Current Residents: What do you think is most important when ranking?

[curius]

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Hi--I would love if any current residents or above could answer this question, please. I'm struggling a bit with my rank list and was wondering what factors, in retrospect, you think are the Most Important when coming up with a rank list? The ones I'm considering are: quality of teaching, reputation, exposure to diversity of cases and both subspecialty Neuro and general Neuro, work hrs (I like places with a night float), collegiality, size of program (would like 5 residents or above), environment (city, hospital), population diversity, ability to obtain a fellowship afterwards. I plan on doing a fellowship and entering academia after.

One big consideration I have is where my fiancee can go. My fiancee is limited to a couple of locations, one of which I prefer not to rank high but feel like I should so we won't be apart for four years. So I'm weighing my professional happiness with relationship and personal happiness. I would love for us to be together but also want to go to a great program.

Any input would be greaty appreciated. I'm in the Neurology match so I have to submit my rank list by Monday.

Thanks in advance.

 

[3dtp]

I would look very carefully at the integrity of the program and the people that run it. I would look very carefully at their attrition rate and why those who didn't finish didn't. Look also at the board pass rate. The written documents the programs provide are meaningless if the programs aren't going to follow them, so I'd place the program's reputation ahead of everything else. Bad programs do not become better with age.

Ask for their latest RRC review to see where their strengths are and are not. I'd also try to get the names of people who have completed their programs and been away for a year. To be sure of honest answers, you need to find people who graduated, and have moved away from the community where they are not dependent on the hospital for privileges or referrals. Call them and do a thorough background check. Make sure they are what they say they are.

I could be less cynical, but there're a raft of good people who've gone to programs that look good and are out on the streets trying to find another residency. I thought I was numb, but I hear stories frequently of bad programs that still make my jaw drop and my head shake in sadness.

I had a discussion with a program director about some of the shennanagans in GME and he said we need to do something since these guys make us all look bad, but until something can be done ...Lets be careful out there!

Good programs do exist, and I'm not sure there's any foolproof method to guarantee you've found a good one. Good luck.

 

[robotsonic]

For the current residents: Are there any factors that med students seem to place highly but that shouldn't be? For example, now that I'm a fourth year I realize that the factors I used to choose my med school really aren't the ones that ended up being important (for example, the whole "early clinical exposure" in MS1 and 2, which seemed like a great idea and turned out to be useless; PBL wasn't as big of a deal as it was hyped to be, etc). Are there things like that for residency - things you thought were important but turned out not to be?

Thanks in advance.

 

[gwb]

to the OP, i wouldn't sweat the "reputation" or rankings of programs within the same tier. you will get good training and preparation for fellowships at any program, given a certain level of competence. on the other hand, i can't STRESS enough how important it is to have an external network of family, friends, or fiancee to support you outside of the hospital. it really can make the difference between enjoying residency and being miserable and isolated. not to say that residents who move to new cities without knowing a soul won't do just fine- just that it makes a stressful transition so much better if you have some support system intact, especially if you're not second-guessing yourself after a rough day when your fiancee is a million miles away!

it does make it more difficult when you're comparing some programs that are apples and oranges, but at the end of the day, my personal advice would be to rank places where you think you will be happy (never mind hospital rankings) and where you can be with your fiancee. i ended up ranking all the programs in boston above the others despite the fact that i preferred some in nyc. now that i'm happily married...

robotsonic- i can't think of things off the top of my head that i would say were useless but thought were important at the time. feel free to PM me or list some factors you're considering and i'll poopoo what i think is unimportant. what i do think is critical besides family/friends, general competence of a program, is to look beyond the lip service of the interview day and see how well a program takes the well-being of its residents to heart. strong academics? make sure the program has protected time for didactics and that the senior residents take interest in teaching the juniors. emphasis on research? make sure residents actually take time for research and are pursuing a variety of interests. ACGME compliant? see what sort of concrete measures have taken place ie night float, moonlighters, more PA's, etc... you get the picture. good luck!

 

[TommyGunn04]

For the current residents: Are there any factors that med students seem to place highly but that shouldn't be? For example, now that I'm a fourth year I realize that the factors I used to choose my med school really aren't the ones that ended up being important (for example, the whole "early clinical exposure" in MS1 and 2, which seemed like a great idea and turned out to be useless; PBL wasn't as big of a deal as it was hyped to be, etc).

I know this isn't the point of the thread, but I must disagree with your dismissal of the importance of early clinical exposure. At Duke we get onto the wards a year sooner, and I think this has made an enormous difference in my education. I can't fathom how earlier clinical exposure could ever be seen as "useless," even if it's just a matter of interviewing patients on the wards as a 1st year to practice your communication skills, the importance of which is underemphasized and poorly taught in medicine today. Medicine is learned best as it's actually practiced, and the classroom always falls short of simulating that. So the sooner you get to see and "do" medicine as it's really practiced, the more time you have to integrate your science knowledge with your new experiences and your interviewing skills, to start truly "doctoring." What's useless about that??? I agree however, that the importance/efficacy of PBL is typically overstated, and am glad our curriculum incorporates very little of it.

