Accurate Assessment of Top 25 IM Programs? Discuss...

[tigermike37]

Here's the latest rankings (ranked in Jan. 2008) from U.S. News and World Report for Internal Medicine: http://premium.usnews.com/grad/mdr/internals

1.) Harvard (MGH, B&W, BID)
2.) Johns Hopkins
3.) UCSF
4.) U Penn
5.) Duke
6.) U of Washington
7.) Michigan
8.) Wash U
9.) Yale
10.) Columbia
11.) UT-Southwestern
12.) UCLA
13.) Stanford
14.) Vanderbilt
15.) Cornell
Mayo
Chicago-Pritzker
18.) UNC
19.) Emory
Northwestern
21.) UAB
UCSD
U of Pittsburgh
24.) Ohio State

Agree??? Disagree??? Discuss...

 

[bof]

disagree.

these lists may serve as a guide, but i think to distill the training of a im program into a ranking is an oversimplification at best.

 

[muscles]

There is a lot to be said for something like this; rankings do have a place to some extent but I don't think they can be too strictly enforced. The program that is ranked the highest is not always the best on an individual basis. When evaluating residency programs, you need to create your own individualized system based on what you think is important - ie, what program will best help you achieve your career goals. Do you want to do research? Do you want experience in a community setting? Fellowship? Do you want to gain expertise in rural medicine? tropical medicine? I dare say that Harvard cannot help everyone achieve any goal simply because it is ranked #1.

 

[velo]

I'd say the one thing a list like this does tell you about is the 'reputation' of the program. This metric is a bit of a self-fulfilling prophecy and should be taken with a grain of salt, but reputation does have it's place. I don't think lists like this are a bad way to start your search, but you should do so with the knowledge that most of the factors that will go into your final decision can't be summed up on a list.

Oh, and I'm surprised U Chicago isn't higher, other than that the list is probably fairly close to accurate.

 

[BaylorLion]

Discuss? Ugh - this is a Molotov cocktail waiting to explode. There are a few schools that are a bit lower or higher than they should be, and some schools that are outright missing, but the list in totality probably catches "the top 25" programs, whether you agree on relative rankings or not. I'm not going to point them out, though, because it's an opinion, and there are people who will argue that Pitt is stronger than BID or that Emory is stronger than Yale (examples only!!!) and could make that point, and the vice versa could be argued successfully as well. But seriously - this could totally become a pissing contest. But Mt Sinai and Colorado should probably be on the list - they're outstanding for GI (Sinai is the home of Crohn's) and pulm/CC respectively. U of Florida just poached off a good portion of Wash U's cardiology dept, including the department chair.... so seriously, there are a lot of good programs and good mentors/peers out there.

That said, you'd be surprised how many people I know/met who were ranking unarguably "lower-ranked" programs higher because of personal or professional reasons. You will get a pretty good sense of the academic quality of a program when you visit and talk to their residents - morning report is gold for that. You see where they're discussing intelligently vs. struggling to think cogently about basic medicine topics. And fit can't be over-emphasized - some people may want a place that's clean and private and cushy and others want to be in the public hospital with paper charts and malignant attendings... so... just apply broadly and visit as many places as you can.

 

[Rogue_Leader]

I would guess that these rankings are for the IM departments rather than the IM training programs. It's odd though that for any rankings of IM departments and IM programs they'd lump the harvard programs together. While the faculty may drift between them to some degree, the residency programs are pretty seperate. I'd be surprised if actual residency program rankings even existed, and if they did, I doubt it'd be in US news given how few people would be interested in such rankings relative to the readership of US news in general.

