UK (http://www.mcw.edu/surgery/gs-rotations.html). I just remember being very impressed with the chairman, Dr. Henry Pitt & the beautiful Froeterdt Clinic facilities way back when I interviewed. I never interviewed in Madison & don't know much about it other some historical things that have come from the research labs there.



It sounds like you're pretty happy where you are (wherever that is).

Sorry--a little confusion on my part--I thought you were saying that UofW hadn't filled last year. (They also have a UK rotation available there, as well as an outstanding chairman, hence the confusion.)

After a fair amount of adapting to no mountains, humid weather and a very different program structure, I have to say that I really am pretty happy here (although I wouldn't mind a little more OR time). Given that we have another of your former chiefs here, acting as a part-time trauma attending, while doing a critical care fellowship--I can't seem to escape you UofL guys!;) --you can probably figure out where I am...

You could definately do worse then where you are! Tell Steve hello for me.... great guy! It will definately get better for you as far as the OR goes, but you have to be patient @ a place like that. Another former chief here is one of your vascular attendings FYI.:)

It's good to hear all the opinions of different places. You can tell that opinions are just that, opinions. We all have different contacts at different places who like/dislike different things about their particular programs.

I spoke to my friend at Oregon who said he did not think his residency was very competitive overall. He says he's getting a little beat as an intern but likes Portland.

I also spoke with my friend in Wichita recently who echoed droliver in that he felt the 4th & 5th year could be stronger with more autonomy. But, he could not speak highly enough for years 1-3, operative experience, as well as the environment. He disagreed with the ability to get fellowships as his chiefs when he was an intern went into surg onc at Sloan-Kettering, vascular at Mayo, and trauma at Baltimore Shock.

It's amazing how I was told not to even apply to Louisville but droliver only speaks highly of the program and his experience. I guess you need to take opinions with a grain of salt and really experience the programs first hand.

One of my interns in med school was from Univ. of Wisconsin and had no negatives to say about it. He just left the program for a change.

Who knows? Just go wherever you want and train to the best of your ability. EVERY program has their strengths & weaknesses. I don't recommend going to a program on probation though. Stability should not be understated.

To the question of who is on probation:
1 solid source is the horse's mouth itself:
www.acgme.org has a listing of all the programs that are approved and when their last review was and the outcome of the review. The only wildcard is that things can change between the time that you look at the site and the time that you start whereas the site is only updated when the results are released (thus the program may know for a few months before it shows up on the site)

Unfortunately they do not list programs by accredidation or probation status on the ACGME site as far as I can tell. Take Yale for example, you go thru the accredited program menu for Connecticutt & it looks as if Yale is accredited until you go to their page & in very small print it tells you it has been withdrawn. All in all it is not a very consumer-friendly database for finding out that kind of info, it would be nice if they seggregated them off on a seperate area

from droliver
One of my fellow chiefs went to Wichita for med school & actually transferred there for his pgy-2 year for personal reasons. He ended up coming back here for his pgy-3+ years because he thought there was a big drop-off in quality in training for what its worth.

I just spoke to my buddy at the University of Kansas-Wichita and told him of your fellow chiefs comments. He thought it was hilarious. Apparently he remembers the guy you're talking about and said the guy had a lot of "issues". Apparently he was a little too 'hardcore' (or so he thought), was unable to fit in with the residents, and had multiple run-ins with faculty.

I just wanted to point out that everyone fits into certain residencies and that we should probably not base our opinions of programs on any one single opinion (no matter how much you trust the person).

Granted, all residents think their program is the best. Otherwise they would not have chosen it for residency or would leave and find another spot.;)

Just beating a dead horse:p

Dr. Evil,

you are so right. I probably sure not have proffered some gossipy advice about other programs (even though I have tremendous respect for the source). Your point about personalities of a program is also very important- and can range from conservative to cowboy & everywhere in between.

Hey, this is a copy of a post I had on another thread. Just another perspective. Good luck all! BTW, our program was recently okay'd for 5 years (which is the highest ranking) by the residency review commission.



Don't equate community program with noncompetitive or poorer training.

I'm graduating from Iowa Methodist Medical Center (heard of it? Didn't think so...). My classmate just matched into a very competitive Plastic Surgery fellowship, and basically had his pick of programs. Our previous grads have matched into Plastics, Cardiothoracic, Colorectal, Vascular and Minimally Invasive Surgery fellowships at highly competitive institutions.

Our absite scores (sort of like USMLE for surgeons) are usually above the 90th percentile for about half of us, and well above average overall. All of us graduate with published research, and usually present research and take home awards at national meetings.

