Let's discuss program rankings!

[powermd]

One reader recently PM'd me regarding Duke's position in tier 1, disagreeing that it is a tier 1 program. Since these rankings are all largely based on hearsay, I thought, as keeper of the FAQ, that I should at least encourage some debate on this issue. Attached below is the relevant portion of the FAQ for those who are interested. There are a few issues I would like to address:

a) how should anesthesiology programs be judged and ranked (ie. methadology)?
b) does any standard methadology exist already?
c) are there any published anesthesiology program rankings?
If not, perhaps we could begin ranking programs based on our own standard set of criteria, and weighting the different factors as we see fit (consensus).


11) What are the top anesthesiology residency programs?

This thread summarizes the feedback many forum members have received from chairmen, program directors, as well as personal experiences regarding the top anesthesiology programs in the country:
http://forums.studentdoctor.net/showthread.php?t=48717

The short list (based on previous thread) basically breaks down like this:
Tier 1 (best of best): UCSF, MGH, JHU, BWH, UPenn, Duke
Tier 2: Stanford, Wash U, UWash, UAlabama, Columbia, Mayo, Michigan, Wake Forest
Tier 3: Beth Israel Deaconess, Cornell, Dartmouth, MC Wisconsin, Mt. Sinai, Northwestern, Penn State, UC Irvine, UCLA, UCSD, UChicago, UColorado, UFlorida, UIowa, UNC Chapel Hill, UPittsburgh, URochester, UTexas Galveston, Utah, UVA, Vanderbilt, Yale

One poster aptly noted that rank based on prestige or research does not always correlate with competitiveness. Some programs are more or less competitive than would otherwise be predicted due to exceptionally good or bad location, lifestyle, and other factors.

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[UTSouthwestern]

I would be a little careful about even putting a Tier system out. Clearly there are some programs that are head and shoulders above the rest (UCSF and Emory being two that clearly stand out in my mind based on any and all criteria), but looking at other factors ranging from case loads, variety, and work hours to research, it is a very difficult proposition to give an appropriate amount of weight to each factor.

I look at the list above and notice that my program doesn't even make the Tier 3 listing, yet in getting feedback for a possible fellowship from our recently graduated residents who are doing fellowships at MGH, BID, Wash U, and UCSF, the consensus among them is that our training is equal to and may even be a little more advanced than the residents that stayed at those respective programs for fellowship.

In particular, I heard from one of our residents doing the combined cardiac/critical care fellowship at MGH and he feels that his training from Southwestern has placed him at a comparable level with his fellow fellows.

Some programs, ours included, also have one or two private groups with which the residents train and the research being done by our Zale Lipshy University Hospital arm almost never gets mentioned in the rankings (probably from the fact that private organizations and drug companies provide a great deal of the funding). Paul White by himself is a research and paper generating machine, but because of his status in the private practice arm, that doesn't get any pub.

I have a great deal of respect for the Galveston program, but when I compared the number and types of difficult cases we do, the time when we are allowed to start doing them, the relative independence we get to run even pump cases, etc., I feel we provide a level of training that compares to any program in the nation. I therefore wonder why we are considered to be of lesser stature than our in state neighbors. We definitely aren't a program that can afford to pamper our residents with all of the bells and whistles, but most of our residents have filled their ACGME requirements by the middle or end of the 2nd year and the entire third year becomes a year of gravy that allows them to polish individual subsets of skills. About a 1/3 of my class is doing a mini cardiac fellowship for the third year with the rest focusing on pedi, pain, or OB.

There are many programs similar to Southwestern as well that receive no love from the press rankings so I would be careful about unintentionally stratifying programs to lower levels, that may provide more than meets the eye. Just my 2 cents.

 

[powermd]

I would be a little careful about even putting a Tier system out. Clearly there are some programs that are head and shoulders above the rest (UCSF and Emory being two that clearly stand out in my mind based on any and all criteria), but looking at other factors ranging from case loads, variety, and work hours to research, it is a very difficult proposition to give an appropriate amount of weight to each factor.

I look at the list above and notice that my program doesn't even make the Tier 3 listing, yet in getting feedback for a possible fellowship from our recently graduated residents who are doing fellowships at MGH, BID, Wash U, and UCSF, the consensus among them is that our training is equal to and may even be a little more advanced than the residents that stayed at those respective programs for fellowship.

