The Post-Interview Thread - Post Interview Experiences Here

Poety said:

I have nothing to contribute yet, but I thought what the other poster in 'interviews' said was a good idea. Can you please post your interview experiences here. I think if we make this thread it will not only help one another for this year, but will make a great reference for future applicants


Please make these points:

1. Important questions you asked/were asked

2. Big highlights of the programs

3. Estimated call hours

4. Friendliness of the program residents, faculty and staff

5. Location pluses and minuses

6. Most positive aspects of program

7. Most negative aspects of program

Please add anything to the list you feel is necessary since I haven't interviewed anywhere yet and I'm a newbie

GOOD LUCK EVERYONE!

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This was a great idea--thank you for the initiative, Poety!

Now--anyone want to get off their hindquarters and actually post anything??

I have nothing yet myself, but I know there must be some people out there, no...?

Thank you,
Roady

Thanks for the template... here goes:

UCLA-Harbor

1. Important questions you asked/were asked
-Very chill, just tell your story a couple times and then they offered to answer any ?s I had.

2. Big highlights of the programs
-County hospital experience. You can love it or hate it, but those who come here love it. You'll get lots of autonomy and will come out confident to handle anything. Their Psych ER is a big highlight. You can moonlight in house starting as an R3. Outpatient starts early in the 2nd year, you get your own office (it's in these bungalows next to the hospital, prettier from the inside than the outside, but you'll never doubt it's a county facility). Free food for residents in cafeteria, but it's pretty mediocre.

3. Estimated call hours
-About q7 as intern on psych, but with 11pm-330am covered for protected sleep time covered by a moonlighter. No weekends unless on call. As an R2 it's slightly less overall calls than as an intern, but more weekends. Then as a higher level it is just phone backup from home.

4. Friendliness of the program residents, faculty and staff
-Extremely welcoming and passionate about the program, the Harbor institution, and it's mission of serving the underserved.

5. Location pluses and minuses
-South bay. I'm in the couples match and the thought of matching one of us at Harbor and the other at UCLA/USC would make finding a place to live with reasonable commutes a challenge. Residents I talked to lived in Redondo or Manhattan Beach and loved the location.

6. Most positive aspects of program
Autonomy. It's a "see-everything" county program, great clinical training.

7. Most negative aspects of program
Not very academic, if that matters to you. There are opportunities for research but they are the strength of the program.

Thanx coop!

I, too, say "Thank you". My first interview is in two weeks, and I will also share my insights/experience.

1. Important questions you asked/were asked

• One thing I am struck by is that I haven't once heard the PD (Grace Thrall) or any of the residents refer to interviewing season as "interviewing season". They all call it "recruiting season". I think that suggests a subtle change in outlook & perspective that speaks well of the attitude here.

2. Big highlights of the programs

• The Family Studies Program: It starts during PGY3, and you are directly observed by a supervisor during your therapy sessions through a one-way mirror. The PGY3s all speak very highly of the program. I've heard a lot of programs talk about how "balanced" they are, but this seems to suggest that Duke takes psychotherapy training very seriously.
• "Academic Half Day" on Thursdays: From 8-12 you are excused from clinical duties to attend didactics. You don't even have to pre-round. The attending basically does all of the work -- the PD had to overcome a bit of resistance from the attendings, but now it is a solid part of the program -- and then you come back from Academic Half Day and get report about the attending's management plan, etc. This works out well for most of the rotations for the psychiatry residents. However, it doesn't seem to work out well for the medicine/psychiatry residents when they are on a Gen Med month (because when they get back from Academic Half Day, they have a crazy amount of catch up to do on their patients, and this gets really bad if you're carrying 10-15 patients). In terms of the content of Academic Half Day, it's a big hit with the residents.

3. Estimated call hours

• It's all on the Web site. Not bad at all.
• Psychiatry interns do their medicine months at Durham Regional Hospital, not at the Duke University Medical Center. Depending on your perspective, this is a plus or a minus. The DRH medicine experience is much easier than the DUMC medicine experience, but you also don't get to see as much.

4. Friendliness of the program residents, faculty and staff

• The PD, Grace Thrall, is wonderful. Enough said.
• Haven't really run into a mean attending yet.
• The residents are all interesting and intellectually curious people, very friendly.
• Whether you end up in a class with married or single residents is variable. Most of the interns are single (two of them are married to each other, and I think 3-4 of the others are also married to people outside of the class), but all of the Y2's are married with the exception of one. Luck of the draw, I guess.

5. Location pluses and minuses

• Durham isn't Manhattan. That's either a plus or a minus, depending on your own social situation. The housing is quite affordable here, and many of the residents own homes or condos. There are lots of lofts downtown (nice ones), and many of the residents rent or own those as well.
• It's 74 degrees today, and I just got back from a run (in my shorts). Can't do that in Boston in November.

6. Most positive aspects of program

• It's not a front loaded program. PGY1 is actually quite easy. I can understand why they have arranged the program this way. Because if you look at the light blue colored program down the road, they get thrown into the craziness of the state hospital during PGY1. And I can imagine that it would be a bit disconcerting to have to go to self-defense classes during PGY1 while you're trying to get used to the newness of everything. Maybe Duke's non-frontloadedness is a good thing.
• Plenty of research going on if you want to get involved. PGY4 is 100% elective (like many other programs), so there's plenty of time to do dedicated research.
• Lots of other stuff going on: Divinity School, Terry Sanford Institute of Public Policy, Law School, etc.

7. Most negative aspects of program

• Y2 is the hardest year, with 5 months of inpatient psychiatry at the state hospital (John Umstead) and 2 months on the extremely busy consult service. I kind of wish the PGY1/PGY2 were more balanced -- maybe you could take 1 or 2 months at John Umstead at the end of your first year or something. (That's not an option, but I'm just thinking aloud about how to make PGY1 and PGY2 more even in terms of workload.)
• No standalone psych ER.
• The child psych program is kind of weak.
• No care programs for refugees or torture survivors. You'll have to go somewhere like UW or OHSU or NYU for that.

Atsai, thanks for taking the time to write such a great review. I have a couple of questions.


1. It does sound like Duke takes psychotherapy training seriously. They also make a point of teaching evidence-based practice. Did you get the feeling that the evidence-based approach was being applied to psychotherapy as well as pharmacotherapy? Or was it being applied willy-nilly according to the particular orientation of the therapist as it so often is?

2. Sounds like residents learn inpatient psychiatry at the State Hospital rather than at Duke. Are the attendings there on the faculty at Duke? Any indication as to the quality of the teaching there?

Thanks again.

N

AWESOME REVIEWS--THANK YOU

<KEEP IT COMING!!!>

One of the individuals in my class cancelled her Hopkins interview today. I asked her what the problem was, and she said that they require a two month CCU rotation for PSYCH!? She feels -- and I tend to agree -- that they are just recruiting cheap labor!

Why would a psych resident need a two month rotation in a CCU? Glad that I didn't apply there -- maybe that's why they have such a great reputation!?

hmmm...hopefully there was another reason to cancel an interview other than unit months during medicine. medicine goes by fast, and isn't always what you are expecting. i didn't mind the CCU even though the hours sucked. i would go to all the interviews that you can, you never know which place will really surprise you. do not listen to everything you read on this site, make up your own mind. i almost cancelled my current program's interview becasue of some mis-information.
being on a lot of interviews you end up noticing that another person's dream program is your least favorite. i was at a rather nice interview and someone else turned to me and said "this place is such a dump." i was a little in shock since we were sitting in the same room all day...you never know.

tangents said:

hmmm...hopefully there was another reason to cancel an interview other than unit months during medicine. medicine goes by fast, and isn't always what you are expecting. i didn't mind the CCU even though the hours sucked. i would go to all the interviews that you can, you never know which place will really surprise you. do not listen to everything you read on this site, make up your own mind. i almost cancelled my current program's interview becasue of some mis-information.
being on a lot of interviews you end up noticing that another person's dream program is your least favorite. i was at a rather nice interview and someone else turned to me and said "this place is such a dump." i was a little in shock since we were sitting in the same room all day...you never know.

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CCU would be an acceptable rotation. A two month CCU rotation, in addition to a medicine rotation, on the other hand, seems -- to me -- a means of cheap labor. Others may disagree, that's fair. Ultimately, I do agree with your post. People SHOULD explore all avenues for themselves; however, listening to others opinions/concerns/experiences ought to be a PART of that exploration.

