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Could you please share your experience regarding interviews at Duke (internal medicine program). Any feedback, suggestion or comment is highly appreciated!
Thanks,
Helops
Thanks,
Helops
Duke interview
- Thread starter Helops
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I am assuming you are an applicant and will direct my comments in this direction. I felt like my duke interview day was very relaxed and the program came off looking good. Some hints that I wish I had known. 7:30 start time which is labeled as breakfast but they will talk at you during this time and it's sort of tough to decide whether appeasing your hunger pains/caffeine withdrawal headache is worth eating and drinking while the chair of the department and PD are talking three feet away from you. Either arrive early to eat there, sit in the back or grab something before the day starts. At least for me I had one interview in the AM and one in the PM. This was the first time I had an interview as early as 8am so bring your A game with you to the start of the day and be ready to go. Don't expect to slowly wake up and go interview. I was asked no difficult questions and each interviewer had clearly read my file. The dinner the night before was great and literally every resident I met was friendly and enthusiastic about the program. even the interns on call months. my impression was that this is an incredible program with an equally incredible amount of work and really hard call. I did not feel that Duke's malignant reputation came through at all and either they are hiding it well or it's a thing of the past.
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As a current Duke resident and former Duke med student, I wholeheartedly agree that "malignant" is no longer an applicable descriptor for our program. About 5-10 years ago it probably was, but with Dr. McNeill at the helm things have become MUCH more supportive. I've never had a problem staying under my 80 hours, and have always felt like the program directors and administrators are looking out for me and constantly trying to make our lives better. In fact, I can think of several instances where changes have been made to the program structure in response to resident concerns/complaints. And I've found that, as the previous poster suggests, my fellow residents are a fantastic group of enthusiastic, very bright, very nice people.
The program has TONS of great conferences - more than you could ever possibly attend - and the teaching is just unbelievable. I found the Duke conferences to be on average much better than most others I saw on the interview trail. Although we don't have a night float system and we do about 8 months of q4 call as interns, I wouldn't say that our call nights are particularly "hard" either, as the previous poster suggests. Don't get me wrong...it's rigorous at times...but that's internship! I just don't believe it's busier than any top program at a tertiary medical center, and the ancillary services are so fantastic that we don't waste time doing lots of SCUT (there's an electronic medical record, computerized order entry, PACS viewable from any computer, and an hourly phlebotomy service that will even draw blood cultures!). There probably is a bit more call as an upper level resident though, compared to similar programs like Michigan. Some months are tougher than others, but the tradeoff is that residents have an amazing degree of autonomy, and we take much more of a team approach than I've seen elsewhere. Unlike many programs, when you're on gen med call you're working with a 2nd or 3rd year resident, who you're assigned to for the whole month. The resident runs the team, and the attendings are just there the next morning to make sure we didn't miss something important. I found that working with a more experienced resident really helped enhance my learning experience on several occasions.
Needless to say, I've been VERY happy with the Duke medicine program, and would choose it again in a heartbeat. It's also an enormous plus that Durham is absurdly affordable, and there's lots to do in the area. Most residents buy homes; you can easily get a 1600 sq ft house for $150-160k within a 10 minute drive of the hospital. The weather is great too! I love being an intern, love living in Durham, and love the Duke medicine program!
I'd be happy to answer any questions people might have about the program or about living in the area. Feel free to send me a PM, or just post here. 🙂
The program has TONS of great conferences - more than you could ever possibly attend - and the teaching is just unbelievable. I found the Duke conferences to be on average much better than most others I saw on the interview trail. Although we don't have a night float system and we do about 8 months of q4 call as interns, I wouldn't say that our call nights are particularly "hard" either, as the previous poster suggests. Don't get me wrong...it's rigorous at times...but that's internship! I just don't believe it's busier than any top program at a tertiary medical center, and the ancillary services are so fantastic that we don't waste time doing lots of SCUT (there's an electronic medical record, computerized order entry, PACS viewable from any computer, and an hourly phlebotomy service that will even draw blood cultures!). There probably is a bit more call as an upper level resident though, compared to similar programs like Michigan. Some months are tougher than others, but the tradeoff is that residents have an amazing degree of autonomy, and we take much more of a team approach than I've seen elsewhere. Unlike many programs, when you're on gen med call you're working with a 2nd or 3rd year resident, who you're assigned to for the whole month. The resident runs the team, and the attendings are just there the next morning to make sure we didn't miss something important. I found that working with a more experienced resident really helped enhance my learning experience on several occasions.