We consistently fill with our top 5 applicants. Our incoming interns have board scores typically in the 240s, are most often AOA, and could easily match into the majority of University or community programs in the country.

Advantages of community programs are many: more liveable, better call schedule (home call - O yeah), nicer staff, better ancillary support, free food and parking, and - most important - better operative experience. In the OR, it is just you and the attending from day one of your internship. There aren't enough residents or med students around to stack people in rooms like at the U. There are no competing Fellows or surgical subspecialty residents to take the great cases. You want to do the complex Plastics, Pediatric, Surg-onc, Gyn-onc, ENT, Transplant, Vascular, Cardiothoracic, Urology cases - it's all you, baby. We graduate with about 1400 cases (we have to stop counting to keep from racking up too many, to be honest).

Another benefit, at the end of 5 years, you'll still be married and your kids will know your face.

If you're planning on doing academic medicine, or if you know that you will want to subspecialize in a highly competitive field (eg. Pediatric Surgery), then you probably ought to limit yourself to University programs.

Otherwise, community programs are often the best of all worlds. That's just my humble, unbiased opinion, of course.

Regards!

Originally posted by womansurg
.
I'm graduating from Iowa Methodist Medical Center (heard of it? Didn't think so...

I have;) Has a great word of mouth reputation among community programs.

We graduate with about 1400 cases (we have to stop counting to keep from racking up too many, to be honest).

womansurg,

I often here residents quote the number of cases that they graduate with. I have a huge problem with that statistic as it does not give any information on the quality of cases. Do you mind expounding on the type of cases you get as a 4th/5th year and what percentage of your overall numbers are "chief level" cases?

This is not meant to be critical at all. I hear great things about Iowa Methodist.

Hey, has anyone heard anything about UT Houston Gen Surg program? I got an interview invite there but really don't know much about the program other than what was on the website and the glorified filf i saw on Houston Medical. thanks

UT-Houston is a very old school academic program (not that there is anything wrong with that). It can be a bit of a beat down but I really don't know if I can say that about any program after the 80 hour work week thing begins. It is a fairly "malignant" program and very hierarchal. That's just what I've heard from a couple of former students from UT-Houston. Take it for what it's worth.

Can someone tell me how strong the following programs are for general surgery training? I've enjoyed all these, but am not sure how to rank them

1 stanford
2 UCDAVIS
3 UCIRVINE
4 UCLA
5 UCLA-Harbor
6 Oregon (OHSU)
7 Baylor-houston
8 U. Colorado
9 mayo clinic-scottsdale

Originally posted by dr.evil
Do you mind expounding on the type of cases you get as a 4th/5th year and what percentage of your overall numbers are "chief level" cases?

This is not meant to be critical at all. I hear great things about Iowa Methodist. Sorry I didn't address this sooner. I didn't have ready access to the numbers at the time, then sort of lost track of the thread.

Looking at the past couple of years, averages for chief cases, which are all major cases, are about 350+ during fifth year. Our chief year is different than at many programs. For 8 months of the year, we don't run a service, but rather cherry pick the interesting cases from the major services that either a third or fourth year is overseeing. So at any one time I am usually tending to around 6 or 8 inpatients. These cases tend to be large cancer operations (whipple, gastrectomy, esophagectomy, adrenalectomy, hepatectomy), larger thoracic cases, endocrine, or anything vascular that we are interested in. Actually most of our vascular exposure is during fourth year - AAAs, bypasses, carotids, anything endovascular that interests us - as well as our core thoracic stuff. As chiefs, we also scoop a lot of the laparoscopic stuff: Nissen, paraesophageal hernias, inguinal hernias - although we still leave a lot for the third years to do.

By fifth year we know what we are going into, so we choose our cases based on that. For instance, one of our chiefs is going into plastics at Indiana U, so he chooses a lot of complex plastics cases, ENT and the like, and dodges the vascular and GI stuff. Another is going into private general surgery practice, so he picks up everything general and avoids vascular and thoracic. I'm going to a broad based rural referral hospital, so I take all general, all thoracic and all vascular - it all sounds good to me. We are a Level I trauma center, so trauma exposure is throughout the five years.

The other four months of chief year is overseeing surgery department at the local charity hospital. Here is where we get our true autonomous exposure. Attending staff are 'available' but usually not scrubbed in during the case (in face, often are at home or at the other hospitals). In clinic or in dealing with consults, same thing: there if you need them but basically you are running the show. These four months are a good, broad exposure of cases - everything from hernias and gallbladders to AAAs, chest, you name it.

Moving to Surgery Forum...

