Some Comments on Community Programs

[Seward]

As a medical student interested in community surgery programs, but schooling at an academic institution, I often found it difficult to obtain information about the well-regarded community programs. I did benefit from information on this forum, thought it also was limited. Below are notes I took on various community programs that I interviewed at, presented here in the hope that it will help future applicants in general surgery choose programs they might want to apply to. My information is based almost entirely on visiting the programs for interviews, so it is admittedly incomplete. I encourage anyone with knowledge about these or other community programs to add to the list.

Guthrie
Three categoricals per year. Good general surgery exposure with no competing fellowships and mostly one on one with attending operating R3-R5. Expecting a vascular fellowship in a few years. Stable leadership., Dr. Trostle (chair) and Dr. Vandermeer (PD) have both been there for at least a few years. Not much OR exposure in R1-R2. Intern year is mostly floor work and R2 is ICU and Rochester rotations. The program seems committed to resident education and has a phenomenal (100%) pass rate. Very small town (Sayre, PA).

Santa Barbara Cottage
Three categoricals per year. Good camaraderie among the residents. Broad operative expereince, including gyn onc, nephrectomies, C-sections. Light on liver, cardiac. Only one vascular surgeon and so don’t do big vascular wacks. High volume experience. New hospital that opened up in February seemed incredible (this is Santa Barbara). Salary is decent, but cost of living is high. Weather is awesome. New program director--Dr. Gauvin. He really read our files and knew the applicants by name and face as soon as we showed up. He seems to advocate for the residents and has made it his personal goal to improve the board pass rates--including increased number and quality of mock orals. Two months trauma at LA County as R3. One month transplant at Cedars-Sinai as R2. Endoscopy rotation at Ventura Community as R4. Call is Q5-6 as R4/5. Attendings are all ‘volunteer’, not hospital employees like at a university hospital. Some talk about setting up an away rotation abroad for credit, likely in Central America. Santa Barabara is level 2 trauma with mostly blunt (old ladies on warfarin who go bump) and MVC. Mix of single and married residents; a couple have kids. Great ancillary staff. Have hired some mid-levels to make the new intern rules work. Have endoscopy trainer in simulation suite. Perks: $2000 moving expenses, hospital provides cell phone, will send to board review course if needed, loupes as senior, $500/year “wellness”. Plenty of available money for concurrent clinical research projects.

San Joaquin Hospital
Two categoricals per year. Extensive operative experience. The residents operate early and often. Their case numbers are sick (but maybe borderline too high by RRC standards). They develop good operative skills. Operative ortho in R1. Good trauma with 30% penetrating. Get 85 scopes in intern year. Main hospital is a county hospital. Do transplant and another trauma rotation at UC Davis. Good thyroid/parathyroid. Good vascular. Mainly only met one resident, who was nice; ran into a couple other residents on the tour, but they seemed overworked or standoffish--did not come across as friendly or interested in applicants, which seems strange for such a small program, because you’d think they would want to get to know the applicants better. Free housing at 1-bedroom cottages on hospital grounds for R2-5 so that all call is “home call”, although some residents with families life off hospital grounds. 100% first time ABS board pass rate over last 10 years, which speaks to the educational investment of the program. M&M is structured basically as a mini mock oral board exam, which helps the residents be prepared for that. Send residents to Osler review courses if needed. It is in Stockton. Patient population has large Spanish-speaking component, although translators are readily available--but great opportunity for aspiring Spanish speakers. Research--even clinical research--is one weak area of the program that they are trying to improve. Family med and Medicine are two other residency programs. Get medical students from Caribbean. Basically, seemed like the opposite of an academic program.

UCSF Fresno
Four categoricals. New hospital attached to older hospital. Both facilities are pretty nice, esp the new hospital facilities. Main hospital (CRMC) is county hospital, but doesn’t seem run-down like many county hospitals. The residents seem to be close and get along well, appeared quite happy. Residents all outgoing and open/engaged with applicants--some of the most gregarious residents I met during interviews. Trauma heavy program with plenty of penetrating. Stable program leadership in Dr. Davis. Full compliment of other residencies at hospital (but not anesthesia). Operative experience is strong starting from intern year, with graduated complexity of cases. Fresno is nicer than I expected, especially the north and east parts of the city (Clovis, etc). Still has its ghetto parts, but that’s where the penetrating trauma comes from. Rotate at UCSF for transplant. (Endcrine now at CRMC since have new endocrine surgeon). Have a VA and Children’s hospital (no fellows) in Fresno. Have trauma, MIS, and ACS fellows, but residents say they don’t affect their cases. Some ortho, but new ortho residency may be changing that. Also have large Hmong population (see The Spirit Catches You).

Huntington Hospital
Two categoricals. Located in Pasedena, CA. Strong clinical experience. Resdients get a lot of expsoure to plastics. Call as an upper-level is paid as moonlighting. Some rotations at USC. Residents were cool. I can’t find my notes on this program, so can’t comment on many other specifics.

Baylor Dallas
Nine categoricals per year. Strong operative experience. Interns are in the operating room and doing cases. Almost all OR time is one-on-one with attendings. Residents rotate at the Baylor University Medical Center, John Peter Smith (a county hospital), Children’s Medical Center, Parkland (for burn), and Presbyterian Hospital. Both JPS and BUMC are Level 1 trauma centers. BUMC does a great deal of surgical oncology and has a building in the hospital complex devoted to surgical oncology. At JPS, residents have considerable autonomy to run the services and in the OR. Program seems committed to resident education. They’ve matched three surgical oncology and a bunch into CT in the last few years for fellowships. Good case variety with broad exposure to all the subspecialties. Considerable vascular experience and strong trauma experience. More hepatobillary than most. Dr. Jones, the chair and program director, has been in charge for decades, but is likely to be stepping aside to some extent over the next few years. Residents seemed happy and to like each other. Implemented a night float system for interns. M&M is presented by attendings, but there are ‘Chair rounds’, at which the residents may be called on to present, discuss, and defend any of their cases (not just the complications). Also good research publications, although the residents do not do any years out. Fellows in Colorectal and Vascular.

