Med School: private school in Georgia - no home ortho program
Step 1: 246, Step 2: 249
Research: three experiences, one ortho (awaiting publication)
1. UAMS (Arkansas): September 2010
Program takes 4 per year, mostly from Arkansas or surrounding states though there are certainly exceptions. This was an extremely tight-knit group of guys who work well with each other and support one another. Not a lot of in-fighting. The facilities were amazing and rotations occur at University Hospital, the attached VA hospital, and the Children's Hospital which is just down the road. One of the best peds experience you could ever hope for - the peds attendings are world-renown.
My rotation was 4 weeks - when you arrive, you are automatically assigned to four services for your four weeks (mine were peds, trauma, tumor, and recon). You are also assigned four official nights of call but you are expected to offer to do more (especially on trauma). Other students also rotated at the VA or on sports or F&A. I liked mine because peds and tumor are very strong (the chair - Dr. Nicholas - is a tumor guy). And trauma is where its at for getting to do stuff.
I learned a ton and I'm glad this was my first rotation. The only negatives for me were one or two of the attendings who were over-the-top arrogant and made trouble for the residents who were on their bad-lists. Also, because of how tight-knit the group is, you really have to fit their personality to fit the program. Of course, this is only a bad thing if you don't fit! Lastly, sports seems a little weak and the best recon experience appears to be while on VA, not while on the recon service. Chiefs didn't seem too comfortable with scopes - even basic ones and were scrounging for shoulder cases to get some experience. All other rotations were stellar.
2. UF-Gainesville: October 2010
Loved this program. Gainesville is a great town though the cost of living is pretty high. Again, spent four weeks here rotating on tumor (again, the chair is a tumor guy and the program is world-famous for the Enneking tumor course), trauma, spine, and sports. The students volunteered to take four nights of call. The residents have a night float system so very little call is in-house.
It's UF so the facilities are the best I've ever seen period. They have a huge center dedicated to ortho and rehab. Not to mention, the new South tower of Shands pretty much just houses oncology and ortho. The ORs are all state-of-the-art and the staff is terrific. Some of the nurses/techs can be a little rough to work with but if they get to know you, they'll tell you it's because they don't like the attitude of a lot of the students (understandable).
Parking is hard to come by and the residents pay for it. They are also not allotted much money for meals when on-call. However, with night float this is less of a problem as most residents work shifts.
Obviously tumor is a fantastic rotation and Gibbs and Scarborough are great surgeons. Trauma with Vlasak is great too - he's a little odd but a lot of fun to operate with. Spine is spine. Sports was my biggest disappointment and it seemed to be that way for a lot of the residents as well. Obviously, they have a killer sports department to take care of the UF athletes. But, resident involvement seems pretty minimal. I didn't see them doing much of the cases - even basic stuff like knee scopes and ACLs. With the shoulder/elbow fellow I think this is even more of a problem.
Peds is the biggest problem however. Their peds guy went to Orlando a year or so ago and they currently have no pediatric ortho surgeons. Don't know what they're going to do about this. I wouldn't think it would take long to recruit someone. Plus, there are plans for a dedicated children's hospital, but with the economy as it is, don't know when or if that'll happen.
UF interviews you while you rotate which is both good and bad. Good because you don't have to travel twice. Bad because its your first interview and you tend to get better.
Result: 14 interview offers, attended 12, matched at my favorite program, Summa Health in Akron, OH.
My advice: aways are important and you need to work hard. Often you can get strong letters from guys who are well known in the field. If you end up loving the program you can increase your chance of matching there - especially if you're lacking in some part of your application. However, keep an open mind. By the time the interview season was said and done, my favorite program was neither of the ones where I rotated. PM me for more specifics on either program.