Funny, I logged on to write my review and saw the above comment about the CCU and "cheap labor". I'll answer both below, but I must say first in sum (this was my first interview, so I may be a bit naive still) that I was thoroughly convinced of the integrity of the faculty and the high priority of resident education within the department. This impressed me so much, in fact, that I was a little annoyed at the suggestion that just because their internship is demanding, they must be exploiting people.

This residency is very structured. The entire first year takes place at Bayview, a different hopsital attended by Johns Hopkins faculty and at which JHU medical students rotate, but which has its own IM residency program. There are 6 months of medicine rotations, of which one is in the CCU and two weeks in in the MICU. The rest are spent on general medical wards. Thee are two months of neurology, divided between inpatient and diverse specialty outpatient clinics. Then there are four months of genreal inpatient psychiatry. The internship has its own director, Dr. Angelino, who came to hopkins to meet with us. He's a real straight shooter who described the internship very thoroughly without overselling it. In the hallway, several PGY2's and PGY3's ran into him and greeted him very warmly. I was told that he invites the interns stuck alone in Baltimore on Thansgiving over to house for the holiday.

There are some important points regarding the internshyip year. 1) It is entirely offsite. While everyone I spoke to was very fond of Bayview, it does mean you will one less year to develop relationships with faculty members as well as residents in the other classes. It also means that as an interviewee, the only residents you meet whom you might actually end up working with are the PGY2's. 2) Yes it is demanding (around 75hrs/week) and the medicine is serious. They make no bones about the fact that they want residents who like medicine and and who aren't looking for a cush residency. The residents I spoke with looked very fondly on their medicine months, said that they were fully-integrated into the medicine teams and treated as equals. And they said that they were never left without support in dangerous situations, particularly on the unit. They also said it prepared them well for inpatient psych, as the psych unites at Hopkins are really all med/psych units where the psychiatrist does most of the medical management without consulting out.

Second Year is spent rotating through the specialty inpatient psych units at Hopkins. This year seems very comprehensive. Hopkins faculty are all required to do research as well as attend so you get a little of access to big shot specialists, such as the chairman. The units themselves are very nice and the resident always has his/her own office right on the unit to read and meet with patients and families.

Residents are expected to start building an outpatient practice in the PGY2 year and this was a questionably negative aspect for me. There is no dedicated time to see outpatient patients at this point, nor any rules about how many or which kind of patients to pick up. You have to find down time or stay late to see your outpatients. You are assigned a supervisor whom you meet with once a week to review the cases.

Third year has 2 months C&L, 2 months ER Psych, and 12 months (extending into PGY4) formal outpatient training in which you rotate through numerous specialty clinic as well as continue seeing your longitudinal practice patients. In the fourth year there are 2 months Child/adolescent and 6 months elective which can be spent doing research, but research is not mandatory. The PD felt very strongly about not creating separate tracks (eg Child, Research) as he wanted everyone to obtain core clinical competencies in Gen Adult Psych before moving on and he wanted the program to be cohesive. He gave the following estimate of work hours: PGY1 75hrs/wk, PGY2 65hrs/week, PGY3 45hrs/week, PGY4 less than 45 (mandatory) hrs/week.

The interview day is very busy and voluminous. I had formal interviews with the PD, assistant PD, Chairman, internship director, 2 other faculty members, 2 residents, lunch with the chielf resident. There was also a case conference run by the chairman at which all of the residents were present and a coffee break organized for us with many residents present. Everyone I met, from the chairman to the residents to the secretary were very warm and down-to-earth. They came across as genuinely liking their program but without a snobby air or putting down other programs. The one negative I consistently heard from the residents was the city of Baltimore itself, and even the PD hinted to me that he had trouble recruiting because noone wanted to come to Baltimore.

Hope that helps create a fairer image of the place. I encourage anyone who has the opportunity to interview there, especially if you have an interest in inpatient psych and/or want to be a psychiatrist with a strong foundation in medicine. Let me know if I can provide any more info.

nortomaso said:

Funny, I logged on to write my review and saw the above comment about the CCU and "cheap labor". I'll answer both below, but I must say first in sum (this was my first interview, so I may be a bit naive still) that I was thoroughly convinced of the integrity of the faculty and the high priority of resident education within the department. This impressed me so much, in fact, that I was a little annoyed at the suggestion that just because their internship is demanding, they must be exploiting people.

This residency is very structured. The entire first year takes place at Bayview, a different hopsital attended by Johns Hopkins faculty and at which JHU medical students rotate, but which has its own IM residency program. There are 6 months of medicine rotations, of which one is in the CCU and two weeks in in the MICU. The rest are spent on general medical wards. Thee are two months of neurology, divided between inpatient and diverse specialty outpatient clinics. Then there are four months of genreal inpatient psychiatry. The internship has its own director, Dr. Angelino, who came to hopkins to meet with us. He's a real straight shooter who described the internship very thoroughly without overselling it. In the hallway, several PGY2's and PGY3's ran into him and greeted him very warmly. I was told that he invites the interns stuck alone in Baltimore on Thansgiving over to house for the holiday.

There are some important points regarding the internshyip year. 1) It is entirely offsite. While everyone I spoke to was very fond of Bayview, it does mean you will one less year to develop relationships with faculty members as well as residents in the other classes. It also means that as an interviewee, the only residents you meet whom you might actually end up working with are the PGY2's. 2) Yes it is demanding (around 75hrs/week) and the medicine is serious. They make no bones about the fact that they want residents who like medicine and and who aren't looking for a cush residency. The residents I spoke with looked very fondly on their medicine months, said that they were fully-integrated into the medicine teams and treated as equals. And they said that they were never left without support in dangerous situations, particularly on the unit. They also said it prepared them well for inpatient psych, as the psych unites at Hopkins are really all med/psych units where the psychiatrist does most of the medical management without consulting out.

Second Year is spent rotating through the specialty inpatient psych units at Hopkins. This year seems very comprehensive. Hopkins faculty are all required to do research as well as attend so you get a little of access to big shot specialists, such as the chairman. The units themselves are very nice and the resident always has his/her own office right on the unit to read and meet with patients and families.

Residents are expected to start building an outpatient practice in the PGY2 year and this was a questionably negative aspect for me. There is no dedicated time to see outpatient patients at this point, nor any rules about how many or which kind of patients to pick up. You have to find down time or stay late to see your outpatients. You are assigned a supervisor whom you meet with once a week to review the cases.

Third year has 2 months C&L, 2 months ER Psych, and 12 months (extending into PGY4) formal outpatient training in which you rotate through numerous specialty clinic as well as continue seeing your longitudinal practice patients. In the fourth year there are 2 months Child/adolescent and 6 months elective which can be spent doing research, but research is not mandatory. The PD felt very strongly about not creating separate tracks (eg Child, Research) as he wanted everyone to obtain core clinical competencies in Gen Adult Psych before moving on and he wanted the program to be cohesive. He gave the following estimate of work hours: PGY1 75hrs/wk, PGY2 65hrs/week, PGY3 45hrs/week, PGY4 less than 45 (mandatory) hrs/week.

The interview day is very busy and voluminous. I had formal interviews with the PD, assistant PD, Chairman, internship director, 2 other faculty members, 2 residents, lunch with the chielf resident. There was also a case conference run by the chairman at which all of the residents were present and a coffee break organized for us with many residents present. Everyone I met, from the chairman to the residents to the secretary were very warm and down-to-earth. They came across as genuinely liking their program but without a snobby air or putting down other programs. The one negative I consistently heard from the residents was the city of Baltimore itself, and even the PD hinted to me that he had trouble recruiting because noone wanted to come to Baltimore.

Hope that helps create a fairer image of the place. I encourage anyone who has the opportunity to interview there, especially if you have an interest in inpatient psych and/or want to be a psychiatrist with a strong foundation in medicine. Let me know if I can provide any more info.

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Thanks for the great review nortomaso! Ultimately, your review is a much more insightful viewpoint than my "hear say". I do realize that so-called "top programs" expect their residents to work; I'm just not convinced that a two month CCU rotation, in addition to a six month medicine rotation/schedule, is necessary. Oh well, I've been wrong before <shhh, it's a secret > and I'm certain that I will be wrong again--though it will be in the very distant future !