 

[piptaz]

Yawn. I am not the first and I won't be the last to say that this list makes sense neither as a list of IM residencies nor, as was just suggested, as a list of internal medicine departments themselves. In either case , it would simply make no sense to lump BID,MGH, and BW and it would be methodologically simple to disaggregate them as the USNWR in fact does for lists of medical subspecialites, for instance. The one way in which the general structure of the list can be defended, to whatever debatable degree it can, is as a rank of medical schools in terms of experience in IM/ prep for IM residency. At the level of medical schools, the HMS students stand to benefit from access to all three Harvard affiliated hospitals so prima facie it would make some kind of sense to count them together in assessing the quality of the IM experience/prep at Harvard. (note: I believe of late HMS students are more or less exclusively tracked into one of three hospitals so the degree that students there can/do take advantage of all three hospital IM departments may be less than it was - I don't know for sure (or care!))

 

[Danbo1957]

"... the list is probably fairly close to accurate."

If what is being considered is General Internal Medicine, the real Top 10:

1) Hopkins Hospital (best GIM fellowship too)
2) BID, MGH, B&W (BID really stands above the other two)
...man, the talent that has gone through those four buildings!
3) U Wash
4) UCSF
5) Duke
6) Penn
7) UT-SW
8) Chicago
9) Baylor
10) UCLA

Interesting how this list would have looked 25 years-ago...

 

[muscles]

where does this list come from and what criteria is it based on?

 

[yippyskippy]

Who knows where that list comes from... but I think Danbo is talking about people going into primary care. For those who want to subspecialize, the list is totally off - obviously most people would not put BID above MGH, B and W, nor would they put UW above UCSF. But for primary care, maybe they would... I am not primary care bound, so I haven't much of a clue.

 

[Danbo1957]

My list is for primary care - and, of course, all the schools listed turn out exellent doctors. Subspecialty IM lists would be different...

 

[johnnywalker]

and, amazingly, schools not listed turn out excellent doctors too.

 

[Danbo1957]

Agreed.

 

[velo]

If what is being considered is General Internal Medicine, the real Top 10:

1) Hopkins Hospital (best GIM fellowship too)
2) BID, MGH, B&W (BID really stands above the other two)
...man, the talent that has gone through those four buildings!
3) U Wash
4) UCSF
5) Duke
6) Penn
7) UT-SW
8) Chicago
9) Baylor
10) UCLA

Interesting how this list would have looked 25 years-ago...

Sorry if I wasn't clear in my post, but what I said was that the one thing these lists are useful for is helping you feel out the general consensus about the 'prestige' or 'reputation' of programs...for what that's worth... In that regard I felt the originally posted list was fairly accurate although, as people said, "Harvard" shouldn't be lumped together, it should be BWH/MGH with BID somewhere in the top 10.

 

[Fexofenadine]

Disclaimer: I will be going to one of the big 3 in boston next year. This is purely my opinion and based on what i have heard from my home program and various medicine faculty members....

1. The top 4 are definitely ranked correctly based solely on academic reputation in the medical community

2. I'm shocked that Mayo is not ranked higher on the list...I would put it at least in the top 10 and would have ranked it highly on my NRMP list if it was not in Rochester, MN. Mayo was definitely a top 5 on my NRMP list.

3. I'm surprised to see Yale, Michigan, and UTSW higher on the list than Columbia, Cornell, and Stanford.

However, all in all these top 25 programs are amazing and anyone would get great training there.

 

[grendelsdragon]

I don't think there is an ACCURATE assessment, because that would require a gold standard which does not exist. Rather, I think we have some degree of PRECISION in grouping good programs that fulfill our needs, whether it be basic research, preventative medicine, clinical research, teaching, academics, expertise in certain clinical specialties, etc. At this point, we should be grown up enough not to respond to ranked lists, but to find groups of programs that suit our needs.

 

[NdSea]

I think it would be better served to rank the programs by region. I'd curious to see what everyones top 10 programs in the south, west, northeast, and Midwest would be.

 

[nattygann01]

Disclaimer: I will be going to one of the big 3 in boston next year. This is purely my opinion and based on what i have heard from my home program and various medicine faculty members....

1. The top 4 are definitely ranked correctly based solely on academic reputation in the medical community

2. I'm shocked that Mayo is not ranked higher on the list...I would put it at least in the top 10 and would have ranked it highly on my NRMP list if it was not in Rochester, MN. Mayo was definitely a top 5 on my NRMP list.