So I spent a month rotating at Atlanta Medical Center. I decided to rotate here primarily because of all the positive reviews I had seen on Orthogate, and the great Atlanta location. Here are my thoughts:
The rotation is set up pretty well, allowing you to maximize your time with all the residents. Your first 2 weeks are on trauma, then you do 1 week of peds, and 1 week of sports/hand. The 2 weeks of trauma are pretty crazy; this hospital is right down the street from Grady and really the only difference between the two is that Grady gets more fractures secondary to gun shots while AMC gets fractures secondary to blunt trauma, which is pretty freakin common in Atlanta. Most nights I would be up all night seeing patients in the ER, splinting, cosenting them for surgery the next day, etc. From talking with the AMC residents who also spend 2 months at Grady, they get (adjusted for hospital size) the same amount orthopaedic trauma that Grady does. So for those 2 weeks of trauma, you are getting to the hospital at 5 a.m., seeing patients and writing progress notes which the residents come by later to sign. At 6:45 a.m. the attendings come in and the resident on call displays all the patients that were admitted with their corresponding x-rays on a huge projected screen. Then after that, they go through all the post-operative x-rays from the previous day and discuss various aspects of each case. Once that finishes up around 7:30 a.m., then we all head to the ER to start various cases. Most days we are in the ER until 5 p.m., but it can stretch further than that. Those students who aren't on call go home around 6 p.m., and the rest stay to see consults.
The 1 week on Sports is freaking cush. I finally got to wake up at a reasonable time, and I drove out to Buckhead (a very ritzy part of Atlanta) to the Sports clinic. We primarily do Sports with Dr. Gilogily, who is the official team surgeon for the Atlanta Falcons and the Atlanta Thrashers (hockey team). His clinic looks like a massive Ritz Carlton hotel, with sign jerseys of various athletes every, 8 physical therapists in house, a crazy nice rehab center, and a spattering of professional and college athletes that come in to see him for their orthopaedic care. During this week you also operate with Dr. Kane, who is the chair and a Sports guy who specializes in shoulder. This is a good time to get some facetime with him.
The last week is split between pediatrics at the Children's Hospital of Atlanta and Hand. This hospital is pretty stingy, so you can't scrub, all you can do is observe, but its still a good experience to see what environment you will be in if you match at AMC. The hand guy there is Dr. Lorie and he is the best teacher I've met in my entire life. He was also trained under Dr. Neer so he is super connected. Its guys like this that you scrub with one to one as a resident at AMC, and that is an aspect that made me excited about the program.
So below is a list of pros and cons that I developed after spending a month there:
cohesive group of residents that are really hilarious and fun to be around
great amount of operative experience overall, and very early operative experience. I saw interns nailing tibias and PGY2s plating distral radius fxs
Great pay for the Atlanta area
Good mix of inner city vs rich city patients due to rotations at buckhead hospitals
no fellows, so every case is just you and the attending.
Brand new operating rooms that were built just for Orthopaedic cases. These rooms are pretty high tech, funded by Synthes with multiple swivel flat screens that can display pre-op X-rays or intra-op fluoro shots
One on one operating with attendings in Atlanta that were trained under big names like Neer and Anderson, So when it comes time for fellowship, all they need to do is make a call
Good fellowship placement. A resident last year matched at Rush and there is one this year going to hopkins for spine
No hospital policy against reps feeding you so they get lots of free lunches from different ortho reps
ability to moonlight for Hand during the PGY 3, 4, and 5 years.
in house PA available to cover floor work
Right down the street from Grady so you get the grady experience without the bad parts of being at Grady
There is no ER residency, only attendings at the hospital, so that makes the experience of being in the ED better somewhat
Ziran is one of their trauma attendings and he is EXTREMELY well known and well connected. And very fun to operate with.
Private attendings that you rotate with are the team docs for the Atlanta Falcons, Atlanta Braves, Atlanta Thrashers, and all the local high school football teams
they have a dedicated phd researcher who is available to help you pump out papers, and dr ziran is still writing tons of papers
-the majority (90%) of their residents are from the south, so its hard to break in there unless you rotate
the hospital itself is pretty old.
definitely not as academic as most other programs. research isn't really required
didactics are mostly resident run (residents teach residents via PPT presentations)
they technically only have 3 main attendings for the program. All the other attendings that you work with as a residents are simply affiliated. not sure how much of a con this is
Their computer system is archaic. like before ms dos archaic. apparently the hospital is inthe process of upgrading to a modern EMR system, but right now its only in the ED
food while on call is terrible. they give you food allowance via "funny money" that can only be used in vending machines that are special for the "funny money". and the selection in the vending machine is terrible. no food place is within walking distance.
hospital is located on a pretty shady road. But about 5 miles away it start to get nice again.
Hey so I rotated at Hopkins last year and wrote this up to share my thoughts. Before I had decided to rotate there I read this thread and was almost convinced to not even rotate because of the malignant atmosphere that was talked about. However my experience after having spent a month there was the complete opposite.
