I didn't apply there, but out of curiosity, why do you not want to rank them?
I think Duke is a fine program, and it might even be the perfect program for someone depending on their goals. For me, however, it just didn't offer what I'm looking for in a residency. I'll list some examples below...
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Broad experience: I want a residency to prepare me well for any possible practice situation after residency. Thus I'd like to gain experience working in a community setting, an academic setting, a county setting, etc. Some programs combine all of these, some do not. At Duke I do not feel like I'd be well prepared to go practice in a county system, or even in a standard community system. This is because nearly all your time at Duke is spent in the Duke hospital -- they do not even allow electives to be done outside of Duke, and do not allow moonlighting. The Duke hospital, and the new ED, are awesome -- but I personally feel that I'd be better trained at a place with more diverse practice settings. Duke does have one month at a Durham community hospital, and one month at a VA, but I'm not sure if that's adequate for me.
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Resident friendly: I'd like to be at a place where residents are well taken care of, and I don't think Duke does as good a job of that as most places I interviewed. For example:
-At Duke you are expected to show up on day 1 having already gotten yourself certified in ACLS, ATLS, PALS, NALS, etc. They offer these for free at Duke, but if you aren't in Durham over the summer you'll have to take them on your own at your own expense. Most other places I'm looking have an orientation month where they provide you with all the merit-badge training.
-Most programs I interviewed at offered an educational stipend / book fund. This ranged from $500/yr to $2000/yr. At Duke, the educational benefit is "1 core EM textbook." This really isn't that big of a deal, but I think it reflects how much they support their residents.
Some other personal reasons Duke didn't fit my needs:
-Electives: Everywhere else I interviewed allowed electives to be done at other programs, and internationally. I have an interest in international health, but if I wanted to work abroad for an elective at Duke they said they would stop my pay for that time. Also, I would like to have more than 6 weeks of elective time.
-Moonlighting: It's prohibited at Duke. I actually don't plan on doing any moonlighting, although if I were at Duke I would want to (in order to get some of that real-world community experience that they are lacking).
Overall, my not ranking Duke is mostly a personal decision for the reasons noted above. I think Duke definitely has some strong points as well -- Durham is a nice and affordable place to live, the new ED will be great, the Duke name carries a strong reputation (more so outside of EM), most of the faculty I met there seemed energetic and friendly, the offservice rotations are strong, etc. I went into my interview at Duke hoping to like it and planning to rank it pretty highly, but I walked away thinking it would not provide me with the training and opportunities that I want from a residency program.
I hope this review doesn't offend any Duke residents out there -- I have tried to offer a balanced portrayal of the program, and I'm open to being corrected if I'm mistaken about anything I've said. Again, Duke is a fine program, it just wasn't the right place for me.