Advantage of "top tier" residency programs?

[duckie99]

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I am wondering from the more experienced people here what the advantages are of going to a so-called "top tier" program such as many that are mentioned often (UCLA, UCSF, BWH, MGH, Mayo, Duke, Hopkins, etc). Is it really that much better to go to, for example, BWH than UVA? I imagine both give you great training and research while opening doors to any fellowship.

I do understand factors such as location will make a program more competitive. But just because a program is more competitive does that mean your training will be better or there is some other advantage that makes it competitive compared to the lower competitive university programs?

 

[disorder]

I am wondering from the more experienced people here what the advantages are of going to a so-called "top tier" program such as many that are mentioned often (UCLA, UCSF, BWH, MGH, Mayo, Duke, Hopkins, etc). Is it really that much better to go to, for example, BWH than UVA? I imagine both give you great training and research while opening doors to any fellowship.

I do understand factors such as location will make a program more competitive. But just because a program is more competitive does that mean your training will be better or there is some other advantage that makes it competitive compared to the lower competitive university programs?

as i understand it, training will not necessarily be better.

however, going to a "top tier" program offers you various research opportunities and the chance at strong fellowship placement. you could say both of those almost go hand-in-hand.

 

[HoldTheCoffee]

Pride and fellowship placement are probably the two main things. Otherwise, I'm pretty sure people coming out of UVA (to use your example) make some pretty fine doctors.

 

[secants]

I also heard that if you want some administration/leadership position like residency director or department chair etc then you'll have a leg up

 

[intmed3]

I think another advantage is that people at a top program likely have connections at the other top programs, which gives you a leg up for fellowship programs.

 

[jdh71]

Funny UVA is brought up because that is a FANTASTIC program.

You're not putting yourself at that much of a disadvantage going to UVA as opposed to Hopkins - not really.

Look. The higher up the academic food chain you match the more options you have for academic research fellowships, and this means basic science usually. If you want to do wet lab research you can't just do it anywhere. If you want to do big prospective clinical trials you can't just do it anywhere. You've got to go where the big names and the money is and to get there the game states that the most likely way for this to happen is to come out of one of these higher food chain residencies. Some of it is also a bit nuanced because PD for fellowship will have a sense of what trainees from this program or that program are like when they show up.

Now, you are probably better served in your training being able to see a diversity of patients, and to me this means an academic tertiary center, a VA, and a county or county-like hospital, with a solid case load that pushes your boundaries but isn't so much you can't learn and not too many useless "elective" months (you know where you look at CXRs until 11am and go home), while giving you significant autonomy. If you can find this, you've hit clinical pay-dirt in a program, regardless of the "academic name" of the program. This isn't to say that programs that don't have all of that are bad or no good. Even a very basic community IM program will have all the bread and butter you'll need to start you medical career, but just know that you may have holes in your training which can be overcome, learned, and adapted too.

 

[doobiedoobah]

Besides what has already been said, one thing I've noticed that makes a huge difference and I think you should pay attention to while interviewing is how they assign patients to resident teams. Some hospitals have a lot of private physicians who practice in them, and some of those physicians do not want to work with residents. This is a problem. Another thing is when every single patient coming in is assigned to a resident team, because sometimes there really aren't any learning points and its just a placement issue or something along those lines, and it's kind of a waste of time to round on those patients daily. Some hospitals have systems in place that filter out these patients, and only assign patients to resident teams when there are learning points. Really, I don't know what I'm talking about since I'm still just a student, but this is just something that I've noticed.

 

[OCallag]

Besides what has already been said, one thing I've noticed that makes a huge difference and I think you should pay attention to while interviewing is how they assign patients to resident teams. Some hospitals have a lot of private physicians who practice in them, and some of those physicians do not want to work with residents. This is a problem. Another thing is when every single patient coming in is assigned to a resident team, because sometimes there really aren't any learning points and its just a placement issue or something along those lines, and it's kind of a waste of time to round on those patients daily. Some hospitals have systems in place that filter out these patients, and only assign patients to resident teams when there are learning points. Really, I don't know what I'm talking about since I'm still just a student, but this is just something that I've noticed.

Don't downplay the student role because you're completely right.

A friend of mine is an intern at a big name place where he consistently has to admit pts strictly for one particular pre-surgical workup. Those patients stay for days and absolutely nothing is done. They don't get their surgery, they don't get treatment for their condition - they just chill in the hospital. Their discharge summaries consist entirely of the studies' results. These admissions are not worth your time and provide little education. I would encourage applicants to ask residents and interviewers about these sorts of admissions and the role of non-resident services when they are interviewing.

As an aside, UVA is a great IM program. I completely agree with JDH's assessment of it.