Disclaimer - I've only been to the program during interview day, and I'm not familiar with Boston. If I've made any factual errors, please somebody point them out to me. I'm also happy to hear differences of opinion. And the reviews I post should not be viewed as a marker of what programs I'll rank highly or not so highly. I've tried to be objective and address some of the concerns I've heard floating around SDN, and like many of the second-hand opinions on the internet, some are well-founded and need to be considered, some are minor, and some are just plain wrong. So without further ado, I present the Adcadet Review of Beth Israel Deaconess Medical Center . . .
Overall - Wonderfully friendly, supportive residents in a very academic environment with a great focus on excellence in education. The two big questions for many is that of private patients and if the new EIP/geographic admitting and growing trend towards hospitalist medicine solves the problem, and the fact that within Boston and Harvard BID can be overshadowed by B&W and MGH.
The Program Director - Previous posters here at SDN noted that the PD, Dr. Reynolds, seemed "less than dynamic" and "a little sharp on the edges." During interview day she was visible and chatted freely with applicants and spent some time talking about her personal/home life. She did not seem perfectly at ease talking with residents and I got the impression that she was forcing herself to be more social than she usually is. But hey, I almost certainly looked stiff even though I'm a pretty laid back easy going guy. Every resident said that she ranged from "good" to "amazing," although few had actually spent significant time with her. One that had spent some time with her told about a scheduling problem was infringing upon some other protected time, and the PD was angry but did not blame the resident and made it clear to the attending and fellows on that rotation that they needed to adjust the expectations to accomodate the protected time - and the problem was solved. Dr. Reynolds is also a national leader in education and her expertise in feedback evaluation seems clear. Like all good residencies, BID is constantly changing and it's clear that she's both proactively making changes for the better and reactively making changes based on resident feedback. Both the PD and Chair spoke, and both made it clear that we should ask the tough questions, take a long hard look, come back for a second look (they said they don't keep track of who does a "second look" nor factor it in come rank time), and feel free to contact them later with any question, and all the applicants had plenty of time with residents away from faculty; I really thought they there was nothing they were trying to hide. The program director is involved in the Educational Initiative Project (EIP). As I understand it, 80 residency programs were deamed eligible to participate based on their history of providing solid training, and 17 applications were accepted. The program waives the traditional ACGME requirements to allow programs to experiment with innovative ideas. There are a number of components, none of which were discussed in any detail. One that was mentioned by residents a lot was geographic admitting, in which all of your patients are on the same floor. This ties in nicely with the firm system they use, and they have firm meetings on a regular basis with all the allied health people, social workers, and even consultants from other services,and unit-based governance boards. Another component being developed is the "dashboard" which is a display of quality measures (DVT proph, fall risk, ASA/BB/smoking for MI patients, etc) for your firms patients that pulls the data directly from the EMR. Another component is a required rotation in QI and patient safety along with a portfolio.
The Chair - I thought Dr. Zeidel was very impressive. First, he's got a pretty amazing CV as one would expect a Chair of a Harvard program to have. But he apparently is not one to sit high in the ivory tower writing books. It's clear he's personally involved, doing everything from teaching third and fourth year medical students on their medicine rotations at the BI, to teaching residents, to attending most conferences including the M&M when I was there. He also seemed like a very warm and friendly guy. He specifically mentioned in his talk that he does whatever he can for residents trying to get fellowships, from helping with mentoring to making phone calls.
Residents - The residents stress that the main reason to pick BIDMC is because of the friendly, supportive residents. The handful that I interacted with certainly were friendly and eager to comment on how nice and helpful their fellow residents are. In fact, the intern responsible for coordinating dinner was in the ICU that month and post call and she was still very enthusiastic although tired. It is apparently common practice for residents to pitch in an help a fellow resident on the rare times when one gets slammed. Residents on the ambulatory block are always responsible for setting up Thursday night outings, which tend to be well attended. It is a big program, with 14 transitional interns and 48 categorical interns per class. Interns mentioned that they really don't know everybody in their program. From my counting, only 3 current residents are from Harvard, making me wondering why more HMS students don't choose BID. One explanation I heard is that HMS students basically get to pick where they want to go, and for those interested in basic science research or a really big name place, B&W or MGH would be a better local choice. It seems BID residents tend to be less snobby than MGH or B&W residents, and I certainly didn't pick up on any attitude. Residents seem to come from a variety of medical schools that range from solid (many from state schools) to outstanding (HMS, Hopkins, UCSF, Yale, Columbia, WashU), although there definitely seems to be a New England bias. There are also a handfull of foreign medical grads in each class. When I asked about how it was working with HMS students, one resident said its like anywhere else, one said it was "typical Harvard" (whatever that means, though it didn't sound great) and another seemed to indicate that it can be less than ideal at times, but of course, there's a range. There is a policy at BID that only interns can write non-emergent orders, and people stressed that interns really run the team and residents and faculty are there for guidance. Nobody talked about fellows being involved in the care of patients except to say that the pulm/critical care fellows in the MICU were awesome to work with. When I asked residents if there was any type of applicant who should not pick this residency, none could really identify anybody except maybe those interested in non-academic medicine or those who didn't want to live in Boston. When I asked about what they would change, the only consistent answer I got was the presence of private patients and nobody seemed to have a major pet peeve that they just were fed up with.
