BIDMC Questions for Residents

Discussion in 'Internal Medicine and IM Subspecialties' started by absolutezero, Dec 3, 2008.

  1. absolutezero

    7+ Year Member

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    I recently interviewed at Beth Israel Deaconess and really loved what I heard and saw. I feel like the program really might be a good fit for me. Had a few lingering detail type questions -- would be grateful for input from any current or former BID residents out there (I'm applying for prelim):

    1. What exactly is short call (i.e. when do you start and stop admitting and do you have a cap)?

    2. Is there any cap on # of admissions (including xfers) on long call days or cap on total census?

    3. When you're in the unit, do you have a cap on admissions? Do you ever sleep?

    4. What is being on call like when you're on oncology or cards? As busy as the wards? Are they good learning experiences?

    5. Do interns dictate discharge summaries?

    6. Can interns trade months if it's mutually agreeable?

    7. What is the Ambulatory block? Do prelims do it?

    7. There's scuttlebutt that the PD has been problematic. I couldn't really tell either way from interview day. Does she impact the program negatively at all or is it all just nasty rumors?

    8. Is there anything you might have been reluctant from talking about on interview day that you think applicants should know?

    Thank you!
     
  2. sam79

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    I would try to answer few of the questions. Let me start by writing I am not a resident in BI and I do not want anyone from BI to be offended by the information. For preliminary year I think it is a good place, compared to the other big's MGH & BWH it is very cushy. We say it is like a vacation when you are off to an elective in Beth Israel.

    I would recommend everyone who is going to rank BIDMC high in there rank list to go through the website http://www.eyeonbi.org (especially categoricals)

    There research is sinking, if you look at the papers produced even by there known departments (including cardiology) the numbers are very few to none in pubmed in last couple of years. Half of the cardiology faculty is not at all involved in research of any kind. They have had problems in last few years in matching there applicants to good cardiology programs, even to an extent that they do not want to keep there own residents in the program and some of the very good ones that I have known personally have gone elsewhere.

    Part of the reason is whatever you have heard and read about the PD on forum including scutwork is true. She is very reluctant to call any programs for fellowship and every much against residents switching calls forget about rotations.

    The best thing about the program is the chairman, the guy puts in lots of efforts to recruit good candidates but has met limited success in last few years. Residents are bunch of happy people because it still carries the name of Harvard...

    When you go for rotation in VA (shared by BWH,BU,BI) you can notice the difference between the housestaff. BU people are good clinically and can manage situations because probably they are more busy in the ward months. Brigham people would not only manage cases but would also let you know the latest evidence for the decision. Beth Israel resident who are overly protected and shadowed by attending in there own hospital are seen facing the music at occasions.

    Please disregard my post, if it has nothing to offend any Beth Israel resident. Just that I live with someone who has been extremely frusturated by this hospital for the lack of support in many areas.

    Hope it helps some people!!!
     
  3. pgarora

    pgarora New Member

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    Hi,
    The above post by Sam79 has brought out some facts that were not known to me or my friends. Although the things about PD have been said in the past as well. But the fact of less autonomy as compared to BU and Brigham is very disturbing. I guess for those of us who want to stay in North East the dilemma can be resolved by residents of all three hospitals to share their thoughts.

    The website in the previous post was interesting eyeonbi, any thoughts?
     
  4. Linus2007

    5+ Year Member

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    A little clarification on eye on BI. It is a labor dispute, they are trying to unionize the hospital workers at all the Boston hospitals, the CEO of BI has spoken against this which is why the hospital is being targeted until they are able to form a union. Doesn't affect the medicine department at all.

    I respectfully disagree with not having enough autonomy though, in fact I think the opposite is true. We don't interact with attendings as much as I would like to and usually it is the resident who really takes on that role with the attending within phone call's reach if there are any problems best suited to their level of experience. I would definitely say BU has the most autonomy as they really are just thrown out there.