3. I'm surprised to see Yale, Michigan, and UTSW higher on the list than Columbia, Cornell, and Stanford.

However, all in all these top 25 programs are amazing and anyone would get great training there.

I bet it's BID...

 

[0382938]

I bet it's BID...

Is that a poorly veiled jab at BID, or is it my imagination? Anyway, the original list that included BID in that position was apparently intended as a primary care list. I doubt any of us would argue that BID is above BWH/MGH in terms of research or subspecialty reputation. (Plesae correct me if I'm wrong.)

 

[LidoEpi]

I'll throw in one for BID too. So Fexo, did you and your GI boyfriend decide to stay in Boston or did you mention that to slyly tell us you might stay in Boston? hehe

 

[Fexofenadine]

I'll throw in one for BID too. So Fexo, did you and your GI boyfriend decide to stay in Boston or did you mention that to slyly tell us you might stay in Boston? hehe

Gosh, how did this conversation become about me? *gigliing like a 12 year-old Asian girl* Just curious, why did you think I will be going to BIDMC and not the Brigham or MGH?

Anyhow...to reiterate...I just formulated my opinion based on what I have heard from my home faculty advisors (hence the disclaimer).

 

[orientedtoself]

because if you were going to the brigham, you would say you're going to the brigham.

 

[nattygann01]

because if you were going to the brigham, you would say you're going to the brigham.

yup...but that's not to say BID isn't awesome. I just think you would have said "the brigham" or "1 of the big 2", etc.

 

[muscles]

It's good to see Ohio State on the list; I've read quite a bit recently that they are making a push to increase their prestige in the medical community.

 

[autobot]

Wow UT-southwestern at #11? That seems pretty high for an institution that has more of a regional reputation than national but that is merely an opinion not based on fact. What do you guys think? Anyone out there on the east or left coast that can attest to how UT-Southwestern is viewed? Of course Im asking because Im thinking about going back to Texas for IM residency.

 

[Myostatin]

"Top programs" obviously depends on what criteria you use. Most of us probably have in mind "top academic reputation," which correlates well with how well a graduate of the program will do in the fellowship match, though it will not necessarily correlate directly with the quality of the IM faculty or residency training.

From recent experiences on the fellowship interview trail, and my recollections from IM interviews, ranking strictly in terms of how well people do when applying for fellowships...

1) MGH => Brigham - these guys get top interviews whether they've done research or not

2) Hopkins, Duke, UCSF - not quite as easy a time as the mgh/brigham people, but still fairly easy to get interviews; Honestly saw fewer UCSF people around than I would have expected, perhaps because many of them want to stay in Cali.

3) Columbia

4) (?) Stanford, UTSW - one might say that UTSW is not as well known as the others, but in terms of where their residents interview and place, UTSW is extremely strong (and no, I'm not from there)

5) Penn >= Yale, Cornell, WashU >= BID , Mayo

6) UCLA, UW - probably have stronger departments than some of the others above, but placements aren't as good, perhaps due to graduates geographical preferences

7) Michigan

I don't have any sense of Baylor, U of C.

One can say it doesn't matter, and that's true if you're going into GIM - then Mayo, U of W, may be among the best places to train hands down. But if you're planning on a competitive fellowship, it definitely does make a difference where you trained, on equal and possibly greater footing than what you've done there.

 

[piptaz]

Duke? Yeah, right.

 

[Rogue_Leader]

When I was whiling time away on a layover last week, I noticed that the 2009 edition of the USNWR graduate school rankings were out. I saw the same "internal medicine" rankings list and it looked pretty much the same this year as last. However, it was interesting in that the other categories on the same page were things like "AIDS" and "Rehabilitation" and "Substance Abuse" and things like that. You would think that if they were ranking core departments, they'd have lists for Surgery, Pediatrics, psychiatry, and the like.