Needless to say, I've been VERY happy with the Duke medicine program, and would choose it again in a heartbeat. It's also an enormous plus that Durham is absurdly affordable, and there's lots to do in the area. Most residents buy homes; you can easily get a 1600 sq ft house for $150-160k within a 10 minute drive of the hospital. The weather is great too! I love being an intern, love living in Durham, and love the Duke medicine program!
I'd be happy to answer any questions people might have about the program or about living in the area. Feel free to send me a PM, or just post here. 🙂
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Since you volunteered:
I was wondering how you felt as an intern about the intern only services. It seems like this is different than many programs and honestly a bit frightening. I guess in the long run it helps you "grow up" but I just worry about being intern only on heme-onc, etc.
also, are there any mechanisms for off loading non-teaching cases (post-procedure from the cath lab/GI lab, bone marrow transplant, etc.) that may be off less educational value?
does Duke adhere to admission caps? I heard different stories and it seemed like maybe at Duke hospital this is the case but not at the VA? again I don't know the answer but just trying to figure it out. thanks.
overall, seems like a pretty special place.
I was wondering how you felt as an intern about the intern only services. It seems like this is different than many programs and honestly a bit frightening. I guess in the long run it helps you "grow up" but I just worry about being intern only on heme-onc, etc.
also, are there any mechanisms for off loading non-teaching cases (post-procedure from the cath lab/GI lab, bone marrow transplant, etc.) that may be off less educational value?
does Duke adhere to admission caps? I heard different stories and it seemed like maybe at Duke hospital this is the case but not at the VA? again I don't know the answer but just trying to figure it out. thanks.
overall, seems like a pretty special place.
Hey, I also really enjoyed my interview at Duke. The residents were really friendly and the dinner the night before was great. Anon was right about needing to being prepared for an interview early. My first one was at 8pm and then my second interview was sometime inthe afternoon. Both interviews were really great--they were very laidback and I didn't get asked any tough questions (even though they could have easily asked me about my grades during my 1st 2 years). Lunch was good--once again, a lot of residents showed up and were friendly and helpful. I can't really say anything bad about what I saw about the program--it totally was not malignant or pretentious as I have heard from other people. I guess the only thing I don't like is that the interns have to wear short white coats and don't get to attend morning report with the residents. Also, I'm a little scared about the intern-only wards. One of the interns told me that on his first rotation, he was running one of the cardiology services without any residents!! That seems a little scary to me to say the least. Anyway, overall I absolutely loved the program but can see that the residents have to work really really hard.
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Hey all, I'm a 2nd year at Duke. Also love the place! I'll give some quick answers to the above ?'s. Intern only services are certainly a bit scary, but becoming much less so. They have added teaching residents who come in at night to help the interns. The also have moonlighting for fellows to help on oncology. I did not have these and did fine. The bottom line is that there is support wherever you look and are encouraged to use it. I actually liked the short coat and never felt the least bit inferior because of it. Believe me, most of the time it is a good thing for people to know that you are an intern. Also, when I graduated med school it was amazing but I didn't feel much like a doctor. When I graudated internship...well....still don't but maybe a bit moreso and it was nice to move up to the long coat. Don't know anything about caps and really never cared that much. I guess we work pretty hard, but isn't that what residency is for? The people here are amazing and I can't say enough good things about my experiences. PM me if you have ?'s
I also got a very good impression from my interview at Duke and would echo what others have already said.
My favorite thing I learned about the program is that on most services, there is NO PRE-ROUNDING which means you get to come in at 7:30 am or so, which is pretty sweet.
Also they are one of the 17 programs selected for the Educational Innovations Project (EIP) and if I remember correctly, one of the things they are doing is that you get 3 months of ambulatory experiences and you don't have to go to clinic on your inpatient months.
My favorite thing I learned about the program is that on most services, there is NO PRE-ROUNDING which means you get to come in at 7:30 am or so, which is pretty sweet.