UT Chattanooga
Four categorical residents per year (although may expand in next year or two). Decent trauma. Main hospital is Erlanger, a nice county hospital. 3 month rural rotation in Athens, TN for PGY-3/4. The chair, Dr. Burns, has been there decades and has no intention of leaving. The PD, Dr. Cofer, has also been there more than 15 years. It is a six-year program with the research time being split into blocks spread out between 2nd, 3rd, and 4th years. In lieu of doing 12 months of research blocks spead out over a few years, the extra year can be done as a critical care fellowship PGY-4/5.. New night float system for interns seems to be working well. Good operative training with the attendings committed to training technically proficient surgeons that can operate. This program has a strong surgical “skills lab/simulation” program with a dedicated PA who works hard to train the residents in technique with lost of hands-on sim lab experience. Good breast (they do their own guided needle biopsies), vascular, trauma, and general surgery. A few fellowships (like Colorectal), but even still cases go uncovered. They are still using paper notes and orders, but have labs/vitals on the computers.Chattanooga is a great medium-sized town, with revitalized downtown, new riverwalk, great outdoors opportunities nearby for hiking, hunting, fishing, and even whitewater rafting. Housing more affordable than many larger cities.

Gundersen Lutheran
Three categoricals per year. Good camraderie among residents. Got along very well. Mostly midwesterners. Program is very committed to resident education and to training technically skilled surgeons. Residents go to UWMadison for transplant and burn; otherwise at Gundersen in La Crosse. New hospital is currently being built and will be opened in next couple years. Hospital uses Epic for medical records. Chiefs year is split between them at their own clinic seeing their own patients and booking their own cases. With 3 chiefs, they will each spend 4 months on that service acting as a “supervised attending” to prepare them for practice. Only other residency is medicine. As PGY-3 they rotate on OBGYN, doing operative OB, operative gyn, and gyn-onc. Urology, ENT, and Ortho are other subspecialty rotations, but no longer do formal neurosurg rotation. Residents have elective time that they can do what they want, including ‘away’ rotations. Some go to rural practices. Some go abroad. Dr. Jarman (the program director) has put great effort into getting the residents credit to do rotations abroad (in the Dominican Republic, Tanzania, Nicaragua, etc) and they can use their elective time for this. 100% board pass rate for over a decade. The residents themselves do informal mini-mock orals each week. Then the R3-5 do annual formal mock orals. In addition, the R4/5 also get together with the Mayo and Iowa Methodist residents at Mayo and do blinded mock orals annually. Lots of curriculum access, including SCORE, access surgery, books. Great salary, made even more remarkable by cost of living. Money for books. Loupes as PGY-1. Residents required to do 2 posters and 2 publications over 5 years; many do more. All research is clinical. No bench research. Faculty is committed to teaching. Do not do night float for interns. Basically, no call for interns. Instead, M-F other residents cover night call (all of which is home call) and then on weekends there are four 12-hour shifts. To make this work hours-wise, attendings cover Tuesday nights all on their own with no resident help. Again R2-5, all call is home call on your own patients, as well as rotating “acute care surgery” call. Because home call is on your own patients, handoffs and signout only happen rarely, which is better for patient care and teaches you to own your patients, as you will in practice. Call rooms are available if you don’t want to live within 5 minutes of the hospital, but everyone does. Hospital also has cheap good housing available. Dr. Jarman has been PD for 3 years after 2 years as assistant PD. Former PD, Dr. Cogbill, is still around, but doing other stuff. There is an MIS fellow who focuses on bariatrics. La Crosse is a small town, but it has two little colleges which gives it an infusion of social activity. General surgery and subspecialty exposure is great. Liver and pancreas are weaker areas, but current chief is going to a hepatobilliary fellowship and then already contracted to come back, so that should increase liver stuff. Plenty of trauma, but mostly blunt (farm accidents, car accidents, etc.) Skills lab is nice with real laproscopic equipment, including real lap cameras and nice lap boxes. They also do cadaver skills stuff (two cadavers present when I toured).

Methodist Dallas
Two categoricals per year and 4 PGY1 prelims. Residents spend almost their entire time at Methodist hospital, which has 500-something beds and 16-18 ORs. Vitals and labs online, but orders and notes are still paper. A new critical care/trauma tower is being added to the hospital soon. One month of Burn at Parkland and Peds at Children’s. There is only one fellow, in hepatobilliary surgery, which according to the residents does not interfere with their hepatobilliary and pancreas experience because they have so many of those cases. The hepatobilliary, pancreas, trauma/critical care, vascular, bariatric, foregut, and bread and butter general surgery are the strongest areas. You also do some obgyn (mostly gyn/gyn-onc), urology, and other subspecialty. They easily get their scopes with colorectal. Trauma-wise, they are a level 2 center, but they get as much or more trauma per resident than UTSW or Baylor, and about 25% of it is penetrating (more than UTSW). Good benefits: loupes as pgy3, absite course as pgy-1, pay full medical, decent salary. The residents were very friendly and happy; met almost every resident. They emphasized that the program has a lot of flexbility built in: because they have more cases than they can even cover, it gives them leeway to tailor their experience as they want. If they want to see a ton or bariatric or vascular cases, they have that option; if they only want to see what they need in that area and focus instead on something else, that too is there. The chiefs run an indigent clinic their chief-year in which all the cases are theirs. They also learn how to code and such during that experience. They have great board pass rate with only one failure in last 20 years. The absite is used basically to see where the residents need more teaching, and the high score each year gets a cash reward. Very little turnover in residents. They have a lecture series also devoted to contracts, finding a job, and other practical things about running a practice. Probably about ⅓ or so of patients are hispanic--this is Texas--so Spanish is a plus but certainly not a necessity (interpreters are readily available if needed). The operative experience is great. Mostly 1-on-1 with attendings and you operate from intern year and really participate in the cases. Sim lab with LapMentor, endoscopic simulation machine, and FLS boxes right next to the library. Only other residencies are OBGYN and Medicine. Interns use night float system.

Virginia Mason
Five categoricals per year. Located in Seattle. They have an interesting interview day in which you scrub in with a team. Some applicants liked that, some didn’t. I guess it depends on who you scrub with. They have ‘apprenticeship’ model, in which each attending is basically assigned a junior and a senior resident, so not service-based. Residents I met seemed cool, esp the chiefs. Fairly even split over the years between fellowship and private practice. Awesome hepatobiliary and thoracic experiences (although next year they are adding their first fellow, in hepatobiliary). Historically strong thyroid/parathyroid due to Dr. Ryan. Trauma, burn at Harborview (literally down the street). Peds at Children’s. New addition to the hospital that will slowly open up. Fully electronic medical records. Computers in the ORs (probably the only interview where I saw the inside of an OR). One resident can take out for research per year (funded). Strong operative experience. You spend a lot of time with one attending and so that attending gets to know you and is thus likely to get you more involved rather than being on a service in which you operate with like 4 attendings and can’t keep straight how they do things. Introducing new (and more complicated, it seems) educational schedule. I think they’ve always had a night float for interns (could be wrong, though), so the system runs fairly smoothly. A lot of home call as upper level. A lot of clinic time because when your attending is in clinic, you’re in clinic too.