Getting back to your original topic - I think it's very difficult to rank the "Top 10" programs, as this will vary depending on what you're looking for. My idea of a Top 10 program is one in which you graduate in 5+ years and everybody knows you've received amazing training. You tell them where you trained and they raise their eyebrows and instantly respect you a little more. It's a combination of clinical exposure, autonomy, research, and a general reputation in the surgery community that you survived 5 years of boot camp and nothing will faze you. With that in mind, and in no particular order:

1) Hopkins
2) MGH
3) UT-Southwestern/Parkland
4) UCSF
5) Baylor (Houston)
6) Wash U.
7) Louisville
8) Duke
9) UAB
10) Michigan

I told myself that I would not get involved in this debate, since the best program is obviously the one that best meets your needs and interests, but being as I am I just can't resist. Let me start with my exceptions from the previous list, which are:

3) UT-Southwestern/Parkland: I don't know enough about this place to really comment one way or the other.

4) UCSF: Is this really a good place? Or do people just like SF that much? I think this is a well thought of program, but is it really all that? My med school advisors don't seem to think so, but that could just be regional bias. I have also been told that the financial status of the hospital affects day to day life.

5) Baylor (Houston): I think this goes in the category of regional powerhouse with some nationwide recognition.

7) Louisville: I know everyone says that people can operate their butts off when they come out of here, but research is pretty much nil. I don't think this is much of an academic environment. I have been told by residents in my program who went med school there that while there is a ton of bread and butter, there is a paucity of complicated cases. I think this place also goes in the regional powerhouse.

9) UAB: A program on the rise. By all accounts, a phenomenal center with big operating and research. I think the location hinders many of the highest quality applicants from looking at it.

Now that I finished bashing programs that I would not mind going to, let me present my thoughts on "top" programs. I prefer to group by grade, since, in my mind, Picking between some of these places is a matter of personal preference, and the gap between the "elite" programs and the next best set is really not all that much either, at least as far as I have seen on the interview trail so far.

A: Hopkins, MGH, Brigham, UCLA, Michigan, Wash U, Duke

A-: Penn, Vandy, Cornell, UCSF, UAB, Baylor, UTSW, Columbia, Cincinnati, U of W (Seattle)

B+: Northwestern, U Chicago, Louisville, U VA, UNC, Emory

Of course, only a partial list. Just the places I considered applying to and actually have some (albeit superficial) knowledge of. Hopefully someone will continue this thread and have some other interesting things to say about my choices.

I totally agree that there are a few different aspects that build into a program's rep on the interview trail- word of mouth, location, history, to name a few.

Kind of funny how there's a program "personality" that is right for all of us. I personally liked UAB and Louisville much more than Duke and UNC. Also thought UVa was quite a nice place. There's a lot of hype over the Raleigh-Durham-Chapel Hill area which I think makes those places more popular with applicants. I used to live in Chapel Hill; it is a pretty place, but unless you are an 18-year-old college boy (I beleive the undergrad pop. > 70% female) or married with an interest in the area's strong public school system, I don't think it is the most interesting place to live. Though the traffic in not comparable to NYC, parking can be a real PITA. UNC's chairman is cool, and you could probably get great training at either Duke or UNC. So I'm not knocking them or anything; the "personalities" of both of those places were not for me- just was not crazy about either of them.

Haven't yet been, but also been hearing over and over great things about UTSW.

B'ham and Louisville- don't know much about those cities, though both appeared to have enough going on that would be fun to check out on free time. Can't say it'd be like living in NYC or Miami, but looked okay. Charlottesville is very, very interesting; not a huge city, but a very unique part of the country.

BTW, womansurg; I actually have heard about Iowa Methodist on the trail- all good things. :)

Originally posted by smithani
7) Louisville: I know everyone says that people can operate their butts off when they come out of here, but research is pretty much nil. I don't think this is much of an academic environment. I have been told by residents in my program who went med school there that while there is a ton of bread and butter, there is a paucity of complicated cases. I think this place also goes in the regional powerhouse.


I would disagree with this word of mouth from personal experience. My operative numbers will indeed be obscene, but this is actually the "braniest" kind of program I interviwed at other then Washington University & has a pretty stong academic bent to it (5 of 8 graduating chiefs are planning academic careers). 1-2 residents per year go into the lab by choice & have been exceptionally productive. This is really the tertiary referall center for the state (as well as southern Indiana and northern Tennessee) and I have several multiples of the national average in literally each index case category for the super specialty cases.