Also they are one of the 17 programs selected for the Educational Innovations Project (EIP) and if I remember correctly, one of the things they are doing is that you get 3 months of ambulatory experiences and you don't have to go to clinic on your inpatient months.
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Thank you very much for your feedback... I have my IV in the second week of Jan and I will post my impression after that as well...
Oh, normally should we sent "thank you" card or "thank you" e-mails?
Thanks again and happy holidays
helops
Oh, normally should we sent "thank you" card or "thank you" e-mails?
Thanks again and happy holidays
helops
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Sounds a little deceptive - have you been 1010? Rolled over to 4040? Then you've capped.
The cap was 7 admissions (and ICU transfers counted 2 for 1), and none after 4am. I don't know if it has been changed.
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I'll try to answer some of these questions here.
Duke adheres VERY strictly to caps, both at the VA and at Duke (it's an ACGME requirement after all). There's actually a lucritive "moonlighting" service that takes admissions after the gen med teams cap. It's staffed voluntarily by 2nd and 3rd year residents, and it pays up to $1,000 per 12 hour shift, depending on what time you get called in (I think it's a minimum of $300). It's a great way to up your income and help pay off med school loans. In addition, we have a hospitalist service that takes a good number of the "less educational" admissions, and does gen med consults for surgical and other services so we don't get scutted out. The ED has a clinical observation unit that also helps limit our exposure to "soft" admissions and rule-out MI's, and the cardiology service has a number of PA's who also take these less educational admissions.
Interns admit a maximum of 5 patients on call and take care of a maximum of 12 at any given time. Also, on gen med months interns aren't allowed to take unit transfers; the resident writes a transfer note and enters orders for these patients. These do count as full admissions though, and thus count towards the cap of 7 for the team. And when there's a sub-I on the service, the intern doesn't have to admit or write orders on these patients! (it's pretty nice)
The "intern only" services have changed a lot this year as well. They're often a source of concern for applicants, but I've found them to be one of the best features of our program. Oncology used to be a dreaded service, as interns were admitting 5 patients and cross-covering on 30-40 rather sick patients (lots of GI bleeds, febrile neutropenia, etc.). Now the hospital has committed to paying fellows to moonlight on this service to do half of the cross-cover, which has transformed it into a very enjoyable month. Instead of running ragged doing cross-cover while trying to admit, we only end up covering 15-20 patients and even having time to sleep! There's also a teaching resident who checks up on all your admissions, to make sure you order the correct studies and don't kill anyone. They even will print out good review articles and teach you things! It made my experience on these rotations really fantastic thus far. On the other hand, the "intern only" months (oncology, cardiology, pulmonary, renal) are absolutely fantastic in terms of forcing you to become good at making clinical decisions on your own. There's always back-up if you need it, but you soon realize how rarely you actually DO need it, because you've learned so much in such a short time. It really helps prepare you for the 2nd and 3rd years, and builds confidence in your clinical skills.
Regarding morning report, there's a reason why interns don't attend. It's geared towards evidence-based medicine, which is a big focus of our program, but not something the intern year is meant to teach. Each morning on gen med one of the residents presents a "CAT," which is a critical appraisal of a journal article about therapeutics, etc. A faculty member and one of the chiefs help moderate discussion and do teaching, and there's also usually a case presentation. Interns are focusing more on the basics of patient management and medicine, not on sensitivities and specificities and hazard ratios, so that's why we don't attend. But we do have our own intern morning report each week on gen med, where an intern presents a case and a faculty member helps lead us through the workup and differential. And there are far more conferences than you could ever possibly attend, so I've never felt like I'm missing out. There's noon conference with free lunch every single day, and they're always really great talks.
I hope that helps!
Duke adheres VERY strictly to caps, both at the VA and at Duke (it's an ACGME requirement after all). There's actually a lucritive "moonlighting" service that takes admissions after the gen med teams cap. It's staffed voluntarily by 2nd and 3rd year residents, and it pays up to $1,000 per 12 hour shift, depending on what time you get called in (I think it's a minimum of $300). It's a great way to up your income and help pay off med school loans. In addition, we have a hospitalist service that takes a good number of the "less educational" admissions, and does gen med consults for surgical and other services so we don't get scutted out. The ED has a clinical observation unit that also helps limit our exposure to "soft" admissions and rule-out MI's, and the cardiology service has a number of PA's who also take these less educational admissions.