Bassett
Three residents per year. Situated in Cooperstown, NY (home to Baseball’s Hall of Fame). Small town, rural lifestyle. Hospital has 5 floors and 10-12 ORs and is fed by 20-something of its clinics in the surrounding area. Program Director has been there 10 years and is very committed to resident education. There is also a medicine residency there and some transitional residents. They currently have paper charts but are transitioning to Epic in Aug 2012. Residents have the option to live in impressive 2 or 3 bedroom hospital-owned townhouses that are reasonably priced. Interns now do a week of nights every 4 to 6 weeks and then continue on that service during days for the rest of that rotation. They have a broad surgical experience, including urology, orthopedics, obgyn, tons of endoscopy, as well as good vascular, tons of plastics, and plenty of general surgery. Attendings seem great to work with. Interns are in the OR from the beginning. Rotate at the University of Rochester for four months to do peds, transplant, and a trauma/critical care experience. Residents required to do at least one research project per 5 years. At least one resident has set up a basic science animal lab that she works on during ‘free time’. Residents got along well with one another and seemed happy. Seems to be a conference of some type daily. Previous first-time board pass rate is mediocre (~65%), but like at all small programs, a few bad apples spoil the results. Mock orals for all years. SCORE curriculum. Skills lab with manniquins, FLS boxes, and a lap trainer. Decent library. Nice facilities. Get a fair amount of their own trauma, but predominantly blunt with the occasional (non-tree stand) hunting accident.

UCSF-East Bay
Seven categoricals per year. Located in Oakland, this is a trauma-heavy program. They have tons of penetrating and operative trauma. They are based out of the Alameda County Hospital, which was a very run-down hospital. They also spend time in the Kaiser system, at a VA in Reno, NV (which the residents really like), and at Oakland Children’s. Their didactics are interesting. Residents present surgical topics for learning in lecture format. In addition, each week one resident presents a short presentation on something from the Harvard Classics series. Finally, they have weekly “debates” in which one resident argues each side of a controversial surgical subject, such as routine use of surgical nutrition (such as TPN, etc). The idea is appealing, but their first-time board pass rates are below 50%, calling into question the effectiveness. Vacation is in a one-month block each year, which the residents said is nice because you can really go and do something with that vacation--like travel abroad. On the flip side, it means going straight through the rest of the year. The residents seem to have a good operative experience and are in the OR beginning in intern year.

Phoenix Integrated Surgery Residency (Banner Good Samaritan)
Five categoricals per year. The Banner system is like the Kaiser system of Arizona. Residents seemed happy and friendly, although probably only saw about half of them. The program director, Dr. Johnson, is new in 2012 (from Shock Trauma at Maryland) after the previous program director left apparently in a dispute with hospital administration. Dr. Johnson seemed nice and articulated a commitment to resident education. The residents all said he was approachable but had not been there long enough to really get to know him. The program has a reputation for great clinical and technical training. Interns get into the OR on most of the rotations and have at least 100+ cases their first year. On their acute care service the interns do not get to the OR as much and mostly do floor work. They have 2-month rotations in Alaska in R1, R2, and R4 years, which the residents love. This is when they get their scopes as R1s. Strong transplant service and broad general surgery training. Rotate at multiple Banner hospitals in addition to Good Samaritan (their flagship). Also rotate at the VA and Phoenix Childrens (where there are no fellows). In fact, there are no fellows of any kind. Lots of complex laparoscopy. Good benefits. Mock orals R4/5 in conjunction with Mayo Arizona. Have matched plastics, transplant, vascular in recent years. Will be starting with SCORE curriculum soon. Dr. Johnson also mentioned to our group that he planned to start using video to set up coaching sessions for residents with retired surgeons in the area . As interns they do one month of surgical simulation in their extensive simulation facilities (they even have a dedicated Da Vinci for training and simulation).

Lehigh Valley
Five categoricals per year. Located in Allentown, Pa. No years out for research available, but residents are required to do one scholarly thing during residency. Three hospitals, with the flagship being LV-Cedar Crest, where residents spend most of their time. Also rotate at LV-Muhlenberg in Bethlehem, PA and LV-17th Street in Allentown, PA. Great operative experience in general surgery. Most residents have upwards of 1100 cases when the graduate. Trauma is mostly blunt (Allentown is located at a confluence of highways). Transplant is kidney and pancreas. Awesome minimally invasive experience. Good vascular and decent thoracic. Some commented that improving foregut oncology was something the program was trying to do. The liver cases can be hit or miss as well. Endoscopy used to be with the GI docs, but they no longer have a dedicated rotation with them after a falling out, so residents get their scopes on colorectal and other surgery services. Hospital at Cedar Crest is big and nice. Ancillary staff is good. Residents have matched in transplant, trauma, CT in recent years. Limited plastics experience because of the integrated residency. Month-long elective time in R4 year which residents can take at another institution or in whatever area they want in the Lehigh system. Town seems nice. Easy distance to NYC or Philly. Notes are still paper, but everything else is electronic. Residents have this microlaptops assigned to them that let them look at labs, radiology, and enter orders wirelessly wherever they are in the hospital. They have a good sim lab with a bunch of their own FLS-like training tasks, and endoscopic trainer, and a lapmentor. Chair, Dr. Pasquale, seemed really cool. Mock orals in conjunction with 5 other programs as R3-R5. There is a chief resident “run” clinic. Otherwise, although they try to make it to clinic ½ day per week (as mandated), some services that is more difficult to do.

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[SmokD]

Very impressive write up. Thank you for taking the time to write such detailed information.

 

[SLUser11]

Very impressive write up. Thank you for taking the time to write such detailed information.

Agreed. It would be nice to hear from some other SDNers on the same topic. I don't think it has to be all puppy dogs and ice cream, though, as surely some of these programs have downsides.

I'm repeating myself from previous posts, but my feeling is that this thread will pop up when future SDNers use the search function correctly: Here's a list of community programs that I believe are high quality and worth a look during the interview trail:

Baylor-Dallas
Mich State- Grand Rapids
Iowa Methodist
KU Wichita
Scott and White
Banner/Good Sam- Phoenix
Virginia Mason

 

[Pir8DeacDoc]

Anyone care to comment on any of the other Southern programs?