1. Important questions you asked/were asked
-My interview day was very relaxed. Talking to people about the program director, Dr. Nemeroff, had me pretty anxious that he would be really intimidating. Even though he is one of the most famous psychiatrists in the world, I found him extremely easy to talk to. Several interviewees expressed interest in a particular fellowship or aspect of psychiatry. He did his best to schedule time with people in that field during the day. Outside of that, I didn't get any hard questions. Most of the interviewers had actually read my personal statement and used the time just to get to know me better and allow me to ask questions (which at 3 or 4 in the afternoon I was out of).

2. Big highlights of the programs

I'll post what I like. Obviously, this is different for everyone

-Psychodynamic focus on therapy - I like the fact that Emory is tied to a psychoanalytic institute. Even though I don't want to do analysis, I like the breadth of training this would provide.

-Multiple training sites - Grady (county hospital), VA, Emory, and other sites for geriatrics, neurology etc. Even though driving gets annoying, esp. with Atlanta traffic, I think this lets you see all different types of patients. I've only dealt with patients on the more indigent side, but I'm sure a first break in the child of a wealthy family looks a lot different from a homeless person.

-Excellent program director - Dr. Crowder really ran a great interview day. All applicants met with him in the morning, interviewed personally with him, and spoke with him at the end of the day. I haven't done my interviews yet, but some program directors aren't even around. I think Dr. Crowder's presence shows an incredible amount of dedication and commitment to the program.

-Lots of opportunity for research - I haven't been involved in a lot of research, but I like what a powerhouse Emory is for clinical research. The chair is world renown. It seems like it wouldn't be hard to get involved with an area of interest.

3. Estimated call hours
-About q6 during psych months both first and second year. First year is at the county hospital. They have mental aides that take a great deal of the history. It sounds like you function like an attending for the most part (ie deciding on disposition). I may have this part wrong, but it sounds like you don't have to call a chief/attending as long as you aren't admitting the patient. Obviously this amount of responsibility has its advantages and disadvantages. Second year call is at Emory and the VA, but you can take the call from home. All cases have to be checked out to an attending. Seems perplexing that 1st years are given more autonomy.

Medicine call is a little odd. All medicine ward months are at Grady. Every second night, the team takes short call, which basically admits up to four patients that the night float admitted. Every fourth night, you take long call. You admit patients until 9 or 11pm (I forget which). So, a big plus is no overnight call/crosscover, but residents let you know pretty quickly that you usually are taking care of your cap, 12 patients. Plus, this is at a county hospital where ancillary staff is lacking.

Neuro call is overnight and one month is pretty hard.

4. Friendliness of the program residents, faculty and staff
-Faculty were extremely nice, as well as the residents who took us to dinner the night before. I didn't get a good feel if the residents were close though.

5. Location pluses and minuses
-Atlanta. Very urban with lots to do. However, Atlanta is very spread out with some of the worst traffic in the world. This can be overcome by not getting on the interstate. Atlanta is not Manhattan though. It has a strip mall kind of feel and is only walkable in small neighborhoods. Having a car is a must.

6. Most positive aspects of program
Great clinical training, breadth of sites and patients, excellent faculty, wonderful research opportunities.

7. Most negative aspects of program
Medicine at a county hospital. Some people may thrive in this environment, but I think that service should be educational. I personally don't get a lot out of not having labs drawn, wheeling people to CT etc. I don't mind working at all, but I would much rather spend time learning, focusing on patient issues than being an extra set of hands.

Residents. During our lunch on interview day, residents weren't very proactive with interacting with applicants; many sat with their own groups. When the Grady chief was trying to answer questions, a couple were even passing notes to each other. I found this pretty immature. I just didn't get a good sense that residents were satisfied. I'll probably go for a second look to re-evaluate this, but interns and second years weren't active in recruitment. I just wish that I would have seen more enthusiasm from housestaff about the program.

Keep the reviews coming. I spoke with the moderator who said this could be a sticky if more reviews are posted and replies were more germane. Good luck everybody!

There was a pre-interview dinner the night before at a very nice restaurant with faculty and residents. I was told by a resident that interviewee groups have been stratified such that there is a night with all MD/Phd candidates from ivy league institutions at which many faculty members-- including the chairman-- attend and other nights with more modest candidates where there are only residents in attendance.

The program is indeed very research oriented and there are tremendous opportunities for those who intend on pursuing research. One nice thing is that they are very open to candidates with little to no experience who want to have a go at a research career. The research track, which one apples to in the second year and begins in the third, does not have a limited number of slots-- one must simply demonstrate a commitment. Once accepted, you can apply for NIH loan repayment funding and potentially finish residency with $70,000 in loan repayment. There is also ample opportunity for moonlighting. Combined with the low cost of living in Pittsburgh, this is a very financially tempting program.

One fourth year told me that he felt that he had not received enough clinical training at Pitt. This was the inkling that I had even before he told me such. Durringthe first year there is a three month rotation in the very large psychiatric emergency room, and according to the interns little teaching occurs there during the day. The attending on the addictions unit is also in charge of the first two years of residency. He is very involved in resident education and struck me as an outstanding individual, but an exception here. Everyone I met was very pleasant, and every faculty member struck me as quite brilliant and accessible, but I just didn't walk away convinced that the clinical training was excellent.

The city itself is very nice and for those doing research, there seemed to be plenty of opportunity to stay on for fellowships and even faculty appointments.

Poety said:

Hi Norto! I just wanted to say that it sounds like this place would be great for someone wanting to go into academia would you say thats true? I didn't even apply here because of location

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Poety, I agree. I think Pitt is an excellent place to launch an academic career. I am interested in an academic career, but I would like a solid clinical foundation, so a program like Hopkins (the only other program I have interviewed at so far) would probably be a better fit for me. As for the city of Pittsburg-- cold winter aside-- the city itself seemed surprisingly nice and culturally rich for such a small town.

nortomaso said:

Atsai, thanks for taking the time to write such a great review. I have a couple of questions.


1. It does sound like Duke takes psychotherapy training seriously. They also make a point of teaching evidence-based practice. Did you get the feeling that the evidence-based approach was being applied to psychotherapy as well as pharmacotherapy? Or was it being applied willy-nilly according to the particular orientation of the therapist as it so often is?

2. Sounds like residents learn inpatient psychiatry at the State Hospital rather than at Duke. Are the attendings there on the faculty at Duke? Any indication as to the quality of the teaching there?

Thanks again.

N

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Sorry, I think I missed this post. Didn't mean to ignore it.

1) EBM is applied across the board. Only "empirically validated modalities" are taught (or at least that is what is claimed -- I've only sat through the PGY1 intro to psychotherapy course so I unfortunately don't really have a good feel for it and can't tell you much more about this).

2) The residents learn inpatient psych at a variety of locations. PGY1 year has 2 months at Duke, 2 months at the VA. PGY2 year has 5 months at the state hospital, 2 months at the VA. PGY2 year sounds hard, especially at the state hospital. One PGY3 was telling me about nights where he would admit one patient per hour or something crazy like that (probably with a bit of embellishment, but also probably with some underlying truth to it). Unlike UNC where the PGY3 is paired with the PGY1 on call, at Duke, you are on by yourself as the PGY2 and you staff patients with the attending by telephone. Both setups have good and bad aspects to them, and it probably depends mostly on your personality and learning style as to which would be a better fit. If you ask the PGY3s and PGY4s, they will say that they liked the autonomy and that they now feel prepared to take any kind of shyt you throw at them. If you ask the PGY1s, they'll admit to kind of being freaked out about thinking about next year. If you ask the PGY2s -- well, they're just tired and waiting for PGY2 to end.

Hope this helps.
-AT.

1. Important questions you asked/were asked

• "Do you have any ties to the Bay area?" Each one of my interviewers -- including the resident who interviewed me -- asked this question.
• "What other programs are you considering?" One of the residents I spoke with told me that your position on Stanford's rank list is "significantly influenced by your level of interest. If you take a look around, you'll see that most of the residents went to a UC or have some kind of tie to the area. So if Stanford is your first choice, make sure you let someone know." (On my interview day, there were 2 students from Case and 5 students from UCs -- 3 from UCSF, 2 from UCI, and 2 from UCD.)
• Stanford is the ONLY institution where I have interviewed (so far) where one of my interviewers actually said, "Oh, by the way, I really liked your personal statement." AFAIK few of my other interviewers even read it. (That's just an assumption, but it would be congruent with my conversations with program directors of EM and Med/Peds at 3 different institutions who all seemed to agree that when they consider an applicant, the personal statement ranks low on their list of criteria.)

