Residency Impressions

[evilbooyaa]

As an aside to a previous thread, there seem to be many current or recent residents who have a negative view of their residency program.

If you are a current or former resident who is interested in providing a review of your residency (anonymously if you so choose), please feel free to PM me whatever you'd like, in whatever format you'd like.

I think that medical students are well served by hearing specifics about a program, without any method for retaliation. This has been done across other specialties as well. While the ideal review would be balanced, for the time being I am open to reading anything and everything may want to write.

If you're happy with your residency program, then feel free to send me that as well! Not all (or even most) residency programs are lead by evil people who want to screw over the residents for fun.

Each residency program that is reviewed in this manner will get its own thread to allow for focused discussion and allow for prospective applicants to search for it in the future.

If nobody wants to do it, then OK, but I want to offer it to people who feel they have an opinion that can't be voiced through official channels.

This is meant to supplant the discussions that happen in the yearly Google spreadsheets, as having MS4s give their interview impressions in private isn't as useful as a resident who has actually lived through the 4 years of the residency.

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[evilbooyaa]

I received this as an anonymous PM. While not a review, it espouses some thoughts that I agree are relevant

"I am a resident at a radiation oncology program in the United States. Unfortunately, I don't feel like I can provide an accurate account of my program to prospective medical students, especially on this forum. The field is small, individual programs are small, and nothing is truly anonymous. As residents, we have all heard stories in which a whistleblower's criticism of higher-ups leads to a host of negative consequences and fallout, not for the higher-ups, but for the whistleblower. This is true for junior attendings (International Journal of Radiation Oncology• Biology• Physics. 2013 Apr 1;85(5):1157-8), but even more true for residents. Residents' professional careers can and have been harmed by speaking truthfully regarding their programs. Residency graduates no longer have the incentive to criticize or fix their residency program, since they're gone. This is too bad, because only 15-20 residency programs are frequently discussed on this forum or the Google spreadsheets, with much of that discussion being superficial selling points touted by those programs. I may describe the positives & negatives of my program to students that I've worked with or talked extensively with during interviews, but even then, much is censored. My advice to medical students would be to be very discerning during the interview season, and even though it's easy to believe authority, to place weight on the information you get from your friends & personal contacts, and less weight on the information you get from the chairs and PD's trying to sell you."

 

[KHE88]

It will not be possible to post anything critical about one's residency program here, even anonymously, as it would cause a lot of stink at work and massive speculation about who spilled the beans. Some former residents might do it, but they'd be putting current residents as it would be assumed they did it.

Med students unfortunately need to read between the lines closely. I will be blunt if asked directly about a problem area. If I can't, for some reason, then I will "damn with faint praise." If you're paying attention, should be obvious.