 

[docrocmayo]

"if you're going into GIM - then Mayo, U of W, may be among the best places to train hands down. .

dont know about UW, but if you dont mind me asking you what makes you think that Mayo is strong in GIM. I would have though otherwise. Our graduates may not be at same level as "the Brighams" but subpeciality training is one of the highlights of our training and most of stay in-house for fellowships ( fyi we love inbreeding here). Although a good chunk of our graduates does go in to primary care, its mostly at Mayo..
Mayo and GIM??? I didnt know that we were so strong in GIM ( trust me egos of certain people in the program would be stroked bigtime if they read your post )

 

[Fexofenadine]

dont know about UW, but if you dont mind me asking you what makes you think that Mayo is strong in GIM. I would have though otherwise. Our graduates may not be at same level as "the Brighams" but subpeciality training is one of the highlights of our training and most of stay in-house for fellowships ( fyi we love inbreeding here). Although a good chunk of our graduates does go in to primary care, its mostly at Mayo..
Mayo and GIM??? I didnt know that we were so strong in GIM ( trust me egos of certain people in the program would be stroked bigtime if they read your post )

I personally thought that Mayo residents were incredibly strong when I was on the interview trial. In fact, they are highly looked at by fellowship directors. As a med student, one of my cardiology attendings at the Brigham believes that Mayo is definitely considered a top tier program. People tend to stay at their home institution for fellowship because of the connections they have made during training as well as the farmiliarity with the program. I would love to stay at my home institution for cardiology if possible (and it's not BID despite what posters on here think).

 

[muscles]

agreed.

when i was at mayo interviewing, they seemed like very strong residents all around. Sometimes I regret not ranking them higher; the program is so good.

 

[Myostatin]

Listen, no need to get defensive - I think mayo is "strong in GIM" because its a very strong program overall. I'm sure most of the mayo residents go into subspecialties, just as in the other highly sought IM programs. My point is that if fellowship placement was not a consideration, I would choose the place with the best training oportunities and I think mayo fits that bill hands down. I would rather be at a residency program where the sole reason for residents being there is to learn, rather than do scut.... and Mayo fits that bill as well.

However, if you're looking at getting into a highly competitive fellowship, it would be difficult to argue that the fellowship placements at Mayo are on par with those of MGH/Brigham/UCSF/Columbia/Duke, rightly or wrongly on the part of program directors. - Not that mayos's placements are by any strech bad, in fact I'm sure they're quite good, but not on par with the above mentioned. From my experiences on the trail, I've run into occasional people from Mayo, but the interview days are dominated by people from the above stated programs. So if you're planning on getting into a top notch fellowship, one would be wise to take this into account, and consider a place like Columbia for example, with a stellar fellowship placements, even if the teaching you get there and the quality of your daily work are vastly inferior to what you'd experience at Mayo. It wouldn't be worth it to make that sacrifice if you were not pursuing a highly competitive fellowship.

As for Fexo's comment, what a particular cardiology attending at the Brigham believes is irrelevant... what's more relevant is what the cardiology PD and chairman think. If you look at where the brigham cardiology fellows trained, you'll find that they're from brigham, mgh, hopkins, ucsf, duke, columbia, with a rare smattering of others -> This is not just due to geographical or inbreeding considerations, as EVERYBODY applies to these programs and even at the interviews you see few people outside of the above mentioned programs. Bottom line is that PDs take into account a "pedigree" of where you trained. Regardless of what they tell you in person, the actions of who they actually take speaks much more loudly. The same is true of the other top cards fellowships, though to a lesser degree than at Brigham and MGH.

 

[Danbo1957]

Mayo trains their own, look at their doctor rosters. I have always felt that the Mayo Clinic intended to teach a certain type of primary care that was to be different than that seen at the hospitals of Boston, New York and, one in particular, Baltimore. They've done very well, obviously, with their care model - but, as a clinic, care is provided in a country club setting rather than in a big city war-zone hospital. Think of the difference in experience a student/resident received, say, at Maimonides in Brooklyn versus that of the experience received at Mayo Rochester or Scottsdale.