2. Estimated call hours

• During your 4 months of inpatient medicine during PGY1, you do take overnight call Q4, but you cap new admits at 6. At Stanford Hospital at 10PM, you stop admitting new patients, and night float comes on to admit new patients and take care of cross-cover issues for the rest of the night. When you are on inpatient psych, you are Q5 but call ends at 10PM. And there are no weekends. No weekends PGY2 either.

3. Friendliness of the program residents, faculty and staff

• Didn't get to see the program director. One of the residents said he was playing golf or something. (Some of the interviewing students got to meet with the associate program director, but I didn't.) But I did get to meet with the Department Chair, who was extremely friendly and very responsive to all of the questions I threw at him.
• All of the residents were extremely friendly and extremely happy. I don't remember if I saw any interns.

4. Location pluses and minuses

• See my comments regarding life in San Francisco. Palo Alto is different from the city and has its own set of pluses (much better weather, sunny all the time, no fog) and minuses (lots of strip malls with good food, missing that city vibrance). Rent is comparable, maybe $200/mo less. Some of the residents life in San Francisco and commute to Palo Alto for work, and they said it was very doable. Maybe less doable during PGY1 and PGY2 when you are doing a lot of inpatient work, but still doable.

5. Most negative aspects of program

• Lots of inpatient work. Actually, pretty much all of PGY1 & PGY2 are inpatient. During PGY1, you have 4 months inpatient medicine, 2 months neuro (1 inpatient/1 outpatient), 4 months inpatient psych, and 2 weeks night float (paired with 2 weeks of vacation). During PGY2, you have 9 months inpatient psych, 2 months CL service, and 1 month night float.
• The upside is that there is no overnight call during PGY3 & PGY4. During PGY3, you take 1 call per month (not overnight, which I'm guessing means you admit until 10PM). During PGY4, there is no call at all. The residents couldn't stop talking about this.

6. Other comments

• The chief resident was very interested in challenging hearsay about the Stanford program. During the opening presentation, he presented his two cents on the following "rumors", including:
  a) "Stanford doesn't do any psychotherapy." According to the chief resident, while psychotherapy may be de-emphasized, you can seek out supervision if you want it. Stanford has several key researchers in the areas of CBT, DBT, group therapy, etc.
  b) "Stanford has no patient diversity." According to the chief resident, the VA population is 35% African American and 25% Latino, and there is an "increasingly large" proportion of Latinos and Asians in the inpatient population. You can take elective time to see patients at SFGH or San Mateo County if you want.
• All of the residents were happy. At the end of the opening presentation, the chief resident said, "Don't pick based on the program. They're all pretty much the same. Just go where you want to live."

Emory:
all around a great program. The first 2 years are hard, we only saw 3 residents the whole time I interviwed (guess they were all sleeping or working). The grady hospital is the real deal in psych with lots of security and metal detectors etc... Everyone (we saw at least) seemed happy with their choice. The facilities at grady were not good (small call room, no computer). They did not take us to the Emory hospital psych ward even though we were there all day, this was a little disturbing. I heard the ward is very small and cramped. On balance, and very good clinical experience in a big city type hospital, with psychotherapy training, and a top name program. Cant go wrong if you match there, but there will likely be days you wished you were somewhere else. The interview was very casual (except for one person who asked all the generic psych questions as if she was reading the assistant profs. guide to interviewing residency applicants).

DUKE:

This was a great program with great facilities, teachers, and residents. I had a hard time finding things wrong with it. It had the private school feel and attitude (unlike UNC; see below), which I could have done without! They have the family studies program and solid psychotherapy. Very "EBM" philosophy. The scedule was easier than emory and UNC. 1st 2 years are easier, and the work is more evenly distributed through the first 2 years. Interviews were casual. Call scedule was easier than Emory and UNC.

UNC:
This was the place all the Duke residents said they did not choose!! A very much more public-community psych feel. They are trying to get people to treat the population of NC that need it, DUKE semmed to get more people from all over (mostly high power schools), at will likely not stay in the area.
The schedule is hard, a lot of training in the county hospitals (as opposed to DUKE). More diverse residents (i'm not profiling, but I did not see any AA residents at DUKE, there were many at UNC). One thing that turned me off even more (if you cant already tell) was that they dont sell their program. The PD said they "beleive in the match" and "play the rules as they inturpret them". This has draw backs since you get the feeling they dont want you, or are so great that they dont need to sell you anything. Personally, I think a little selling goes a long way.

If anyone has specific questions please message me,
2010

Disclaimer: I go to med school here.

1. Important questions you asked/were asked

No hard questions. Mostly stuff about my research interests and career goals. Not asked in such a way to make me squirm, but so that they could better pitch their program to my interests.

2. Big highlights of the programs

- If you want to do research, they are VERY flexible. Their research track is pretty much you sitting down with the PD and figuring out how to best work it in, based on your clinical and research interests. One or two students a year do it. Usually, you can have June and July (end of PGY1, beginning of PGY2) for research if you want it. During your third year, you can do research up to 30% of your time. It's up to you how to schedule it - in blocks, a certain number of days or half-days per week, etc. In your 4th year, you can do research up to 70% of your time. I met with one of their faculty members who did residency here, and she did both the research track and the 5-year child psych track. So it is possible to do both. During her last year, she got a K award, so she started of her faculty career with her own funding. Examples of research areas chosen by students include neuroimaging, clinical trials (both investigator initiated and drug company trials), genomics/DNA microarray, neuroendocrinology. A wide range. Their neuroimaging center is run by a psychiatrist, so it's very easy for the residents to get involved. There is also another neuroimaging center at Cincinnati Children's across the street.
-Lots of supervision. PGY1 you get a ward supervisor once a week, and also an off-ward supervisor, with whom you can meet up to once a week. Most residents don't meet with the off-ward supervisor that often though. In January of your PGY2 year, you get your first therapy patient, so then you have a therapy supervisor in addition to the other two. Your third year is totally outpatient, except for a PES shift maybe once a month. At this point, you get lots of different supervisors: various therapy supervisors, pharmacoptherapy, group/couples therapy, etc. I can't remember all of them, but you can have up to 8 hours of supervision a week. Some of it is one on one, with others (like the pharacotherapy supervision) you meet in small groups with 2-3 other residents and the supervisor. You get to pick or indicate a preference for all of your supervisors.

3. Estimated call hours
-PGY1: Medicine call has traditionally sucked (trust me, my medicine AI sucked the life out of me) but they are changing it next year. They are eliminating all overnight call for the general med teams! The night float will take all admission and calls. On your call night, you stay until 10 pm, check out to the night float, then go home. Sweet. Psych is Q5. The residents say they get 6-7 hours of sleep on call nights, because you only deal with the floor patients while the R2 in PES deals with everything else. I know for a fact that the R1 is often watching the simpsons box set DVDs up in the call room ;-) The exception is Sunday and Monday nights. There is not an R2 in the PES, so you are up all night.
- PGY2: This is when you do your 1.5 months of PES nights. (not all at once) At the beginning of the year there is an R3 on buddy call with you. After that you're on your own. You staff the admissions the next morning. If you decide not to admit someone, then you call the attending at home and staff it before the patient goes home.
- PGY3 and 4: These are outpatient years. PGY3s have buddy call with the R2s for a couple months. After that, no call and no weekends for the rest of the residency, aside from ~10-12 PES shifts a year. The exact number of PES shifts fluctuates depending on how many R4s left to do child psych.
-vacation: you get 4 weeks a year, to taken as one or two week blocks. The PD tries to have them end and begin on weekends, so a week's vacation is really 9 days.

4. Friendliness of the program residents, faculty and staff
- everyone is very friendly, laid-back, and happy. Since I know a lot of the residents, I can testify that they're not just putting on a happy face for the applicants. They really are happy. It's mostly a younger crowd, but some are married with kids. The residents have a social committee that organizes outings once a month or so. One of them is in a Neil Diamond tribute band. The PD is a great person who is really a resident advocate. The residents have regular meetings to discuss issues and suggest changes to the program. The residents all say that the faculty are into teaching, and as a med student here, I can attest to that.

