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monkeybaronjr

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I know that there are gripes about the vast majority of military residency programs regarding their inferiority when compared to their civilian counterparts. I know this spans many specialties including general surgery, EM, ENT (as have been mentioned in prior threads). So, my question is simple: are there any military residency programs (Army) that are better than civilian, whether a specialty in general (e.g. military ortho >> civilian ortho?) or a specific program (e.g. Peds @ MAMC >> avg civilian peds?)? Or, are the best military residencies comparable to a mediocre civilian program?

Any input or specific examples (orthopedics anyone??) would be much appreciated! Thanks, all...
 

virtu

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bump; i'd be interested in this information as well.
 
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resxn

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I can definitively state this for the case of otolaryngology in all branches of the military. None have a good reputation compared to their civilian counterparts. I speak this having done a civilian residency and now being AD military.

The USAF/Army residency in ENT in San Antonio does well on the in-service, and routinely rates toward the top, but in terms of operative experience and clinical experience, it is as good as a mediocre civilian program. In terms of reputation, it is no better than mediocre at best when taken together with all programs. There are some nice articles coming from some of the attendings there who I think are all excellent, but the reputation lags for all reasons listed in previous posts.
 

VolatileNavyDoc

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I know that there are gripes about the vast majority of military residency programs regarding their inferiority when compared to their civilian counterparts. I know this spans many specialties including general surgery, EM, ENT (as have been mentioned in prior threads). So, my question is simple: are there any military residency programs (Army) that are better than civilian, whether a specialty in general (e.g. military ortho >> civilian ortho?) or a specific program (e.g. Peds @ MAMC >> avg civilian peds?)? Or, are the best military residencies comparable to a mediocre civilian program?

Any input or specific examples (orthopedics anyone??) would be much appreciated! Thanks, all...

The only example I really have is from NMCSD Peds. This has changed a lot now, but when I was there this is how it was. We worked a lot with the residents and fellows from UCSD. Our Navy residents and fellows were much more prepared to manage patients independently. I think this is because we were trained to work independently from intern year. In the higher acuity areas (NICU/PICU) our residents were expected to actually know how to manage each patient and know everything about that patient, whereas at UCSD, they were treated more like an MSV than a doctor. We were always more comfortable with really sick patients than the UCSD residents. A lot of civillian residents rely on in house specialists to practice medicine for them and become more of accurate referral specialists than astute clinicians. This probably accurately represents how a lot of pediatricians practice in the civilian world, but it doesn't really represent pediatrics in Guam or Keflavik.

They did see a lot more pathology though, and admitted (read wrote admission orders for) some pretty sick kids. I don't know which one would be considered a "better" program. It really depends on what you want. They all have to meet minimum competencies, and I'm sure there is a lot of variation among the civilian residencies as well.
 

edmadison

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I know that there are gripes about the vast majority of military residency programs regarding their inferiority when compared to their civilian counterparts. I know this spans many specialties including general surgery, EM, ENT (as have been mentioned in prior threads). So, my question is simple: are there any military residency programs (Army) that are better than civilian, whether a specialty in general (e.g. military ortho >> civilian ortho?) or a specific program (e.g. Peds @ MAMC >> avg civilian peds?)? Or, are the best military residencies comparable to a mediocre civilian program?

Any input or specific examples (orthopedics anyone??) would be much appreciated! Thanks, all...

I rotated at one civilian and two military ortho programs. In my opinion, the military ortho programs were not even close to the quality of the civilian programs. They simply do not have the case volume.

Ed
 

runningmom

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Can any one speak for the Navy OB/GYN residencies? I would think they would be on par at least if not pretty good compared to the civilian side, but then that is just me guessing. You can't say there is a shortage of pregnancies in the military community!! :laugh:
 

chopper

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Can any one speak for the Navy OB/GYN residencies? I would think they would be on par at least if not pretty good compared to the civilian side, but then that is just me guessing. You can't say there is a shortage of pregnancies in the military community!! :laugh:

Total conjecture here, but I would think you might be a bit light on some of the more interesting GYN stuff that happens in older populations.
 

NavyFP

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I would stack Navy and Army FP programs up against any of our civilian counterparts. Can't speak for AF because I really have not worked with any of their programs.
 

monkeybaronjr

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I rotated at one civilian and two military ortho programs. In my opinion, the military ortho programs were not even close to the quality of the civilian programs. They simply do not have the case volume.

Ed

Which military ortho programs did you rotate at?? Thanks.
 

mitchconnie

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I would stack Navy and Army FP programs up against any of our civilian counterparts. Can't speak for AF because I really have not worked with any of their programs.