Interns admit a maximum of 5 patients on call and take care of a maximum of 12 at any given time. Also, on gen med months interns aren't allowed to take unit transfers; the resident writes a transfer note and enters orders for these patients. These do count as full admissions though, and thus count towards the cap of 7 for the team. And when there's a sub-I on the service, the intern doesn't have to admit or write orders on these patients! (it's pretty nice)
The "intern only" services have changed a lot this year as well. They're often a source of concern for applicants, but I've found them to be one of the best features of our program. Oncology used to be a dreaded service, as interns were admitting 5 patients and cross-covering on 30-40 rather sick patients (lots of GI bleeds, febrile neutropenia, etc.). Now the hospital has committed to paying fellows to moonlight on this service to do half of the cross-cover, which has transformed it into a very enjoyable month. Instead of running ragged doing cross-cover while trying to admit, we only end up covering 15-20 patients and even having time to sleep! There's also a teaching resident who checks up on all your admissions, to make sure you order the correct studies and don't kill anyone. They even will print out good review articles and teach you things! It made my experience on these rotations really fantastic thus far. On the other hand, the "intern only" months (oncology, cardiology, pulmonary, renal) are absolutely fantastic in terms of forcing you to become good at making clinical decisions on your own. There's always back-up if you need it, but you soon realize how rarely you actually DO need it, because you've learned so much in such a short time. It really helps prepare you for the 2nd and 3rd years, and builds confidence in your clinical skills.
Regarding morning report, there's a reason why interns don't attend. It's geared towards evidence-based medicine, which is a big focus of our program, but not something the intern year is meant to teach. Each morning on gen med one of the residents presents a "CAT," which is a critical appraisal of a journal article about therapeutics, etc. A faculty member and one of the chiefs help moderate discussion and do teaching, and there's also usually a case presentation. Interns are focusing more on the basics of patient management and medicine, not on sensitivities and specificities and hazard ratios, so that's why we don't attend. But we do have our own intern morning report each week on gen med, where an intern presents a case and a faculty member helps lead us through the workup and differential. And there are far more conferences than you could ever possibly attend, so I've never felt like I'm missing out. There's noon conference with free lunch every single day, and they're always really great talks.
I hope that helps!
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To those in the know,
Duke uses the 1 resident/1 intern system on the general wards. Under this system, what is the maximum team cap? I assume the resident will usually take 1/2 of the team's patients. How do residents feel about this system, as opposed to the more common (I think?) 1 resident/2 intern set up? Seems like residents would continue to act as interns under the 1R/1intern system. Any thoughts?
Duke uses the 1 resident/1 intern system on the general wards. Under this system, what is the maximum team cap? I assume the resident will usually take 1/2 of the team's patients. How do residents feel about this system, as opposed to the more common (I think?) 1 resident/2 intern set up? Seems like residents would continue to act as interns under the 1R/1intern system. Any thoughts?
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The 1 intern/1 resident system is one of my other favorite features of the program. It's much more team oriented than other places I've seen. The admission cap for the team is 7 per night; intern can take up to 5, and resident takes the other two. But by no means does the resident need to act as the intern. The intern does all cross-cover and enters all the orders, and the resident supervises patient care and directs the plan. The max team cap at any given time is 16, but the intern can only be directly taking care of 12 at a time, per ACGME rules. It's rare to have more than 12 on a team though, and when it does happen there always seem to be enough discharges that you end up back below 12 again by the end of the day; it's not usually an issue.
So in summary, I really like this system. I think it has distinct advantages and a great team feel. But I don't want to monopolize the discussion here...any other Duke people that want to weigh in?
So in summary, I really like this system. I think it has distinct advantages and a great team feel. But I don't want to monopolize the discussion here...any other Duke people that want to weigh in?