5. Location pluses and minuses
- I've lived in Cincinnati for 8 years and I like it. You can live like a king on the starting salary of $41K. Many of the residents buy houses either in Cinci or right across the river in Kentucky. It won some rating as the best city to raise a family, which makes sense, esp considering the low cost of living. It has a reputation for being a conservative city, and many parts are, but there are lots of distinctive neighborhoods with their own character. For example, where I live there are lots of college students and professors' houses, and it's got a bohemian feel, and within walking distance to the hospital. It's not the most glamorous city, but there is lots of stuff to do. Pro sports, symphony, theater, concerts, museums. We get snow every winter, but not as much as places like Boston or Cleveland. However, the city freaks out and shuts down pretty much every year because they are unprepared for it, and they are sometimes slow to clear the side roads. But today it's 70 and it's November, so the winter isn't terribly long. Spring is glorious, summer is muggy, but it stays daylight to 10 pm. Public transportation sucks. A car is a necessity. And if Delta goes under, the airport situation is going to suck, because we're a hub and Delta/Comair is pretty much all you can get in and out of here.

6. Most positive aspects of program
- flexibility. Many of the residents made a point of saying that if you want to do something, the PD was great about figuring out a way to make it happen.
- Facilities/patients: Four inpatient units plus the VA. They are building a new psych hospital slated to open Jan 2007 that will be staffed with residents, in addition to the existing inpatient units. Child psych is done at Cincinnati Children's, which has a large fellowship program of its own. They have a 13-bed PES (and lots of lobby patients) which is the busiest in the US and one of the largest. The psychoanalytic institute is down the street. As a third year, you get your own office and even a little $$ to decorate it. You can also rotate at the undergrad campus to see more high-functioning patients. All of the facilities are right next to each other (except the new psych hospital will be a 20 minute drive).
- strengths in both therapy and biological. The psychoanalytic institute is right down the street, and the program has traditionally been very strong in psychodynamically oriented psychotherapy. But there are also leading researchers in psychopharm, and you get a lot of training in that as well.
- didactics are protected and well-attended. We went to a psychopharm lecture during our interview, and it was really good. The other applicant and I even took notes.

7. Most negative aspects of program
-You are kind of thrown into independence early on, which some people may not like. Some of the residents told me they didn't like that at the time, and wished they had more mentoring by senior residents, but in retrospect they said it was good to get an early start at being autonomous.

Quite frankly, if not for the location, this program would be a no-brainer to put at the top of my list. Not that there's anything wrong with Cincinnati, but I've been here 8 years, and neither my husband nor I have family ties here. So on the one hand, we'd like a change, but on the other hand, we like it here and could see ourselves staying.

I also go to med school here

1. Important questions you asked/were asked
The interviews/meetings were primarily for me to ask questions, and they asked questions to assess what I wanted out of a program. No difficult questions from them (maybe some from me though). All the faculty interviewers wanted to know where else I applied. Most gave me feedback on my choices and one suggested another program to add to my list. I think they all felt some responsibility toward me as one of their students.

I was told UC ranks all its interviewees and typically has to go about 25 deep to fill. It probalby doesn't matter to know that, but I thought it was interesting.

2. Big highlights of the programs

This was my first interview, so I have nothing to compare, but it seemed very flexible. I am interested in both child and research (both of which can be completed in 5 yrs). They told me a resident could basically start in on the child fellowship IN the 3rd year.

There is a new mental health center being built in a northeastern suburb which received a very large donation by a rich family in Cinci. One of the faculty at UC will be the director. It is slated for completion in two years and will have adult and adolescent beds, teaching, research. I was surprised they didn't use it as a selling point (I brought the subject up with the named director during the interview).

Plenty of research opportunity at Cinci. They don't expect it, but if you want to do it you will be well supported.

Psychotherapy institute is here, although I can't say I know very much about it yet.

PES has 2nd largest capacity in nation (as told to me by a resident).

Interesting note: I happen to know a pediatrician here that has a 1.8 million/5 yr grant based out of the Children's hospital to improve diagnostic and treatment skills for area pediatricians. Its certainly not something for which one would choose a program, but I thought it was a great project, especially since the pediatricians are the front line for all the behavioral problems in children.

3. Estimated call hours
Call hours as described by Hurricane above.

4. Friendliness of the program residents, faculty and staff
I agree with Hurricane. Everyone I met was laid back, friendly and enthusiastic about their work. I got the impression from a few that Cinci was not their #1 pick, but they also told me they were happy nonetheless.

5. Location pluses and minuses
I think the location seems bland for many people and I can't say I don't sometimes feel the same way (I detected the same sentiment from Hurricane). However, there isn't anywhere else in the midwest that is much different in my opinion, and cost of living beats the piss out of anything on west coast (or most worthwhile destinations on east coast too).

6. Most positive aspects of program
I agree with Hurricane as explained above and don't really have much to add.

7. Most negative aspects of program
Maybe I will have something for this section after my other interviews (OHSU, UCD, UTSW, UTSA), but I can't really write anything intelligent here at the moment. However, location might be a negative for some people for reasons stated above. In my opinion the Cinci location is neither a plus or minus.

In sum, as it stands now, this is #1 or #2 for me. Its a great match for what I want. I will have to see what happens at other interviews.

Good luck everyone.

I thought only residents and attendings were supposed to be writing "agree with above" after my notes.

Good luck on the rest of your interviews!

Poety said:

There is no overnight call, but this may change if they get a psych ER - there are new offices being built that will be used individually beginning in the second year (yes you will have your own office)

3. Estimated call hours

There is no real call except beeper call from home, but this may change.

Click to expand...

That's unbelievable.

Actually, a little scary too. As much as I hate call. And you all know I do, there is a LOT of independent learning going on (so-called "in the trenches") learning. Amazing what your brain can come up with at 3:30am when you're by yourself. And, the morning rounds discussing the patients you saw give me a lot of "mentored" knowledge. Still though, that's pretty awesome.

please share

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1. Important questions you asked/were asked

• The program director, Karon Dawkins, spent quite a bit of time during the interview asking me about other programs, the unique aspects of these programs, how they compared with UNC's curriculum, my family, geographical considerations, etc.

2. Big highlights of the program

• PGY2 is mostly outpatient. However, you return to inpatient work during PGY3 (but with no call). This way, the long term psychotherapy cases you begin during PGY2 can be followed up during PGY3 & 4 for a total of 3 years. Many programs start long term cases during PGY3, so you only get 2 years of follow up.
• UNC has a pretty big psych hospital (76 beds) with 6 units: gero, child, adolescent, psychotic, eating d/o, and crisis management.
• You get 1 month of child inpatient psych during PGY1. So far I haven't seen this at any other programs.
• UNC is very much a state institution, and during PGY2 & 4 you do 1 day of AHEC work per week. Many of the AHEC sites are within driving distance, but some of the sites are in fairly remote areas of North Carolina. UNC operates a two-seater plane, and some of the residents fly out to their AHEC sites (e.g., leave at 7am, fly for 2 hours, see patients from 10-2, then fly back to UNC). They're fairly flexible with your choice of AHEC sites, so if there is a particular site at which you want to work, if you can find a supervisor chances are they'll let you do it.
• There is a lot of emphasis on teaching. PGY3s rotating with PGY1s are expected to teach. And you will pretty much always have a medical student with you as well. I thought this was a pretty neat feature of the program, because one of the things I will miss about being a psychiatry resident is that there isn't that same focus on teaching as there is on medicine (because a lot of psych programs have you taking call by yourself).
• If you're into health services research and policy type work, the Sheps Center is a huge resource.

3. Estimated call hours

• PGY1 is Q4 straight through.
• During PGY2, you do about a month of night float, 1 week at a time.
• The inpatient medicine experience is 2 months of family med at UNC, 2 months of medicine at Dorthea Dix Hospital (the state mental hospital). Family med doesn't cap. At DDH, there are 2 interns for 10 beds. All of the residents were effusive about their medicine rotations at DDH -- apparently the attending is this super-brilliant guy who really, really, really likes to teach. If it's a slow day, apparently he will teach at the bedside of each patient. And he knows retention is low, so even if he gave a talk on hypernatremia last week and you have a new patient presenting with hypernatremia, he'll give the talk again. All that repetition -- you're bound to learn it at some point.

