We had an applicant come interview for a PGY2 spot when someone left to transfer to family medicine. That candidate asked the most relevant questions, and came at around the same time as the MS4 applicants. Its unfair, but there is almost NO WAY to know what makes a good program til you have spent a year in residency. Most programs are pretty decent and have a mix of good and less great points.
But again, I cannot stress enough that as a med student, you simply have almost NO perspective as to what your life as a resident will be like and the finer points of what path training is all about. Having said that, and realizing that there is no utopia, in no particular order:
1) lots of grossing bigs
2) zero to as little biopsy grossing as possible
3) opportunity to attend meetings with funding from institution
4) avoid places where there is obvious hatred/drama/infighting
5) pick a place with a heavy call schedule - more learning for you, take the reins after hours, etc - this is CRUCIAL now that PGY1 not allowed to be on call (so short-sighted)
6) leadership is present, expectations are clear
7) good camraderie among staff, among residents - you'll spend a lot of time at work
8) good amount of previewing time
9) maybe most importantly, pick a place with high volume and low enough # residents such that each resident gets their OWN CASES to preview AND DICTATE, does not share cases with other residents OR FELLOWS, works up case with attending, orders own stains, signout consists of attending correcting minor errors/wording in RESIDENT report, and pressing sign out button: hands on for the resident! Approach like apprenticeship! Get your hands dirty, pretend you have only 4 years to learn it all, pretend you won't do a fellowship, etc.
10) good/full conference schedule, variety of conferences, well attended by residents/fellows/staff
11) good case variety, not only big cancer cases but also high volume of inflammatory lesions, skin, liver, kidney, GI, lung, all the non-cancer stuff. There's more to life than cancer, and cancer can look easy compared to some of it!
12) regularly scheduled feedback, structure of feedback
13) Is there a schedule? Is it controlled chaos or just chaos? Are people pulled from one service to cover another? How are absences handled so residents can attend meetings? Etc, etc.
14) conferences are mix of resident-led and attending-led. There is no fun in being a powerpoint monkey, and there is limited education from residents teaching other residents all the time.
15) Does program treat residents like junior staff or like idiot children? Some big name places reserve the grown-up duties for the fellows. Do residents present at tumor boards? Do residents present at CPC? Medical lung and kidney and liver conference? I would stay away from any place where the fellows outweigh and outshine the residents. When you are a resident, you need to be PUSHED to the front of the team, to learn and think like a physician. You cannot do this if fellows are taking all the tumor boards, cases, etc.
I think advice to pick a program based on the number of fellowships is poor advice. Get the best training possible as a resident, then you will get a good fellowship at the same place or outside. My place is high volume, low # residents compared to high volume, each has own cases and dictates from day 1, heavy call, and a few fellows.
I did an outside rotation at a huge name place and was stunned that their 2nd and 3rd year residents had zero experience doing what we do from the first month of residency: tumor boards, dictating our own cases, etc. There, they only do such things if the fellow is out sick, and then there is panic over whether the poor widdle wesident will be able to handle it. I nearly fell over. Not all places are big name, but some places teach you like an apprentice from day 1 to do your future job. Not spend 4 years waiting in line to maybe get the chance to practice your future job when the next person up the totem pole is out sick.
IMHO, #9, 6, 4, 5 above are most important, also #1.
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