Currently on interviews right now and honestly the programs are all starting to blend together. I have no strong geographic ties just want to get good training without getting burnt out. All the programs so far have had good vibes and seems like I could work with the residents and faculty no problem. All also seem to have enough volume (usually too much). I honestly don't know how to rank these programs outside of like doximity reputation... is there something else I should be thinking about?
What is honestly important when ranking residencies?
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Where do you want to live is the big one. And prestige factor if that’s important to you. Any mid size place is going to be largely the same. It’s all about the vibe and not being overworked.
Yeah I think I'm unlike many other people I know where I don't care where I live (for the most part). I didn't get any Big 5-10 interviews so I am really not sure how to assess prestige. Even most programs fellowship matches look largely great, plenty of internal and good places.
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In neuro, unless you want the biggest name place or something, you can get anything you want. I’m an average DO student with 3 job offers and I just started residency. Think about where you wanna live and start there. Then think of sub specialty exposure they may have that you might be interested in. Besides stroke because every residency gets that
Think about where you want to live geographically. Look at where affordable apartments are at that place in relation to the hospital, how you'll get to the hospital, what the weather will be like in January at 2am when you might be required to go in, how much you'll pay for the apartment, getting to and from the hospital, and for meals. State taxes make a big difference as well- $50k in Texas, Florida, Washington equals nearly $60k in NY, CA etc in wages. Think hard about whether the residents seemed to be generally happy, and how close all the hospitals you rotate at are together (commute time is very important). Prestige is the absolute least important factor in my opinion as one you start working for St. Elsewhere Community Hospital as an attending you'll never, ever get asked where you trained. Unless you want to stay in academics or do research, then it might matter a little but not as much as one thinks because most academic neuro depts are begging for faculty at the low wages they pay.
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Xenotype has the best answer in general. Some of this has to do with your personal priorities. Prestige itself matters very little outside of some very specific scenarios (grant applications come to mind). However, prestige can in some cases be a proxy for quality - not so much in comparing "elite" vs "good" places - but some things matter, like having all the major sub-specialties, more variety than just "stroke, AMS, more stroke, oh here's some more AMS, yay a seizure!", and faculty with enough supported effort to be actual educators rather than people you shadow in clinic. Places you've heard of tend to have this. Places you had to google to be sure they are real often don't.
Location is a big deal. In general, if you have roots somewhere and you want to be there long term, go to residency in that area if you can help it. Otherwise, remember that many places that are known to have attractive quality of life are often difficult places to live on a resident salary. When you're making basically the same amount of money as a resident in NYC, that Midwest city that sounds really blah starts to sound great once you realize you can afford a house, car, frequent outings, and save a decent amount of money instead of living on rice and beans in a dumpy shoebox while having nurses at work that actually do the job of nurses.
Location is a big deal. In general, if you have roots somewhere and you want to be there long term, go to residency in that area if you can help it. Otherwise, remember that many places that are known to have attractive quality of life are often difficult places to live on a resident salary. When you're making basically the same amount of money as a resident in NYC, that Midwest city that sounds really blah starts to sound great once you realize you can afford a house, car, frequent outings, and save a decent amount of money instead of living on rice and beans in a dumpy shoebox while having nurses at work that actually do the job of nurses.
Thats the thing I don't have roots anywhere really and I moved across the country for med school and have adjusted fine. I think I could live most anywhere but I also didn't apply to any super cold or rural areas. Also I'm quite frugal and have no SO or kids so money isn't a consideration for me.
I guess the main thing I'm looking for would be quality of the program as you say- with faculty that are interested in and good at teaching. However, all the programs I'm interviewing at are academic and have most subspecialties. I am also looking into staying in academics possibly (I want to do a little research in addition to clinic) so maybe prestige is something I should weight more heavily.
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I went by location and gut feeling.
I passed on more prestigious programs (i.e. top 5 places). I think it worked out okay. I didn't go into academics though so your goals may be different.
I passed on more prestigious programs (i.e. top 5 places). I think it worked out okay. I didn't go into academics though so your goals may be different.
Why did you pass on the more prestigious places? You didn't vibe with the residents? Also, I'm starting to wonder if I'm discounting location too much as I am single and would like the option to date during residency.
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Contrary to 95% of the people on SDN, prestige is not that important. Getting good training a job after training is more important than being "Stanford trained".
Outside academia, the Yale grad and VCU grad will have the same patient volume and likely quality of care.
Well I think prestige as Thama said above is a marker for quality as I've found it very difficult to assess how good a program's training is from a one hour zoom meeting. And frankly talking to the faculty and residents is not helpful as outside of truly malignant places, they are just trying to sell you on the program.
I agree that there is a close relationship between prestige and the quality of training, and that it is difficult to approximate the quality of training through Zoom sessions. In terms of quality of training, this probably has been said before, but there is a difference between learning from those who read the guidelines and learning from those who wrote the guidelines. Residency is the time to build frameworks of clinical approaches, explore various fields, shape the early part of the career, and start to build one’s professional network (or at least beginning it). In that sense, I believe talking to the residents would be helpful, as you could ask about and explore any unique opportunities, non-traditional career paths, and professional networking — and the residents could share their honest opinions on these topics. If there is nothing unique or any “bonus” features, the residents would also say that. Otherwise, I agree the location/family factor would be just as important.
