What is the difference between different residencies?

[bGMx]

This title is a bit tongue in cheek; perhaps its true, perhaps my eyes are roasted from reading and watching the different program webpages. Aside from a couple factors (namely: geography, academic vs community) most programs look almost identical aside from one or two factors, which in my case, most programs don't have a definitive "that's a real game changer" factor. Every program I've looked at so far has the canned line: "what sets us apart is [insert thing that every residency appears to also do]." Is there an easier, more effective way for a medical student to pick a residency that will fit the bill? The most important thing for me is excellent training to the point that I am as close to a competent physician as I can be when I am an endstage PGY4, and idiosyncratic fit. Most training seems to fall within 2 standard deviations of the norm, and I can't gauge for idiosyncratic fit online. How did you s/p medical students solve this predicament? One fleeting thought I had today, partway through my self-induced browsing burnout, was to send it to all of the programs and then worry about this issue after I get interview invites, but alas, I am not even remotely close to affluent (I am negative affluent aka sinking in massive debt) so that sounds like a massive waste of money. What is a good way to approach this fun problem to have?

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[Old&InTheWay]

There's no way for you to answer the question you want answered. And no matter which program you end up in, you'll never really know how it would have stacked up against other programs.

 

[splik]

I don't understand this post. There are massive differences between programs in terms of culture, volume of work, call, emphasis, research, clinical program, rotation sites, population served etc etc. Some programs you dont treat involuntary patients. Some programs you don't learn therapy. Some programs you rotate at the VA. Some the VA is the main site. Some have state hospital rotations. Some are more heavily psychodynamically oriented. Some are more social justice oriented. Some teach critical race theory. Some have very respected psych departments. Some get shàt on by everyone else. There is a lot of information out there. In the old days people used to post their interview/program impressions here. Unfortunately that doesn't really happen anymore but that info is on reddit and other places.

It is true that if you complete a psych residency, you will be a psychiatrist at the end of the day. It is also true that the standard of training at most of these programs is not where it should be. Many programs lack the faculty and resources to provide adequate training in different psychotherapies, teach neuroscience, or provide exposure to the breadth of the profession.

 

[bGMx]

Thanks for this response @splik . I suppose I'm a bit flummoxed by the fact that I don't know what I don't know. If you were to choose a residency next year, knowing what you know, what would you be looking for and what programs particularly shine? A true effort on my part would involve combing each program in a systematic effort, but even then I don't what I don't know; and although I mostly know myself, I don't know my potential. This confrontation with "aways" and residency selection has become rather existential for me.

 

[mistafab]

Dude, you got to rank in terms of factors that matter to you. The differences or priorities clear to you may not be clear to others.

 

[splik]

Thanks for this response @splik . I suppose I'm a bit flummoxed by the fact that I don't know what I don't know. If you were to choose a residency next year, knowing what you know, what would you be looking for and what programs particularly shine? A true effort on my part would involve combing each program in a systematic effort, but even then I don't what I don't know; and although I mostly know myself, I don't know my potential. This confrontation with "aways" and residency selection has become rather existential for me.

Your school should have careers advisors to help you. You want to meet with a psychiatrist advisor who is not too far out from their residency training and they will hopefully be able to tell you which programs you are competitive for and what programs you might want to consider applying for. They may have information about programs of interest. When I was a med student careers advisor (which was quite recently), I had access to information like the step scores, number of publications/presentations, AOA etc of residents at different programs etc so this is something the advisors will have access to as well.

Your question also assumes you have the luxury of being able to choose where you end up on. Only about 80-100 applicants will have their pick of programs. The rest will be constrained by where you get interview invites and how highly those programs rank you.

 

[bGMx]

What I'm hearing is that the nash equilibrium is set for me to apply everywhere, and go talk to my advisor about aways. Thank you splik sincerely. It's frustrating to not know what programs are considered honest and worthwhile, and what programs are falsely advertising.

I would like a genuinely well rounded program that offers freedom to pursue interests, broad or narrow, to a high level of expertise. I would appreciate a program that affords the opportunity of being able to carry a decent psychotherapy case load, as well as the breadth to treat very sick inpatient patients. I wouldn't mind being worked hard, as long as there is emphasis on residents having opportunities to reflect and debrief.

 

[FlowRate]

What I'm hearing is that the nash equilibrium is set for me to apply everywhere, and go talk to my advisor about aways. Thank you splik sincerely. It's frustrating to not know what programs are considered honest and worthwhile, and what programs are falsely advertising.

I would like a genuinely well rounded program that offers freedom to pursue interests, broad or narrow, to a high level of expertise. I would appreciate a program that affords the opportunity of being able to carry a decent psychotherapy case load, as well as the breadth to treat very sick inpatient patients. I wouldn't mind being worked hard, as long as there is emphasis on residents having opportunities to reflect and debrief.

I'd say that the bigger programs at generally better-reputed academic institutions are going to be a safer bet for those preferences, if going for heuristics. If I tried real hard I could probably name 30-50 programs off the top of my head that are likely to meet those criteria (but only personally interviewed at like 10 of them.) But I don't know if you're competitive for those ("top") programs. Most of those programs sound very similar because they actually offer most of everything, although there are still differences to some degree or another in terms of types of rotation sites, workload, true research support, etc.

Things to look for when actually interviewing with those programs would be hearing about how many supervisors of what kind (modality) are assigned for therapy supervision and frequency/duration of supervision. Talking to residents and asking what sort of breadth/intensity of presentation they see while inpatient. Asking about outpatient caseload including therapy caseload in a tone that conveys that you're looking to actually see patients.

Applying everywhere is only true if your application is poor and you're just trying to get an interview anywhere.

The other thing no one has mentioned yet in this thread, but usually someone mentions in similar threads, is that location matters. If there are good programs in places you want to live, focus on those programs. There are a lot of advantages to doing residency in the place you want to be after residency.