Anesthesia at University of Michigan

Discussion in 'Anesthesiology' started by jswolverine, May 14, 2008.

  1. jswolverine

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    I am writing this thread as a concerned collegue and a person looking out for my fellow residents and prospective applicants looking to go in the field of anesthesiology and specifically anesthesia at the U. of M.
    From 1st hand experience the program has a lot of advantages, great cases, solid schedule and good fellowship opportunites once you finish residency. However, this year the program heads have fired 3 CA-1s after 5 months and are in the process of possibly firing a CA3 resident who has one month to go in residency. The CA3 had a job lined up and was all set to go, then suddenly the clinical compentency comittee wanted to review his record. Resident had some minor incidents throughout the year, but mainly a personality issue with many attendings who did not like him.
    Program looks great when you interview, all smiles, but when they call in a CA3 resident a month before graduation and tell him that he may have to repeat his CA3 year or possible get kicked out it makes you think twice. The morale of the program is low, the adminstration does there thing behind doors and then reports to us that we are all fine as we see are class size dwindle one by one.
     
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  3. Arch Guillotti

    Arch Guillotti Senior Member
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    Whether or not all this is true, most of us who have been around here a while look upon info like this pretty skeptically, afterall it is your first post.

    That being said, residency is a pain. Sometimes you have to pretend to like people when you really hate their guts. You just gotta play the game till your ticket is punched.
     
  4. EKG2007

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    If a program is willing to fire 3 CA-1's, it is a red flag no matter what.
     
  5. invitro

    invitro Member

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    Despite the above post being the OP's first, he/she speaks the truth. I know of one resident that was fired there. It was not pretty.

    Make sure to find a program that is kind to its residents. Going to a "name" program may not be that great if your environment is sucky.
     
  6. IctalSmile

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    Not to resemble the "cut throat bitch" from House......but does this mean there will be more spots available for the next match? (I dont graduate for a couple years, just wondering how things work)
     
  7. bobg504

    bobg504 Senior Member

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    LMAO:laugh:
     
  8. usnavdoc

    usnavdoc Senior Member

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    How does a CA1 get fired? Thats kinda insane. That is basically the program admitting that they cannot train you to their standards.

    I wouldnt go somewhere like that.
     
  9. Taurus

    Taurus Paul Revere of Medicine

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    For the fired residents, any chance they have of getting another gas spot?
     
  10. Gaseous Clay

    Gaseous Clay ASA Member

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    I see no reason for this individual to lie. Unfortunately, there is a lot of behind the scenes with attendings. At my program, all the 3rd years last year (I am a CA-1 so this is 2nd hand info) were very disgruntled and did not attend the end of the year Resident appreciation dinner. They were all ticked off about one Resident getting fired and the Attendings getting on their cases about their poor in training exam scores. Well, the one who was fired was truely incompetent and then some of the other Residents ended up failing the written boards. So sometimes the administration has their reasons and the fellow Residents don't understand.

    At the same time, it is the residency program's job to properly train individuals and if some are seeming to be inadequate in certain areas, it is their job to right the ship, whether it be to start a study schedule for reading, or various types of cases, or what not. Sorry to hear about U of M ...
     
  11. Ender

    Ender ASA Member

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    I am currently at the end of my internship at the University of Michigan. I can tell you what I know. Every year during a time regularly scheduled for weekly grand rounds the Chiefs come and talk to the residents about schedules, testing, getting feedback on rotations, etc. About a month ago they also used this oportunity to discuss the current issue.

    From my understanding this is the first time in many years that a resident has been fired, and it was TWO CA1's not 3. They basically outline all that has to happen to get to that point. First of all it starts with a pattern of poor reviews from attendings. They will ignore outliers. Then one of the attending brings you in for a chat to see how things are going (family trouble, other issues affecting work, etc). They can offer help (refer to couciling), give you time off, etc to help you deal with personal matters. If that is not the issue then they try to work with you on getting the useful feedback, and making goals on performance. If that fails then a committee meets, etc. Eventually if you consistantly cannot perform up to certain standards then they help you set up rotations at a different institution. The thought is that perhaps it is the environment. These residents could be hired by that other institution or possibly back at Michigan. I have forgotten many details, but the short of it is that it is a long process that takes many months. No one is just fired.

    Think about the following questions. Why would a program want to fire a resident? What have they to gain from it?

    Firing residents only hurts them as a program. They fire people when they have to.

    Now here are my caveats, I am a just a dumb intern and I have not worked as a CA1 yet. Maybe things will change next year and I will find that moral is low, but it sure doesn't look like that from here. I haven't heard about a CA3 being threatened with being fired. I am not saying it is not true because something like that would be quiet unless he/she actually gets fired, then it would be big news. It just seems unlikely.

