Unfortunately a top-5, 100% boards pass rate, super-happy residents, powerhouse fellowship match, 40 hours a week, close to my family program doesn't exist. All applicants must attempt to balance their ranking criteria to compare programs.
This is a question for current residents and staff: what factors were most important to you as your built your rank list? Did you realize during/after training that some of these issues were more or less important?
I'm trying to sort out my top 5, but each has very different +/-'s. Right now location and fellowship match is most important to me, but I'm trying to identify if experience would suggest other factors are more important.
My priorities now are probably different than they were 10 years ago, but here you go (note these are not in order):
1. Operative experience: numbers, breadth of cases, and different learning environments (including a VA and a community hospital if you choose an ivory tower program). A nice gauge is the number of TA cases that the chiefs get.
2. Board pass rates, available on the ABS website. You can't be a surgeon if you can't pass your boards.
3. Fellowship match rates, including a history of matching people into your subspecialty of interest
4. Geography. I thought it didn't matter when I went through, but 5 years is a long time to spend in a city that is difficult/expensive/time consuming to leave when you want to see family and friends. In addition, if you are married, you need to choose somewhere your spouse can tolerate for 5-7 years.
5. Resident camaraderie. If you hear residents talking crap about eachother or the attendings, remember that they are on their best behavior in front of you. Things will only be worse when you get there.
6. BALANCE of experience. You don't want to trains somewhere with a very lopsided caseload or patient population. You need to treat insured and uninsured, first crack and reoperative, complex and straightforward, etc. If you go somewhere and do 5 whipples a week, but never do an inguinal hernia, you will be lost. Some places are too heavy in vascular, or possibly too heavy in the reop-reop-reop game. You want everything to be balanced.....some graduates should go into high-powered fellowships, but others should be going into general surgery practice...some rural, some urban...you want attendings that trained at multiple institutions so you'll have several unique perspectives and approaches to the same problems. You want a nice lifestyle, but not TOO nice (you want to work hard and earn it)....you want hard call nights, and easy call nights. I cannot stress enough how important it is to have balance.
7. You don't want to be on the front or the back end of any concept....shouldn't be the first or last program to adopt robotics, or simulation, or SCORE, or whatever.
8. If you are a competitive applicant, you should never rank a new/emerging program high. Sure, they may be great, but they are unproven. You don't want to be the guinea pig for your surgical education.
9. You should avoid places where they complain constantly about work hour rules, etc. Yes, we are all frustrated by the limitations of current surgical education, but the strong programs will focus on how to adjust and evolve, and keep the resident experience high yield, while those that are simply butt-hurt and fixated on the unfairness of the situation will not survive the winter.
Good luck!