Questions med students can use to flush out problems in a program:
- Turnover (Residents especially, but also chair/PD and staff/nurses/therapists/etc)
- Quality of clinical didactics (how often? are faculty involved?)
- Dedicated research time and any restrictions on how it's used (can you work from home or is facetime in the clinic required, do you have good mentorship, do you get pulled away to cover clinic, productivity expectations/accountability)
- Case load, case log numbers, # of consults/week, avg. number on beam on each service, etc.
- Low volume areas (gyn brachy, LDR prostate, peds, SRS/SBRT, sarcoma, no prostate 2/2 urorads, etc.)
- How is peer-review/chart rounds conducted? What cases get reviewed? When? How often? Do residents present? Is it educational or just box checking?
- Do residents get pimped? Is it non-threatening and educational or malignant?
- Radbio/physics instruction
- Radbio/physics pass rate from the last year
- Research expectations, publication expectations, conference attendance expectations
- Faculty support for research and publishing
- Reimbursement for conferences
- What happens if residents try to raise concerns?
- Cross coverage requirements
- Do attendings ever go uncovered?
- Are residents responsible for billing?
- Scut-work (peer 2 peers, calling in orders and other things that nurses can do, prior auths, transporting/rooming patients, etc).
- Call coverage and call policy
- Coverage at satellites
- Overall department morale and attitude (is everyone invited to staff outings, holiday parties, BBQs, family fun days, potlucks, etc).
- Moonlighting restrictions
- Hard deadlines for documentation/contours (same day, 24 hours, 48 hours, etc).
- Vacation policy (how much and restrictions on when you can take it)
- Does the department cover the residents' ABR fees ($640/year)?
- Educational allowance/book fund
- Faculty/resident relationships (flushing out malignancy - do the attendings take the residents on outings, team building events, retreats, happy hours, etc.)
- Research day policy (can you use it to get caught up on clinical work or is research activity mandatory, do they make you cross cover another attending when it's your attending's academic day or is on vacation?)
- Remediation/probation/termination policy
- In-service and ABR board study protected time
- Job search process of seniors (did they find a job? Did they get the jobs they wanted? Did they have any faculty help? Could they have stayed on as faculty with a fair deal?)
- Use of fellows in clinic
- PA/NP support
- Documentation policy (do residents only do consult notes or do they have to do literally everything from consults to on treats to EOTs to sim notes and treatment notes?).
- Inpatient consult volume. Do you ever treat inpatient cases on the weekend or at night or wait till next business day?
- Unsafe practices (attendings that only know how to treat 2D and rely on residents for 3D and IMRT plan generation, performing sims alone as juniors, sim and treating patients alone on weekends without attendings present, residents doing T&Os or LDR prostate alone, etc.)
- Maternity leave policy (how does department handle absent of a resident? Is the program family friendly or did residents who got pregnant feel their chair/PD was unhappy about it?)
- Workflow/efficiency issues (problems with therapists, brachy waiting times, etc.)
- Can't think of an easy way to do this, but try to sniff out if there is/was a recall/cheating problem in the program. Most are super-tight lipped about this now (and PM me if you get names as I'm still working to put a stop to this). Probably not a good idea to be involved in a cheating scandal or in a culture where there is permitted.
- Would you still go into radiation oncology if you were in my shoes again?

That's all I can think of off of the top of my head. Feel free to add more. I didn't know to ask most of this stuff when I was interviewing.

 

[Gfunk6]

It is interesting that years ago, posters were far less reticent about posting impressions. Mine still live on SDN for posterity. What has changed between now and then?


Sent from my iPhone using SDN

 

[KHE88]

I think that was mainly people who were interviewing who posted impressions on places they visited. There's little risk in doing that and would be great to see impressions again on this site rather than the google doc dumpster fire.

What's being asked here is current/former residents to criticize their current programs. While in an ideal world, that would be great, these forums are widely read and we all know there would be repercussions if someone claiming to be a current resident got online and said their program sux. I don't see that happening, but if someone out there has a real axe to grind, by all means go for it. Would personally love to see a former resident call out a program on recall use.

 

[thecarbonionangle]

Most programs of 2-3 residents per year, speculation would get out of hand of who did it and people would be harmed. Its unfurtunate. I agree with the above poster, ask questions and read between lines. Often it is not just what is said but what is not said

 

[evilbooyaa]

I agree that this may not be used given the concerns posted above. However, if people wanted to do some sort of thing (whether it be catharsis at end of their chief year or other motivation) I wanted to leave the option open.

Again, people who LIKE their programs are more than welcome to send me responses as well. This does not have to be all negativity all the time. Perhaps the best way to know what doesn't stink is to push it up and elevate it above the rest of the mud. Of course then it brings up issues of attendings forcing residents to write favorable things and stuff like that, but just a thought.

It's just hard for medical students to hear 'residency sucks everybody sucks' without knowing which ones are actually the ones to avoid (and only put up a happy smile on interview day).

 

[Mandelin Rain]

Seriously, some programs only exist to scut residents out and take advantage of cheap labor.

