Applicants beware: Yale EM a mistake

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[Rendar5]

I'm sorry to hear this about your experiences there, and do feel for you if you find that good rotations are being lost (though as someone who only did 2 weeks of CCU, I could not imagine what 2 months are like). I also feel for you if you feel betrayed by your program or put into a position that is of no educational benefit for you. But honestly 2 separate identical posts to warn applicants at a time when people aren't applying yet? methinks there's a bit more going on here and a bit of a different purpose to your post than you say (perhaps a coping mechanism more than anything)

I will say, though, that the better the applicants, the better the program; you yourself are doing a disservice to the program if you're steering well-qualified applicants away from your program.

If you have an issue with the way your program is run, just as you said, the ACGME is coming around and if all the residents in the program truly feel the way that you do, then it will affect both your program and your program director in the way that you feel it should.

 

[GoGetEM]

I agree with Rendar. It's obvious that you are upset, but you are doing a disservice to your program and yourself by driving away strong applicants. Your disappointment will likely pass, but your training program will always be a reflection of you.

 

[xaelia]

My residency is certainly in a similar boat to Yale (I imagine in a sense many residents feel their residency is a sinking ship - but we really are!). We scrambled four spots three years ago. Two EM/IM interns (the entire class) transferred. The next year, we lost five of twelve EM interns to other programs (one came back). Another EM/IM resident switched to IM-only. This year we scrambled three spots (only U.S. program [i.e., the other was Puerto Rico]). Our first-time ABEM written board pass rate for the last five years is 82% (national average is 91%).

A year ago, someone submitted an anonymous complaint to the ACGME regarding deficiencies in our program. The GME head from our hospital came and met with a few residents, said she would follow-up with us in a few months regarding a response from our administration...and nothing ever came of it. GME head came back again this year after we scrambled to find out why, and she suggested that maybe changes would happen now that they'd had a "wake up call". Needless to say, that was met with some skepticism.

I would not count on the ACGME to descend upon your residency to fix the issues.

And, we know why we didn't fill. We didn't fill because our program has a reputation as a miserable place on the interview trail. Why? A significant portion of our faculty are borderline hostile towards medical students because they're otherwise overworked - and the rotating students see the residents miserable at work, as well. Sure, we put on a happy face and song and dance during the interview day - but the student experience at our institution is not enjoyable, and we all know people talk about other programs at interview dinners.

How do we fix this? Easy, replace all the bad attendings with good ones, and then add more! Well, we've had an advertisement in the back of the SAEM rag the entire time I've been out here, and we're just barely faculty attrition neutral. We don't pay enough and we're not located in an appealing enough location to attract faculty, let alone good faculty.

Some things can be fixed with small changes, but significant change requires resources that might be outside the scope of your program director's power.

 

[hrandani]

Although I would never have a shot at Yale I am baffled as to why people think it's bad to let others know your program blows. It's basically the only true feedback you get on programs, everybody else has something to sell you; or they don't want to get in trouble.

The only way to actually get stuff changed is to let people know about it. I agree it's not smart for this guy to post this stuff, as generally someone figures out who you are. However, I stand by the fact that anonymity and honesty are the only defenses we generally have against the absurd power structure of most medical training. Very few careers encourage you to be a whistleblower and report violations of the law (work-hours, etc) yet automatically, permanently blacklist you from everything you're qualified to do.

I'd like to read the letter.

 

[gro2001]

While these changes sounds concerning, and I appreciate how upset and cheated you feel, at this point this is just displaying you dirty laundry to the world. We are a good 6 months away from the next interview season. Since things changed so dramatically in such a short period of time, they may well change again by then. If they do change for the better, all you've done is put an extra blotch on your program's reputation, which can only hurt you, the other residents and graduates of your program. If they don't, this warning coming in September 2011 would be even more effective at protecting the future applicants to your program.

 

[Venko]

Although I would never have a shot at Yale I am baffled as to why people think it's bad to let others know your program blows. It's basically the only true feedback you get on programs, everybody else has something to sell you; or they don't want to get in trouble.

The only way to actually get stuff changed is to let people know about it. I agree it's not smart for this guy to post this stuff, as generally someone figures out who you are. However, I stand by the fact that anonymity and honesty are the only defenses we generally have against the absurd power structure of most medical training. Very few careers encourage you to be a whistleblower and report violations of the law (work-hours, etc) yet automatically, permanently blacklist you from everything you're qualified to do.

I'd like to read the letter.

Its one thing to try and change the system for the better which would be by working within his internal structure and that of the ACGME. It would also be kosher to not post any "go to Yale" rah rah statements. This type of post is another beast entirely, and even if true (I have no personal experience with which to speak), this post could have been better handled...

One resource I would suggest is to contact the graduate school of medicine and ask for an ombudsman (I apologize for the spelling if its off), but its an impartial person from the graduate school to come and evaluate your concerns without singling out any "whistleblowers".