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Another dukie here...I'm also open to any comments or questions (feel free to PM me). I love it here. I'm happy. I'm getting smarter. People are nice. I am delighted to see a positive Duke thread up here! I think that our intern year is intense but fabulous. The gen med months at Duke are challenging and stimulating with interesting cases along side of the bread and butter placements that ARE medicine. The VA gen med months are fun too with a great patient base - plus a chance to hone in on different sorts of skills(aka - only 3 phlebotomy draws a day = learning to draw blood well). The off service months were where I learned the most and really got the chance to interact with my attendings. And although intern year was great - life as a second year is far superior. Once in a while I actually feel like I know what I am doing!
As for caps - Duke adheres to the ACGME caps. An genmed/pulm/onc intern will never take more than 5 new admissions at night (on the rare nights of the dreaded genmed "super-cap" the resident will take more than the team total of 7 which is within the ACGME rules, but the intern will stay at 5).
I am happy to answer any other questions here or through PM, but I too would make the same choice again. Trust your gut instinct about any program...even if it means that you don't end up here.
As for caps - Duke adheres to the ACGME caps. An genmed/pulm/onc intern will never take more than 5 new admissions at night (on the rare nights of the dreaded genmed "super-cap" the resident will take more than the team total of 7 which is within the ACGME rules, but the intern will stay at 5).
I am happy to answer any other questions here or through PM, but I too would make the same choice again. Trust your gut instinct about any program...even if it means that you don't end up here.
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a little more than deceptive i'd say. the malignant side's definitely still there. it's just better hidden under all the two faced lies from the current program director. last year when i was an intern, some 50% of us were reduced to tears in the chief resident's office. how many horror stories have you guys heard of people being farmed out to the durham regional hospital for "rehab" because they are not living up to the duke marine standard. how many have been punished with extra er shifts? when are the chiefs ever on our side? how about the two tiered system where you either suck up to the program and become a part of the "inner circle" or be an outcast. how about the super-cap and uncapping? and being the guinea pigs for the EIP just sucks. come on guys, stop lying to the medical students. at least present them with a balanced picture so they can come expected of what they'll get. duke's a good academic program, but it's still malignant as hell and may not be the right choice for everyone.
p.s. when you come to interviews, don't bother talking to the interns, they don't know better and they are eager to please. don't bother talking to us junior residents either, we are all waiting to get into fellowship and no one's going to tell the truth in public. find a few of the cadid senior residents. they might be able to give you a better idea.
p.s. when you come to interviews, don't bother talking to the interns, they don't know better and they are eager to please. don't bother talking to us junior residents either, we are all waiting to get into fellowship and no one's going to tell the truth in public. find a few of the cadid senior residents. they might be able to give you a better idea.
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thank you for the post. pretty scary stuff considering the friendly interview day. anyone at duke care to respond to these comments?
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Wow...this is just plain ridiculous! Everyone is of course entitled to their own opinion, but I'm pretty sure the above tirade doesn't come close to the majority feeling among housestaff in the medicine program. Also, as I mentioned earlier, there have been a number of fantastic changes enacted this year, and as a result my life as an intern has been made much better than it would have been for the above poster last year. Chiefs change each year too, and I've found this year's chiefs to be much more supportive and friendly than some that I've known in the past (although I strongly disagree about them ever not being supportive). I've been at Duke for over 4 years now and have seen the medicine program from several perspectives (med student, sub-I, applicant, and now intern), and I can assure you that being a resident at Duke is NOTHING like the above poster described. Sure, it's a tough program - we still do q4 overnight call, and take more call in the 2nd and 3rd years than some other programs - but it's hardly malignant or mean-spirited. And I still feel like the interview day presentations and representations of the program were entirely accurate.
"Duke marine," I'm not sure what happened to make you so bitter, but I'm quite sure you're in the minority in feeling this way about our wonderful program.
Carol ann, could you weigh in here as well?
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I'll weigh in. First, what I said about caps was in reference to team totals and how many pt's interns can carry at once. Of which I really don't know anything about. Second, that kinda sucks if there is someone in our program who feels that badly about it. I know almost everyone in our 2nd year class and can't think of anyone who might feel that way. Certainly, I can see feeling that way at certain times based on a difficult rotation or experience but not to that extent. It is a tough program no doubt about it. However, people like Carol Ann and many many others make it well worth it. Also, I happen to love the chiefs from both this year and last. Having signouts with them at night on-call as a resident is fantastic. I feel much more confident on rounds with the attending the next day having gone over my admissions with them the night before. Also, I'm not sure why interns or jars wouldn't want to be honest w/ applicants. If I say my program sucks that is somehow going to keep from landing a fellowship?