I agree with the regional powerhouse categorization, mostly due to the less prodigious research bases of the University (as a whole) as compared to some with multi-billion $$$ NIH funding. However, Dr. Hiram Polk, Dr. David Richardson, and Dr. Frank Miller are known internationally in surgical education circles & there dozens of alumni who are department chairs and in other academic positions of power

Originally posted by Foxxy Cleopatra
B'ham and Louisville- don't know much about those cities, though both appeared to have enough going on that would be fun to check out on free time.

As a native of Birmingham & current resident of Louisville, I can say I love these two cities. They are very much similar & if you like one, you'll like the other. Both are very pretty, easy to live in, & great for raising families. IMHO I think that the training program is better here ;) , but UAB has had a much improved quality of life reputation since Dr. Kirby Bland took over which has lead to a resurgence in popularity among interviewees

I would think the Mayo Clinic would rank in the top 20. Some people have claimed that the Gen Surg residency is not so great because of the limited responsibility/independence residents get in the OR. I heard this isn't true anymore- it is actually quite the opposite. Residents now get a ton of experience and responsibility. Anyone with first hand knowledge willing to comment? I'm interviewing there in a few weeks.

Originally posted by superstar
I would think the Mayo Clinic would rank in the top 20. Some people have claimed that the Gen Surg residency is not so great because of the limited responsibility/independence residents get in the OR. I heard this isn't true anymore- it is actually quite the opposite. Residents now get a ton of experience and responsibility. Anyone with first hand knowledge willing to comment? I'm interviewing there in a few weeks.

Hi there,
I spent some time at Mayo Clinic, Rochester in General Surgery and it profoundly affected the way that I practice today. I found that the chiefs have plenty of independence and the academics are off the scale. The residents are a close-knit family-oriented bunch that are great folks. The only weakness of Mayo is lack of trauma experience but Detroit is there to fill that hole. The attending physicians are off the scale and I love the Mayo method of training. Mayo Clinic sees and handles things that you are just not going to find elsewhere in the country. The nursing staff is well-trained and plentiful. There is almost no scut to be found anywhere. The total emphasis is on training excellent surgeons. I found Rochester, MN the worst part of the whole deal. Housing is overpriced and I have to be wary of any locale where there are too many underground walkways.

The best General Surgery program is going to be the one that you can match into and grow with. Some of the community programs are very strong and offer excellent opportunities both from the standpoint of academics and from the standpoint of research. Inova Fairfax Hospital (outside DC) is going to be one of those outstanding community programs. This program is wealthy (read they bought some of the best attendings) and located very close to NIH, the premier research center in the country. This brand new community program offers cushy digs, plenty of money for travel and books and some very dedicated teaching faculty. The biggest drawback to this program is that housing in the DC area is very expensive and the traffic is murder even at 0400h.

I have found the University of Virginia to be the best of all worlds. There is excellent research, good town to live in, excellent colleagues and great attendings who take a personal interest in your development as a surgeon. There is a good mix of autonomy here and the support in the hospital is great. We have a plan in place to meet the 80-hour work requirements and provide a quality educational experience for the residency. We are even starting to pick up on the penetrating trauma as the "bullet and knife club" of DC has set up shop in the I-64 corridor.

When I first arrived at Va, I thought the academics would be far below Mayo but I have been blown away. These folks teach and heavy emphasis is placed on academics and research. There are opportunities to write book chapters and the "Recall Series" is a total UVa project. The hospital is very modern and totally computerized. We have the most wonderful panoramic views of the mountains with almost any kind of sporting experiences that you might want to do. Our department chair invited us fly-fishing during my first month of residency. The nursing staff is well-trained and the scut work is a minimum.

Our residency director is off the scale and really makes sure that the resident experiences here are top notch. The attendings have been trained at a variety of places from Harvard to Duke to Michigan to Penn. I have far more than 90 cases and I am only 6 months into my first year with my VA experience yet to come. There are loads of operative experiences even at the intern level. This place has been heaven for me.

It is of great comfort to have the rank of #1 program but if you match at Duke, Birmingham or Mass General and you are miserable for whatever reason, the rank of your program is secondary. A good match at a strong community program is way better than a bad match at a university program. I knew that a surgery intership was going to be extreme and it is better than I thought it would be and more work that I have ever experienced in my life but I have grown and learned so much.

Spend some good quality time with the residents (they will be totally honest with you) in the Mayo program and do some real running around town so you can get the total feel of Rochester. When that 15 below zero wind hits you in the face, you cry and your tears freeze. I just found that Minnesota was not the climate for me for five + years.

My experience at Mayo was great and I would not have changed it for anything but I am totally happy to be here at University of Virginia. Have fun with the interview.

njbmd:cool: