Assessing Clinical Training of a Residency Program

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I will be applying to academic IM residencies this fall. My ideal residency program would be one that has great research opportunities and provides excellent clinical training. My ultimate goal is to practice at an academic institution as a faculty member with some percentage of my time dedicated to research. I have a pretty good handle on how to assess research opportunity, but I don't really know how to go about assessing the clinical training of a program. My guesses would be:

(1) Variety and volume of patients residents typical see
(2) Stability/number of teaching faculty
(3) Style and consistency of formal didactics
(4) Positive vs toxic learning environment
(5) Where do residents end up after graduation

Any other recommendations on how to assess the clinical training of a program? i.e. another a metric, or a good question to ask during interviews
Do you think those rankings put out by US News/Doximity are a good proxy for clinical training?

Thank you in advance!

 

[Milotic]

I will be applying to academic IM residencies this fall. My ideal residency program would be one that has great research opportunities and provides excellent clinical training. My ultimate goal is to practice at an academic institution as a faculty member with some percentage of my time dedicated to research. I have a pretty good handle on how to assess research opportunity, but I don't really know how to go about assessing the clinical training of a program. My guesses would be:

(1) Variety and volume of patients residents typical see
(2) Stability/number of teaching faculty
(3) Style and consistency of formal didactics
(4) Positive vs toxic learning environment
(5) Where do residents end up after graduation

Any other recommendations on how to assess the clinical training of a program? i.e. another a metric, or a good question to ask during interviews
Do you think those rankings put out by US News/Doximity are a good proxy for clinical training?

Thank you in advance!

1) Some old timers say Yes because they think Volume = Quality. But this is not always true. Going to the County hospital program to admit 50% Alcohol Withdrawal/Cellulitis patients will not make you a better doctor, honestly. Keeping you there for long hours doing those types of admissions later will make you more miserable unless you're a workhorse who can "tough it out".

2) Meh
3) You will establish whether or not you like the didactics when you interview.
4) See how happy the residents are on interview day. When there is a miserable looking resident ask them what they think. The happy looking ones are always going to say good things about the program.
5) Yes, but be cognizant of the interest of the program. Heavy Cardio programs tend to recruit Cardio lovers, same with GI, etc. If the program doesn't have a fellowship in the respective field you're interested in, it's going to be a lot of headaches to match the fellowship trying to outsource your research etc.

Oh and Doximity is BS. The common rule is to see if they are a University Based hospital (Affiliation doesn't really count unless it's Harvard campuses and the Bayview one for Johns Hopkins). That should be your goal when assessing "prestige".

 

[aafisahar]

Any university program will train you well. You don't need a "County experience", as mentioned earlier. It's mostly drug abuse and etoh withdrawal. You don't learn much except that safety net care is the best reason to be a republican.

Go to a program that suits your career goals. If you want to be a clinician educator, go to a program that supports that. If you want a fellowship, go to a program that supports that. If you want to be a hospitalist or PCP, any decent university program will do. You don't need to go to Hopkins or MGH unless it's an ego thing, that is unless you want to be a powerhouse researcher.

 

[ShiningDragon]

For (1) I would argue that variety of patients is important but be careful of volume. People tend to think higher volume = better but after some point the volume becomes an obstacle to your own education as you're constantly trying to admit/discharge patients without being able to fully sit down and think about them. Programs that say they're main strength is being "clinically" strong are more likely to overload residents with insane number of patients.

Definitely speak with residents about their training and things like how much time do they realistically have to do research (do they have dedicated research elective time or do they have to juggle research time with clinical duties) especially if you're interested in research in residency. Any mid to high tier academic residency should set you up to be an academic hospitalist if you can find the resources. If your goal is fellowship, definitely agree with looking at fellowship match lists for the residency for the past 3-5 years or so.

 

[fasteddie911]

Good question. I'd say it's volume, variety, autonomy, culture and didactics. You don't need to kill yourself with volume, it can affect learning and sometimes you only see the same things over and over. Variety is good too, but even if you don't get it, a good program will give you the tools and such to figure it out when you do see it. You likely won't see everything or know how to do everything in residency. Ultimately ask residents, especially former residents, how they felt about their training there. A lot of it comes down to individual too. Some people could come out rockstars from the worst program, and the best program can't even help the worst residents. Most people I talk to were able to only talk confidently about their training experience after they were an attending, practicing in the real world and seeing how other folks are trained. Most major programs should prepare you well enough. However, don't be fooled, there are some big name programs that aren't as strong as one would think for clinical training. Sometimes focusing too much on subspecialties, research, etc.

 

[Trogghunter]

Find yourself a university program, not necessarily university affiliated, in a fun city or near family and you'll be able to balance good training with some quality of life. Those leadership opportunities will come later. Focus on getting the best training possible and not burning out.

 

[deleted547339]

1) Some old timers say Yes because they think Volume = Quality. But this is not always true. Going to the County hospital program to admit 50% Alcohol Withdrawal/Cellulitis patients will not make you a better doctor, honestly. Keeping you there for long hours doing those types of admissions later will make you more miserable unless you're a workhorse who can "tough it out".

2) Meh
3) You will establish whether or not you like the didactics when you interview.
4) See how happy the residents are on interview day. When there is a miserable looking resident ask them what they think. The happy looking ones are always going to say good things about the program.
5) Yes, but be cognizant of the interest of the program. Heavy Cardio programs tend to recruit Cardio lovers, same with GI, etc. If the program doesn't have a fellowship in the respective field you're interested in, it's going to be a lot of headaches to match the fellowship trying to outsource your research etc.

Oh and Doximity is BS. The common rule is to see if they are a University Based hospital (Affiliation doesn't really count unless it's Harvard campuses and the Bayview one for Johns Hopkins). That should be your goal when assessing "prestige".

I dunno. I’m EM/CCM and I feel like volume is hugely important. You figure out which patient is going to crash by watching enough people breathe a little funny - you can’t put your finger on what it is, but something about how they’re breathing says badness is coming. Maybe it’s not the same in IM, but in both EM and CCM, the only way to learn is volume. It’s rare to catch a spinal epidural abscess in the sea of lower back pain, and the only way to see it is by wading through the water. It also made me that much faster is sorting out the BS.

 

[IMreshopeful]

I dunno. I’m EM/CCM and I feel like volume is hugely important. You figure out which patient is going to crash by watching enough people breathe a little funny - you can’t put your finger on what it is, but something about how they’re breathing says badness is coming. Maybe it’s not the same in IM, but in both EM and CCM, the only way to learn is volume. It’s rare to catch a spinal epidural abscess in the sea of lower back pain, and the only way to see it is by wading through the water. It also made me that much faster is sorting out the BS.

It is a huge difference between IM and EM because we have to work up issues not simply triage and stabilize. I’m treating now the MI that you guys gave heparin/ASA/plavix to, by obtaining the echo, risk stratifying, evaluating for intervention/determining approach, managing complications, etc. Generally by the end of intern year, you have a sense of when a patient is sick and getting worse vs getting better vs stable. This is meant in no way to demean the work that EM does but there is a clear difference

Volume is very important in IM but excess volume compromises patient care. Also variety is important - admitting 10 COPD/PNA/simple CHF patients is very different from managing complex rheumatologic patients, myocarditis, acute renal failure due to GN, etc. Also unlike EM and CCM we see patients in clinic - beyond the inpatient cardiac stuff I also have to manage chronic afib, HF, CAD, and evaluate new complaints