usnavdoc said:
I see. So you would categorize your peds program on the same level as say CHOP? Or even a less known University Program? Well maybe you are right. But I highly doubt it. There is more to being a top tier program than a large patient base to work from. To be on track with a University Med Center you need all the other specialties in your hospital to be there in support at the same level you are talking about. You need strong didactics and publications from your dept. Not that I am a snob but there is something to be said about hearing a lecture from the physician who wrote the book on the topic..
CHOP is CHOP. sure, if you take the top 1-2% of programs and compare them to military GME, they won't compare-- but neither will 99% of the civilian university programs.
at our program i have personal contact on a daily basis with pediatric gastroenterologists, neurologists, cardiologists, developmentalists, neonatologists, adoloscent(ologists?? lol), infectious disease (ologists?), pulmonologists, nephrologists, radiologist, nutritionist, physical therapist, occupational therapist, psych, etc etc. we don't have peds rheumatology. that's pretty much it, lol.
usnavdoc said:
Everything I have seen at Portsmouth, Bethesda, SD and now Camp Lejeune function on the level of a community hospital. Good or Bad That is Navy GME. All three have large patient bases to draw patients from and all three do a large number of bread and butter cases. But didactics in all places were not on par with a good civilian University program. Forget about top tier. .
perhaps. my knowledge of portsmouth and lejeune is second-hand, and my experience at Bethesda is limited to peds and OB. the peds program there is the program i'm at (it's a combined NCC program) so everything above applies to it. hardly community caliber. the OB/GYN program, at least from an OB persective, is pretty busy. they have high risk pts (nothing like at inner city programs, as i have yet to see a "crack" baby or HIV+ mom) and run the navy's inertility program so they get a lot of advanced maternal age pts. other than that i can't comment-- but from my point of view they're hardly a community program, if only b/c everything difficutl gets sent there-- from all military facilities.
usnavdoc said:
The largest problem with repairing Military GME is that people PCS and EAS. The stability at most programs is always in question. One year you may have a CT Surgeon. The next the guy from bethesda has to drive down two days a week to do cases. Then there are none. Just the way things work. .
i agree wholeheartedly. continuity military-wide for the most part stinks. with EFMP you can try to keep people in general areas, but between pts and physicians the moving and ETSing makes things difficult.
usnavdoc said:
The next problem would be having to travel to put the check in the box regarding RRC curriculum mandates. Ie...Portsmouth Anesthesiology rotating through UVA. Portsmouth ED rotating through NY poison control center for toxicology. Portsmouth Gen Surg rotating at EVMS..granted not as problematic due to location. Similiar things are done at all Navy MTFs..
this isn't necessarily a bad thing, and is not uncommon even in civilian programs. we go to Children's National for a PICU rotation, and the surgery folks go there for peds surgery. other services fulfill requirements at other local institutions as well-- where i can see this being a problem is when you may have to travel outside of your local area for the rotation-- going 200 miles to fulfill an ICU rotation would really suck, lol.
i think residency is a crapshoot, regardless of where you go. the best advice i can think of is to really know the programs you are applying to so you can hopefully mitigate those programs' weak points through electives and self study, and to take advantage and maximize whatever positives the programs have.
--your friendly nieghborhood ready for dinner caveman