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Not to try and start a problem but is there substantive truth from those residents that are pro-Duke about punitive extra ER shifts, being sent away to Durham Regional, super-cap/uncapping, interns regularly breaking down crying, etc. I understand that some may not agree with the sentiment of Duke Marines post but is the factual information correct? is this sort of thing going on at Duke even if you guys like the program?
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No problem. I'll try to answer your questions here:
I've never heard anything about extra ER shifts. The person who does scheduling for the ED wouldn't really have anything to do directly with the program leadership either, so that doesn't make sense to me (our ED is an entirely separate program, housed within the surgery department, not medicine). Regarding the Durham Regional allegations, 3rd year residents often choose to go to Durham Regional and most of us spend at least 1 month there during the 3 years so that we get some exposure to a more community medicine setting. I've never heard of anyone getting forced over there because they're somehow viewed as "sub-par," and have known many of our best interns and residents to do rotations there. In fact, one of the changes I've heard for the coming year is that interns will spend 2 weeks in the MICU at Durham Regional, so that there's more opportunity to do critical care and procedures during the first year.
The super-cap is a complicated but rare happening (and it's only on the Duke gen med month, not at the VA or DRH or any other rotations, so it only applies a maximum of 2 months per year). Basically, there are 2 gen med teams on call per call night and each can take 7 admissions (5 per intern and the resident on each team can take another 2 for a total of 7). So if by some act of evil there happens to be an 8th admission, the gen med teams CAN take an additional admission each, but only if the patient comes in before 9 or 10pm if I remember correctly (it never actually happened on my gen med month). Most importantly, it's only the resident who takes this extra patient, not the intern, since we cap at 5 per night in accordance with ACGME rules. And according to the current ACGME rules, residents can actually admit 10 new patients plus 4 transfers per call night, and up to 16 in a 48 hour period, so the super-capping, although quite rare, is actually well within compliance with current regulations. Like I said though, I've never actually seen in happen, but it does every once in a while. But it's certainly not a malignant thing. And after 10pm, if more admissions come in there's a backup "4040" person who takes the next 7 (and gets paid $1,000 for moonlighting, which is an awesome way to make extra cash during the JAR and SAR years). Subsequent admissions generally get held over for admission to the "short call" teams in the morning.
And finally, regarding the regularity of "crying interns," I can honestly say I've never witnessed it, nor have I heard of it happening on more than 1 or 2 occasions this year. Regardless of where you train, internship is quite stressful, and can be a very emotional experience. I've had occasions where I've felt overwhelmed, but I think these are pretty universal during the intern year, and they've always been great learning experiences. But I hardly think there's anyone or anything in particular about our program that makes interns cry regularly!
Sorry that was so long, but I hope it's helpful! I'm happy to be candid about life in this program. I really love it and have overwhelmingly positive things to say, but that doesn't mean I'm being dishonest. There's no incentive for me to somehow inflate or distort the reality of Duke's program on an anonymous message board. There are positive and negative things about every program, but for me the pros definitely outweigh the cons!
I've never heard anything about extra ER shifts. The person who does scheduling for the ED wouldn't really have anything to do directly with the program leadership either, so that doesn't make sense to me (our ED is an entirely separate program, housed within the surgery department, not medicine). Regarding the Durham Regional allegations, 3rd year residents often choose to go to Durham Regional and most of us spend at least 1 month there during the 3 years so that we get some exposure to a more community medicine setting. I've never heard of anyone getting forced over there because they're somehow viewed as "sub-par," and have known many of our best interns and residents to do rotations there. In fact, one of the changes I've heard for the coming year is that interns will spend 2 weeks in the MICU at Durham Regional, so that there's more opportunity to do critical care and procedures during the first year.