I admire IM grads from Mayo, I've trained several residents/fellows and more than several MD grads from Mayo Medical School. But, one doesn't see many "Mayo doctors" working at medical facilities outside their comfort zone...

 

[grendelsdragon]

Wow UT-southwestern at #11? That seems pretty high for an institution that has more of a regional reputation than national but that is merely an opinion not based on fact. What do you guys think? Anyone out there on the east or left coast that can attest to how UT-Southwestern is viewed? Of course Im asking because Im thinking about going back to Texas for IM residency.

UTSW has a very strong national reputation amongst program directors in academically oriented programs. It's presence is best felt in the basic sciences, especially in cardiovascular disease. Intellectual resources include Eric Olson, Helen Hobbs, and 4 active Nobel Laureates (including Brown and Goldstein, co-discoverers of the LDL receptor). UTSW has been the launchpad for Deepak Srivastava (now director of Gladstone, UCSF) and Ken Chien (now director of CVRC, MGH).

You can probably measure the quality of the training program by the success of fellowship placements, where UTSW seems to perform well. In the field of cardiology, I know in the past several years UTSW has placed a number of housestaff into Johns Hopkins, Duke (rumor has it 1-2 residents every year), UCSF and Brigham for example.

 

[grendelsdragon]

Listen, no need to get defensive - I think mayo is "strong in GIM" because its a very strong program overall. I'm sure most of the mayo residents go into subspecialties, just as in the other highly sought IM programs. My point is that if fellowship placement was not a consideration, I would choose the place with the best training oportunities and I think mayo fits that bill hands down. I would rather be at a residency program where the sole reason for residents being there is to learn, rather than do scut.... and Mayo fits that bill as well.

However, if you're looking at getting into a highly competitive fellowship, it would be difficult to argue that the fellowship placements at Mayo are on par with those of MGH/Brigham/UCSF/Columbia/Duke, rightly or wrongly on the part of program directors. - Not that mayos's placements are by any strech bad, in fact I'm sure they're quite good, but not on par with the above mentioned. From my experiences on the trail, I've run into occasional people from Mayo, but the interview days are dominated by people from the above stated programs. So if you're planning on getting into a top notch fellowship, one would be wise to take this into account, and consider a place like Columbia for example, with a stellar fellowship placements, even if the teaching you get there and the quality of your daily work are vastly inferior to what you'd experience at Mayo. It wouldn't be worth it to make that sacrifice if you were not pursuing a highly competitive fellowship.

As for Fexo's comment, what a particular cardiology attending at the Brigham believes is irrelevant... what's more relevant is what the cardiology PD and chairman think. If you look at where the brigham cardiology fellows trained, you'll find that they're from brigham, mgh, hopkins, ucsf, duke, columbia, with a rare smattering of others -> This is not just due to geographical or inbreeding considerations, as EVERYBODY applies to these programs and even at the interviews you see few people outside of the above mentioned programs. Bottom line is that PDs take into account a "pedigree" of where you trained. Regardless of what they tell you in person, the actions of who they actually take speaks much more loudly. The same is true of the other top cards fellowships, though to a lesser degree than at Brigham and MGH.

I am on faculty at one of the brand name programs you listed (and even interviewed cardiology fellowship applicants!). Overall, the fellowships you describe have a heavy (if not absolutely strict) bias towards selecting applicants with a trajectory in academics. Although Mayo enjoys an outstanding clinical reputation, the culture of academic medicine values research that has won competitive NIH funding (and HHMI and others), an area where Mayo has not yet gained as great a footing as the other listed programs (though Mayo appears to be a growing force in this arena). I think in addition to a solid clinical performance, a Mayo resident can be as competitive as any applicant from the top 5 if he/she enthusiastically pursued research with a nationally prominent mentor. The applicant should be willing to travel for this research experience, and a solid first author publication is a huge asset.

