CA-3 Electives: How Important?

[repititionition]

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I'm fortunate to have my pick of great programs in the geography where I want to live and work after training.

That said, I've looked at the CA-3 year structure (number of elective months) as a big differentiator between programs. Is this as important as I'm making it out to be in my head, or am I over-valuing the ability to design my own education at final year of residency?

All opinions appreciated, truly, cause this is making me run in circles.

 

[ambiturner]

I would look more at the total experience - when I was looking at programs, UCSF had essentially no elective time, yet was one of the best programs in the country. At my program electives were used to round out your experience, and some of the best rotations were elective, but there weren't enough spots for everyone to do them and you were not guaranteed to get them even if requested. So rather than bank on an experience that not everyone will get, I would make your decision based on the experiences everyone is likely to have.

 

[deleted641888]

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[agammaglobulin]

I think it depends on what you want to do/where you want to end up. For example, if the program has elective rotations at a private practice run hospital you're interested in getting a job at, that's worth a lot. My advice if you have your pick of programs is to choose the program in the location you want to live upon completion of residency.

 

[Pharmado]

Electives are nice, but the number and freedom of electives is not high on most people’s list of important characteristics. Location (proximity to family as well as future practice sites), hours, call schedule, prestige, fellowships, finances and personalities should probably all be ahead of electives in your decision making process. If somehow those things are all equal at the end of the day, sure, add electives in as a deciding factor, but remember that the electives that are available now aren’t necessarily the same options you will have in 4 years. One change in leadership and those things all change.

 

[Robotic Wis-Hipple]

A program that offers a lot of elective time implies that they don’t need you to run ORs, take from that what you will both positive and negative. I personally liked having a bunch of elective time my CA-3 year as it let me tailor to what I was planning on doing with my career and/or make up some deficiencies etc.

 

[anbuitachi]

Our program front-loads us in terms of work hours. There is something to say about being able to choose your own adventure during CA-3 year instead of having to do rotations you'll never in your life have to do again (e.g., peds rotation if you're going into adult cardiac). Added benefit of being able to do the "bigger" cases earlier on in training because of the case exposure/volume--the drawback being a pretty tough CA-1 year. I interviewed at some programs that had the amount of work hours increase as you progress during residency which is insane to me.

Wait, dont most program hours increase as you move on? When i was CA1, we only did 'simple' cases (no cardiac/thoracic, no liver transplants, and in general no cases that needs a PA catheter), and we couldn't relieve seniors in senior level cases, but seniors can relieve anyone, so CA1s usually get out before senior residents.

 

[Hoya11]

I'm fortunate to have my pick of great programs in the geography where I want to live and work after training.

That said, I've looked at the CA-3 year structure (number of elective months) as a big differentiator between programs. Is this as important as I'm making it out to be in my head, or am I over-valuing the ability to design my own education at final year of residency?

All opinions appreciated, truly, cause this is making me run in circles.

I wouldnt let CA3 year structure be a big part of the decision making process. You end up doing most of the same stuff either way, as long as there is some elective time, I would focus on other factors for sure.. like location/reputation/call schedule/weekends off per month/people

 

[Hoya11]

Wait, dont most program hours increase as you move on? When i was CA1, we only did 'simple' cases (no cardiac/thoracic, no liver transplants, and in general no cases that needs a PA catheter), and we couldn't relieve seniors in senior level cases, but seniors can relieve anyone, so CA1s usually get out before senior residents.

No, as others have mentioned, some programs (mine included) are "front loaded" which lead to a very busy and intense CA 1-2 years and easier CA3 year with plenty of elective time.

 

[AdmiralChz]

I agree that you shouldn’t pick a program based off of CA-3 offerings, things could very well change in 4 years. But it’s better to consider that rather than focusing on intern year, which is a waste of time.

That being said talking with my co-fellows, CA-3 years vary widely across the country. Looking back, electives are important - especially for a grad not going into fellowship where extra training is provided. The more academic the program, the more likely the divisions are siloed (especially regional). Plus academic ORs are typically slow as elephants, so new grads may not be used to the fast pace of outpatient/PP.

Rotations I would suggest are:
- Regional, especially at a surgery center with Ortho.
- TEE. Basic certification doesn’t mean much, but I think new grads should be able to place a probe and have some clue what they are looking at
- Outpatient Peds. Hell hath no fury like ENT T&A day.
- High-volume OB, if you went to a place with a slow L&D floor like my program.

Obviously not all programs are in a position to offer these, but if I was a PD they would be the rotations I would focus on.

 

[partydoc]

I was able to pretty much design my ca3 year. But, I had no elective time...

 

[deleted641888]

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