Although I have no personal experience with FP, I bet this is totally accurate. FP’s place a very high premium on training without competition from other specialists and the military seems to make this happen at many of its FP training sites.

In general, residencies which are dependent on a large volume of high-acuity inpatients and/or older (Medicare eligible) patients for training are of rapidly declining quality throughout the military. Procedural subspecialties are the most vulnerable since the shrinking med centers no longer generate the necessary high case volume, and administration boots the older, sicker folks out of the system. Gen Surg. and its subspecialties (vascular, CT, colo-rectal, surg-onc, transplant) are particularly hard hit, and the limitations of military EM training have been discussed on other threads. My impression is that some of the other surgical disciplines (urology, ortho, ENT) are declining but still treading water due to a decent volume of outpatient surgery on younger active-duty folks.

In some cases military programs may have a very different case mix than civilian programs. For instance, the ortho program at WRAMC probably has the worlds greatest exposure to complex extremity blast trauma, but very low volume of joint replacement. This is great if you are planning on spending your career at WRAMC or NNMC, but not so nice if you intend to eventually do private practice, where you will never, ever see an IED injury.

Least affected would be specialties that are largely clinic based—FP, peds, derm, etc. They also see a fair number of younger patients which are Tricare Prime, and thus stay in the military system. Training here is probably hurt less by the current downsizing/outsourcing mania, although there might still be issues with staff deployment, lack of staff retention, lack of research programs, etc.
 

Bubblehead-to-MD

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I rotated at one civilian and two military ortho programs. In my opinion, the military ortho programs were not even close to the quality of the civilian programs. They simply do not have the case volume.

Ed

When I recently spoke with the chairman of the Orthopedic Surgery Department at Georgetown University, he told me that the ortho residency programs at NNMC and San Diego were very highly regarded in the civilian community.

Yes, another anecdote, but still good feedback regarding a couple of military residencies nonetheless.
 

Bubblehead-to-MD

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Can any one speak for the Navy OB/GYN residencies? I would think they would be on par at least if not pretty good compared to the civilian side, but then that is just me guessing. You can't say there is a shortage of pregnancies in the military community!! :laugh:

I know the program at NMCP averages close to 400 deliveries a month. I would venture to guess that most civilian hospitals do not deal with that kind of case load.

Based on that, I would say that the military Ob/Gyn residencies are very strong in Ob. Routine Gyn would probably be on par with civilian programs, but as one poster said, they may not see as much Gyn-Onc cases as in the civilian programs.

That being said, it is highly unlikely that you would be doing a Gyn-Onc fellowship at a military facility (you would most likely receive a full deferment or full time outservice (FTOS) due to availability), so the point is almost moot.
 

Bubblehead-to-MD

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Which is ironic, since before the war, it was actually Portsmouth that had the biggest patient base.

I will say that, having rotated through both these programs this year, there was a pretty dramatic difference in case load.

The NNMC program was slammed, and we were seeing 15-25 patients on the wards every morning (probably half were trauma, the rest the elective/consult stuff). The R2s were exhausted from getting hit with MedEvacs 3-5x per week. The ORs were running into the evening and all day Saturday.

NMCSD didn't schedule cases with start times after 2pm, per the demands of nursing. That was fine, because there really weren't that many cases to do anyway. Most days there were zero inpatients to see. The R2s took call once a week, and were usually going home around 4:30p.

Screw what people tell you about "reputation". Before you fill out that rank list, make sure you go look at the these programs in person.

For all I know, the department chair could have formed an opinion of the programs years ago - and is assuming that they are still of the same quality.

I was somewhat surprised by the fact that he did not mention the NMCP ortho program.
 

Bubblehead-to-MD

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3) Strong patient base for elective procedures due to the nature of the local population. Supposedly very heavy on Sports, Foot/Ankle, and Peds.

I've done some shadowing there, and these are primarily the types of cases that I observed.

If you're going to go this route, go to every site. Hell, rotate at all three if you can, even if it means not getting credit from your school. Each program had very distinct personalities, and you really need to spend time there to figure out if you're going to like it.

Thanks for the tips! I have a long ways to go before I get there, but I will be sure to keep that in mind when I do.
 

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Total conjecture here, but I would think you might be a bit light on some of the more interesting GYN stuff that happens in older populations.

I don't know where this notion comes from. I'm at a med cen, and we have some of the oldest sickest (and most painful) patients around. I'm not ob-gyn, but I imagine they have a similar population.
 
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