    Thats my 2 cents

    Ender
     
  12. Green912

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    Thanks for the post Ender. Helps give a more complete perspective.
     
  13. seinfeld

    seinfeld ASA Member

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    My first thought is perhaps this is one the people who was let go. perhaps they are trying to get back at the program for telling them they are not right for anesthesia. In this era of lawsuits for any little thing i doubt they just up and fired a person without merit

    Someone posted that it is the programs fault for not educating them. Have you ever seen a surgery resident who just was not good at operating? Well i have encountered many anesthesia residents who are not good at anesthesia. They would have been much better and less stressed it they went into neurology, Radiology, or internal medicine.

    Remember anesthesia is considered to be one of the ROAD to a good life specialties. not everyone is choosing to do it because their personality, and apitutude fit the responsibilities.

    Thanks Ender for bringing both sides into the story but my overall feeling its just someone who is mad.
     
  14. MaizeBlue

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    Even though unsubstantiated claims such as this one are correctly viewed with skeptisicm by most readers, the allegations here at least warrant a response by someone who is not as misinformed as jswolverine. Ender has done an excellent job of detailing the clinical competency committee process, so nothing more needs to be said there. So, here are the facts (from a Michigan anesthesiology resident).

    Two CA-1's were let go this year. One will retain credit for the entire CA-1 year as Michigan set up anesthesia rotations for him at another hospital to get a 2nd opinion. He was then allowed to finish the year here. He will continue training at another program. Since details surrounding clinical competency are confidential, all that needs to be said is he a great person, great doctor but some have questioned his choice of field.

    The other CA-1 will not continue in anesthesiology. Some skills and characteristics are essential in the practice of anesthesiology. Rarely, these skills cannot be learned.

    There is a reason Michigan anesthesiology grads are sought after by great fellowships and anesthesiology groups. We have a clinical competency committee that ensures a high standard of practice for our graduates. There are around 140 interns, CA-1s, CA-2s, CA-3s and fellows in this program and we lost 2 CA-1s in the last decade (both this year). This is not a persistent problem, nor is morale low in the program. We all feel bad for the CA-1s that we lost, but this is still the greatest place to train in the country (in my opinion).

    Regarding the claim that a 3rd CA-1 was "fired", all I can say is that statement says to me that jswolverine is an uninformed outsider with an agenda. A 3rd CA-1 did leave the program this year because he was a DDS/MD fully-trained oral surgeon who was a couple months into switching fields to anesthesiology when he was offered a great job pulling teeth for a living. As he weighed the option of resident salary for 3 years vs oral surgeon salary for the rest of his life....he left the better field for a great job. You can hardly blame that on the residency program.

    Regarding the claim that the clinical competency committee up and decided to hold back or fire a CA-3 is simply untrue (again discrediting jswolverine's claims that he/she is a colleague, or at least an informed colleague). A CA-3 did recently make some decisions outside the OR and outside the realm of medicine that jeopardized his career, the details of which are, again, confidential. We don't practice medicine in a vacuum, and poor decisions outside the OR will eventually catch up with you at home or work. The residency program did what it always does and helped him work out a solution that is in his best long-term interest. He will be starting his job upon graduation as planned.
     
  15. Green912

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    to paraphrase:

    "A rumor gets halfway around the world before the truth has a chance to get its pants on."
     
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  17. Calilove

    Calilove "Louisianimal"

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    Having only one month to go, I can reflect on negative/positive propaganda that goes on in anesthesiology resident training. As a chief resident, I've had the opportunity to "evaluate" junior residents upon the request of the department chairs.

    Our field is unique in the fact that we are isolated, usually in a room all day with one attending, then with a different one each day. In my residency, we can go up to a month without working with the same attending.

    I've seen many residents receive their poor evaluations based on ONLY one or two workdays with an attending. This is fueled by having that same attending go to his colleague and spread that negativity. Before you know it, the resident is the weak link and only requires a low score on the inservice (which usually happens after taking a totally unnecessary test after only a few weeks of residency) to seal their "weak resident" status.

    I've always thought this was unfair. Everyone can have a "bad" day. I've learned alot from my attendings, including how NOT to evaluate and interact with residents. I've witnessed several attendings at my program and at other institutions, during out rotations, recommend that several CA-3s not be allowed to finish due to several ridiculous reasons including missed arterial and central lines. However, I've seen these same attendings unable to function alone, unable to perform the aforementioned procedures, when left alone without a resident (during conferences, etc.).