If creating a tiered ranking system is unlikely to work, perhaps we could rank programs locally (ie. best to worst reputation in specific geographic regions), and then have a list of the top ten programs nationally (in no particular order). It sounds like you have a pretty good idea of what's going on at the Southern programs.

 

[Gator05]

Powermd, this sounds like a fantastic idea. Now, I'm just a 4th year student, but have been talking with interviewers asking about their comparisions. Please feel free to comment on the statements below. I hesitate to even write this, as I've yet to interview at any of these programs myself, but figure something is hopefully better than nothing.

For the southeast, here's what I understand about the programs in speaking with faculty:

Duke: unless tip-top of class, probably requires externship to significantly increase chance of matching there. However, in speaking with interviewers from last year, was told that while Duke's research and name were remarkable, their training was topped by UNC and WF.

UNC: Am told of an awesome PD. Also home to a Peds Fellowship program, one of just a few in the southeast. Have been told by some that it is great training, and also that residents sometimes are paired up into rooms if not enough cases. Others remark that it has a good rep in the SE, but not elsewhere. I have a hard time believing this, as 24,000 anesthetics (advertised) plus a relatively smaller program leads me to think somebody has to be doing the work...

UF: My thoughts on this program are well known from previous posts. Reputations as a "malignant" program are out there, but unsure if this is confusion of "hard working". Great clinical caseload; in speaking with interviewers from last year, they were of the opinion that it offered some of the best training around. Lots of tech-based research too; always seem to bump into protocols in the OR. However, I'll openly admit I'm biased.

UAB Birmingham: Have always heard this is a fantastic program, but that is all I know.

MayoJax: Have been told the residents are quite happy, questions about quality of teaching as program transitioned from private --> academic.

USF: Poor teaching, on probation. Avoid.

Miami: Great training, hard working. PD from Duke, new OB MDA seems pretty cool based on some talks at recent meetings. Trauma anesthesiology fellowship offered.

Emory: Have heard all-around wonderful things about the program. Alas, personal bias against Atlanta; polluted, big, lots of traffic. I mean, you can see the haze from an hour away.

Wake: Consistently reads as one of the top programs in the country in discussions with faculty. Supposedly a smaller program with excellent CRNA support ---> shorter days. Supposedly awesome faculty.

UVa: Some faculty say it's a great program. Interviewers seem to shrug shoulders, regarding it as just another program. Had researchers involved in the latest neuroapoptosis flap in this month's Anesthesiology, which I was impressed with. Charlottesville rated America's #1 city to live in this year. Can't get a handle on their caseload, but understand it to be strong. Other interviewers say their schedule "might be even lighter than UNC's".

MUSC: Have heard good things about the program in general. Charleston is a fun town.

So my votes would trend toward standouts in...

Research: Duke, Emory, UF (I'll admit I can't rank Emory and UF's with much certainty when compared with Duke)
Quality of Life: UNC, WF, UVa
Caseload: UF, Duke, Miami, Emory

I'm pretty anxious to hear what others think. And in the end, I hope to just get an especially warm feeling about one or two programs. Hopefully these'll trigger some questions we can ask, and compare, on interviews.

 

[seaofred]

As a resident at Emory I can tell you that we do have a good mix of cases. We rotate through 3 hospitals for our general OR work. At Grady you will get all the trauma you want and will get very good at managing those patients. At Emory see the typical teaching hospital cases (AAA, Liver Transplants, General Surg stuff, ENT, Neuro ect..) and then we also rotate at Crawford Long which will give you a feel for what private practice might be like.

Our days are pretty tolerable:
Grady- Out at 3pm if you are not on call. Call approx 5 times a month which can be busy if you get a few traumas. You are supervising the anesthesists and helping out in the OR, running the PACU and preops, so you get a good feel for what it would be like to manage CRNAs and PAs.

Emory- Out between 3-5pm, Call 2-3 times a month. You usually get to sleep on call unless you are doing a liver all night. Great exposure to neurosurg (you will do several intracranial Vasc cases), vasc cases, hearts ect..

Crawford- out 3-5pm, no call (big bonus).

Overall Emory has been a great place to train. I have seen about everything from GSW to the L. Vent to ruptured AAAs. The teaching is pretty good and the chairman puts a lot of effort into making sure the residents are learning and taken care of.