4. Friendliness of the program residents, faculty and staff

• All of the residents I met were very happy with the program and couldn't imagine being anywhere else. Lots of residents from UNC undergrad and UNC med.
• Karlina Matthews, the program coordinator, was fabulous. She totally made my day.

5. Location pluses and minuses

• Chapel Hill is no NYC, which is a plus or minus depending on your perspective and situation. However, whereas Durham has cheap housing for the Duke residents, Chapel Hill is quite expensive -- so many of the UNC residents end up living in Durham as well.

6. Other comments

• PGY1 seems rather tough. But this also makes UNC "a good program to be from", because they will turn you into a competent psychiatrist.
• No elective time during PGY1, 2, and 3. PGY3 returns to inpatient work (7 months). While the PGY3 carries fewer patients than the PGY1 (when rotating through the crisis service and the psychotic unit), it's still inpatient work. However, you do continue seeing your long term cases throughout PGY3. So you begin to develop some good skills with managing inpatient and outpatient work at the same time.
• The focus of psychotherapy is definitely psychodynamic, but I didn't get the sense that the focus was ideological in any way. And you also training in CBT and other modes of psychotherapy as well. There are a lot of resources there; you just have to seek it out by yourself.
• There is no VA hospital. Again, a plus or minus depending on your preferences.
• Attendance at 70% of didactics is mandatory, and if you slip below 70% then you will have to undergo remediation. If you attend >75% of didactics, you will receive a $250 book stipend per year (PGY1-3 only). Pretty sweet how you get paid for doing something you should be doing anyway.

1. Important questions you asked/were asked

• "Do you have any ties to San Francisco?" Each one of my interviewers (with the exception of the non-M.D. interviewer with whom I spoke, strictly regarding research) -- including the resident who interviewed me -- asked this question.
• "What have you heard about our program?" I think I was asked this on two occasions. They seem to be very interested in what students have heard about UCSF, notably that UCSF is "hard" compared to other programs. One of the residents said in defense of the program that this is a rumor "that just won't die -- we don't know where this rumor comes from". When I met with the program director, he also was interested in what preconceived notions I had about the program.

2. Big highlights of the program

• You begin long-term psychtherapy training during PGY2. You have 6 months of outpatient psych during PGY2. They have 9 months total of inpatient psych, the ACGME minimum.
• IMHO, nothing beats working at "the General" (San Francisco General Hospital), but I think that will depend on whether you like the county hospital atmosphere generally. I had heard that SFGH was kind of a dump, but after going through it on our tour, I have to say that that certainly isn't the case. SFGH is actually pretty decent for a public hospital. Almost as nice as ours
• When you are on inpatient psych at SFGH, you will rotate through each of the "specialty focus" wards (HIV/AIDS, GLBT, Asian, black, female, and Latino). For example, on the Asian focus unit, the nursing staff and attendings speak some 15+ Asian languages, they serve rice & tea at meals, etc. The race/gender/culture-specific wards have received some significant educational awards by the APA.
• A resident told me that the inpatient neurology month is pretty good and relevant for psych residents ("you're not just babysitting stroke patients"), but right now I'm blanking on exactly what he told me about the experience.

3. Estimated call hours

• Contrary to what I have heard, the schedule doesn't seem all that bad. There is only 1 inpatient medicine month (which is a plus or minus, depending on what you think about medicine training in a psych residency generally), during which you are Q4, and of course medicine is going to be bad everywhere. There are 6 months of inpatient psych during PGY1 that are Q7.
• I think the one thing that people do say is a strike against the program is the fact that you take call all 4 years. But here's the thing: PGY2 and onward, there is no real overnight call. As a PGY2, you do 2 weeks of night float at the VA, 1 week of night float at Langley Porter, and 2 weekend shifts per month. And there are occasional holiday calls. As a PGY3, you do 2 weeks of night float at Langley Porter, and 1 weekend shift per month. As a PGY4, you do 2 weeks of night float at the VA. So yeah, you are taking call all 4 years, but it doesn't seem especially burdensome to me.

4. Friendliness of the program residents, faculty and staff

• I had been told that the program director (Marc Jacobs) is not the world's warmest personality, but I actually came away from our interview with a favorable impression of him -- he seems to care deeply about our society's care for the poor and disadvantaged.
• Happy residents. I saw two PGY1s, and a few PGY2s and 3s. At the recruiting dinner, everyone was talkative and seemed honest and happy. They told us that they do hang out with each other outside of work. For lunch, they split us up into groups of two and three, and my group had lunch with two PGY2s, who were also very satisfied with the program.

5. Location pluses and minuses

• IMHO, you can't beat San Francisco, city-wise.
• San Francisco is expensive, and rents near the UCSF Medical Center can reach $1000-1400 for a 1BR. You can get it down to maybe $600-800 if you live with a roommate farther away (say, in the Sunset neighborhood). On the plus side, UCSF provides its residents with a $500/month ($6,000/year) housing stipend. I don't remember if it's taxed or not.

6. Most negative aspects of program

• Call all 4 years, but like I said it doesn't seem all that bad.
• Not much flexibility until PGY4. There are a lot of requirements to take care of during PGY3. One of the residents said, "You need to argue for your time if you want to do research."
• No existing apparatus to send residents on overseas rotations. I think this year there is a resident who wants to do an overseas elective, and so they are going to convene some sort of working group to discuss the issue.

7. Other comments

• PGY1 class is 10/14 female. PGY2, 10/16 female. PGY3, 13/18 female. PGY4, 8/10 female. I only noticed this because on the interview day I was the only male (out of 7) interviewing, and at the dinner I was one of 3 males (out of approximately 13). To me, this is not necessarily a plus or a minus, just something I'm curious about. Nobody really had a good explanation for the demographic composition of the resident cohorts, and I don't have data on hand to comment on whether this is reflective of national trends generally.
• Vacation seems to be quite flexible. You have 20 days total. They prefer for you to take it in 1 week blocks during PGY1 and during your inpatient PGY2 months. Other than that, however, they are comfortable with you taking it in days here and days there. I came away with the impression that you could quite conceivably split your vacation up into 20 "long weekends" throughout your year.

Please make these points:

1. Important questions you asked/were asked

The program as a whole seemed very relaxed for an uber-competitive program. The pre-interview dinner was very enjoyable, and the residents availed themselves to many questons, including:

Is moonlighting available? Yes, after first year. Some residents have actually doubled their salaries by moonlighting (I verified this during the actual interview). PGY-1s often supplement their incomes by doing research in the University and within the Hospital.

Does the program offer domestic partner benefits? Yes, it's in the contract.

Does the program have educational benefits at Wash. U.? No. Since the program is actually administered through Barnes-Jewish Hospital, there is no reciprocal educational benefit through Wash. U..


2. Big highlights of the programs

Barnes-Jewish Hospital is a monolith, for some this could be a negative; for me however, the size of the hospital is a definate positive. The St. Louis Children's Hospital, several clinics, and the VA are all within walking distance. Parking -- always an issue -- seemed to be less of an issue here than at other hospitals that I've visited in the past. The Psych. clinic is in the penthouse of the main building, with wonderful views of the city.

The biological focus of training is what appeals to me. The C/L service is utilized throughout the hospital complex, and while they don't offer a C/L fellowship (my aim), residents have had no problems landing their desired fellowships. Additionally, they place a large number of their residents in top-notch academic positions each year (according to the PD, residents begin being recruited during their PGY-1 year).


3. Estimated call hours

Call is very manageable: q6 during regular rotations during PGY-1 and PGY-2. On Medicine, there is NO call; however, days can be long as they can be at all hospitals.



4. Friendliness of the program residents, faculty and staff

This is what sold me on the program. Everyone seemed genuine -- not just like they were blowing sunshine up my butt. The PD, Asst. PD, Researchers, and the Residents all seemed eager to discuss the program, the city, and the opportunities afforded by the program. The Chief Resident endeavored to include all interviewees in the discussions at the dinner, and also saw to it that we knew how to maneuver the hospital and the interview day. The PD took time to explain what they are actually looking for in their reidents, and asked me what I expect from my program. The residents actually fraternize outside of work, and also enjoy each others company at work. The patients also seemed to LIKE their attendings and their residents -- they appreciated the excellent medical care that they were being given (this really amazed me more than anything that was being said by the program itself).