    Residents are often deemed as "strong" or "weak" from one encouter... sometimes during the first week of residency! I've seen these conversations firsthand! In our program, I've seen residents be deemed "strong" just for getting in an I.V. and intubating successfully and being a "nice" guy/girl for the day. I've also seen many be deemed "weak" for missing an intubation and not having an "outgoing" personality and just being quiet person (which is seen as disinterest by many attendings)! Evaluation can be very fickle!
     
  18. GassiusClay

    GassiusClay PGY-2

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    Were these CA-1s just not a good fit for anesthesia or were they actually lazy? UofM seemed actually nice, but I guess anyone can be two-faced.

    Any other programs out there that future applicants should know about that do this kind of [email protected], especially bag a last year. That's some Fed up stuff. We need a thread on this stuff to keep programs possibly more honest about their practices.
     
  19. mm78

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    UGHHH...I hope none of the Chitown programs have problems like this. If you know something about UIC, Loyola, UofC, NWMH doing such things, please tell me cuz I'll stay away from that program. I hope not though :(. Fired first year residents. That is gagging on a big one.
     
  20. Bertelman

    Bertelman Maverick!

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    Ummm...

    You may want to read Maize's reply above.
     
  21. MaizeBlue

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    The role of the clinical competency committe is to identify early on (i.e. CA-1 year) residents who will almost for sure run into clinical problems in the future and do not respond to extensive efforts to train them to be safe in the OR. Like I mentioned before, ~200 residents have passed through here the last decade without a single problem and by luck-of-the-draw 2 this year were just not right. I don't understand why you interpret that as two-faced. UofM is an extremely nice environment, but that does not mean that we'll compromise patient safety.

    If you want honesty, please read my post above. I spelled it out clearly for you as best as can be done without compromising confidentiality. The program did not "bag a last year." It is fortunate for this particular CA-3 that his series of bad choices outside the OR occured before he was in practice or his job would have sooner or later been on thin ice.
     
  22. polyposis

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    Thank you for your posts MB. I am more impressed now with Michigan for emphasizing competency and accountability and then actually making good on it.
     
  23. MaizeBlue

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    That's exactly why when you finish your anesthesiology residency at UofM you won't have to settle for a mid-tier job or fellowship. Those in the know understand UofM grads will be strong across the board. The fact that we lost two CA-1s this year was a necessity and an anomaly. I doubt anything similar will happen for another decade.

    And, the best part about the program is that you don't get killed during your training, yet you do incredible cases. There aren't many programs around where you can get extensive experience doing multiple liver transplants, heart/lung transplants, cranis, aortic arches under circ arrest, ventricular assist devices, AAAs/dissections and do it all in ~55hrs/week. I haven't done a regular ortho or gen-surg case in about 8 months (thank goodness). During my residency I've done more circ arrest cases than appendectomies. That's how anesthesiology training should be.
     
  24. coprolalia

    coprolalia Bored Certified

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    :clap:

    This is a HUGE problem across the field of medicine and medical training. The marginally competent resident who shows up, kissess the right a**, smiles a lot, and learns to say "yessir" no matter what will often get higher evaluation marks than his/her colleagues who dares to question authority... even a little.

    Both will miss the same number of lines. Both will forget to order the right test. Both will forget to diagnose something important. These things will happen infrequently, but will happen to everyone.

    The impression of the kiss-a** is that they are earnest, hard-working, and just had a bad day. The impression of the rabble-rouser is that they are a danger.

    It underscores the fact that, while physicians are motivated, intelligent, competent people, they really don't know how to manage people. They've never been trained. They've never learned or been taught how to confront without being confrontational. It's much easier to meet in private committees behind closed doors without the person present and determine the fate of someone who's invested hundreds of thousands of dollars, as well as a lot of blood, sweat, and tears, in their life. It's less painful for them to generate a letter, put it in a file, and then send a courtesy copy via interoffice mail to the person in question. I've seen this happen all the time.

    There are attendings who are meak and clinically not very strong. There are attendings who are bullies and clinically not very strong. Be very wary of these people. They are the ones who will burn you. There are troublemakers throughout any organization, and they have different ways of making trouble for you... if you find yourself in their sights. What a resident has to learn early on, hopefully not painfully, is to identify these people and either put on their best face when they have to interact with them, or try to avoid them altogether (or, at the very least, minimize their interactions).