 

[Cathay]

I would not rank residency programs numerically but would do it by tiers, with programs in a tier roughly being equal (i.e. some strengths, some weaknesses).

Tier 1
MGH
Hopkins
UCSF

Tier 2
Brigham
Columbia
Penn
Stanford
UCLA
Mayo
Duke

Tier 3
BIDMC
Cornell
Yale
UTSW
UW
UChicago
WashU
Michigan

Tier 4
UCSD
JH-Bayview

Etc....

At least that's how I ranked them

 

[duncan11]

I have posted this previously:

1st group: MGH, BWH, JHU, UCSF

2nd group: Penn, Duke, Columbia, Michigan, Wash U and UW

3rd: University of Chicago, Stanford, Mayo, UTSW

4th: Vandy, Emory, Cornell, BID, Northwestern, UAB, Yale, UCLA, and probably many more

 

[johnnywalker]

wonder if duke falls on this list after having 2 scramble for 10 spots

 

[Myostatin]

Can't speak to what happened with Duke's residency match as I'm not from there... but there could be many explanations from a secreterial error to obviously that they didn't rank enough people. Either way, little effect on the rep of the residency program. I know UCSF anesthesia didn't fill (?) two years in a row... doesn't affect the training / rep of the institution. Now if it were a recurring theme I would start to wonder...

 

[Linus2007]

I have posted this previously:

1st group: MGH, BWH, JHU, UCSF

2nd group: Penn, Duke, Columbia, Michigan, Wash U and UW

3rd: University of Chicago, Stanford, Mayo, UTSW

4th: Vandy, Emory, Cornell, BID, Northwestern, UAB, Yale, UCLA, and probably many more

Based on how I ranked I would have put BID, UofChicago and Mayo in the second group and moved UW down to 3rd and Cornell 4th. Only because Cornell has a private PA system which I didn't like, they violated cap and hours too. That and the program director and asst program directors got into it during the interview day. UW is still in transition and there are a lot of new things starting at once. Will be awesome once they are completely up and running post troubleshooting. Plus Dr. Steinberg is one hell of an asset!


I would consider these all 'top tier' I guess. They are all good programs which will get you where you want to go. (Unless you want to be the program director at BWH etc).

I actually would rank programs with the following system.

Tier 1: Academic centers, High Patient Flow, Great Autonomy

Tier 2: Community Centers, High Patient Flow, Great Autonomy

Tier 3: Academic Centers, Lower Patient Flow, Low Autonomy

Tier 4: Community Center, Lower Patient Flow, Low Autonomy.

Oversimplification...maybe but if you put tiers that consist of 3 hospitals it would be a 50+ tier system. Postings of the 'Top 25' etc are always going to be debated but its a good way to think about which places you want to apply to. Then when you interview you will really see how things rank how you see them. Sad to say but the 3+ years are really decided on half a day.

 

[grendelsdragon]

I know it's fun to go back and forth about lists, but there should be only 2 tiers worth considering. Features contributing to each tier are listed below.

Tier One:
Personal geographic preference (also goes hand-in-hand with major city vs. cost-of-living).
Availability of resources for personal research interests and good mentors along these lines.
Good track record for placing graduates into fellowships in fields you are interested in.
Personal preference for training environment (for example: private hospital with good ancillary services and sometimes less autonomy vs. municipal/VA hospital with annoying ancillary services but excellent autonomy-- and everything in between).

Tier Two:
Programs not in tier one but worth considering for backup.

As I have tried to say before, there is no rank list that satisfies all criteria in Tier One. Seriously, we are talking about your career and livelihood. Better to place your priorities in order and do the footwork to determine the right fit for you than to give even an ounce of greater consideration to a program due to its position on some list.

 

[BlackNDecker]

My decision was based on which program had the best cafeteria...seriously. Quite possibly the most pressing consideration every 4th day of your life for 3 years.

 

[CANE4LIFE]

Where would Mt Sinai NYC be ranked among the tiers people have discussed, is it really any different than Cornell