5. Location pluses and minuses

St Louis is a great city -- especially if you are a sports fan. There are a vast number of shopping centers with the usual chain department stores (Nordstrom, Lord and Taylor, Macy's, etc...) and the usual discount fare (Wal-mart, Target, K-mart, etc...). Additionally, the cost of living is very doable on a resident's salary (the Chief Resident stated that most of the residents own their own homes that run around $150,000.) Apartments in the St. Louis area are also affordable: 1000 sq. ft. for around $700..


6. Most positive aspects of program

The people.
The biological emphasis, which may be a drawback for some.
The city.

7. Most negative aspects of program

Little emphasis given to psychoanalysis, which may be problematic to some --to me this is a plus.

Poety said:

So Mosche, are we in love? Sounds like love to me!

I'm in love but I'm scared U of F is going to confuse me

Click to expand...

I think that I may be in love! What scares me though is that this was my first interview. If I get down to the end, and still feel the same way, I will definately do a second interview -- I was told that they would be happy to have me back for a second look!

I noticed that someone seemed to have a great time/interview at MUSC!! I've had several friends who have done their training at MUSC, and each one has LOVED the experience -- I can say that I've heard no negatives about MUSC from anyone -- that speaks bundles. I also think that with your outgoing self, you will fit into that "Southern Belle" stereotype (that's a compliment, though the feminists amongst us might disagree! ).

For the combined program, you interview with medicine and psychiatry on separate days. Both the medicine faculty and the psychiatry faculty make it very clear that they are interested in "quality, not quantity" and that if they don't identify any candidates they are truly interested in, then they don't rank the candidates, i.e., they would rather go with unfilled spots than accept subpar candidates.

Since it's all the same faculty, whatever I wrote in my review of the psychiatry program holds here as well. I will focus here mostly on medicine and the combined aspects.

1. Important questions you asked/were asked

• None, really. A lot of "what else can we tell you about the program?" and "do you have any other questions for us?"
• They seem to place quite a bit of emphasis on getting a candid evaluation of your abilities from someone "they know". One of my letter writers, Dr. Z, is a Duke Medicine graduate, and on several occasions my interviewer made some comment suggesting that Dr. Z's evaluation of my ability was "good enough for us, since we know she's good". Alternatively, you might consider doing an away rotation at the program. One student from my school did an elective here on one of the (very busy) consult services, and I was told that doing so was a big plus for his application.

2. Big highlights of the program

• This year they made a substantial change in going to a one-year intern year (as opposed to the previous two-year intern "year"). In the past, you did 6 months of medicine and 6 months of psychiatry, and then another 6 and 6 -- but during the second year, you were still considered an "intern" (and hence still wearing the short white coat) while the other interns you entered with were doing JAR (Junior Assistant Resident) activities. It was kind of demoralizing to see your classmates advance to JAR status while you were kicking around as an intern for another year, so this year they changed it to only one year of internship. The first year is pretty much a medicine internship (8 months medicine), and this was done for 2 primary reasons: (1) The medicine structure is more rigid than the psychiatry structure. On the medicine side of things, second year residents are JARs and have a different set of responsibilities, and it's only possible for the med/psych residents to do this during their 2nd year if they've done a medicine internship. (2) They've had some problems with attrition, with residents dropping out of med/psych to do just psychiatry. This creates administrative and scheduling problems for both programs. So front loading makes it a little easier in terms of being able to advance to JAR status with the rest of your intern class (and hence less demoralizing), but also in terms of having the 2nd and subsequent years being a little lighter. The later years of the program are more heavily weighted towards psychiatry.
• Some med/psych programs are dominated by what I would call the "hyper-competent hospitalist" type: docs who can handle pretty much any inpatient situation and hit doubles and triples every time they step up to bat no matter what kind of patient you throw at them. Other med/psych programs are dominated by what I would call the "I want to take care of the whole patient" type: docs who want to do primary care psychiatry. Because internal medicine is such a huge presence at Duke (40+ interns per class or something like that), the med/psych program is understandably dominated by more of the "hyper-competent hospitalist" type of faculty members. If this is any indication: When Dr. Gagliardi applied for residency programs as a 4th year medical student, she applied for medicine and med/psych programs. And Dr. Silvertooth started out in the medicine program and transferred to med/psych after her intern year. Of the residents, I would guess that only 2-3 of them are the primary care psychiatry type, with the rest being future hyper-competent hospitalists.

3. Estimated call hours

• The first two years are pretty tough. The PGY1 year of the medicine program kicks your ass. While the PGY1 year of the psychiatry program is relatively cush, the PGY2 year of the psychiatry program kicks your ass -- and you do the equivalent of the PGY2 year during Y2 of the combined program. So it's two tough years back to back. I'll bet that will make for some pretty dark days.

4. Friendliness of the program residents, faculty and staff

• The Associate Program Director, Jane Gagliardi, is wonderful. She's a ball of energy and would rather walk up 8 flights of stairs than take the elevator. And I'd bet a quarter that her pulse is sitting at an even 50/min by the time you get to the top.
• The other Associate Program Director, Erin Silvertooth, is moving to Texas for personal reasons. The transition should go smoothly, though, because they have known about this for a while. One of the chief med/psych residents this year, Sarah Rivelli, will be taking over some of Dr. Silvertooth's administrative duties next year as a new faculty member.
• The two Program Directors, Diana McNeil (Medicine) and Grace Thrall (Psychiatry), are in close contact. This is a big plus. One of Dr. Gagliardi's roles is to make sure the two programs stay in touch so that things go smoothly for the combined residents.

5. Location pluses and minuses

• See my previous comments on Durham.

6. Most positive aspects of program

• The combined program has a long history at Duke, and it enjoys strong support from both programs. Dr. Ralph Corey, the former internal medicine program director, started the med/psych program, and he seems to be pretty much venerated at Duke by the medicine faculty and the psychiatry faculty alike. (He is no longer the medicine program director, but apparently he still commands an imposing presence at the institution. The chief resident refers to him as "the big man".)
• The Duke medicine residency has an international health program where you can opt to do a 3 month rotation abroad during your PGY3. If there is any scarcity, med/psych residents get dibs because Ralph Corey is such a strong supporter of the program.
• The Duke combined med/psych program is beginning to develop a critical mass of faculty that other programs don't seem to have. (except for maybe Rush? UIowa? I have no idea, having not yet visited those programs)

7. Most negative aspects of program

• It's hard.
• The "private services" (subspecialty wards -- cards, renal, pulmonary transplant, etc) are pretty tough. While the other services are organized as teams (1 JAR or SAR, 1 intern, 1 or 2 medical students, and 1 attending), the private services are just 1 attending, 1 fellow, 1 intern. One intern was carrying 18 patients on the pulmonary transplant service. That's flat out insane. At 18 patients, I kind of think it would just be 4 weeks of reflexive survival mode and very little active learning.

More so than for other programs, beauty is in the eye of the beholder. Wash U has an extremely well articulated philosophy that you either agree with or you do not, which in itself is a positive since you are less vulnerable to buyer's remorse.

Some interesting facts about the program (I will leave out points made by Mosche in his excellent review):

-All the training facilities are either at BJH or the state hospital 2 miles down the road. There is a charming neighborhood (Central West End) right near the hospital where some of the residents live and a really nice, big park.
-You have a caseload of 150 outpatients in the third year. You have (at least) two supervisors who you choose, but the patients are YOURS and you make all the final decisions i n their care including treatment and follow-up. 4 of your charts are randomly pulled and scrutinized with you each month.
-Contrary to popular belief, psychotherapy IS taught. Most of the third year didactics are centered on different psychotherapeutic techniques, including (1/3 of course time) psychodynamic therapy. What you actually do in the clinic depends on you and what types of supervisors you choose. Long term psychoanalysis is not encouraged nor are residents encouraged to get themselves "analyzed".
-THE PROGRAM DIRECTOR WILL BE STEPPING DOWN NEXT YEAR. This in itself does not seem like a big deal. He will be staying on and teaching and his assistant will be filling the head honcho role, but I learned this from a resident; i.e. it was not officially disclosed by the PD who told us that he had been doing his job for 20 years. IMO this information should not be hidden from appilicants. If you interview there, please make sure that your fellow interviewees are aware of this too. I would not want to receive this kind of surprise during my PGY1 year.

