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I hadn't seen any updated posts on Boston Medical Center /Boston University Medical Center when I was applying last year, so I thought I'd drop this update into the forums. Here are my thoughts as an intern a few months into the program. I don't pretend that this is unbiased-- I'm very happy here. But the match exists for a reason-- this will 'fit' with some people much better than others. Please feel free with any questions you have but don't expect timely replies.
#3+1 system. 3 weeks of pure inpatient /electives, then 1 week of ambulatory medicine. Programs that feature this setup are fundamentally different experiences, for better and worse.
- I get a golden weekend pretty much every month. Pretty much no matter how much you work in those 3 weeks, you will definitely average it out to be below 80 with the clinic week, where you go in from 8-5 on 4 days and only work the morning or afternoon on the fifth. Clinic week also gives you time to progress with extracurricular projects (research, QI, or even just to relax).
- You work pretty hard those weeks on general wards. Whether you think this is worth it or terrible is up to you. I don't think it is a malignant amount of work/hours by any stretch, but it certainly is tough. It is exactly what I wanted from a good training program -- training. You'll put more hours in early while you learn how to be an intern, and it gets faster and easier as you gain experience. I'd say its pretty much on par in terms of workload with most other academic medicine programs from what I've gathered from friends and family.
- Our outpatient week is split morning/afternoons -- you may spend every morning in continuity clinic and every afternoon in a subspecialty clinic, which rotates. The experiences of subspecialty clinic tends to vary quite a lot, but generally, I think it does provide for good teaching with attendings, and you (usually) don't work too hard. Much less ownership than in continuity clinic. Also, some people just dislike ambulatory so much that they don't want a solid week. I certainly prefer inpatient, but I think it is nice to get it out of the way and also to catch up on sleep (A LOT) during that week.
#Patient population. This is simply priceless, and the big reason I came here. In any given day, I'll see a wide variety of diversity along...
- socioeconomic status (the major safety net hospital in the region)
- ethnicity (languages I've never heard of appear in front of me, and hatian creole is probably the #1 language I've seen besides english so far -- and there is good translator service, but yes, it will always take longer with a translator and set your day back, again up to your preferences).
- disease. For example, pott's disease -- not crazy to list on differential of back pain here. You just see absurd things. you get people who walk off the plane and walk into the ED with a white count of 50 and you diagnose AML. You probably see a lot of things at a lot of programs, but the global nature of BMC means that you see disease that would have been prevented or caught much sooner, and that forces you to have a much broader ddx and to learn a lot of 'old school' medicine.
#Autonomy -- I didn't know this was a feature of the program, but it sure is. You get tons at BMC itself, and when we rotate at the VA (about 1/3 of our time, I think) we usually get to maintain that.
#VA -- the VA here is incredible. It is a VA, and it has all of the features and drawbacks of any VA i'm sure, but the attendings are stellar and I don't know many other programs where you get to spend quite a bit of time working with IM residents in other great programs-- spending months on teams with BWH and BIDMC residents, fellows, and attendings all mixed together. Not to mention some spectacular research opportunities here.
#Teaching -- it is just superb. I haven't ever had the chance to work with attendings that give so much autonomy for basic decisions, really allowing me to stretch my muscles and learn how to be independent, while making use of their time on the service for directed, patient-specific teaching. Granted, there is always variability here, but I've had so many attendings that take whatever question the patient's condition brings up and turn it into a quick teaching topic. Some attendings do it during rounds, others set aside formal time during the week. They've all been fantastic so far. I'm sure I'll see a variety here and it won't always be such high quality, but so far, at least in the MICU, cards, and consult services it has been stellar. Also, faculty here have trained at all of the Boston hospitals and at great programs all around, so you get a very nice mix. It doesn't feel inbred, which was important to me. Bottom line, I've always felt like the attendings have considered it as important that I learn as that I work hard.
#Residents -- every program will probably tell you that they have great camaraderie. This is probably true at a lot of programs. You'll just have to come and see if you fit in here-- but I knew right away that I did, and I've made amazing connections already. The people here are AWESOME, and it is a big enough program that you can do what you want-- some residents are into the bar scene, some get together for board games, others go biking and hiking and pretty much everyone loves to eat.
#Conferences This is a specific point that was important to me. At this program, people not only show up to conferences, but are generally pretty vocal as well. I hate sitting in conferences where the moderator asks a question and the room is dead silent. To me, it is important that people have some degree of comfort to speak up and not be petrified of saying something incorrect. I was also looking for a program where it was not strange to be excited about medicine, but also a program where people wouldn't be pretentious. I like the balance we have here.
#Nursing -- I think our relationship (as residents) with nursing at BMC tends to be pretty good. I'd be skeptical of anyone who says it is amazing, because there are a lot of reasons for there to be strain between nursing and residents. Overall, I've so far experienced almost entirely good relationships and understanding, and I'd mark this as a plus for the program.
#Origins and Destinations-- one of the things I like about our program is that you have people from all over the US (and a couple from outside) and from a wide spectrum of programs, small community med schools and large academic programs alike. Also, people match really well. This is always tough to gauge because by the time you apply for fellowship, there is probably a lot more going on than just which program you want to be at (life does progress in residency). Also, unless you know the field, you won't always know where the best programs are. Given all of that, our residents have still matched very, very well from my perspective. I'd take a look at the lists (which are on the website) and draw your own conclusions.