 

[margaritaboy]

I suppose it depends on your residency. For EM, residencies are pretty uniform in their structure and training is excellent at most programs.

Therefore, I looked at where I wanted to live. Geography. Out-doors sports and activities. Did I like the city I was interviewing in? Did I get a good vibe from the residents and faculty that I was going to be working with? Was there something special or innovative about a program?

I think ultimatly it came down to a lot of personal prefrence and gut feeling.

 

[skypilot]

One big consideration I have is where my fiancee can go. My fiancee is limited to a couple of locations, one of which I prefer not to rank high but feel like I should so we won't be apart for four years. So I'm weighing my professional happiness with relationship and personal happiness. I would love for us to be together but also want to go to a great program.

Any input would be greaty appreciated. I'm in the Neurology match so I have to submit my rank list by Monday.

I would definitely go to an area where you can be with your Fiance. If you are really committed to getting married I don't see how you can do otherwise. Maybe you can convince your fiance to move with you no matter what. Four years apart is a long time and a big strain on even the most stable relationship. 🙂

 

[8744]

I know this isn't the point of the thread, but I must disagree with your dismissal of the importance of early clinical exposure. At Duke we get onto the wards a year sooner, and I think this has made an enormous difference in my education. I can't fathom how earlier clinical exposure could ever be seen as "useless," even if it's just a matter of interviewing patients on the wards as a 1st year to practice your communication skills, the importance of which is underemphasized and poorly taught in medicine today. Medicine is learned best as it's actually practiced, and the classroom always falls short of simulating that. So the sooner you get to see and "do" medicine as it's really practiced, the more time you have to integrate your science knowledge with your new experiences and your interviewing skills, to start truly "doctoring." What's useless about that??? I agree however, that the importance/efficacy of PBL is typically overstated, and am glad our curriculum incorporates very little of it.

Yeah, but don't you all then spend third year doing research or other non-ward educational activities?

I'm at Duke by the way. The medical students are pretty sharp, I'll give you that.

 

[Selznick]

I balance my gut feeling of how I'd enjoy working in the environment/culture of the program with all the other technical aspects of the training and give each, essentially equal weight. Are there any residents out there who did that and regret it? Why?

 

[Pilot Doc]

My thoughts

1) Realize you are making an enormous decsion with almost no useful information and you could easily make a good decision that has horrible consequences. Take a deep breath and accept there is no alternative

2) Do not rank any program that does not regularly turn their interns into minimally competent, board certified docs. (i.e lots of people quit/are fired, people fail their boards, remarkably inadequate clinical experience, etc.)

3) After #2, put your fiance's interests first. (Or if you realize you can't, break up because you're not meant to marry.)

4) Next consider OBJECTIVE criteria that you can easily compare between programs. It can be whether they have a X fellowship in house - or how close the city is to ski slopes - whatever is going to make you happiest.

 

[TommyGunn04]

Yeah, but don't you all [at Duke] then spend third year doing research or other non-ward educational activities?

Not entirely. There's a required continuity experience during the 3rd year. While it's officially only a half-day per week, I found that I learned an enormous amount of medicine during this year. You don't get much exposure to outpatient clinics during your core clerkships, so the third year is a time where a great deal of integration of material occurs, as you're increasingly required to work under the time pressures of "real medicine" in a real doctor's clinic, and you're often doing research/reading about topics closely related to clinical care if not directly so. I felt like I grew just as much clinically during my 3rd year as I did during my "clinical year." Others might not have had the same experience, but it definitely made a huge difference for me. Ultimately, although we're not spending large amounts of time practicing medicine as 3rd years it's still a whole extra year in which to integrate what we've learned during the first two years, and as such I strongly believe it's an advantage. Plus, we generally study for the boards during the 3rd year, and doing so after having already done your core clerkships really helps solidify the material (more so than taking the exam before ever having set foot onto the wards).

 

[3dtp]

My thoughts

1) Realize you are making an enormous decsion with almost no useful information and you could easily make a good decision that has horrible consequences. Take a deep breath and accept there is no alternative

2) Do not rank any program that does not regularly turn their interns into minimally competent, board certified docs. (i.e lots of people quit/are fired, people fail their boards, remarkably inadequate clinical experience, etc.)

3) After #2, put your fiance's interests first. (Or if you realize you can't, break up because you're not meant to marry.)

4) Next consider OBJECTIVE criteria that you can easily compare between programs. It can be whether they have a X fellowship in house - or how close the city is to ski slopes - whatever is going to make you happiest.

'zacktly!

 

[bigeyedfish]

I would definitely go to an area where you can be with your Fiance. If you are really committed to getting married I don't see how you can do otherwise. Maybe you can convince your fiance to move with you no matter what. Four years apart is a long time and a big strain on even the most stable relationship. 🙂

What he said. If you think you can be apart four years and still be togother you're a fool. Figure out what your priorities are.

Also realize that no matter what program you go to, you get out of it what you put into it.