    1. What exactly is short call (i.e. when do you start and stop admitting and do you have a cap)?

    Short call means you admit overnight admissions. There is a nightfloat team of three residents who start admitting at 8:30pm until 7am and you take on usually several patients per intern, any more admissions go to the long call team.


    2. Is there any cap on # of admissions (including xfers) on long call days or cap on total census?
    There is a time cap for admissions, you basically admit until 8:30pm during wards.


    3. What is being on call like when you're on oncology or cards? As busy as the wards? Are they good learning experiences?

    Oncology can be really busy as there is a very steady flow of patients, you admit to a cap of 10 patients for solids and 8 for liquids (BMT pts) and you stop admitting at 1930. You get oncology rounds at noon but basically most of your learning is on the job. Again as the intern, aside from chemo, you have complete autonomy, I would be the one talking to pts about their cancers, CT scans etc.


    4. Do interns dictate discharge summaries?

    No it is done using a template in the medical record. It is a lot quicker than dictation.


    5. Can interns trade months if it's mutually agreeable?

    Yes.


    6. What is the Ambulatory block? Do prelims do it?

    It is basically the greatest block ever, a nice break. You have clinic in the afternoon and in the morning you have conferences mainly on clinic things like managing HTN, DM, etc etc how to bill correctly (the most important lecture). Prelims do take Ambulatory block.


    7. There's scuttlebutt that the PD has been problematic. I couldn't really tell either way from interview day. Does she impact the program negatively at all or is it all just nasty rumors?

    Actually this issue concerned me the most as I researched thoroughly on Scut as well as other forums. So far she has been great and friendly, also everyone at the program I've spoken to has not encoutered any issues with her. Maybe back in the day she was like that or maybe it was a few disgruntled residents, who knows. Zeidel is the best particularly as he will call your fellowship on your behalf.


    8. Is there anything you might have been reluctant from talking about on interview day that you think applicants should know?

    I still am trying to adjust to a system that has no central attending for the team. At my med school you had one attending who you rounded with etc, at BID you can have several attendings for patients. Which is why this really argues against the prior post, there is not enough attending involvement I think. The program does recognize this and compensates well with attending education rounds which are great but sometimes not ideal if you are slammed as it takes an hour out of the afternoon.


    Any other questions let me know. I really do like it here, the other residents and interns are really great to work with and I do like the teaching that goes on. Plus if I do make an error I am not thrown under the bus, so to speak. I can't comment on whether other programs in Boston are better or worse, if you look at it no-one can unless you attend residency in all those programs.

    My advise to applicants is go with your gut, if you have a great feeling about a program go for it. In terms of academic centers I think they are all the same in terms of research opportunities. I always found it funny when programs advertised including BI the vast amount of money they have available for research etc. It's great if you want to get a job there to do research but as a resident I only have time for something simple like a chart review which is pretty cheap to perform.
     
  5. absolutezero

    7+ Year Member

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    Linus- thank you so much for taking the time to read and answer my questions. That was really helpful and I appreciate your consideration. BI sounds like a great place to train. It will be at or near the top of my rank list.
    AZ
     
  6. Gharfunkle

    7+ Year Member

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    I'm a current Resident at BIDMC.

    To allay some of the concerns, I can comment on a few of the issues raised above.

    1. "Eye on BI" - This is a campaign being waged by the local Service Employees International Union because the workers at BIDMC are not unionized unlike some of the other hospitals around Boston. A lot of the employees at BIDMC, because they're actually very satisfied with their workplace, are actually irritated by the SEIU campaign. Feel free to review our CEO, Paul Levy's blog for further details on the subject. I for one am very satisfied with the work environment at BIDMC.