This is my impression of what goes on at maybe 50% of programs. You are there as a PA who can contour. You learn primarily via osmosis, self study, and senior residents.

How you suss this out in the interview process is up to you. Attending presence/participation at didactics, a process for formalized mentorship, and the look on the faces of the residents are usually telling.

 

[Phantom1]

This is a great list of questions to ask. I would add:

1. Did the program extend an offer to hire all the graduating PGY5s? Was market price salary offered (ie. 300K according to ARRO survey this year). If yes, rank that program highly.

Is this really your expectation?? I’m sorry if you expect the world and get dissapointed. What if one of the graduating residents was subpar? Someone who did contours at the last minute with little thought? Someone who did not prepare or read up on consults? Someone who took a full research year but produced next to nothing? This graduating resident should still be offered a position making 300k in your world?

What if there was no position available one year, but a Department offered a highly qualified resident a fellowship year to build their clinical skills or research further and then offer a position the following year? This would be a malignant program in your world view?

 

[RadOncDoc21]

I definitely could see it going both ways, I would rather do locums then work where I did my training. Also don't junior faculty still get treated like residents at the place they trained?

 

[20181121]

I frankly have very highly positive things to say about my program - its overall clinical training, emphasis on education, interesting breadth of research options, collegial faculty and referring services (with both groups taking the time to teach residents), excellent job placement for graduates, etc. - with few complaints.

But the tone of this forum leads me not to name my program, since I ultimately foresee the conversation somehow turning unprofessional and uncivil.

At the end of the day, I advise medical students to a) rank the big name programs highly, b) be geographically flexible, and c) avoid Student Doctor Network since I feel its discussions simply do not reflect reality.

 

[Mandelin Rain]

I definitely could see it going both ways, I would rather do locums then work where I did my training. Also don't junior faculty still get treated like residents at the place they trained?

Even if you ultimately want to land where you did your residency long-term, it doesn't hurt to go away for a couple years somewhere else to avoid the PGY-6 label. Also, to see some of the wide variability of practice out there.

 

[taserlaser]

I frankly have very highly positive things to say about my program - its overall clinical training, emphasis on education, interesting breadth of research options, collegial faculty and referring services (with both groups taking the time to teach residents), excellent job placement for graduates, etc. - with few complaints.

But the tone of this forum leads me not to name my program, since I ultimately foresee the conversation somehow turning unprofessional and uncivil.

At the end of the day, I advise medical students to a) rank the big name programs highly, b) be geographically flexible, and c) avoid Student Doctor Network since I feel its discussions simply do not reflect reality.

Which specific parts do you feel do not reflect reality?

 

[thecarbonionangle]

K there are absolutely some truly good programs out there (minority per my experience) that highly value learning, collegial environment etc rather than using residents as PAs. If you’re lucky enough to be in such program thats awesome dude. I understand the concerns about not naming your program but dont imply those in less positive situations or even outright abusive situations are “crazy” or exagerating. You have to have empathy, important in cancer care methinks, and part of this means trying to understand and see how possibly this could happen, and some people’s true suffering is real. There is real angst here so dont diminish it or delegitimize it, please.

There is nothing more demoralizing than overwhelming objective evidence that your program does not care, apathy. There are places where legitimally you get no help getting jobs, nothing. little to no education or faculty involvement. Hearing your colleagues brush concerns aside delegitimazing peoples experiences, gaslighting them, is not cool or constructive. Some of the posters here express some truly negative things about their program. I feel sad for them. These things are real.

 

[udrag14]

K there are absolutely some truly good programs out there (minority per my experience) that highly value learning, collegial environment etc rather than using residents as PAs. If you’re lucky enough to be in such program thats awesome dude. I understand the concerns about not naming your program but dont imply those in less positive situations or even outright abusive situations are “crazy” or exagerating. You have to have empathy, important in cancer care methinks, and part of this means trying to understand and see how possibly this could happen, and some people’s true suffering is real. There is real angst here so dont diminish it or delegitimize it, please.