So I will preface all of this by saying that YES, Hopkins in the past WAS MALIGNANT, and the residents, particularly the chief residents will tell you this. X-ray rounds WAS a beat down session and call WAS insane because it was just you covering all of the orthopaedic services for the entire hospital. But with the change of Dr. LaPorte as the PD and a concerted change by the chair to improve the atmosphere, for the past 4 years the program has been completely different and when I arrived to do my rotation I didnt notice even a hint of malignancy. X-ray rounds in the morning are mild even when the resident missed something or could have put on a better splint. Call is still crazy, but is getting more cush as they have hired PAs to do the floor scut leaving you to mainly take care of the ER consults. In 2 years they should have 24 hr PA coverage which also frees up the PGY-2s to be in the OR more. Coming from a home program that isnt malignant at all, I didnt feel uncomfortable at Hopkins. They work you very hard but it definitely is not malignant at all. And most reports of malignancy at Hopkins are from attendings or fellows who were there before the program changed its atmosphere, or heresay from people who talked with people who were familiar with the old Hopkins.
Okay so now that that is out of the way, I will talk about my rotation. When you rotate at Hopkins you have the choice of rotating in Peds, Trauma, Spine, Hand, Tumor, or Joints. I chose Peds which I think is hands down the best experience. My days were involved waking up at 4 a.m. to get to the hospital by 4:30, to start pre-rounds. After pre-rounds and rounds, then we met for X-ray rounds which like most programs involved the resident who was on call overnight going through all of the patients they saw overnight. At my home program, the attending on call is the only attending at X-ray rounds. However at Hopkins the attending over each service comes in to observe patients that would have been admitted to their service, so its a little bit more intense, but barely, and this is from someone coming from a lax mid-west program. After X-ray rounds then we head to the OR. Something that impressed me the most is that the PGY-2s are primarily in the OR, not running the floor and doing scut work like other programs. On the peds service the PGY-2 was with either the attending and the chief, or the attending and the fellow. On the other services, the PGY-2 was first assist a lot of the time. And even though the peds service has a fellow, the cool thing about Hopkins is that the chief resident actually sets the OR schedule for residents and the fellow, so while the fellow does need to learn they dont run the show at all. And there are 4 peds ortho attendings so there is plenty to go around. For peds ortho the volume is unbelievably high, which is why UMD and Union residents come to Hopkins for their peds experience. There is just nothing better. As a student I wasnt pimped really at all. They mostly wanted to get to know me and see if I was a hard-worker that was their main criteria because they work hard, and they dont want to pick up someone elses slack.
In terms of the atmosphere, like I said before there was not a hint of malignancy. The residents there worked hard, but they seemed very happy for my month rotation. Early into my rotation they took all the rotating students out to dinner just to get to know them and they were very cool to hang with and extremely funny. During those drinking sessions the residents loosened up a bit and vented about different aspects of their program, but none of those things were any different from any academic program: OR turn over time, eccentric attendings, BS ED consults, etc. I had a chance to get to know a fair number of residents on different ortho services and all of them very quite nice and diverse too. Some were from Ivy League schools, some were from the south, some were definite silver spoon guys, others seemed more blue collar, some were from overseas, some were from Cali schools, some were women, some were Hispanic, Asian, Black it was just a good mix that all seemed to gel. Im a pretty laid back guy and I really felt like I could get along with the residents for 5 years.