Overall I thought this was the most level-headed and congenial program I've visited so far. Most of the residents and faculty I met seemed very bright, but displayed a spirit of collaboration and didn't have the thirst for prestige and glory that I encountered at Columbia and, to a lesser extent, Yale. The residents were also a diverse group from all over the country including some top ranking med schools (Wash U, Baylor, Columbia, Hopkins). They were younger than in the other programs I have seen, about half single, half-married, and most without children.

P.S. Happy Thanksgiving everyone!

Excellent review Nortomaso! I was also told that the PD was leaving in 2007; however, I was told that the Asst. PD -- who's held the position for 10 years -- is taking over when the current PD steps down. Very glad to hear that someone else was equally impressed with the Wash. U. hospitality and I was very happy to discover that there is little psychoanalysis when I was interviewing.

For those who apply in the future, I will also add that Wash. U. picked up the tab for the hotel. This is always a welcomed savings in this financially draining process!

1. Important questions you asked/were asked

• Nothing, really. A lot of "what can we tell you about our program?" One of my interviewers asked me the usual questions ("What are your strengths?" "What are you looking for in a program?" etc etc) but spent the entire interview reading through my CV and looked up at me maybe twice. Poor EC; verbally expressed enthusiasm incongruent with body language.

2. Big highlights of the program

• Four different sites. UW Medical Center is largely voluntary, has 16 beds, and when you are on the C-L service you will do a lot of psycho-oncology (because of the Fred Hutchinson center). The VA has a PTSD unit. At the county hospital, Harborview, there are 60 beds, half involuntary, lots of crazy stuff going on, and when you are on the C-L service you will do mostly bread-and-butter. I don't know much about what goes on at the Children's Hospital. But if you are interested in child psych you have the option of doing your 4 months in pediatrics instead of medicine.
• No pre-rounding! Apparently the nurses print out everything you need -- vitals, labs, overnight events, etc. You just swoop in and pick it up.
• UW has a rather unique setup where some psychiatrists staff the outpatient medicine (general med, oncology, diabetes, etc) clinics and do primary care consultation. That's pretty cool.
• Harborview, the county hospital. I love county hospitals, and Harborview had a nice feel to it, comparable to SF General or MetroHealth (Cleveland). Harborview has an international clinic; one of the psych faculty sees patients there, and residents have the option of rotating their during PGY3.
• Psychotherapy training is balanced. PGY1 you get an intro to psychodynamic, CBT, IPT, DBT, group, and family. PGY2 you do more general principles with an emphasis (my impression) on psychodynamic theory, but you have seminars in both psychodynamic psychotherapy and CBT. You start learning more about DBT, family, group, IPT in PGY3.
• Lots of research opportunities if you want it. You have up to 2 months of elective time in PGY2 for research. Peter Roy Byrne (Chief of Psych at Harborview, Vice Chairman) is a dynamic person and definitely rocks the hard sell. The researchers over at Harborview do a lot of research on services, while over at UWMC there seems to be more of a focus on chronic illness care. Lots of cross-collaboration, and they have tons of data coming out of the Group Health Cooperative. (The medical director of UWMC recently resigned to direct research over there.)
• Lots of cool elective opportunities -- jails, Alaska, etc. The program director, Deborah Cowley, is very flexible and willing to work with residents who want to set up their own experiences. Because UW is the tertiary center for a 5-state region (including Alaska), there are all kinds of crazy things to do and see. The way it was described to me, the reason why there is such a diversity of elective opportunities is because every time they have a resident who wants to do her own thing, they work with her to set it up and then BAM -- new elective opportunity for future residents.
• There is a "Spokane Track" for residents specifically interested in rural medicine. PGY3 and 4 years are spent in Spokane, about 4 hours east of Seattle. It's a separate match, and when you come out for your UW interview they actually take you out to Spokane. Can't say much about it since I didn't apply to it, but it seems like a great program.

3. Estimated call hours

• I had been told that there is "a lot" of call in the UW program, but I couldn't really see it in the schedule. PGY1 is Q4 medicine of course, but when you are doing your 6 months of inpatient psych there is a night float and there are no weekends. PGY2 also has 6 months of inpatient psych with night float. You do a total of 12 months of inpatient psych: 3 months at each site, and then you double up with another 3 months at a site of your choosing. PGY3 has maybe 1-3 calls per month (night float presumably), and PGY4 has maybe 1 call per month. Sure you take call all 4 years, but come on, it's like qmonth.

4. Friendliness of the program residents, faculty and staff

• All of the residents I met were very happy with the program and loved living in Seattle. Quite a few of the faculty I met with were transplants from San Francisco who decided that Seattle was more livable/affordable. There are a lot of lifers at UW.
• Deborah Cowley, the program director, is wonderful and cares deeply about educating her residents. If you PubMed her, you will see that she had an active research career prior to becoming a program director. AFAIK, that is a rarity.
• Athena Wong, the program coordinator, is tireless and friendly.
• Didn't really get a sense for how close-knit the residents were, but my guess is that the 4-site spread doesn't help things. FWIW, one of my friends in the program says most of the residents in his class are married and do their own thing, and he kind of does his own thing too.

5. Other comments

• In 2004, 100% of graduates passed the boards on their first attempt. National rate is 64%.
• Seattle is an expensive city to live in but not as expensive as San Francisco. A small minority of the residents own their own places. Seattle has quite a few nice neighborhoods.
• Lots of driving, with 4 sites. If you want to live in a "central" location, you end up living about 20 minutes from each site.
• Psychiatry is very prominent at UW. The medical director of UWMC is a psychiatrist. And the president (?CEO, ?director) of the UW physician practice group is also a psychiatrist. When you rotate through medicine and neurology, you are treated like a member of the team (i.e., it's not just "oh, here comes the off service psych intern") -- which is a plus or minus depending on how you look at it.
• I don't remember seeing any interns.
• At the overview session, Deborah Cowley informed us that the internal medicine program at UW was placed "on probation" by the RRC in July 2005 (based on the May 2004 ACGME site visit). She was open about this and stated that the IM program remains accredited and that they expect to have the probationary status resolved after the new site visit in Nov 2005 (and the RRC meets in Jan 2006).

Great Timing Atsai! I wasn't expecting that when I posted my question about UW last night. Did you find out if moonlighting opportunities are available?

nortomaso said:

Great Timing Atsai! I wasn't expecting that when I posted my question about UW last night. Did you find out if moonlighting opportunities are available?

Click to expand...

Glad to help.

I haven't been specifically asking about moonlighting opportunities, so I don't think I can answer that question. However, I don't remember anyone specifically denying the possibility.

-AT.

Added this to my review of UW below:

At the overview session, Deborah Cowley informed us that the internal medicine program at UW was placed "on probation" by the RRC in July 2005 (based on the May 2004 ACGME site visit). She was open about this and stated that the IM program remains accredited and that they expect to have the probationary status resolved after the new site visit in Nov 2005 (and the RRC meets in Jan 2006).

atsai3 said:

Added this to my review of UW below:

At the overview session, Deborah Cowley informed us that the internal medicine program at UW was placed "on probation" by the RRC in July 2005 (based on the May 2004 ACGME site visit). She was open about this and stated that the IM program remains accredited and that they expect to have the probationary status resolved after the new site visit in Nov 2005 (and the RRC meets in Jan 2006).

Click to expand...

My friend who is applying to UW IM said that the probation is for hours violations, and as you said, they've fixed it and hope to be off probation next year.

In the interest of fairness to this program, I wanted to elaborate on the PD situation. The current PD will be handing over the reigns to the assistant PD in 2007, but he will be staying on as Vice-Chair for education and will be increasingly involved in overseeing the curriculum and in teaching, just not in the administrative day to day tasks. The chairman is relatively young and supposedly is there for the long haul, which I believe, given that he has been there since residency. He also appears very involved in residency training and is very close to the current PD (they did their residency together). The department as a whole seems very stable and there is often mention of a "loyalty-model" where careers are nurtured from within rather than hiring big guns from the outside a la "imperial Pittsburgh model".

This modus operandi is great for those pursuing an academic career. But keep in mind that Wash U does not have clinical fellowships except for child/adolescent. So if you know that you will be going into C/L or forensics, you are probably better off looking somewhere where those fellowships are offered.

I was just curious of the vibe anyone got from Florida...on the trail I have heard that the residents aren't the happiest. Any info would be appreciated.

I loved my interview at Univ. of Florida about 2 years ago. The people seemed nice, and the facilities and research solid. I would have liked to have gone there if I didn't have to stay in NYC.