Studentdoctor.net is also full of many people who are in administrations or leadership positions around the country and would be a great resources to ask for suggestions on ways to remedy things or give the residents more say. EMRA is another resource to utilize to help as they are a strong resident advocate nationally.

Lastly, my advice would be to take this down and to post a comment suggesting that people private message you for more information but that in your opinion people should not apply there. It might be the best first step in my humble opinion.

For what its worth, I have a friend who has been attending at Yale for two years and felt it was intense but a worthwhile experience and he would do it again he noted. I have another who is going to join the staff at Yale this coming summer who is a strong, kind, clinician who might help make things better too.

 

[Apollyon]

ombudsman (I apologize for the spelling if its off)

I am dissapointed at teh rediculous and seperate way u definately spelt that word absolutely correctly. I didnt loose my kewl while writing this sentence (which was just my opportunity to use so many of the Internet-specific misspelled words, plus "spelt").

(In other words, you apologize when you get it right. Some of these people - not on this thread, but on this board - seem like they're typing by sound - barely literate, and without apology at the atrocious manner in which they present their ideas. "Speak, that I may know thee" vs. "Better to be thought a fool, than to open one's mouth and remove all doubt".)

 

[Arch Guillotti]

In fact, the loyal followers of SDN will recall that a substantially long letter from a group of our residents (intended for our faculty) was posted on this webpage, only to be taken down a few days later thanks to pressure from our unusually quick to respond administration.

I took down the letter myself due to multiple complaints that were posted in thread as well as users who utilized the "report post" feature. The EM mods and SDN admin agreed with removing the document.

Yale admin had nothing to do it.

 

[otacon88]

My residency is certainly in a similar boat to Yale (I imagine in a sense many residents feel their residency is a sinking ship - but we really are!). We scrambled four spots three years ago. Two EM/IM interns (the entire class) transferred. The next year, we lost five of twelve EM interns to other programs (one came back). Another EM/IM resident switched to IM-only. This year we scrambled three spots (only U.S. program [i.e., the other was Puerto Rico]). Our first-time ABEM written board pass rate for the last five years is 82% (national average is 91%).

A year ago, someone submitted an anonymous complaint to the ACGME regarding deficiencies in our program. The GME head from our hospital came and met with a few residents, said she would follow-up with us in a few months regarding a response from our administration...and nothing ever came of it. GME head came back again this year after we scrambled to find out why, and she suggested that maybe changes would happen now that they'd had a "wake up call". Needless to say, that was met with some skepticism.

I would not count on the ACGME to descend upon your residency to fix the issues.

And, we know why we didn't fill. We didn't fill because our program has a reputation as a miserable place on the interview trail. Why? A significant portion of our faculty are borderline hostile towards medical students because they're otherwise overworked - and the rotating students see the residents miserable at work, as well. Sure, we put on a happy face and song and dance during the interview day - but the student experience at our institution is not enjoyable, and we all know people talk about other programs at interview dinners.

How do we fix this? Easy, replace all the bad attendings with good ones, and then add more! Well, we've had an advertisement in the back of the SAEM rag the entire time I've been out here, and we're just barely faculty attrition neutral. We don't pay enough and we're not located in an appealing enough location to attract faculty, let alone good faculty.

Some things can be fixed with small changes, but significant change requires resources that might be outside the scope of your program director's power.

If you don't mind me asking, where do you train at? You can pm me if you don't want to respond here.

 

[la gringa]

xaelia - i am from the state where i'm pretty sure you are... and the town where your hospital is would be off limits to most people. when i interviewed there for medical school they pretty much laughed at me b/c i have no suitable accent, am from the state's largest city, and went to the flagship state univ. and my mcat was 1.5 pts higher than their avg. i understand their "goals" and all but it seemed to me that the whole institution had a baaad inferiority complex...

 

[la gringa]

also i/r/t yale - word on the street when i applied way back in 2004/5 was that they were still pretty firmly under the thumb of the dept of surgery. sounds like that may still be true i/r/t the rotations?

i worked w/ a gal who trained at yale - she's a great doc. sounds like the internal problems would drive one batty though, now.

 

[deleted109597]

Its one thing to try and change the system for the better which would be by working within his internal structure and that of the ACGME. It would also be kosher to not post any "go to Yale" rah rah statements. This type of post is another beast entirely, and even if true (I have no personal experience with which to speak), this post could have been better handled...

The kind of outside "I know better than you" statements smack of patronizing. For someone to post that, similar to xaelia above, implies that they have likely gone through all of the normal avenues and have given up. Similar to the Hopkins kid with the lawsuit, at some point people have to realize that not all residencies are here to benefit all residents. Often, the residency is an "aside" to the actual department running, and they will devote as little resources as possible to it. To whit, our volume has gone up 20% per year, with a decrease in the number of total residents and a net negative in attendings. The off-site "fast-track" has hired more faculty (FM and PA/NP), but the main department has simply floundered. And when suggestions to hire more people to work are brought up, they are shot down with the "it impedes your training", not that we are getting any teaching from the overworked attendings.
At some point the people in the residency realize the only way to change things is to turn people away. Every single person that went to my medical school and asked me my opinion of the residency was told bluntly the concerns, as well as the benefits. Very few came for interviews, and none of the people I knew matched here.