The hospital is absolutely monstrous thats all I can say. Navigating the place took 3 weeks to really get down and I wasnt even visiting the adult hospital side much. I didnt get the chance to observe the other services much, but when I was on call covering all the services with my resident, the trauma team seemed to get very good volume. While the Hopkins residents dont go to UMD-Shock Trauma anymore, they hired/stole one of Shock Traumas best attendings, Dr. Osgood, who really is just an amazing teacher. Because of that Hopkins trauma volume has been steadly increasing, but nothing will ever compare to the volume at Shock Trauma. And if residents are interested in going into trauma, they are allowed to do an elective at Shock Trauma as part of their curriculum. But I feel that the trauma you get at the main hospital is quite adequate. Besides this though, you also rotate at Good Samaritan and Bayview which give you a lot of trauma too, so its a good mix. The Spine service at the main downtown hospital gets the unbelievably complex cases that other spine surgeons dont want to touch. In fact I was told that if a Hopkins resident bases their decision off of the downtown hospital rotation as to whether they would want to go into Spine, they would never chose it, because the cases are crazy. The more bread and better spine is done at their other hospitals (either Bayview or Good Samaritan..cant remember). This is where they get to learn the type of Spine surgery that most Spine surgeons are doing and its a very good experience where you are first assistant just you and the attending. There is a fellow on spine, but only at the downtown hospital, not at the other 2 hospitals. At the downtown hospital, the fellows run the show, not the residents, but this is balanced by the great experience they have at Good Sam and Bayview. I didnt really have any experience with Hand or Tumor so I cant comment on those, but from questioning the residents, their only weak service is Trauma since there is one main attending and maybe Foot & Ankle. Like I said before, I think the Peds service is the best in the country. They see a lot of common cases and completely rare cases that are only done or were pioneered at Hopkins, like pelvic osteotomies for bladder exstrophy where the Urologist and the Orthopaedic surgeon are operating together (blasphemy right, lol).
The thing I liked about Hopkins the most was the well balanced experience. At Mayo (which I think is #1 right?), you have amazing teachers and rare cases being flown in, but your trauma experience is pretty light. At Hopkins you are in Baltimore, which is the city where The Wire was filmed, so you get your inner city and homeless patients coming in off the streets in the ER which you have to see and evaluate and you get your private millionaire that is flown to the hospital on their private plane. There arent many places that you can get that type of experience. I also liked you can see a nice mix of common bread and butter cases and rare cases too.
At the end of my month I was required to give a research presentation between 20-30 minutes on a topic that they selected. All of my other rotations allowed me to chose the topic. Either way this really pushed me to research my stuff so that I would know it well on the day of my presentation. And I would say that this represents the overall atmosphere of the place it really pushes you to get into research and make a mark on the field of medicine, however nobody is stuck-up or stuffy about it. The Hopkins name is big, but they have great hands on experience to back up that name. And by the end of my 1 month rotation, I was very impressed by the skill, patience, cool under fire attitude of the chief residents. I would be happy to be like them after 5 years.
And while fellowship placement is generally a piece of cake, having a resident from Hopkins seems to make placement a little easier. I know this is out of order, but another thing that I was impressed with was that most of the pediatric ortho books I was reading, were contributed by or edited by the attendings at Hopkins. So when attendings have that type of academic clout, it can only help the residents in the end.
So overall, I had a great time with the residents and really liked the program. Forget all the other crap about Hopkins on orthogate. My experience as a rotating student from another state is more on par with what Hopkins is like now. Hope this helps future students considering away rotations.
So I did one of my away electives at Howard this past year. I would describe Howard as an academic program that tends to feel a little bit more community. The main hospitals that you will work in are Howard University Hospital, VA Hospital, Children's Hospital of DC, Providence Hospital, Washington Hospital Center, and some hospital in Virginia for tumor.
The overall operative volume at the main Howard hospital seemed a bit on the low side while I was rotating there. I talked with some of the residents and they told me that since Washington Hospital Center is across the street, the Howard hospital doesn't get a ton of trauma. With that said, you are only at the main hospital for 3 months each year. Otherwise you are spending your time at the other hospitals which do give you a great amount of operative volume. When i went to Providence hospital I got to work with Dr. Rankin, Sr who just finished being the AAOS president (he can definitely get you great fellowships). They do an insane amount of joints at the hospital...its virtually a knee and hip factory there. I didn't have a chance to go to the Children's hospital or the VA hospital but from my understanding they are extremely busy there also.
There are no fellows to deal with so you are mostly working one on one with the attending as a pgy-3 or pgy-4.
Overall the residents were the best thing about Howard. They were all very cool, very down to earth, and hard workers. I had the chance to hang out with them a couple of times and felt that I would enjoy being with them for 5 years.
In terms of cons, I would say the facilities are definitely old. They have an electronic imaging system, but it was crashing for the majority of the time I was there so I'm not sure what its normal state is. Also, while I was there it seemed like they had a lot of clinic time at the main hospital. Also they have to do their tumor rotation at Medical College of Virginia, which isn't all that close.
Overall,I think Howard is a great program. From my time there it seems like the residents all came out with good operative skills, and due to the connections they get from Dr. Rankin and Dr. Thompson they get great fellowships also (got a guy into Pitt for sports).