Man I'm getting tired of writing these things. But since somebody asked...
Disclaimer - I've only been to the program during interview day. 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 Yale . . .
Overall - a very academic environment with a heavy research focus and tons of research programs, a solid international rotation, and a great name with an excellent match list. The big concerns for some is the traditional q4 call system which other people have said is on the harder side of the spectrum, and some recent and impending leadership changes at Yale. I think the program put on an excellent interview day that showcased their strengths well. I was impressed by the number of people who spoke with us - Chair, PD, Assoc. Dean for GME, somebody from the VA, head of the mentoring program, ~4 recent grads from their research programs, APDs, and a good number of interns and residents.
The Program Director - The PD is an older physician who's been at Yale for a while, and has served as PD for perhaps 5-6 years. He greeted people at the interview dinner along with an APD, and then they both left us alone with residents, which I thought was a pretty ideal way of doing things. While greeting us he made a point to comment on some parts of our application, which was impressive. Apparently he is responsible for choosing who to interview and then advocates for applicants in their committee meetings. During his multiple presentations he stressed "graded responsibility." Residents weren't really sure if he was specifically responsible for any changes in the program lately.
The Chair - Yale was without a Chair for a while (I think 4 years), which people on SDN in years past felt was a weakness. Their new PD is a Yale grad who was the head of pulmonary/critical care at UPenn, and said that he's only been at Yale now for 3 months. Supposedly he only agreed to come back to Yale after a number of his demands were met regarding some changes he wanted to make, the biggest of which was the creation of a medical step-down unit which they currently lack. He runs a basic science lab and is a pulm/critical care guy. He spent large parts of time with the applicants on interview day and seemed pretty sociable. Some of the clinical divisions within medicine at Yale are also without division leaders, including cardiology. Now that they have a chair of medicine they can move to fill those, and cardiology is supposedly first in line to get a new chair. One faculty member said that it should be filled this year, and that the new division head should be given some resources to impliment changes as he/she sees fit which should create a "honeymoon" period of sorts.
Residents - Residents seemed reasonably happy. The dinner the night before was relatively well attended, and lunch was with residents who seemed more than willing to talk. We didn't round with a team but did see a morning report. The morning report I saw was a very interesting case, but the resident (intern?) who presented didn't seem all that on top of his/her presentation, the Chief resident's teaching points were rather basic and seemed less than prepared, he/she attempted to give some positive comments but ended up complimenting the wrong person, and he/she seemed less than thrilled to have applicant participation even though resident participation seemed moderate at best. As advertised, they did bring in a specialist to comment on the case, and he/she was invaluable for the discussion. I did not see a medical student at morning report. The residents and Chief I talked to over lunch seemed nice enough, although it was a bit odd that one simply dismissed research as something he/she was just not interested in, but that's reality at even the most hard-core academic programs and it's good to know that there is some diversity of interests. As part of their commitment to "graded responsibility," interns are never alone at night, and they continuously work closely with a supervising G2 or G3.
Faculty - I really only talked with two faculty members who weren't directly involved with the program administration, so it's hard to make any meaningful comments. Neither tried to sell the program. I also picked up on the "not cold but not warm" East Coast vibe. As mentioned, the Chair and PD were around the whole day, along with most, perhaps all, of the Associate Program Directors for most of the time, which I thought was a good sign.
Patients - The Yale traditional program covers Yale-New Haven Hospital and a VA. YNHH is a mix of a community hospital serving a medium sized town (80% of patients come through the ED), and a teriary and quaternary care medical center. Multiple local residents I spoke to said that most people go to YNHH and think that it gives better care than the other hospital in town. Yale uses a firm system, so there are no sub-specialty primary services. They have a large and growing hospitalist service, but it's not clear to me if they have a mechanism for routing the less interesting patients to the hospitalists and the more interesting cases to the teaching service.
Conferences - There are a number of didactics at Yale. There are attending rounds at least 3 days/week and weekly with the firm chief. There is morning report each morning, frequently with an invited "professor." There is a summer lecture series for new interns covering many of the basic topics. There are core curriculum lectures, weekly M&M, weekly medical grand rounds, intern report once per week, and physical diagnosis rounds for interns weekly. An intern said that interns typically attend 70-80% of morning reports (60% is required by ABIM) and nearly 100% of all noon conferences.
Sites/Facilities -the Yale program covers Yale New Haven Hospital, a VA, and the categorical/traditional pathway residents recently stopped covering a private hospital near New Haven. YNHH is a thousand bed hospital, and it looked like a relatively nice hospital from my tour. I saw mostly single rooms, but my guide said that most rooms were actually quads - I find this hard to believe. There is currently a "$420 million hole in the ground" that will be the new cancer center in 3 years. The VA is in the top 5 nationally for VA grants, recently renovated, and a leader in quality of care. The VA of course uses CPRS, and apparently includes home access. YNHH is going through some EMR changes, and from what I remember they lack a single, comprehensive EMR. One resident said that in your first week of internship you'll want to throw the computer out the window. Residents claimed that ancillary services were good though no details were given and it does sound like you have to do your own blood draws now and then. On SDN it's been mentioned that YNHH has recently had union issues; these didn't come up on my visit. One faculty member did note that there is some tension between the hospital's desire to remain a community-focused hospital, and Yale's desire to have a world-class, specialized facility. Somebody outside of Yale has described YNHH as poorly run. As mentioned earlier, they currently lack a medical step-down unit. As the hospitalist service at YNHH has expanded they haven't changed the number of ICU or step-down beds, but supposedly the new Chair is creating a step-down unit.