The city is big but it doesnt have the big city feel to it. There are several very nice neighborhoods around the city with plenty of restaurants and bars. If you want a big city with plenty to do it is a good choice. If you want a college town or small town then this isnt the place.

Powermd, this sounds like a fantastic idea. Now, I'm just a 4th year student, but have been talking with interviewers asking about their comparisions. Please feel free to comment on the statements below. I hesitate to even write this, as I've yet to interview at any of these programs myself, but figure something is hopefully better than nothing.

For the southeast, here's what I understand about the programs in speaking with faculty:

Duke: unless tip-top of class, probably requires externship to significantly increase chance of matching there. However, in speaking with interviewers from last year, was told that while Duke's research and name were remarkable, their training was topped by UNC and WF.

UNC: Am told of an awesome PD. Also home to a Peds Fellowship program, one of just a few in the southeast. Have been told by some that it is great training, and also that residents sometimes are paired up into rooms if not enough cases. Others remark that it has a good rep in the SE, but not elsewhere. I have a hard time believing this, as 24,000 anesthetics (advertised) plus a relatively smaller program leads me to think somebody has to be doing the work...

UF: My thoughts on this program are well known from previous posts. Reputations as a "malignant" program are out there, but unsure if this is confusion of "hard working". Great clinical caseload; in speaking with interviewers from last year, they were of the opinion that it offered some of the best training around. Lots of tech-based research too; always seem to bump into protocols in the OR. However, I'll openly admit I'm biased.

UAB Birmingham: Have always heard this is a fantastic program, but that is all I know.

MayoJax: Have been told the residents are quite happy, questions about quality of teaching as program transitioned from private --> academic.

USF: Poor teaching, on probation. Avoid.

Miami: Great training, hard working. PD from Duke, new OB MDA seems pretty cool based on some talks at recent meetings. Trauma anesthesiology fellowship offered.

Emory: Have heard all-around wonderful things about the program. Alas, personal bias against Atlanta; polluted, big, lots of traffic. I mean, you can see the haze from an hour away.

Wake: Consistently reads as one of the top programs in the country in discussions with faculty. Supposedly a smaller program with excellent CRNA support ---> shorter days. Supposedly awesome faculty.

UVa: Some faculty say it's a great program. Interviewers seem to shrug shoulders, regarding it as just another program. Had researchers involved in the latest neuroapoptosis flap in this month's Anesthesiology, which I was impressed with. Charlottesville rated America's #1 city to live in this year. Can't get a handle on their caseload, but understand it to be strong. Other interviewers say their schedule "might be even lighter than UNC's".

MUSC: Have heard good things about the program in general. Charleston is a fun town.

So my votes would trend toward standouts in...

Research: Duke, Emory, UF (I'll admit I can't rank Emory and UF's with much certainty when compared with Duke)
Quality of Life: UNC, WF, UVa
Caseload: UF, Duke, Miami, Emory

I'm pretty anxious to hear what others think. And in the end, I hope to just get an especially warm feeling about one or two programs. Hopefully these'll trigger some questions we can ask, and compare, on interviews.

 

[UTSouthwestern]

seaofred, your program sounds an awful lot like mine. Is Todd your chief resident by chance?

 

[seaofred]

Yes, Todd is the chief this year. Are you friends with him? He is doing a good job.

 

[UTSouthwestern]

Yes, Todd is the chief this year. Are you friends with him? He is doing a good job.

Todd and I went to school together. I haven't heard from him in a while, but I suspected his work was probably not leaving him much free time. Tell him I said hi and he needs to check his e-mail.

 

[Matty]

There is very little if any info on the program at UT Knoxville that I can find. Anyone have any input? Thanks in advance.

 

[oxford]

Any input on...

1. Cleveland Clinic
2. Case western University
3. University of Cincinnati
4. Ohio State
5. St. Louis U
6. Wash U
7. University of Maryland
8. University of Kentucky
9. UConn

Thanks

 

[Skip Intro]

Miami: Great training, hard working. PD from Duke, new OB MDA seems pretty cool based on some talks at recent meetings. Trauma anesthesiology fellowship offered.