    This is a system you cannot change as a resident. It's about balance of power, and you have to realize that you have none. If you find yourself in such a system and are being screwed by it, I would suggest that you document - with specific times, dates, and occurrences - your performance and keep it in your own separate file. Then, I would suggest you get a lawyer. It's amazing how quickly the administration will change their tune when you inform them that you've hired a lawyer. Doctors are tough in groups, but become incredibly spineless when confronted with litigation. And, they are typically so bad at managing people that they will not have secured the necessary water-tight documentation to make a strong case against why you are the worst resident they've ever seen when confronted with the bright-light and microscopic scrutiny of a good employment attorney.

    This is a system that demands, indeed prides itself, on expecting that you will recognize that you are a peon, that you know nothing, and that you should be grateful that you have a place to come to everyday with the opportunity. You will be treated poorly from time to time. If you make waves, you will get wet. You will have to learn to either suck it up, take your lumps, and say "thank you sir may I have another" - or you will struggle. Despite the illusions and all pretenses to the contrary, not everyone training you is looking out for your best interest.

    -copro
     
  25. coprolalia

    coprolalia Bored Certified

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    Having said all that...

    I'd like to know who got fired at U of M. Not to sound too evil, but I seriously hope it was one of the former medical students I know who went there (and would've been a CA-1 this year). :smuggrin:

    -copro
     
  26. EKG2007

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    If more than 200 residents have passed without any problem, the standard of clinical competency can not be that high. All of a sudden, two 'weak" CA-1s were fired due to incompetency after FIVE months. How can you possibly identify the weaker ones AND make extensive efforts to help them AND fire them in FIVE months? There got to be something else other than what the chiefs/PD told you guys.

    I know U of M is a great program. However, as I said before, it is a red flag to fire multiple CA-1s no matter what.
     
  27. m3unsure

    m3unsure Junior Member

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    What was with this student? Lazy?
     
  28. coprolalia

    coprolalia Bored Certified

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    Let's just say that I didn't feel this particular student was a good fit for anesthesiology. More 'prima donna' than lazy.

    But, I just checked, and this person's picture is still on the website. So, either they didn't get rid of them, or they just haven't updated that page.

    -copro
     
  29. coprolalia

    coprolalia Bored Certified

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    For this, you need a strong program director and a complicit chair, both of whom fundamentally understand and agree that the primary mission and reason for having residents is to train their future colleagues.

    If you don't have both of these - both are requisite - you're going to be doing your residency in a sweat shop, not a Hallowed Hall of Learning. Doesn't mean you won't ultimately learn your craft; just means it's going to be extra painful during those three or four years. Without being in a supportive environment, your education will tend to be more "fend for yourself" than it will be a systematic, educational experience.

    -copro
     
  30. Arch Guillotti

    Arch Guillotti Senior Member
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    Interesting thread.

    Probably an average of 1 resident every 1-2 years doesn't make it out of my residency program which is medium in size. The vast majority of them just washed out for one reason or another and simply put just weren't cut out for anesthesiology. Unfortunately, part of what hastened their demise was the fact that a few of them didn't get along w/certain attendings. A crummy resident can make it through easily as long as they put on a good face all the time and do half-decent on the inservice. A good resident who bucks the system likely will make it through but may not be in the good graces of everyone. So I am not surprised that a couple washed out at Michigan for whatever reason.

    I guess my point is that you have to play the game and don't fight the power, because there is absolutely no way you can win. I tust very few attendings to "have my back" - but I am sort of a burned out pessimist with the whole residency thing. A lot of the attendings are very "cliquey" - they have their own little social set at work that they are tight with. Cross one and you cross them all. And they talk, just like a bunch of high school gossipers (though to be fair obviously residents bitch to each other about attendings all the time as well). The difference is that we can't really do anything about them whereas they have all the power. I have seen a resident get on the wrong side of an attending, and I have seen that resident mercilessly hounded until they are literally run straight out of the residency. Sucks.

    I am just glad that I have one month more to but up with all this nonsense.
     
  31. MaizeBlue

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    You're right. I should have clarified the timeline in my previous posts. The statement that these residents were let go within 5 months is false (again...and again....lessening the credibility of jswolverine's claim to have insight into the Michigan program).

    After a problem is identified
    by multiple faculty, the clinical competency committee process takes a minimum of 6 months to evaluate, train and give extensive feedback to the resident involved. As mentioned by Ender in an earlier post, after these 6 months UofM usually sets up anesthesia rotations at another hospital so the resident has an opportunity to convince somebody else he/she has what it takes. Of the 2 CA-1s that got let go this year, 1 of them will continue anesthesiology training somewhere else.