Location - New Haven is a medium-sized city that has a reputation as being a really crappy city full of crime. Apparently things have significantly improved in the last 5 years, with crime decreasing and new businesses coming into New Haven. Most residents live downtown, within walking distance of YNHH, although many other options exist including living near/on the waterfront, although it seems that this is expensive enough to require a significant other with a good income. Boston is 2 hours away, and New York City is 1.5 hours away and easily accessible by train. It seems there is a large contingent of residents who head into NYC whenever they can, making me think that its harder to socialize with residents in New Haven. On the other hand, many people did comment on the great restraurants in New Haven. There are few flights into New Haven, and they tend to be more expensive, so many fly into more distant airports (NYC, Hartford, etc).
Schedule -They said that they have hired large numbers of hospitalists at YNHH in order to comply with the 80 hour work week. The G1 year includes 24 weeks on the firms, 4 weeks in the Yale MICU, 4 weeks in the Yale CCU, and 2 weeks in the Yale MICU or CCU or VA MICU for a total of 10 weeks of ICU experience in the first year. Interns get 4 weeks of elective, are on "jeopardy" for two weeks, and night float for 4 weeks. All of this time (24+10=34 weeks) is spent on q4 call, and there is a generalist rotation where you see outpatients and discuss them with inpatient docs while also taking call q4. Interns get 4 weeks of vacation. When I asked two residents about the worst part of the program, one said that with their q4 schedule they don't get golden weekends, and the other resident just remained silent. They clearly have one of the most traditional schedules out there, for those who appreciate the older ways of doing things.
Tracks - I only applied to and interviewed for the traditional pathway. They also have a primary care pathway which spends more time, perhaps most, at a private hospital nearby. There is no international health pathway per se but they have a well-developed international health experience. The international health experience is funded by Johnson & Johnson that covers your salary and a $2000 stipend. They have chosen to focus on 6 main sites, although you can still go to other sites if you wish. The Uganda site (Malaga Hospital) includes a Yale Ward, staffed entirely by Yale doctors. Time spent on the international rotation can count towards the tropical medicine CAQ.
Research - They heavily stressed research during the interview day. Someone on SDN suggested that it had a very basic research slant to it, although it was very clear to me that they are supportive of any type of research from bench to population studies and everything in between, and looking at their Research in Residency abstracts I would only call 5 out of 14 "basic" science. They did stress that they are a special place for human translational research, but many Universities are trying to make that claim. The Yale Dept of Medicine ranks in the top 8 in terms of NIH funding, and ranks #3 in terms of NIH funding per investigator. Yale has a number of research programs available to residents. There is the required Research in Residency program that involves a research proposal and 3 months of research over the G2-3 years. They also have an ABIM "short track" pathway, and it sounded like every resident at Yale was welcome to participate, although it wasn't clear to me if they would then guarantee a fellowship slot. There is a Investigative Medicine pathway which is a 3-year PhD combined with fellowship. There is a 1-year MPH without a thesis. And they are 1 of 4 sites to have a Robert Wood Johnson Clinical Scholars program, which is a 2-year master's level program in clinical research. To support this Yale as a NIH CTSA grant and is one of 4 original sites, they have a Center for Clinical Investigation, and of course there is the greater Yale University. They also mentioned that they are open to discussing "special needs" for residents who want to do something slightly off the beaten path. Nobody knew of any residents who have been able to do research during their intern year although they mentioned that in special cases it might be possible.
Fellowships - they stressed on interview day that they consider residents to be future fellows and leaders in medicine. Yale has a semi-formal mentoring program which was called a "dating service" of sorts by the faculty member who runs in. In October of the G1 year residents are partnered with suitable mentors, and from there they can do as much or little together as they want. The match list at Yale seems to be among the best anywhere - based on handouts at the interview day, their match list by graduating class is as follows:
Cardiology 2006: Cleveland Clinic x2, Stanford, Yale, Yale (invest. med program), UIC, UCSF, Mount Sinai, NYU, Tufts/NEMC
Cardiology 2005: Tufts/NEMC, Yale, Mount Sinai, Cleveland Clinic x2, Yale x2
Cardiology 2004: Yale x2, MGH, BU, BWH, Northwestern
Pulm/Critical 2006:UPenn
Pulm/Critical 2005: Yale
Pulm/Critical 2004: Yale x4, BU, UWashington (Seattle)
the intern quality did seem not up to what I have seen at comparable hospitals: there was one fmg on the team I rounded ( was kickass as someone suggested in a previous post: shd have been an attending somewhere, I am not so xenophobic after all you see) . but the intern I rounded with was from some Southern medical school ( accent yeah!) and was pretty basic ( read more like a fourth year medical student): so is resident quality hurt by Rochester??? are people there just for the MAyo tag?