I have heard that in my home state New Hanover Regional and Carolinas Medical Center offer excellent training, but since I'm not in GS I can't comment. I seem to recall hearing that Beaumont outside Detroit provides good training too...

Anyway just throwing out some stuff to generate more discussion....

 

[Mr Cookie Pants]

Anyone care to comment on any of the other Southern programs?

I have heard that in my home state New Hanover Regional and Carolinas Medical Center offer excellent training, but since I'm not in GS I can't comment. I seem to recall hearing that Beaumont outside Detroit provides good training too...

Anyway just throwing out some stuff to generate more discussion....

I didn't interview at Carolinas, but the big name community places have significant research requirements so they're not 'community' in the pejorative way that is thrown around. My friends that went to Carolinas, and the people I know who've been to Beaumont say its great. It's 6 years.


I think the system should be further classified

-Strictly academic- these usually 7 year programs focus on prestige, who you know, research and take operating early as a no no (not maliciously, but usually fellow driven services). Your department chair went to one of these.

-Communiversity- some might call them hybrid programs- university affiliated programs that prepare you for PP/fellowship, have some/many fellowships. Operate earlier, good complexity etc

-non-university affiliated, academic programs- like above, but just doesn't have University Hospital tagged in front of them. May not have basic science labs, but usually have research (clinical) emphasis, a few fellowships

-community programs- train PP general surgeons. You'll do 600 choles and endoscopies, graduate with 1500 cases. A whipple is a few times a year and you might even have to rotate to for Trauma, SICU, peds etc.

 

[catch the sun]

Communiversity: St. Luke's Hospital in Bethlehem, PA should be noted

-Temple/St. Luke's Medical School main campus
-Leve-l 1 trauma (most of the trauma staff trained at and on staff at UPenn or from shock)

-operate from day 1:
--great all around gen surg and minimally invasive experience
--heavy vascular and endovascular experience(official GE test site)
--large range of all around surg onc, thoracic, colorectal and plastics cases as well. 2nd year rotation in CTS and in GI (1 mo of endoscopy)

-No fellows except visiting UPenn trauma fellows...residents cover all cases on every service

-successful fellowship placements at the top programs for most fellowships except pediatric surgery(no designated time off for research)
-dedicated research staff available

-peds surg rotation at CHOP; transplant rotation at Jefferson; burn at Lehigh Valley Hospital

-3 categorical per year

 

[Seward]

I don't think it has to be all puppy dogs and ice cream, though, as surely some of these programs have downsides.

Certainly all these programs do have downsides, as does every program (though by report Wichita does come close to perfection). But I don't think my descriptions are all puppy dogs and ice cream.

The downside of a program depends in large part on what an applicant is looking for in a program. For instance, if you want to do operative trauma East Bay and Fresno are probably your best bets among the programs I listed. If you want to do some gyn/ob (which some rural general surgeons still do, or that folks do on mission work abroad), then you might take a closer look at Gundersen and Cottage. Folks who don't want to do anything in the pelvis would likely avoid those two programs. If you hate clinic, perhaps Virginia Mason would not be your cup of tea, but Lehigh Valley would be a better fit. If you are interested in plastics, Huntington Hospital does a lot of that and the gen surg residents are the ones involved. Going to Baylor Dallas involves working in both Ft. Worth and Dallas, which means driving alot--some folks won't want that. Banner residents spend 6 months in Alaska over five years--the residents love that rotation, but for applicants with families, perhaps spending 6 months away from your family wouldn't be right for you. UT Chattanooga is a 6-year program--again, maybe a 200K decision to go to that program, but you still get your research time or perhaps a CC fellowship rolled in there. And Sayre, PA makes Wichita look like Gotham, again not an ideal choice for every applicant, but it's not so bad a place to have a family. And on and on and on.

So the downsides are there. My information is from interviews, which are inherently skewed toward the positive, but I tried to put down the objective information. Applicants should still look to the first-time board pass rates, location, fellowship match lists, and their own overall impression of the program during an interview to guide their actual rank lists. My surgical mentors at my home program for the most part simply couldn't offer much information about these programs, and I applied 'blind.' I applied to these programs based on meager information (some from SDN and some word of mouth from friends in residency). Stuff like: "hey, I heard Baylor Dallas is a great program. You should apply there." But that doesn't honestly tell me much about the program itself. I don't even think there is a great description on here of the basics about UK Wichita despite the PR-efforts of a vocal alumnus on this forum. And many of the program websites are not very informative.

Thanks to you folks who have added comments about other programs. I'd love to see more information get out there.

 

[SLUser11]

Certainly all these programs do have downsides, as does every program (though by report Wichita does come close to perfection). But I don't think my descriptions are all puppy dogs and ice cream.

...I don't even think there is a great description on here of the basics about UK Wichita despite the PR-efforts of a vocal alumnus on this forum. And many of the program websites are not very informative.

Thanks to you folks who have added comments about other programs. I'd love to see more information get out there.

I feel like I may have upset you with a pretty benign comment.

As for KU- Wichita, I've always been open and descriptive of the pros and cons, and I think I've described the program ad nauseam, but I'm willing to put more info in here.

KU-Wichita is a university-affiliated community program with 6 categoricals per year, making it larger than most similar programs. Residents have early operative experience, and graduated autonomy. Endoscopic experience is almost unparalleled, with numbers being more than 2 SDs above the mean. Team structure includes a panel of surgeons, senior/junior residents, and medical students. Most of the time is spent at 2 large community hospitals with nice amenities and solid support staff. There is a focus on education and didactics. There is operative diversity as Wichita is the referral center for most of Kansas. 30% of graduates go into fellowship in a variety of fields including colorectal (shout-out), vascular, plastics, CT, Transplant, MIS, Trauma/CC (no Peds or Surg Onc). It is 0% IMG/FMG and 7% DO, with most residents being native to the midwest. Wichita has 500K people and is basically suburbs and strip malls. Here's the website. It is recommended by 100% of SDNers that trained there (1/1).

Pros include operative caseload and autonomy, pleasant environment, strong ICU experience, didactics, fellowship placement, and board pass rates.

Cons: 90% of trauma is blunt. Wichita is the "middle of nowhere" if you're from the coasts. There is no basic science research or opportunity to do lab years. There are no electives. There are no famous surgeons to write LORs for you. All attendings are private practice. Tornadoes happen nearby. Jayhawk fans are plentiful and can be annoying if you are from Nebraska.

