Can be found on residencyandfellowship.com (not written by me) concerning the Duke (Durham) Family Med. Program.
Posted: Fri Nov 11, 2005 7:16 am Post subject: It is Worse Than You Know
The program, lately, has the feel of some creaky, poorly designed machine throwing off parts as it self destructs. The faculty seem edgy and preoccupied and the I sense a general feeling of malaise from the residents and interns.
Everytime I go there they are either at, going to, or coming back from some meeting where I suppose they are wailing, gnashing their teeth, and trying to stop the exodus.
It is not a healthy place to do a residency. Criticism is not tolerated even though evaluations for everything are ubiquetous and mandatory. I have been tracked down on a rotation to come back to the office and fill out some missing evaluations of some meaningless noon conference on some fuzzy, irrelevent subject. I once wrote down an honest criticism and was subsequently brow-beaten, talked too, and harrassed until I admitted I was wrong and more-or-less recanted.
Safer to just put "excellent" in every evaluation category. Who needs the hassle.
I understand that they have, in a panic reaction to some ACGME deficiencies, increased the interns panel of patients for their half day clinic from three to five. It is wonderful to watch them scurrying around between the scarce preceptors and their impatient patients (most of whom are paying customers) trying to get everything done before six so they can dictate and get out before seven.
For those of you who think that five patients for a half-day clinic doesn't sound bad, you have to realize that every single one of them has to be precepted which easily triples the time required for an encounter especially since there is never more than one preceptor for the four or five residents at clinic.
I used to look forward to clinic when I was an intern because it got me out of rotations and let me slow down a little to carefully work up a patient. Speed and efficiency are important but you have to learn to do things the right way first which should mean, for the interns, having a decent amount of time for a history, exam, and most importantly to formulate a plan to present to the preceptor, not presenting in a hurry and writing down the preceptors plan.
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Posted: Fri Nov 11, 2005 10:19 am Post subject: On the Other Hand
If you are into community medicine this might be your program, at least just as soon as they drive away or silence all of the dissenters. The real problem, as I understand it, was the sudden change of foucus of the program from a traditional hospital-based FP residency to a hybrid "community and family medicine program."
One of the interns is leaving for family reasons I have heard so I have no idea of his level of disgruntlement.
I feel kind of sorry for the interns because they are making them sit through all kinds of happy happy joy joy kumbayah inspiring lectures taught largely by medical degree-less instructors extolling the virtues of community medicine with the kind of zeal seen previously only in Soviet re-education camps. It all appears, at least from the outside, to be kind of goofy.
I should add that real medical training suffers for this.
You either buy into the premise or you don't. That is, you either believe that the future of our specialty involves us all becoming just another social welfare functionary or you don't.
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I know I have posted a lot of negative press about this program. I really can't help it. It is so easy and as you can see from this site, scutwork.com, and residencyandfellowship.com The negative press is abundant.
Posted: Fri Nov 11, 2005 7:16 am Post subject: It is Worse Than You Know
The program, lately, has the feel of some creaky, poorly designed machine throwing off parts as it self destructs. The faculty seem edgy and preoccupied and the I sense a general feeling of malaise from the residents and interns.
Everytime I go there they are either at, going to, or coming back from some meeting where I suppose they are wailing, gnashing their teeth, and trying to stop the exodus.
It is not a healthy place to do a residency. Criticism is not tolerated even though evaluations for everything are ubiquetous and mandatory. I have been tracked down on a rotation to come back to the office and fill out some missing evaluations of some meaningless noon conference on some fuzzy, irrelevent subject. I once wrote down an honest criticism and was subsequently brow-beaten, talked too, and harrassed until I admitted I was wrong and more-or-less recanted.
Safer to just put "excellent" in every evaluation category. Who needs the hassle.
I understand that they have, in a panic reaction to some ACGME deficiencies, increased the interns panel of patients for their half day clinic from three to five. It is wonderful to watch them scurrying around between the scarce preceptors and their impatient patients (most of whom are paying customers) trying to get everything done before six so they can dictate and get out before seven.
For those of you who think that five patients for a half-day clinic doesn't sound bad, you have to realize that every single one of them has to be precepted which easily triples the time required for an encounter especially since there is never more than one preceptor for the four or five residents at clinic.
I used to look forward to clinic when I was an intern because it got me out of rotations and let me slow down a little to carefully work up a patient. Speed and efficiency are important but you have to learn to do things the right way first which should mean, for the interns, having a decent amount of time for a history, exam, and most importantly to formulate a plan to present to the preceptor, not presenting in a hurry and writing down the preceptors plan.
_________________________________________________________________
Posted: Fri Nov 11, 2005 10:19 am Post subject: On the Other Hand
If you are into community medicine this might be your program, at least just as soon as they drive away or silence all of the dissenters. The real problem, as I understand it, was the sudden change of foucus of the program from a traditional hospital-based FP residency to a hybrid "community and family medicine program."
One of the interns is leaving for family reasons I have heard so I have no idea of his level of disgruntlement.
I feel kind of sorry for the interns because they are making them sit through all kinds of happy happy joy joy kumbayah inspiring lectures taught largely by medical degree-less instructors extolling the virtues of community medicine with the kind of zeal seen previously only in Soviet re-education camps. It all appears, at least from the outside, to be kind of goofy.
I should add that real medical training suffers for this.
You either buy into the premise or you don't. That is, you either believe that the future of our specialty involves us all becoming just another social welfare functionary or you don't.
_______________________________________________________________
I know I have posted a lot of negative press about this program. I really can't help it. It is so easy and as you can see from this site, scutwork.com, and residencyandfellowship.com The negative press is abundant.