UPenn

[Nivens]

Curious if we have any current residents or recent grads lurking around who can comment on residency at HUP. The opportunities seem excellent, especially as I am looking to do pediatrics after residency, and Bob Gaiser seems like an ace PD. However, I have some concerns about morale. Of the residents I met that day, most said they were reasonably happy, and a few expressed displeasure with their experience. I know residency is hard and I know people are bound to get down from time to time. But Im having a hard time determining where Penn should fit in my top 5 (in no particular order: Duke, Stanford, UMichigan and Emory)

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[afob100]

bump - also got similar feelings of low-ish morale on interview day.

 

[deleted171991]

Curious if we have any current residents or recent grads lurking around who can comment on residency at HUP. The opportunities seem excellent, especially as I am looking to do pediatrics after residency

It's almost always better to do your residency in a different place than where you intend to do your fellowship, so that you will be exposed to at least two different cultures. Plus you might change your mind about pedi anesthesia (number of graduates might become too high, reimbursements might go down etc., things do change in 3-5 years). Choose a strong balanced residency program, and you'll be able to go into whatever fellowship you want at the end of it.

Just my 2 cents.

 

[loveumms]

Several of my colleagues are Penn graduate. They are very strong anesthesiologists with great knowledge and skill. That being said, many of them said they worked pretty hard. They also feel like they got a huge amount of autonomy (sometimes a little too much).

 

[nimbus]

Several of my colleagues are Penn graduate. They are very strong anesthesiologists with great knowledge and skill. That being said, many of them said they worked pretty hard. They also feel like they got a huge amount of autonomy (sometimes a little too much).

If you select residents who can handle it, hard work and autonomy is basically the formula to make a strong anesthesiologist. The same could be said of most of the great programs.

 

[loveumms]

I agree partially but as an academic attending, there are varying degrees of autonomy. Some beneficial, others not so much (and quite frankly dangerous to patient care). A few of the stories I was told harp back to the 'golden' days of medicine where your attending slept all night and you did the cases on your own. I guess some people would see this as a positive because they learn how to handle the situation themselves. I'm not sure it always is. These are people who trained >5 years ago too so, things might have changed.

Yes, handwork is important. I always tell residents who are interviewing with us, you don't want to be at a program where you get relieved every day at 3pm to go 'study'. Anesthesia is very similar to surgery in that MOST of the real learning occurs in the operating room. Sure, we could all argue over whether a 21 year old lap chole is really solid learning but you never know what is lurking in the shadows of those cases. We could also argue over the amount of book learning that needs to occur to make a good anesthesiologist. I personally feel that being in the OR is where the money is during training.

 

[deleted171991]

I too think there is a fine line to walk here. What I like to see is supervised autonomy which, for me, is the equivalent of the attending sitting in the corner, watching the key moments. No drug pushing, not helping the resident, nada. Just a silent safety net, ready to intervene before bad things happen to the patient.

It doesn't mean not being in the room for key moments, or not checking on the resident, at least by EMR. It means letting the resident crap her pants before intervening, then fixing the problem elegantly and explaining the mistake to the resident. That's what good teaching means in my book. That's why every academic attending needs to be as close to a superstar as possible; the attendings I disrespected the most as a resident got scared way before I would have.

It's proven that learning experiences are best when charged emotionally; one will never forget a truly scary moment. But the resident should not be alone in those moments. There is a big difference between autonomy and independence.

Yes, handwork is important. I always tell residents who are interviewing with us, you don't want to be at a program where you get relieved every day at 3pm to go 'study'. Anesthesia is very similar to surgery in that MOST of the real learning occurs in the operating room. Sure, we could all argue over whether a 21 year old lap chole is really solid learning but you never know what is lurking in the shadows of those cases. We could also argue over the amount of book learning that needs to occur to make a good anesthesiologist. I personally feel that being in the OR is where the money is during training.

Although I used to oppose this as a resident, now I can't agree enough with it. One can't win if one doesn't play. Anesthesia happens in the OR, not in the books. Anesthesia is an applied science, and "applied" is even more important than "science", especially during residency. Those times when one is in the OR and has a safety net will never come back. These are the moments to explore the shadows, even if one doesn't have the skills to tackle them alone yet. We are in the tablet era; one can take one's entire library to work, and let's not talk about all those free ebooks every decent residency program offers online. Taking care of the patient and reading are not mutually exclusive as long as they are kept cyclical, with no more than a few minutes dedicated to reading before checking on the patient again.

 

[gasman7k]

FFP, could you expand on reading in the OR? I'm an intern, but always assumed it was poor form.

 

[Nivens]

Thanks for all of your thoughts. Rank list is going to be really tough- after the first few interviews I realized I was in for a season of the same sales pitch over and over, with very little exception. People like Gaiser seemed like one of those X-factors, but I really would rather live Ann Arbor or the Triangle than Phili... can't believe it really is going to come down to location.

 

[Chief Brody]

Current CA-3 at Penn. Born and raised in Southern California, undergrad and medschool in Portlandia. Came to the east coast after my wife and I decided to try "something different" for residency... Best choice I could have made from a professional stand-point. The program here has evolved during my tenure here, to include a greater emphasis on regional anesthesia (4 fellowship trained attendings hired in last 2 years plus new outpatient surgicenter to rotate through for blocks), CRNAs hired to reduce work load (4-5 work 7-830p each week day, Cardiac CRNA hired for 1 day a week), Out of OR anesthesia rotation ( CA-1 rotation - endoscopy, EP, neuroIR, bodyIR). The catch is that the Main OR schedule continues to grow, so our overtime system of ECC ($100/hr after 530p) is still intact. Cardiac, Vascular, Peds, OB, Neuro, big belly cases, ENT, Urology cases all remain strong (easily met all of my ACGME minimums by the middle of my CA-2 year).Thoracic is unfortunately light, but this has been addressed and starting in February residents with rotate at Penn Presbyterian for additional cases. Our faculty has grown from large to gynormous, and this has improved the quality of our didactics and education program. The UPENN anesthesia residency is better now than when I came here on the suggestion of the chair at my med school who at the time described it as "one of the top 3 programs in the county" (for what it's worth... he said his was one of the top three as well). Dr. Gaiser is a fantastic advocate, a wonderful mentor (he was one of my 1-1 attendings), and a dynamic educator. The patient's here represent any combination of old and sick, young and very sick, old and nearly dead, young and recently guilty of just "minding their own business" (trauma is heavy in W. Philly, but our Level one trauma center is moving to Penn Presbyterian in February, so that once heavy component of call will be going away for the fore-see-able future), or any combination of the previous categories. I have not been out in the real world of anesthesia yet, so I am describing anectdotally what I believe to be a program that is heavy on workload ( you will not leave before 5:30p during your main OR months... ever), where you will leave feeling very comfortable taking care of just about any train-wreck case that can come into the OR. My class of 24 have all either matched into the speciality fellowship of their choice or found jobs in their first choice location (nice mix between private practice and academics). As mentioned previously, the reputation of UPenn being a workhorse program is justified, and that is not going to change. Neither is the fact that it is a fantastic place to train. Good luck!!!