I hope that helps!

 

[Seward]

I feel like I may have upset you with a pretty benign comment.

Not upset, but wanted to clarify that my program comments do include downsides.

KU-Wichita is a university-affiliated community program with .....

Great summary of your program. I think it will be valuable to have it all in one place. Thanks!

 

[JackShephard MD]

Bump. Good thread.

 

[ESU_MD]

communiversity

I love that term. Cant wait to use it.

Nice thread, you did alot of research. Wonder where you ended up.

My two cents: be wary of places that send you on rotations in the " big name" places. Might be a good experience if you are a single person, but will likely really suck if you have a family and have to live elsewhere or have a long commute for 3 months!

 

[blue2000]

I love that term. Cant wait to use it.

Nice thread, you did alot of research. Wonder where you ended up.

My two cents: be wary of places that send you on rotations in the " big name" places. Might be a good experience if you are a single person, but will likely really suck if you have a family and have to live elsewhere or have a long commute for 3 months!

I think that's the nice thing about VM; while they go to a "big name place" for burns and trauma, it's less than a mile away. Most of the residents there park at VM, get food at VM and then head over to Harborview for the day. Compare that to the Madigan (Army) residents who come up from south of Tacoma. They have an apartment, but spend a lot of time on I5 which is painful.

 

[JackShephard MD]

In general, is it fair to say you'll be able to gain more operative experience at smaller community programs?

If your goal is to operate more in your career (as opposed to being an academic/researcher), are community programs better preparation?

 

[SLUser11]

In general, is it fair to say you'll be able to gain more operative experience at smaller community programs?

If your goal is to operate more in your career (as opposed to being an academic/researcher), are community programs better preparation?

Not necessarily. You can't really make blanket statements that would accurately generalize either academic or community programs. There are community programs with limited autonomy and limited case variety, which would not provide an adequate technical education. There are also plenty of high-volume academic programs with great operative experience.

To be honest, the only easy conclusion to draw is that if you want to be a high-powered academician and do basic science research, you should go to an academic center for residency. Otherwise, the best idea is to decide what you want, then do a lot of research on the internet. Next, you apply broadly, casting an intelligent net....SDN can help you do that. You can then cater your interview trail to taste different environments and see which one is the best fit.

I think one of the best things to do as a MS4 is do an away rotation in an environment different from your home institution. For KU students, I recommended spending a month at a high-powered academic center. For students in strict academic environments, I recommend the opposite. In doing so, you not only see what you want in a program, but you also see what you don't want in a program, which is probably more valuable information.

 

[Buzz Me]

That's good advice. I did two away rotations as an M4, at vastly different programs on opposite ends of the country. Helped me figure out what kind of residency program I wanted.

 

[Seward]

I think one of the best things to do as a MS4 is do an away rotation in an environment different from your home institution.

Totally agree. See it first hand for more than a few hours on interview day (when they're not on their best behavior and you can actually get into the OR). Folks told me that "you don't need to do an away for gen surg" and "an away can only hurt you if you're a good applicant", but I think those folks were ignoring the benefits of seeing another institution,

In my opinion, you do an away rotation to see another place and evaluate it and its training style, because most med students get such limited exposure to places outside their home institution.

Also, applying to more and more kinds is better, so you can at least have the option to interview at different places.

The away(s), applications and interviews can get expensive, though. Put it on your tab, I guess.

 

[Dan Plainview]

Totally agree. See it first hand for more than a few hours on interview day (when they're not on their best behavior and you can actually get into the OR). Folks told me that "you don't need to do an away for gen surg" and "an away can only hurt you if you're a good applicant", but I think those folks were ignoring the benefits of seeing another institution,

In my opinion, you do an away rotation to see another place and evaluate it and its training style, because most med students get such limited exposure to places outside their home institution.

Also, applying to more and more kinds is better, so you can at least have the option to interview at different places.

The away(s), applications and interviews can get expensive, though. Put it on your tab, I guess.

Agree with this totally. An away dropped a place to the bottom of my list that in my initial impressions I thought I'd rank very highly. However my experience on the away there was nothing short of terrible. Many faculty malignant/non-supportive, residents clearly unhappy, work hours ignored, crappy facilities, etc. I went to their interview day (for multiple reasons that I'll explain if you want to know more about the program, won't divulge them on the board) and it was such a show. Had I only the interview day to go on, I could have matched there and would have been in for five years of misery.

I'd say the same (sort of) for second looks. I did a second look at a program and that had a negative impact on their position on my rank list.

Admittedly with second looks and to an extent aways, you are only getting a look at a slice of a certain program, but I still think you can draw some general conclusions about a place. Just my $0.02.

 

[Chakrabs]

Folks told me that ... "an away can only hurt you if you're a good applicant", but I think those folks were ignoring the benefits of seeing another institution.

I've received this advice myself quite a bit. However on my part, I just don't understand this advice. Not doing an away rotation could potentially hurt your overall chances of matching, while screwing up an away rotation messes up your chances of matching a single program. And in general if you've been receiving decent to excellent grades with your residents and attendings giving you strong evaluations and saying "strong work on blah blah blah" then I really don't think you'll have any issues on away rotations. If it were me giving the advice, I'd say do as many away rotations as possible. It'll only hurt you if you're a poor student/applicant, and if you're so out of touch that you can't recognize that you're a poor student/applicant then you're probably not going to be doing all that well in the match anyway.

 

[SLUser11]

I've received this advice myself quite a bit. However on my part, I just don't understand this advice. Not doing an away rotation could potentially hurt your overall chances of matching, while screwing up an away rotation messes up your chances of matching a single program. And in general if you've been receiving decent to excellent grades with your residents and attendings giving you strong evaluations and saying "strong work on blah blah blah" then I really don't think you'll have any issues on away rotations. If it were me giving the advice, I'd say do as many away rotations as possible. It'll only hurt you if you're a poor student/applicant, and if you're so out of touch that you can't recognize that you're a poor student/applicant then you're probably not going to be doing all that well in the match anyway.

If you are a strong student, this will usually be evident on your away rotation, and you will receive positive evaluations.

If you are a weak or marginal student, this will also usually be evident, and your evaluations will be poor.

So...if you suck, and you are trying to trick a program into taking you, don't rotate there. It's much easier to pretend to be awesome for a day than for an entire month.