Faculty - The faculty really stresses teaching at BID. The different Harvard programs all have a different flavor, and at BID the thing that sets them apart is the emphasis on teaching. BID faculty are the most involved faculty group teaching at HMS and win more HMS teaching awards than any other Boston program. BID has some outstanding resources for teaching their faculty how to teach, and the residents seem to appreciate this emphasis. It is clear that teaching is a valid career path at BID and both faculty and residents are supported in learning how to teach. From what I've read, faculty are rigorously evaluated by residents and they have to "earn" the right to teach, although I didn't hear any specifics when I visited. Many faculty members are very involved in program administration and clearly seem to care deeply about the program and the residents. Beyond being great teachers, there are also some big names here which almost goes without saying since it's a Harvard program. With the private/non-private patient mix, I was concerned about teaching while on service. They have dedicated teaching rounds 4 times/week with faculty who want to teach as opposed to other programs who's attendings are just putting in their 1 month out of the year and really just want to get back to the lab. There is also a good number of nationally-known faculty on staff at BID, including the founder of UpToDate, the current editor-in-chief of the Sanford Guide, the Godfather of EP cardiology, a JAMA editor, characters from House of God (one of which was pointed out to me during a tour, but I won't say which!), and many more.
Patients - Previous posters here at SDN thought BID had an overabundance of geriatric and suburban patients, so I tried to see if current residents felt the same way. One resident did think the patient population might be a little skewed towards older, richer, and Russian-speaking patients but not by much. A number of other interns denied that they saw too many geriatric patients. It was clear to me that BU is the city leader in impoverished/inner-city care. I asked a number of other residents if any particular disease seemed over or under represented, and the only specific group I could find was heart transplant patients, since BID does not have a transplant program. There's also the issue of private patients. Residents said that maybe 5-10% of patients are truely private, whereas another ~20% or so are covered by the hospital-based hospitalist service ("APG"). There are no private patients in the CCU, ICU, or specialty services. Residents to admit that tracking down private attendings can be a hassle. Many of the local physician groups are using hospitalist services more, and the largest one is in-house and gets good reviews in terms of teaching and level of autonomy from both residents and students. From what I've heard, it seems BID falls somewhere between B&W (less) and MGH (more) in terms of resident autonomy.
Conferences - There are different morning reports are for interns and residents. This allows the residents to cover more basic topics like SOB, hypotension, etc, and residents to cover more advanced topics. I asked numerous people if they felt this was disadventageous and none thought it was, and a few liked it. And with the program being as large as it is, it makes the conference smaller. There is a Resident as Teacher program in which trainees in each year receive some formal education in teaching. There is food at each conference, which rotates between different genres of food which residents uniformly loved. On interview day we saw an M&M, which was pretty good. The room was packed as we had a large interview group, with lots of attendings and the residency leadership present and participating, as well as consultants from other services who were involved in the case. There was no noon conference that day; there was one of their great lunches and time to chat informally with residents which was nice. If I recall, they have noon conference ~4 days/week. I did attend teaching rounds, which was good - nice doctor went over a topic that a resident had requested.