Keep in mind that as far as residents go, we basically only really know our home program. I'm very happy I came here, because it was one of the only programs I saw that really offered me a safety-net population + an incredibly diverse population + academic and research opportunities + a strong VA. To put it simply, considering my next step, I really do feel like I could go anywhere-- but I'm not sure I'd really want to go anywhere else.
#3+1 system. 3 weeks of pure inpatient /electives, then 1 week of ambulatory medicine. Programs that feature this setup are fundamentally different experiences, for better and worse.
- I get a golden weekend pretty much every month. Pretty much no matter how much you work in those 3 weeks, you will definitely average it out to be below 80 with the clinic week, where you go in from 8-5 on 4 days and only work the morning or afternoon on the fifth. Clinic week also gives you time to progress with extracurricular projects (research, QI, or even just to relax).
- You work pretty hard those weeks on general wards. Whether you think this is worth it or terrible is up to you. I don't think it is a malignant amount of work/hours by any stretch, but it certainly is tough. It is exactly what I wanted from a good training program -- training. You'll put more hours in early while you learn how to be an intern, and it gets faster and easier as you gain experience. I'd say its pretty much on par in terms of workload with most other academic medicine programs from what I've gathered from friends and family.
- Our outpatient week is split morning/afternoons -- you may spend every morning in continuity clinic and every afternoon in a subspecialty clinic, which rotates. The experiences of subspecialty clinic tends to vary quite a lot, but generally, I think it does provide for good teaching with attendings, and you (usually) don't work too hard. Much less ownership than in continuity clinic. Also, some people just dislike ambulatory so much that they don't want a solid week. I certainly prefer inpatient, but I think it is nice to get it out of the way and also to catch up on sleep (A LOT) during that week.
#Patient population. This is simply priceless, and the big reason I came here. In any given day, I'll see a wide variety of diversity along...
- socioeconomic status (the major safety net hospital in the region)
- ethnicity (languages I've never heard of appear in front of me, and hatian creole is probably the #1 language I've seen besides english so far -- and there is good translator service, but yes, it will always take longer with a translator and set your day back, again up to your preferences).
- disease. For example, pott's disease -- not crazy to list on differential of back pain here. You just see absurd things. you get people who walk off the plane and walk into the ED with a white count of 50 and you diagnose AML. You probably see a lot of things at a lot of programs, but the global nature of BMC means that you see disease that would have been prevented or caught much sooner, and that forces you to have a much broader ddx and to learn a lot of 'old school' medicine.
#Autonomy -- I didn't know this was a feature of the program, but it sure is. You get tons at BMC itself, and when we rotate at the VA (about 1/3 of our time, I think) we usually get to maintain that.
#VA -- the VA here is incredible. It is a VA, and it has all of the features and drawbacks of any VA i'm sure, but the attendings are stellar and I don't know many other programs where you get to spend quite a bit of time working with IM residents in other great programs-- spending months on teams with BWH and BIDMC residents, fellows, and attendings all mixed together. Not to mention some spectacular research opportunities here.
#Teaching -- it is just superb. I haven't ever had the chance to work with attendings that give so much autonomy for basic decisions, really allowing me to stretch my muscles and learn how to be independent, while making use of their time on the service for directed, patient-specific teaching. Granted, there is always variability here, but I've had so many attendings that take whatever question the patient's condition brings up and turn it into a quick teaching topic. Some attendings do it during rounds, others set aside formal time during the week. They've all been fantastic so far. I'm sure I'll see a variety here and it won't always be such high quality, but so far, at least in the MICU, cards, and consult services it has been stellar. Also, faculty here have trained at all of the Boston hospitals and at great programs all around, so you get a very nice mix. It doesn't feel inbred, which was important to me. Bottom line, I've always felt like the attendings have considered it as important that I learn as that I work hard.
#Residents -- every program will probably tell you that they have great camaraderie. This is probably true at a lot of programs. You'll just have to come and see if you fit in here-- but I knew right away that I did, and I've made amazing connections already. The people here are AWESOME, and it is a big enough program that you can do what you want-- some residents are into the bar scene, some get together for board games, others go biking and hiking and pretty much everyone loves to eat.
#Conferences This is a specific point that was important to me. At this program, people not only show up to conferences, but are generally pretty vocal as well. I hate sitting in conferences where the moderator asks a question and the room is dead silent. To me, it is important that people have some degree of comfort to speak up and not be petrified of saying something incorrect. I was also looking for a program where it was not strange to be excited about medicine, but also a program where people wouldn't be pretentious. I like the balance we have here.
#Nursing -- I think our relationship (as residents) with nursing at BMC tends to be pretty good. I'd be skeptical of anyone who says it is amazing, because there are a lot of reasons for there to be strain between nursing and residents. Overall, I've so far experienced almost entirely good relationships and understanding, and I'd mark this as a plus for the program.
#Origins and Destinations-- one of the things I like about our program is that you have people from all over the US (and a couple from outside) and from a wide spectrum of programs, small community med schools and large academic programs alike. Also, people match really well. This is always tough to gauge because by the time you apply for fellowship, there is probably a lot more going on than just which program you want to be at (life does progress in residency). Also, unless you know the field, you won't always know where the best programs are. Given all of that, our residents have still matched very, very well from my perspective. I'd take a look at the lists (which are on the website) and draw your own conclusions.
Keep in mind that as far as residents go, we basically only really know our home program. I'm very happy I came here, because it was one of the only programs I saw that really offered me a safety-net population + an incredibly diverse population + academic and research opportunities + a strong VA. To put it simply, considering my next step, I really do feel like I could go anywhere-- but I'm not sure I'd really want to go anywhere else.