On the other hand, if you are a solid student, and you want a taste of the way things are done elsewhere, an away rotation will give you some much-needed outside perspective. Too often, students get tunnel vision and assume that the @$$-backwards way that things are done at their home institution is ubiquitous and somehow inherent to surgical training.


Now, I'm obviously being a little histrionic for effect. Many wise and experienced SDNers recommend against away rotations...the most vocal of which is Pilot Doc. It can definitely hurt you, and sometimes unfairly.

 

[45408]

Too often, students get tunnel vision and assume that the @$$-backwards way that things are done at their home institution is ubiquitous and somehow inherent to surgical training.

If I do a fellowship, one of the things I'll be really interested to see is just how a different place handles things. Culture runs deep at an institution, and what seems like "just the way things are done" is actually "just the way we do it." Obviously, I read the literature and can see what the standard of care is, but it often is vague on things like medication dosages, intervals between studies/labs/etc and so on.

For example, we do not "fast track" our colon resections here, and I'd like to see it done.

 

[ESU_MD]

Its pretty interesting how once you are on the "fellowship" trail, you really know what you're looking for in a program and its alot easier than when you are an MS4 looking for a residency!

Ironically, looking for a first job is alot harder than fellowship finding though.

 

[Svidrillion]

Many wise and experienced SDNers recommend against away rotations...the most vocal of which is Pilot Doc. It can definitely hurt you, and sometimes unfairly.

This may be true. It may hurt you at a particular institution if you screw up, but I also think there is simply value in seeing another place or two. If you see the away rotation as a foot in the door at a particular institution, that's one thing. But if you see it as your chance to explore another teaching style or another hospital style or another regional style, I think you can't go wrong.

For me personally, when I was ranking programs, I kept coming back to this same thought: there are only two programs in the whole world that I've actually seen function: my home institution and my away institution. So regardless of the sunshine and puppy dogs of interview day, I felt I could only trust what I'd personally experienced and that made all the difference in my rank list. Guess I'll never know if it was the right call or not, but such mysteries are life.

 

[naus]

How's Maine Medical? Have family up there. I heard there's lots of operating time since no competition from fellows.

 

[Seward]

bump

Anyone who matched this year want to add or amend anything written here?

 

[WinslowPringle]

This was a very helpful thread when I was applying this year. In honor of Black Monday, I'll necro-bump this add a few community/communiversity programs that I thought were "hidden gems". Some other threads that were helpful were: http://forums.studentdoctor.net/threads/what-are-the-hidden-gems-out-there.1051596/#post-14827821, http://forums.studentdoctor.net/threads/hidden-gems.492385/#post-6172476, http://forums.studentdoctor.net/threads/g-surgery-programs-the-diamnods-in-the-rough.64896/.

Sorry/not sorry for the wall of text.


Good Samaritan/TriHealth – Cincinnati, OH.
5 residents/year. ~1200 total cases. Good board pass rates (90%). Average graduating cases 1100 - 1300. No VA. 1 vascular integrated/year – no other surgery fellows at Good Sam. Most rotations at Good Sam or Bethesda north; will rotate at Cincinnati Children’s Hospital (peds – 1.5 mo, PGY3), Shriners Burn Institute (burn – 1.5, PGY2), Christ Hospital (transplant – 1.5mo, PGY3) and University of Cincinnati (Trauma/Critical care – 2 mo, PGY4, 1 mo PGY1). All are within a close driving distance. No “off-GS” rotations. Enclosed free parking attached to hospital. Loupes, Step 3 (if taken as a PGY-1) paid for. Meal allowance and residents are well fed (emphasized throughout tour!). Call rooms are in an older part of hospital but you can keep your shared call room throughout your years there and fix it up – ends up being a pretty nice “retreat.” Other benefits well-delineated online. Fellowship placement: Trauma/CritCare (Ucincix2, Rush), SurgOnc (Moffitt, ULouisville), CRS (Georgia, Mayo), Vascular (OSU, IUSM), MIS (Maryland, JHop), HPB (Penn State), breast, CT (Miami)
Personal- There was excellent resident turnout the night of the dinner – unfortunately, I got stuck in an awkward corner position and only got to really talk with 3 of the residents (all of whom I liked and seemed super chill). Said they had good autonomy. Good resident turnout for the lunch the following day, too – liked the rest of the residents I met there. Morning M&M was very good, but intense. Residents definitely knew their stuff; not at all a malignant atmosphere (ie, residents weren’t on the line and hung out to dry) but spirited (lots of inter-faculty discussion and there were educational questions to the resident). The overall feeling I got from the program was that it was tight-knit, you’d be worked hard but fair, and you’d get excellent training. Everyone was very proud of their program, and it really showed. PD very responsive to the needs of the residents; the SICU rotation in PGY1 year at University Hospital is new and in response to resident request. Residents said that rotations at UCinci and Christ Hospital went well and didn’t feel they were treated differently in terms of opportunities than UCinci residents. Cincinnati isn’t my favorite city, but it wasn’t as bad as I was expecting.



New Hanover Region Medical Center - Wilmington, NC.
3 residents/year. Increasing physician number, including a new surg onc. Good board pass rates (90%), good volume (~1300 cases total per the copy of a graduating chief’s log given to applicants). Will start operating intern year. Outside rotations –transplant/burn at UNC. No fellows. Two “golden weekends”/month. Hospital recently finished renovations. Free parking just beside the hospital. Dedicated charting area for residents. Level II trauma center – primary out-transfers are peds neuro. No “off-GS” rotations. No research rotation. Vascular surgery and trauma included all years. PGY 3-5 – endoscopy. PGY 3,4 – SICU rotations. Can arrange subspecialty rotations. Mix of full-time faculty and private practice (Wilmington Health Associates, Coastal Carolina Surgical Associates, Miles Surgical). Some changes due to SEAHEC affiliation changing. Fellowship placement: Vasc (UTnKnoxville x 2, NYU), Breast (CMC, Washington), PRS (Utn Chattanooga, UNC), MIS (WFU, St Francis), CRS (Georgia, CC), Peds (UAMS >10 years ago)
Personal – Also really liked the residents here. Loved that they included pictures of some of their neatest cases on the welcome Powerpoint. Residents seemed very happy and spoke strongly of the support in place for them. Liked that rising chief resident encouraged us to always ask about procedures in place to deal with problems, remediation; also liked his outlined approach to surgical education. Several residents mentioned that they thought they had good autonomy; chiefs said they felt comfortable doing cases alone. Didn’t see M&M on interview day. Wilmington is also an awesome city with a gorgeous beach and surprisingly reasonable COL for a coastal town.