Sites/Facilities - BIDMC was formed by the merger of two religious-based hospitals that were started to provide good medical care to those who couldn't get it elsewhere regardless of demographic factors. I felt that sort of spirit remains strong. The BID residents cover the West and East Campus of the BIDMC, although they're being pulled away from the East Campus, partially because they "uncovered" a medicine service on the West Campus and truned it over to a hospitalist service at a cost of $2 million/year because they thought it was stretching the residents too thin in other places. Only rarely do residents have to travel between facilities within the same day - usually it's only for conferences on consult rotations. They rotate at the Joslin Diabetes Center and the Dana-Farber Cancer Institute. They also cover the West Roxbury VA along with residents from BU and B&W. The VA is supposedly pretty typical of most VAs - typical VA patients, typical run-down facilities, and typical questionable ancillary services. Residents do have to start iv's there, and getting imaging can be difficult. Overall, I believe interns spent 4 months there so it's not a trivial amount of time. Many residents commented that they went back to the BI much more appreciative of their great ancillary services, which one resident described as "excellent" and one described as "a range"; one faculty member and the Chair specifically mentioned that BIDMC is a national leader in nursing and that the nursing colleages are great. My tour on the West Campus consisted mostly of the ED, the CCU, and an MICU which all looked reasonably nice although I was more focused on listening to the answers to my questions from my great tour guide. I only spent a few minutes on one of their general medicine wards, which is the last of the bunch to get remodeled, and honestly it looks older and less well kept up and many patient rooms are doubles. The non-patient areas also look old (which they are) and aren't perfectly kept up. The room where most conferences are held looks nice, and across the hall is the resident lounge which looked wonderful - some computers, a big screen TV, couches. People who have seen more Boston-area hospitals say BIDMC is one of the nicer places in town. The EMR at BIDMC is arguably the best in the world. A few years ago Forbes declared BIDMC to be the most "wired" hospital in America, which is ironic since now the push is toward wireless. All clinical data is in there with the exception of daily progress notes. It will print out your daily census for you along with new labs. It's web-based, and you can access it at home. It includes radiology images. Residents raved about it because they said it saves them time. The only part I didn't like was that daily notes go into the chart and never make it into the permanent computer record. You can either old-school hand write your daily notes, or type them up, print them out, and put them in the physical chart. BIDMC also uses a "trigger" system, which serves as a rapid response approach of sorts that I only partially understand. From what I could tell, nurses can call a "trigger" based on defined (i.e.-HR >110) or non-defined triggers (patient just looks bad), which sends a text message to the residents who then have 5 minutes to respond. This has dramatically reduced the number of codes called, and yet keeps the resident team in the loop on their patients. The residents I spoke to seemed to really like it.
Location - Located in the Longwood neighborhood of Boston, this has to be one of, if not the greatest concentrations of medical research and teaching in the world. Within a few blocks there's Harvard Medical School, Mass College of Pharmacy, Brigham and Women's Hospital, Children's Hospital of Boston, BIDMC, Joslin Diabetes Center, and Dana-Farber Cancer Institute. If you include the rest of Boston you have Mass General Hospital, Mass Eye and Ear Infirmary, Tufts-New England Medical Center, Boston University/Boston Medical Center, Harvard University, MIT, and probably a few more great places that I'm forgetting. From my brief time there and speaking with residents, Boston is a young, hip, highly-educated, energetic place. Mass transit seems pretty good, with a mix of subway and buses serving most places. Some residents and faculty mentioned that they are either "no car" or "one car" family because they can easily walk/bike/bus to work. Cost of living is relatively high, although its hard to tell if this is totally adjusted for with the resident compensation. Using cityrating.com, Boston's cost of living is 4.6% higher than the national average, and 8.0% higher than Minneapolis. However, BIDMC residents also get paid more (11.5% more than in Minneapolis), and after dividing intern pay by the local consumer price index from cityrating.com, BIDMC residents get paid 3.3% more than University of Minnesota interns. Of course, this is a crude analysis and does not account for other benefits or lack there of (educational stipend, health insurance, retirement plans), other costs (parking, taxes, perhaps housing), or what significant others might be able to get for a job. Residents weren't taking out loans to live on, but nobody could tell me if they thought they were paid better or worse than residents in other cities. BIDMC is also the "official hospital of the Boston Red Sox" and many people there are huge fans. Ironically, when some players were sick last year they received their care elsewhere. BID residents get cheaper tickets, and can pull medical shifts with the medical crew at Fenway. Many of the ID lanyards have the Sox logo on them and advertise the connection. You see their Red Sox ads all over the place. Not a big deal if you're not a Sox fan, but pretty neat if you're a baseball fan and I always like to see some personality in a program. Heck, I'd probably even become a Sox fan if I went there.