Prestigious places actually pay faculty substantially less than non-prestigious places (this is a fact), and there is absolutely no guarantee they will protect resident training or faculty teaching time more just because they have a fancy trademark. In terms of resident teaching many of the most important things (truly protected didactics, continuity clinics that actually have continuity and variety, wide latitude for elective time across many specialties, high acuity and high but manageable volume on call with high patient complexity (transplant, onc, tropical disease, etc)) have very little to do with whether a program is prestigious, and actually don't necessarily have much to do with funding either- more culture within a program and geographic location. It is merely a hypothesis that a name brand program will do better at these things because it is name brand. As for patient diversity- many of these name brands have major competition that is 10 minutes away siphoning off patients in entire categories- eg Case Western and CCF, Duke and UNC, etc. Better to train in a big place with no competition within 2+ hours as you'll get everything sent to you with no filter.
I don't agree as above. There's no guarantee when you train at a name brand institution that you'll work much if at all with the guy who 'wrote' the guidelines. Additionally, guidelines do not apply in all situations and clinical judgement is the most important skill, and is difficult to teach. Random faculty in a random program may be way better at teaching clinical judgement and reasoning than the guy who wrote a guideline for a particular situation. In real life, the times it gets hard is when you are forced off the beaten path by a weird situation with a really sick patient and balancing a number of factors with a wide differential is key. What you learn (and how you learn it/what you retain) from being on call with faculty as a resident is much more important than what the faculty do themselves- this is about you becoming a skilled neurologist.
This is extremely important for you and again why I refer to prestige being the least important factor. Your day to day, week to week life is the most important factor and dating if you are single will be something you'll worry about daily. Avoid small towns and stick to cities, but I wouldn't worry about prestige. The program I trained in for example even in the worst, busiest, darkest months of PGY2 guaranteed two golden weekends off a month. This was critical for everyone's sanity and very important if you want time (and mental energy) to actually go on dates during busy rotations. The other thing you will certainly need for dating is money. You won't have any money to spare in an expensive city like Boston or NYC. A midwest or southeast/southwest city (not CA) in a low to medium cost of living area you'll have plenty of money as a resident for dating, restaurants, a car payment, and a decent apartment.
Personally, I passed on prestige as a US MD student that had good enough scores to really go wherever I wanted, and have had zero regrets with where I trained. Location was extremely, extremely important as was having enough money during residency that I could live comfortably and build a relationship with my significant other.
Sorry for the delayed response.
I agree that the external factors such as location, family/friend support, and other aspects of day-to-day life are very important. However, these factors vary so much from one person to another. Each applicant should know about these factors already, and interviews (especially virtual ones) would not add much new information, unless there is an obvious red flag. The interactions with the residents would be very important, but I would not write off an otherwise great program, just because the residents don‘t look fun, per se.
As to the clinical training, however, it depends on one’s career goal and definition of “skilled neurologist.” What is required in a great neurointensivist is vastly different from what is needed in a great behavioral neurologist. That said, I agree that the trainees should be exposed to many cases, especially really sick patients from various conditions, and I argue such cases usually come to and are clustered in a major tertiary medical center. It is needless to mention that those medical centers are usually also major academic centers in that region. Therefore, experts with a lot of experiences in making nuanced and difficult clinical decisions are also nurtured in such centers with a much higher frequency, and they tend to stay and mentor the next generation in similar institutions. Sure, this does not happen only at Harvard or UCSF, but once again such centers are usually the leaders in that region to build and maintain a great volume with variety, a wide referral network, and breadth and depth in many subspecialties. Such centers have already built up a good reputation in most cases too. These centers may not always be at a “brandname” place per US News College Rankings. But good mentors would know which centers have a good volume of varied cases, and which centers have the breadth and depth in certain subspecialties.
It is also important to think about one’s career trajectory. A good residency program should expose the residents to a wide spectrum of subspecialties with true experts in each, instead of forcing them to take stroke codes for 3 years. Perhaps, local hospitals would afford more EMG time for the residents, in part because of the attendings’ practice pattern, compared to bigger academic centers. But again, more complicated, nuanced cases would be referred to those academic centers far more frequently. Thus, if a resident chooses to use his/her elective time in neuromuscular, for instance, I argue that an academic center with a good referral base can provide a much better educational experience and a more accurate depiction of what a true neuromuscular expert would do, which is important in making the fellowship decision. Who would be better at EMG for a carpal tunnel at the time of residency graduation? Probably the ones from a local hospital with more hands-on EMG time. However, if there is a case of second or third opinion for possible ALS with multiple comorbidities, the ones from a larger academic center would have much better exposure with similar diagnostic/management conundrums, and would know what to do in the inpatient setting. EMG in such cases would likely be carried out by a fellowship-trained neuromuscular physician at a large center anyways.
With all that said, I think no one would come out of a residency as an expert in EMG, EEG and DBS, certainly not in all three simultaneously. However, a good program should prepare its graduates to take on a neurohospitalist job with no issues. In other words, a realistic goal of neurology residency would be turning medical interns to good neurohospitalists with a good fellowship placement (after letting residents make an “educated” decision on fellowship). A famous residency program usually has some track records of doing this and a better chance of still doing this, compared to less known, smaller, community programs, IMHO. And that’s what I meant by “prestige,” not US News College Rankings.
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