University of Tennessee, Knoxville.
5 residents/year. Reported average 90-95th percentile case volume for graduating chiefs; they have doubled attendings in the last 10 years but not residents (there is talk about expanding to 6 residents in the next 5 years). Decent board pass rates (80%). Will start operating as an intern. Hospital looks nice with recent renovations/additions. Rotate away for peds (ETCH) and a rural community rotation (Morristown, 1 hr away). “Off-GS” rotations are 1 mo long and are: Anes (PGY1), Uro (PGY2), Gyn-onc and Elective (PGY3). Some fellows – Trauma/Critical Care, Vascular, and this (2014/15) is the first year of a trial MIS fellowship (took a resident from in-house). Optional research year for 1 out of the class. Good catchment area. Will be a new Chair of the Department of Surgery starting summer 2015. No VA. No burn center. 35 main ORs + 6 day surgery ORs+. Level 1 trauma, with ~10% penetrating trauma. Free parking close to the hospital Meal allowance, loupes PGY2. Rest of the benefits easily found online. Fellowship placement since 2009: Vasc (Greenville SC, Emory, UTMCK, UNC, UTnMemphis),MIS (UAB, UTMCK, CMC), Crit Care (UTSA, Umaryland, Umich, Vandy), CRS (UT), CT (Maryland), PRS (UTnChatt)
Personal – liked the residents. Very impressed with the rising chiefs and appreciated their approach to the teams. Enjoyed hearing “You’ll operate like crazy here; we observe work hours closely, but if there’s a cool case, we won’t send you home. We know our volumes are high, but keep a close eye on making sure we have quality didactics and floor responsibilities.” Residents said they had good autonomy; one of the attendings emphasized he thought resident autonomy was important. Didn’t see M&M on interview day. Liked Knoxville as a city; nice downtown area, reasonable COL. Plus, SEC football (even if it is the Volunteers).

 

[funshi baba]

This may be true. It may hurt you at a particular institution if you screw up, but I also think there is simply value in seeing another place or two. If you see the away rotation as a foot in the door at a particular institution, that's one thing. But if you see it as your chance to explore another teaching style or another hospital style or another regional style, I think you can't go wrong.

For me personally, when I was ranking programs, I kept coming back to this same thought: there are only two programs in the whole world that I've actually seen function: my home institution and my away institution. So regardless of the sunshine and puppy dogs of interview day, I felt I could only trust what I'd personally experienced and that made all the difference in my rank list. Guess I'll never know if it was the right call or not, but such mysteries are life.

I couldn't have agreed more with this. I feel the exact same way. I did an away elective rotation and currently applying for fellowship. Every program program looks good on interview day but what happens there at night will always be a mystery. I was toled it was a bad idea to do away elective, its turning to be the best decision I've made during this whole interview process. I don't like surprises, and any opportunity to eliminate the unknown is always welcomed.

 

[BruceWilly]

What kind of step 1 score puts one in the ballpark of comfortably matching into a community program?

 

[SLUser11]

What kind of step 1 score puts one in the ballpark of comfortably matching into a community program?

No such number exists. As we said in this thread and in several others, programs cannot be lumped into "Community" and "academic" in terms of competitiveness or quality of training.

The step scores are likely relatively equivalent when all groups are compared, so a bad academic program and a bad community program will both accept applicants with poor scores.

In general, it is hard to match into the general surgery program THAT YOU WANT with a Step 1 score below the national average, which I believe is nearing 230 at this point. That being said, you can certainly match somewhere with a Step 1 score of 210, 215, etc....it's just going to be an uphill battle.

 

[Kaustikos]

I'm going to go ahead and write up a review of a community program to avoid:
University of Illinois Urbana-Champaign/Carle General Surgery:
Let me start by saying I was excited to start a month at this program. Having spent my undergrad at this city, having friends in the medical community and all other reasons. I met with the staff before applying and they seemed receptive. I was in for a shock...
I got a taste for what malignant truly means. The residents hate each other, medical students and patients. The residents pull rank on lower ranking interns/medical students constantly. I mean... literally yelling down at people to do the simplest things. Belittling them. Calling them idiots for not knowing something. At first I thought I was just seeing a bad month. But read on;
The medical students are mandated to wear a specific color scrubs so that everyone knows they're students. I mean, initially it didn't seem bad. Until you step foot in the OR floor and see exactly what that entails; scrub techs/nurses will not listen to you. They will treat you like dirt. They even pull ranks.
Example? There was a procedure I wasn't scrubbed in on and couldn't see anything. I get that as a medical student, I'm supposed to be all eager/be there/etc, but I also had other responsibilities. So, I get a page about a patient and tell this PA that I have to step out. I go and take care of this issue and come back. One of the nurses tells me to come outside with her. She begins this ridiculous speech about how I can't just leave/enter the OR whenever I want. That I need to decide if I want to stay or not and just not come back until the procedure is over. I told her I had a page/patient to see and she responds that I need to prioritize. Wow. She made it clear I was below her. All the more when she was the scrub tech and I asked for a retracter and she didn't even budge until the resident looks at me and asks why I don't have a retracter yet. I screwed up by responding "Because medical students can't ask for things." Some of the attendings literally, LITERALLY try to make medical students cry. They talk about how they hate them and want to make them feel horrible. One of them tried to do so by berating/insulting me for missing one question/pimp question. I didn't think anything about it when she called me stupid until I was out on the PACU and she confronted me in front of the staff and began this speech about how I lacked knowledge and would be an incompetent intern/resident if I didn't know anything.

There was also the time I missed a weekend day because I drove to an interview wherein my car broke down and I couldn't make it. I texted the chief resident, like he said to do, about my situation. He didn't respond to acknowledge he understood. Worst yet; he didn't tell the attending why I wasn't there that day. The attending (on Monday) bans me from the OR because of my lack of presence that weekend. I'd understand if they'd been like "It's your responsibility to take care of problems and get here." Not to have a chief resident throw me under the bus like that.