This statement, in and of itself, proves to me that you have to take ANYTHING said in this forum about program quality with a grain of salt and/or consider the source. For instance, I'm currently rotating through an apparent "Tier 2" program (at least according to this thread) and have been shadowing the chief quite a bit. The subject of Miami came up and we discussed the recent change to the new PD. Supposedly, this was going to make things better.

According to the chief of the program I'm at, who also happens to be good friends with a resident who's currently at Miami gas, the residents would tell you that this is anything but a "great program". Apparently, things have actually gotten worse. Now, instead of any anonymity of in-service exams, everyone's scores are actually posted. I guess this is okay if you're the type who responds to this sort of Nazi-esque motivation technique. Supposedly the workload has also not gotten any lighter, and there still is no time to study outside of the exorbitant case loads. So, you're pretty much set-up for failure. Also, it's a huge program where it's easy, again from my source (whom I consider to be very reputable), to get lost in the mix. We'll see if their board pass rates come up in the next couple of years.

All in all, this just goes to show that it all depends on who's doing the reporting and underscores the almost pure subjectivity in starting such a thread.

-Skip

 

[InductionAgent]

There is very little if any info on the program at UT Knoxville that I can find. Anyone have any input? Thanks in advance.

Matty,

This tidbit from the ACGME site tells a bit about the UT-Knoxville program, which you probably want to take off your list.

List of withdrawn programs
Academic Year 2004-2005

Anesthesiology

University of Puerto Rico Program Accreditation Withdrawn 6/30/2005

University of Tennessee Program Accreditation Withdrawn 6/30/2005

Texas Tech University (El Paso) Program Accreditation Withdrawn 6/30/2005

 

[Wahoowa]

Matty,

This tidbit from the ACGME site tells a bit about the UT-Knoxville program, which you probably want to take off your list.

List of withdrawn programs
Academic Year 2004-2005

Anesthesiology

University of Puerto Rico Program Accreditation Withdrawn 6/30/2005

University of Tennessee Program Accreditation Withdrawn 6/30/2005

Texas Tech University (El Paso) Program Accreditation Withdrawn 6/30/2005

I believe that it is the University of Tennessee-Memphis that had its accreditation withdrawn. UT Knoxville I believe took six PGY-1's this year.

I did a rotation at UT Knoxville last year. It was a good program with a good caseload. The residents all got along really well together as well as with the CRNAs. The faculty was very encouraging and interested in teaching. I also thought that the didactics were good. Everyone seemed to be pretty happy.

 

[joshmir]

be careful with numbers coming out of miami. they have booted out (mostly) FMGs with poor english who performed very poorly on inservices (and who susequently sued, and lost), so you could interpret that as an artificial inflation (but probably not, b/c scores would be going up anyways with the quality of applicants)...current residents thought the bootings were good b/c these residents would have hurt the reputation of miami gas.

i think you get great training there but you also get beaten down. q4 for 4 years almost all the time!

This statement, in and of itself, proves to me that you have to take ANYTHING said in this forum about program quality with a grain of salt and/or consider the source. For instance, I'm currently rotating through an apparent "Tier 2" program (at least according to this thread) and have been shadowing the chief quite a bit. The subject of Miami came up and we discussed the recent change to the new PD. Supposedly, this was going to make things better.

According to the chief of the program I'm at, who also happens to be good friends with a resident who's currently at Miami gas, the residents would tell you that this is anything but a "great program". Apparently, things have actually gotten worse. Now, instead of any anonymity of in-service exams, everyone's scores are actually posted. I guess this is okay if you're the type who responds to this sort of Nazi-esque motivation technique. Supposedly the workload has also not gotten any lighter, and there still is no time to study outside of the exorbitant case loads. So, you're pretty much set-up for failure. Also, it's a huge program where it's easy, again from my source (whom I consider to be very reputable), to get lost in the mix. We'll see if their board pass rates come up in the next couple of years.

All in all, this just goes to show that it all depends on who's doing the reporting and underscores the almost pure subjectivity in starting such a thread.

-Skip

 

[InductionAgent]

I believe that it is the University of Tennessee-Memphis that had its accreditation withdrawn. UT Knoxville I believe took six PGY-1's this year.

I did a rotation at UT Knoxville last year. It was a good program with a good caseload. The residents all got along really well together as well as with the CRNAs. The faculty was very encouraging and interested in teaching. I also thought that the didactics were good. Everyone seemed to be pretty happy.

Duly noted. My apologies.