    2. Research opportunities - Academic opportunities in both clinical and basic science research abound with numerous mentors in many fields, especially cardiology, gastroenterology, hematology/oncology and general medicine. All of these mentors all well-known in their respective fields. Some people were publishing several papers in their intern year. One of our interns last year was first author for an Infectious Diseases study in Annals of Internal Medicine. Of course, academic productivity increases in the 2nd and 3rd year, where there is more opportunity for research time. We get up to 9 weeks of research time in one year, in addition to a 2-week research coruse for those who are more in the early stages and don't have additional degrees or research experience. The faculty are top notch. I personally worked with a great mentor who is associate professor at the Harvard School of Public Health. One of my classmates has published at least 6-8 papers with the TIMI Study group DURING his residency, of which he was first author on several, and he's not even a PhD. I've heard similar opportunities from classmates in other fields such as GI, Heme/Onc, etc. The dude who invented Up-To-Date, Burton Rose, is a nephrologist at BIDMC, as are a number of the Deputy Editors of Up-To-Date. The Deputy Editor of the New England Journal is also on BIDMC staff. If you're interested in diabetes research, the Joslin Diabetes Center is part of the BIDMC system.

    3. Fellowship matches - The Chief of medicine and program director meet with each person planning to apply to fellowship starting early in the season, and will meet with you as often as you like to help you solidify your application. Once you know your top choice program, they both personally call the fellowship director for each applicant's top choice. With regard to the director's letter, it is an amalgamation of letters by three people. The BIDMC Housestaff is divided into Firms, with each firm having its own chief. The point of this firm is to have one leadership faculty get to know you very well over the course of the residency. That's not to say that our PD does not also get to know you well. The final Chair's letter is put together with input from the Firm Chief, the Program Director, and the Chairman of Medicine. I personally applied in cardiology and got my first choice. As for BI not taking its own, Cardiology usually takes 1-2 candidates out of 8 internally. This year, they took 3/8 candidates because there was such a strong pool. We had several people interviewing at the most prestigious cardiology programs, including Partners, Hopkins, Penn, Duke, Cleveland Clinic, or any other top notch program. Of course for people interested in Electrophysiology, BIDMC is the place to be, given the father of modern electrophysiology, Mark Josephson, is our Division chief. It is also a very strong program for echocardiography and MRI imaging, with Warren Manning our many research mentor in that area. Our division chiefs also meet with applicants, and Mark will personally call for you the program director of your top choice when you tell him your choice. And Mark's opinion is not taken lightly in the cardiology world.

    5. Clinical training - I've had ICU nurses who have worked at several hospitals around Boston who have commented that BIDMC residents run the most organized and efficient Codes of any housestaff in town. Clinical training is strong in all of the Boston hospitals, but each has its own styles. Brigham has a reputation of being fellow-driven, so they medicine housestaff often have to request consultations from subspecialty services. MGH is seen as probably the most autonomous of the Harvard programs. BIDMC is a balance between the two. BIDMC also takes its duty hour compliance very seriously, which is important in our housestaff's well-being.

    Overall, I've been happy with my training at BIDMC and the opportunities it has provided. Feel free to PM me with any messages.
     
  7. gcs3

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    You're making some bold generalizations there (with which I strongly disagree), and I wonder where all your bitterness is coming from.

    I'm a PGY2 at BIDMC, and have no regrets about going there. I feel lucky to have the co-residents that I do, and the PD and chair have been nothing but supportive. The claim that BI research is "sinking" is just unfounded -- OP, you're going to need to put up some hard numbers if you're going to make claims like that. I've had no trouble connecting with a research mentor and have been able to publish as a resident and an intern.

    Is it a perfect program for everyone? Of course not, and that's one of the points of the interviewing process - to find the style that works for you.

    I'd be happy to speak with anyone who has specific questions about the program.
     
  8. EyeOnBI

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    Sam79, what is your deal? You are just making yourself look bad. Repeatedly cutting down a program that you are not even a part of is despicable, uninformed, and just plain malignant. What do you have to gain here? I feel sorry for the program that puts up with you. For those of you who want an accurate appraisal of training at BIDMC, please read the posts of people who actually trained here. Also, please view our CEOs blog, runningahospital.org. He sets the tone for our program - one of honesty, transparency, and continual quality improvement. Quite a refreshing approach to the practice of medicine.
     

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