    The concept may seem foreign to some, but you can identify clinical competency within the first year of anesthesiology training and that is the goal at U of M. You aren't called into question if you don't know the pKa of Ropivacaine. That's not what clinical competency is all about. It's a matter of judgment. As physicians we are paid to make judgments that will affect people's lives. It is our ability to make educated judgments that sets us apart from non-physicians. Unfortunately just because you have an MD/DO doesn't guarantee you have acquired medically correct or even safe judgment.

    We have a great applicant pool and 99% of the residents do fine.
     
  32. Med0000

    Med0000 ASA Member

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    I wonder why Michigan had to use the scramble to fill spots this year?
     
  33. scotchnwater

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    Word on the street was a lot of people were turned off by (what was perceived as) a pretty brutal intern year (all of Michigan's spots are categorical). One of my classmates matched there and according to him the intern year has already been tweaked a little bit to make it more manageable.

    I thought it seemed like a fantastic program when I interviewed there, just felt Ann Arbor wasn't quite what I was looking for as far as location.
     
  34. fascinoma

    fascinoma destined for excision...

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    I don't recall hearing any specific reasons why they didn't fill, but I would have to agree with Scotch--the intern year there is supposedly brutal. On my interview day I brought it up with our resident tour guide and she mentioned how tough it was, but said no more. Any Michigan interns who are now done care to comment?

    I was not personally impressed with the program at Michigan. I had heard a lot about it before I went--the reputation is quite strong. However, the interview day and the subsequent dinner left me, at best, ambivalent about the program. Just something about it just didn't click for me. I did like Ann Arbor, though. Great little college town. The highlight of my trip was my rental car--brand new cadillac sts...yeah, it cost a bit more than the kia i had reserved, but it was worth it. :)
     
  35. Strength&Speed

    Strength&Speed Need more speed......

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    when you say categorical, do you mean internal or surgical, or both? i know the internal year is difficult, with nearly 10 months of call.
     
    #33 Strength&Speed, Jun 28, 2008
    Last edited: Jun 28, 2008
  36. scotchnwater

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    I don't recall exactly what the schedule consisted of (and I blessedly purged my files of paperwork before my big move), but I believe it was a bit of both, albeit weighted towards the IM side of things. There were months of ICU, Med Wards, etc. I'm not sure if there was surgery or not...

    It was kind of like a Transitional Year (inasmuch as you did lots of different rotations) except it wasn't cush. Quite honestly, that didn't turn me off to the program.

    My program now is very similarly structured (have 2 months of straight-up Surgery, 2 months of ICU, 4 months of IM Wards, 1 month of ER, etc etc etc). I expect to work hard. The hours suck but it was my feeling that I would come out better in the end than doing 4 months of Endocrine consults at a more cushy program.
     
  37. Breathe08

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    I currently am an anesthesiology intern at Michigan. Despite the rumors, we only have 8 months of call. Not 10. In those 8 call months, we have 2 months of ICU, 3 months of surgery (vascular, transplant, neuro, or peds), and 3 months of gen med (pulm, cards, and gen med floors). The program responded to criticism that the intern year was harder than most by dropping the ER month and replacing it with a research month.

    I don't mind working hard during my intern year. I think I will be better prepared for my CA1 year because of the diverse experiences offered. Michigan anesthesiology is looking out for the best interest of their residents. Period. You can't find better training, and the people hiring you after residency know this.

    Also, Michigan has a lot of perks that I did not see at other programs. We get paid 1/364th of our salary when we work holidays. That's an extra 150 bucks! Moreover, we also get a bonus every November that is an extra $3000 in addition to our salary. This is all thanks to the fact that the residents are part of a house officer's association.

    I could go on and on about why Michigan is a great program, but the 4th years invited here for an interview will find out for themselves.
     
  38. lord_jeebus

    lord_jeebus 和魂洋才
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    Isn't a month of emergency medicine now part of the ACGME requirements for the clinical base year? How are they getting around that?
     
  39. LSUfan

    LSUfan Resident

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    Resident [Any Field]
    Does your program have any open spots for finishing my CA-1 starting in Jan or starting my CA-2 in July? My husband got a job offer near our family in michigan, looking to transfer.
    Thanks
     
  40. GoGreen04

    Joined:
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    Other Health Professions Student
    I am thinking of applying to U of M for anesthesia. I am just curious about how the program is now compared to when this thread was first started? (ie program support, resident satisfaction, case load, etc)
     
  41. stimmed

    stimmed New Member

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    Nothing has changed - program support of residents is still excellent, resident satisfaction is still high, and case mix are still world class.

    This shouldn't be surprising since the majority of the OP's "accusations as a concerned citizen" were misplaced fabrications.
     

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