But wait! There's more. You're probably asking if my opinion is biased...well, I got the truth when a couple medical students talked to me. One of them just broke down and asked me if he was that horrible of a third year medical student. I didn't understand so I asked what was up and he told me how the Attending told him the student was barely passable and probably going to get a failure for knowledge base. This student... wasn't stupid. He knew a lot about medicine. If anything, he was average at worst. Then I try to think back on what he did wrong.... and I remember that laparoscopic distal panc wherein the attending asked the student what vessel this was they were looking at. I looked at it and I wanted to respond there's no real way of knowing which artery since there was no reference point. I kept quiet because I had an idea of what they wanted. The student answered "wrong". When the hilarity was they were wrong since it wasn't actually that artery. They then asked him the entire components of the diaphragm and diaphragmatic crura with their origins. There are questions... and then there are questions. He didn't know. They turn to me and ask and I just respond "I'll find out when I read on it". They look at me like I should know this. I didn't care but fast forward to now and I can see what happened. He then told me that the attending said this student was interfering with my progress. This student actually believed that this was true and apologized TO ME. I told him that he didn't do anything wrong and had been beyond helpful.

I saw more and more of this. Saw a third year almost break down and cry at 6am before rounds had even started. Why? The surgeons had told her that she needed to study the anatomy for the shelf exam because that's what was important. She believed them and did this for weeks until she finally took a practice exam and realized how screwed she was. I mean, I get that you're supposed to be able to find out things on your own, but I felt horrible for her. I wish I was there when they told her this so I could've told her how wrong they were.

Now... now I understand why almost every resident asked why I wanted to be here. Or why I was even here. I hope I'm 100% wrong. But I doubt it.

 

[ThoracicGuy]

I'm going to go ahead and write up a review of a community program to avoid:
University of Illinois Urbana-Champaign/Carle General Surgery:
Let me start by saying I was excited to start a month at this program. Having spent my undergrad at this city, having friends in the medical community and all other reasons. I met with the staff before applying and they seemed receptive. I was in for a shock...
I got a taste for what malignant truly means. The residents hate each other, medical students and patients. The residents pull rank on lower ranking interns/medical students constantly. I mean... literally yelling down at people to do the simplest things. Belittling them. Calling them idiots for not knowing something. At first I thought I was just seeing a bad month. But read on;
The medical students are mandated to wear a specific color scrubs so that everyone knows they're students. I mean, initially it didn't seem bad. Until you step foot in the OR floor and see exactly what that entails; scrub techs/nurses will not listen to you. They will treat you like dirt. They even pull ranks.
Example? There was a procedure I wasn't scrubbed in on and couldn't see anything. I get that as a medical student, I'm supposed to be all eager/be there/etc, but I also had other responsibilities. So, I get a page about a patient and tell this PA that I have to step out. I go and take care of this issue and come back. One of the nurses tells me to come outside with her. She begins this ridiculous speech about how I can't just leave/enter the OR whenever I want. That I need to decide if I want to stay or not and just not come back until the procedure is over. I told her I had a page/patient to see and she responds that I need to prioritize. Wow. She made it clear I was below her. All the more when she was the scrub tech and I asked for a retracter and she didn't even budge until the resident looks at me and asks why I don't have a retracter yet. I screwed up by responding "Because medical students can't ask for things." Some of the attendings literally, LITERALLY try to make medical students cry. They talk about how they hate them and want to make them feel horrible. One of them tried to do so by berating/insulting me for missing one question/pimp question. I didn't think anything about it when she called me stupid until I was out on the PACU and she confronted me in front of the staff and began this speech about how I lacked knowledge and would be an incompetent intern/resident if I didn't know anything.

There was also the time I missed a weekend day because I drove to an interview wherein my car broke down and I couldn't make it. I texted the chief resident, like he said to do, about my situation. He didn't respond to acknowledge he understood. Worst yet; he didn't tell the attending why I wasn't there that day. The attending (on Monday) bans me from the OR because of my lack of presence that weekend. I'd understand if they'd been like "It's your responsibility to take care of problems and get here." Not to have a chief resident throw me under the bus like that.

But wait! There's more. You're probably asking if my opinion is biased...well, I got the truth when a couple medical students talked to me. One of them just broke down and asked me if he was that horrible of a third year medical student. I didn't understand so I asked what was up and he told me how the Attending told him the student was barely passable and probably going to get a failure for knowledge base. This student... wasn't stupid. He knew a lot about medicine. If anything, he was average at worst. Then I try to think back on what he did wrong.... and I remember that laparoscopic distal panc wherein the attending asked the student what vessel this was they were looking at. I looked at it and I wanted to respond there's no real way of knowing which artery since there was no reference point. I kept quiet because I had an idea of what they wanted. The student answered "wrong". When the hilarity was they were wrong since it wasn't actually that artery. They then asked him the entire components of the diaphragm and diaphragmatic crura with their origins. There are questions... and then there are questions. He didn't know. They turn to me and ask and I just respond "I'll find out when I read on it". They look at me like I should know this. I didn't care but fast forward to now and I can see what happened. He then told me that the attending said this student was interfering with my progress. This student actually believed that this was true and apologized TO ME. I told him that he didn't do anything wrong and had been beyond helpful.

I saw more and more of this. Saw a third year almost break down and cry at 6am before rounds had even started. Why? The surgeons had told her that she needed to study the anatomy for the shelf exam because that's what was important. She believed them and did this for weeks until she finally took a practice exam and realized how screwed she was. I mean, I get that you're supposed to be able to find out things on your own, but I felt horrible for her. I wish I was there when they told her this so I could've told her how wrong they were.

Now... now I understand why almost every resident asked why I wanted to be here. Or why I was even here. I hope I'm 100% wrong. But I doubt it.

So I'm guessing you didn't rank that program in the match...

 

[SLUser11]

I'm going to go ahead and write up a review of a community program to avoid:
University of Illinois Urbana-Champaign/Carle General Surgery

Yikes. That sounds like a very negative experience. I'm not sure the color of the scrubs matters much, but the generally unpleasant vibe is obvious. Was this all on one rotation?

I know the PD from that program, and she is a very passionate and energetic educator. I'm very surprised to hear her program is considered malignant. I know she took over recently, so perhaps she inherited the negativity.

 

[Kaustikos]

So I'm guessing you didn't rank that program in the match...

I did... only because I had to. But not high.

Yikes. That sounds like a very negative experience. I'm not sure the color of the scrubs matters much, but the generally unpleasant vibe is obvious. Was this all on one rotation?

I know the PD from that program, and she is a very passionate and energetic educator. I'm very surprised to hear her program is considered malignant. I know she took over recently, so perhaps she inherited the negativity.

Some were good. But the rest made me hate it to the point that the bad outweighed the good. Some residents were cool... but others were just deliberate dinguses.

 

[futurgensurg]

I know this is an old thread, but does anybody have any thoughts on Morristown (Atlantic Health) and how it might compare to Santa Barbara Cottage?