There is nothing more demoralizing than overwhelming objective evidence that your program does not care, apathy. There are places where legitimally you get no help getting jobs, nothing. little to no education or faculty involvement. Hearing your colleagues brush concerns aside delegitimazing peoples experiences, gaslighting them, is not cool or constructive. Some of the posters here express some truly negative things about their program. I feel sad for them. These things are real.

Where is the data that a minority of programs are truly good? The last time I checked most people completed only one rad onc residency program.

Furthermore, I think the education of residents is a problem across all fields of medicine. A majority of specialties place educational responsibility on the resident.

I think that every residency program has pros and cons, and any medical student should weigh them when ranking program. I do think medical students sometimes prioritize incorrectly, but every individual needs to make his or her decision on what will make them happy in the short and long term.

 

[thecarbonionangle]

Where is the data that a minority of programs are truly good? The last time I checked most people completed only one rad onc residency program.

Furthermore, I think the education of residents is a problem across all fields of medicine. A majority of specialties place educational responsibility on the resident.

I think that every residency program has pros and cons, and any medical student should weigh them when ranking program. I do think medical students sometimes prioritize incorrectly, but every individual needs to make his or her decision on what will make them happy in the short and long term.

PMID 27523441 raises significant concerns about the education in a significant portion of the field, even if not a mathematical majority. I stated that in my limited experience such was the case. Also interestingly, there is a fundamental disconnect between residents and PDs. Obvious shortcomings of the survey but does offer some “objective” data on what many already suspect/believe.

I think our field truly has an education crisis. Is it present in other fields? Maybe/sure, honestly dont know enough but doesnt make it ok in our field.

 

[Mandelin Rain]

I will say, that I've noticed new grads come out very reluctant to manage a basic case on their own, let alone a clinic independently. While some amount of trepidation is normal and expected, I've seen applicants passing on good jobs if the expectation is to be the main/sole provider at a clinic on a daily basis. Not sure if this is universal though.

 

[medgator]

, I've seen applicants passing on good jobs if the expectation is to be the main/sole provider at a clinic on a daily basis. Not sure if this is universal though.

Not the worst thing in the world compared to trying to get "mentorship" from 2D trained dinosaurs that don't stay up to date with guidelines imo

 

[Phantom1]

Maybe you can share which program you are at? This would help the med students applying this year stay clear of your program.

Why would they want to stear clear of my program? I can tell you we certainly dont offer every single PGY5 a position. According to you that means a program should be ranked low. We have fantastic faculty and are ranked as a very desirable program exactly because we dont offer every resident a position. We dont have a fellowship, but that doesn’t mean that programs that do should be “run away from.”

I’m sorry your disgruntled and unhappy at your current program and you cant reach your attendings. My suggestion to you is to make the best of what you have where your at and work hard to improve your situation, instead of giving out rediculus naive ranking advice to medical students.

 

[Radiator20]

What if there was no position available one year, but a Department offered a highly qualified resident a fellowship year to build their clinical skills or research further and then offer a position the following year?

I've personally seen this situation work out well. Sometimes a program wants to keep a resident, and the resident wants to stay, but the timing of staffing needs doesn't quite work out. This arrangement is obviously not ideal, but it can be a way to provide a bit of flexibility to get things to the desired conclusion. If a program has kept a resident for a year as a fellow and then given that resident an attending position, I don't think that's intrinsically a sign of malignancy at all. That said, of course this arrangement could be abused, so it needs to be evaluate case-by-case and in the broader picture of the program.

 

[evilbooyaa]

Maybe you can share which program you are at? This would help the med students applying this year stay clear of your program.

I agree with the other user who said that not all PGY-5s should simply expect to have a job offering at their home institution. If there is an opening, should the PGY-5 have an inside track at it? Sure, maybe, depending on the other candidates interviewing.