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Academic Residency=Tertiary=Good Doctor?

Discussion in 'Internal Medicine and IM Subspecialties' started by ucla2usc, Nov 25, 2005.

  1. ucla2usc

    ucla2usc Senior Member
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    Anybody get the impression that all the "top" IM programs include the majority of inpatient training in tertiary based referral centers? Do you think that this ideal for training? It seems some programs (i.e. UCLA/Stanford) offer a couple months at County/VA hospitals, but still focus the training in the tertiary care universitiy hospitals. In one respect I think that these places are filled with insane pathology with very sick patients with multiple problems, hence offering a great learning experience. However on the other hand, I wonder if tertiary care training is deficient on learning experiences with "bread and butter" medicine and first time diagnostic skills. Just curious what others think on this matter.
     
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  3. dieulafoy

    dieulafoy Junior Member

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    Hi ucla2usc,

    I guess for me, autonomy has been incredibly important, and at tertiary care centers, there is understandably less than at a county/public institution. I also feel that the divide between what technology is available and what we as a society can afford is increasing. To me, so what if small bowel transplants are available at an institution? It's probably more cost effective to make sure all eligible patients are vaccinated.
    I feel that technology and advancement in medical science and procedures forces us to think more, not less, about what to do for patients. When i've rotated at Cedars, I saw 95 year old patients getting cathed and having their 6th taxis stent in their LAD...does that make any sense? I'd argue no. On the other hand, I've never dealt with patients who've failed 2 allogenic BMTs and have GVHD and have disseminated salmonella infections...but at that point, I feel discussions should had about the goals and values of the patient. From your handle, it seems like you've had experiences with both the county side and private side of things. Where are you in your training?
     
  4. inositide

    inositide Senior Member
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    From what I have seen as a medical student working with various members of the house staff, attendings, fellows, etc and from what I have seen as an applicant is that if you do a medicine residency anywhere, you will become more than proficient at internal medicine. In other words, there are tons of places to learn medicine. You will learn at a tertiary place and also in a community program. I am sure that as applicant you will consider fellowship placement and all of that stuff, but in my opinion it is very important to pick a program that you will be happy at because you will no doubt learn medicine whereever you go.
     
  5. TommyGunn04

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    Another important thing to consider is where residents rotate at any given institution. For example, while Duke is certainly considered a major tertiary, academic center, the medicine residents spend a decent amount of time at the Durham VA and/or at Durham Regional Hospital, where bread and butter medicine is the rule rather than the exception, and autonomy is as preserved as it gets. I don't think this is an uncommon feature compared to other programs, but I mention it because I believe it's a great example of what is a very good feature of many programs. In addition, outpatient care seems to comprise 25-50% of resident time at most IM residencies, at least according to official records. Consequently, I would think that even at major academic centers where one might suppose that residents see more "zebras," there's still plenty of bread and butter medicine and tons of autonomy.
     

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