I just wanted to add some input as I am a current resident at CC.
Bottom line is there is nothing unique you will see at CCF that you won't also see at the vast majority of other big institutions, but you should worry about all the baggage CCF carries with it (hence the rumors, that really don't seem to be rumors at all).
This is probably true. I think at most of the biggest institutions you will get a broad spectrum of disease with some skew towards the type of urban population close to your center.
Maybe CCF knows something that all the top instututions in the US don't regarding why they should be taking top IMG's and DO's over top US MD graduates. My guess is that CCF can't recruit any of the top US MD graduates, and they'd much rather fill their spots with average MD graduates, top DO's, and top IMG's over below-average US MD graduates. That seems reasonable. Just take a look at the "Official Rank List Help" thread to see where all the top US MD grads want to go. If CCF is so great then why is it so rarely on applicants' lists at all (much less on top)?
I am not sure why top US medical school graduates are not attracted to CC. If I had to guess it probably has to do with previous perceptions about the program (fellow run, malignant etc). I can attest that this must have changed significantly as in my years at CC I have not seen any of the for-mentioned issues on almost all internal medicine services.
The thing about fellows and residents running completely different teams sounds completely absurd to me. For one thing, the fellows would need to run services that are specific to their area of expertise. In order to get adequate fellowship training they would need to get the best cases pertaining to that subspecialty of medicine.
I will just give specific examples.
Cardiology Teaching (internal medicine): has no fellow on the inpatient team. Teaching cases have wide variety of clinical pathology (no clear triaging to a particular service).
Cardiology Fellow run services (no medicine residents) include the imaging service (post-intervention etc), the heart failure service (heart transplant etc), and probably a few others. Ridiculed actually by cardiology fellows for the sheer amount of "intern/resident" work they are doing, including regularly writing 10-15 progress notes per day.
CICU: mix between medicine, anesthesia, and cardiology fellows. This is a fellow run unit (the exact opposite of our MICU) and most of the procedures (swans, pacer wires) are completed by the fellows. Residents write H&Ps and progress notes, presents cases to staff, and take call with fellows. In my opinion, one of our weaker rotations, you would probably have to do 1/block in 3/yrs.
Cardiology Consults: Fellows and Residents. All consults triaged out by cardiology fellow. Residents workup the patients up, present directly to the staff, and call the fellow if they are unsure about some part of the management or unstable/critical patients.
Gastroenterology
Green Team (inpatient GI): mix of fellow/residents. Residents admit, workup, and complete all evaluation of patients. Present to staff/fellow during rounds and then may have further input from the staff/fellow after they have evaluated the patients.
GI Consults: similar to cardiology consults
Hepatology consult: similar to cards/GI consults
Renal:
Gifford (inpatient renal): no fellow, all resident run teams (such as above)
Renal consults: like GI/Cards consults
Pulm/CC
MICU: fellow on each team (3 teams) in 44/bed ICU. Senior resident is the primary team leader with fellow available for help and input. All lines, evaluations, management are initiated by the resident teams and presented to staff.
Pulmonary Consults: like GI/Cards consults
Advanced lung disease: no resident, lung transplant patients, again ridiculed by fellows by the 10-15 notes that they are writing daily.
Hem-Onc
Inpatient (Hem/Onc): fellows on the team with role related primarily to chemotherapy and BMBx etc. Residents workup and evaluated all of the patients. May be more fellow input on the hematology service.
Hem and Onc consults (seperate services): like GI/Cards
Endo: consult service
Well, I guess you must then be blowing smoke regarding CCF's "high acuity and complexity" rating if the fellows get all the best cases and the residents just settle for the "left-overs".
Discussing with different staff (including the MICU director and Hospitalist director) the acuity on the floor at CC based on Medicare data (I will try to get more details) is similar to other hospital ICU levels (probably does not include the largest medical centers). The CC MICU has one of the highest acuity ratings in the country.
If this is true then this is a terrible admission on your part that applicants on this forum should pay real close attention to. The alternative (which seems more likely) is that the subspecialty teams are fellow-run and the residents on those teams play the role of "scut monkey". At most large academic healthcare institutions there are services staffed by attendings, PA's and NP's, but they are the non-teaching services (without residents or fellows) that take cases that aren't deemed worthy of a teaching service (i.e. very straightforward cases like uncomplicated cellulitis) and exist to keep business for the hospital.
I think I have answered the first part of this statement (it is not true).
We definitely are not the "scut monkey" on any of our inpatient medicine or inpatient sub-specialist months. There are some services with high turnover volume (cardiology teaching and solids-onc service) which the program is addressing by adding more residents and dedicated teaching.
We also have quite a few non-teaching hospitalist and NP/PA services. The cases that are deemed non-teaching are triaged to them (especially true for general internal medicine).
If these are the services at CCF that are staffed by residents or fellows then that is a real eye opener indeed. Either way, though I don't think it's healthy for a fellow to completely run a service staffed by residents, I also don't think it's healthy for residents to not be exposed to fellows at all (the fellows should serve as the expert consultants, which will be their role as attendings in most cases anyway).
I think that I have also answered this. We have great exposure to fellows on multiple consults and some inpatient services. Outside of the CICU, they do not run the show. As stated in the quote, they serve as junior consultants and help with management of the respective team.
But, alas, if attendings are so apt to turn an intern's experience into nothing more than an observership (my interviewer admitted that this practice happens at CCF), it really doesn't matter anyway because if this happens to you then you won't be doing anything as an intern regardless of the acuity or complexity of the cases. I love how zzmedicine did nothing to refute or deny this practice.
An intern and residents experience at CC is notable for high levels of autonomy and strong clinical training (with a wide range of highly acute pathology). I have no idea if we are seeing a wider range of pathology then any other big center in the country (probably not), but as one of the largest centers I would argue that we are seeing at least the same level of pathology.
I am not trying to start a war-of-words with RocketMan80s. Just wanted to make sure the recurrent misconceptions of our program can be addressed on sdn.