Of course, one of the benefits to our program is that you can feel comfortable seeing 3 patients per hour but now knowing why you're doing what you're doing. That kind of education goes a long way.

 

[Venko]

The kind of outside "I know better than you" statements smack of patronizing. For someone to post that, similar to xaelia above, implies that they have likely gone through all of the normal avenues and have given up. Similar to the Hopkins kid with the lawsuit, at some point people have to realize that not all residencies are here to benefit all residents. Often, the residency is an "aside" to the actual department running, and they will devote as little resources as possible to it. To whit, our volume has gone up 20% per year, with a decrease in the number of total residents and a net negative in attendings. The off-site "fast-track" has hired more faculty (FM and PA/NP), but the main department has simply floundered. And when suggestions to hire more people to work are brought up, they are shot down with the "it impedes your training", not that we are getting any teaching from the overworked attendings.
At some point the people in the residency realize the only way to change things is to turn people away. Every single person that went to my medical school and asked me my opinion of the residency was told bluntly the concerns, as well as the benefits. Very few came for interviews, and none of the people I knew matched here.

Of course, one of the benefits to our program is that you can feel comfortable seeing 3 patients per hour but now knowing why you're doing what you're doing. That kind of education goes a long way.

Fair point mcninja; I am not in it. Let me say Im sorry for my poor form. Surely they have asked for help in fixing the problems already through all avenues to get to this point. I (for my own opinion) still recommend for their benefit to take it down asap and consider alternative means of assistance. This is just my opinion. I do apologize if I came off as an outsider preaching...I am just worried that if as posted Yale is so terrible and malignant the poster could be in trouble and if it is not as bad as billed the post could frighten potential candidates unnecessarily.

With that said my posts represent my opinion on a topic and I have nonfirst hand experience at Yale from which to speak.

 

[xaelia]

If you don't mind me asking, where do you train at? You can pm me if you don't want to respond here.

I don't mean to advertise my program as a deterrent to future applicants, only to provide illustrative evidence that I feel the OP's pain - and to associate this evidence with a lack of significant administrative recourse. We had our ACGME site visit this year, and, reading through our PIF, we obviously have all the resources and structure of a quality program on paper. I expect they'll be re-accredited for the maximum term. I would not expect the ACMGE to externally influence the situation at Yale, our program, or other programs with similar frustrations.

At the same time, I highly doubt the powers that be at our program are maliciously undermining our education - I don't see where the changes are coming, but I likewise empathize with the impotence they have to make them. But, when only one PGY3 scores above 80 on the inservice and half the graduating class scores below 75...man. Irritating.

 

[deuist]

I remember interviewing at Xaelia's program two years ago. The town didn't turn me off, and the hospital did seem interesting, but it was the rotation schedule that caused me to look elsewhere. When I asked the PD why a 3-year program had ward medicine months, she seemed defensive against the idea that other places had none. Her reply was, "Because you get to build relationships with outside departments."

 

[suckstobeme]

Well, this is just one man's opinion, but I don't think the OP is doing anything wrong, and I don't get why there are so many calls to take it down.

Maybe what the OP is saying is true and legitimate, but maybe not. The applicants should be able to read his post and decide what they want to do with it. They need to due their own due diligence when picking a program; if they cross Yale off their list solely on the basis of this one post, they might be missing out on a great program. At the same time, obviously there's at least one resident there that isn't happy, and if I were an applicant I would want to know about it.

Certainly, I understand the concerns that this may injure the program. I kinda think that we should concern ourselves more with the well-being of applicants and future colleagues instead of "the Program" (even though some current residents may feel the hurt of program probation or program suspension or just having crappy residents around).

These forums are to share knowledge, opinions, (and funny stories), so they should be allowed to serve their purpose.

That said, I recently met a Yale trained doc. He was pretty darn good. They must be doing a few things right. N=1.

Just my two cents.

 

[southerndoc]

I trained at Yale, and we weren't "firmly under the thumb of surgery." I never could tell we were even a section of surgery.

I can't comment on what's going on there now, but I will say that I feel that my training at Yale was top notch. I would do my residency there again in a heartbeat.

 

[medic25]

Just to clarify, Yale EM is no longer under the Department of Surgery. We've had full departmental status since 2009.

 

[spyderdoc]

I trained at Yale, and we weren't "firmly under the thumb of surgery." I never could tell we were even a section of surgery.

I can't comment on what's going on there now, but I will say that I feel that my training at Yale was top notch. I would do my residency there again in a heartbeat.

I concur with Southerndoc.

 

[spyderdoc]

Thread closed per OP request. Plus, it looks like OP self removed the original post, which was not quoted later on in the thread......