Schedule - The schedule is always changing in response to resident feedback, and what I was told during my visit looks different from what I see on the BIDMC website. Given the frequency of schedule changes I'm starting to pay less attention to the specifics, so forgive me if I get a detail wrong, and please correct me. The important points are that they use a night float system even for the interns on the general medicine services so they can go home and sleep in their own bed. Interns do take call in the CCU (one month) and MICU (two months), which is Q3. A resident I spoke to about call said that she actually really likes Q3 at the BI since she gets out post-call around noon and is allowed to leave as soon as she can on pre-call days, which is usually by 1 pm. Call is team call, although there are occasionally "orphan interns" - with senior residents going home interns will sometimes (q6 or q8) be admitting overnight with a different senior resident. Another resident stressed that the schedule at BID is probably one of the most relaxed schedules anywhere. Interns do, however, spend considerable time on ICU months, with one CCU month and one ICU month and nobody suggested that interns don't work hard enough. All ICUs are closed, and a resident specifically said that the pulm/cc fellows from the Harvard program are great. The ICUs have 24/7 in-house critical care attending backup who can be called for any in-house issues.
Tracks - There is a primary care track that you can start off on or move into during your first year. There also is the ABIM research pathway/"short track" option that they stress is usually only for PhDs or people with many first author publications. There is also an international health program for G3s and is limited to 6 weeks total of which 4 will be counted against vacation time. There is funding of up to $2000/resident available by application, and there is a cap of $12,000/year for all residents, which if my math serves me works out to 6 residents per year out of the 48 residents per class. One of the residents did her "international" program in Alaska with the Indian Health Service. To me the international health program sounds very limited.
Research - There are research electives for residents, although it's unclear to me if the EIP program allows them to increase research time beyond the traditional 3 months per ABIM requirements but one handout claims that you can get up to 6 months of protected research time. The typical way they have residents doing research is to put them through an intense 2-week course called Research for Residents, at the end of G1 or early G2 year in which they go use a very good book and all-day lectures to help plan out their project, and then present an NIH-style proposal to the Physician Scientist Committee to be approved for time off, with the better projects being granted more time. It sounds like a rigorous way of doing things, and I fear that those who are already research-savvy will be bogged down a bit. Most projects are done during G2 or G3 years, although there are a few interns who are doing research because they hooked up with faculty early and are able to scrounge some time where they can from less busy rotations to get a jump on things. In keeping with their emphasis on mentorship, there is also a program called Paths in Research which are months informal dinners with faculty members who talk about life in academia, balancing the demands on a family with clinic time and research time, etc. There is also the CITP program which is a 2-year program that provides industry-sponsored training in clinical investigation that is interwoven with fellowship training, and the Scholars in Clinical Science Program which is another 2-year program in clinical investigation. Both the CITP and SCSP award master's degrees, are Harvard-wide, and CITP is run out of BID. There is also a Summer Program in Clinical Effectiveness, which is an intese 7-week 15-credit course that can be turned into an MPH. Residents who have their work accepted for presentation at a meeting are given time off and their expenses are covered. A handout listed a "house officer bibliography," showing that many residents had multiple publications, many as first author during residency, although I'm not sure how many of those residents were just doing a straight IM residency vs. fast tracking or doing the CITP or SCSP programs.
Fellowships - During my visit they stressed that fellowships, like research, isn't just about learning genreal IM well, publishing research, and getting good letters, but is also very much about proper mentoring. Interns get some emails about mentoring options about half way through their intern year, although some interns seek out mentors much earlier. As mentioned above, the Chair in particular is very much into interacting with residents and advising them as he can. There is also all the program above under "research" that help with fellowship mentoring. Not being as familiar with the North East, it's hard for me to gauge their match list, but in the two areas I'm personally most interested in it looks like they send their grads to some great places. I think they said that 70% go on to fellowships. The popularity of cardiology seems to be on the rise, just like everywhere else.
Cardiology 2006: Cornell, NW, Columbia, Pitt, UMASS, NYU, GW, BIDMC x3
Cardiology 2005: NEMC, Pitt, Lahey, Brown, BIDMC
Cardiology 2004: UPenn, Georgetown, Downstate, UMASS, BIDMC x3
Pulm/Critical 2006:Cleveland Clinic, Emory, Harvard Combined x2
Pulm/Critical 2005: UWashington, Emory, Harvard Combined
Pulm/Critical 2004: Emory, Harvard Combined x4