The super-cap is a complicated but rare happening (and it's only on the Duke gen med month, not at the VA or DRH or any other rotations, so it only applies a maximum of 2 months per year). Basically, there are 2 gen med teams on call per call night and each can take 7 admissions (5 per intern and the resident on each team can take another 2 for a total of 7). So if by some act of evil there happens to be an 8th admission, the gen med teams CAN take an additional admission each, but only if the patient comes in before 9 or 10pm if I remember correctly (it never actually happened on my gen med month). Most importantly, it's only the resident who takes this extra patient, not the intern, since we cap at 5 per night in accordance with ACGME rules. And according to the current ACGME rules, residents can actually admit 10 new patients plus 4 transfers per call night, and up to 16 in a 48 hour period, so the super-capping, although quite rare, is actually well within compliance with current regulations. Like I said though, I've never actually seen in happen, but it does every once in a while. But it's certainly not a malignant thing. And after 10pm, if more admissions come in there's a backup "4040" person who takes the next 7 (and gets paid $1,000 for moonlighting, which is an awesome way to make extra cash during the JAR and SAR years). Subsequent admissions generally get held over for admission to the "short call" teams in the morning.
And finally, regarding the regularity of "crying interns," I can honestly say I've never witnessed it, nor have I heard of it happening on more than 1 or 2 occasions this year. Regardless of where you train, internship is quite stressful, and can be a very emotional experience. I've had occasions where I've felt overwhelmed, but I think these are pretty universal during the intern year, and they've always been great learning experiences. But I hardly think there's anyone or anything in particular about our program that makes interns cry regularly!
Sorry that was so long, but I hope it's helpful! I'm happy to be candid about life in this program. I really love it and have overwhelmingly positive things to say, but that doesn't mean I'm being dishonest. There's no incentive for me to somehow inflate or distort the reality of Duke's program on an anonymous message board. There are positive and negative things about every program, but for me the pros definitely outweigh the cons!
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Sorry but I dont quite get this? Is Duke the only program that does this? Who decides on the 4040 person, the PD? My understanding was that the on-call team takes all patients. At least thats the convention at the programs I've visited.
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Sorry if that was counfusing...the on-call team does take all patients, but only until they "cap." Duke is a big enough hospital that there are generally more admissions than the medicine teams can take, so we have backup systems like "4040" to admit additional overflow patients to the "short call" teams the next day, or to other services like heme/onc, pulmonary, renal, etc. It's an entirely voluntary position that pays up to $1,000 per 12-hour shift, depending on what time you get called in. It's basically a way for residents to be able to moonlight to make some extra cash, and is a good enough deal that everyone wants to do it and there's never a problem with getting the slots filled. There's also a hospitalist service with no residents that takes extra and/or non-educational admissions to help make the gen med services more palatable.
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Wow! Thanks for the info. This is great..
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duke marine? didn't you have anything else to do on Christmas than be sad and bitter? I'm always a little bitter, but unless I'm in the hospital I'm not rushing to post it online...
- as for crying on the "couch of tears," I view it as a privilege to have cried there last year. No one berated me into crying, it was more the whole being a doctor is a lot of responsibility and hard thing (well there is a little more to the story but we will leave it there) but there was little hostility involved...
- I've never heard of punishment with extra ER shifts, seems unusual.
- I know of one person who's schedule was changed to involve a trip out to Durham regional early in intern year due to a multitude of factors, but mainly to help that person learn to be more efficient on a less intense rotation, but that is the exception rather than the rule
- overall Duke isn't perfect, but nowhere is. EIP is a work in progress and there have been problems, but there have been a lot of benefits as well. THIS IS NOT A MALIGNANT PROGRAM (and this is coming from a whiny over-sensitive freak). If you need a hug mr. duke marine, just let me know (i'm a little worried if someone in my class actually feels that way - maybe I just live in my happy little lala land).
- and Art, I sure like you too stranger....and TommyGunn - I'm terribly curious who you are in real life.
S
- as for crying on the "couch of tears," I view it as a privilege to have cried there last year. No one berated me into crying, it was more the whole being a doctor is a lot of responsibility and hard thing (well there is a little more to the story but we will leave it there) but there was little hostility involved...
- I've never heard of punishment with extra ER shifts, seems unusual.
- I know of one person who's schedule was changed to involve a trip out to Durham regional early in intern year due to a multitude of factors, but mainly to help that person learn to be more efficient on a less intense rotation, but that is the exception rather than the rule
- overall Duke isn't perfect, but nowhere is. EIP is a work in progress and there have been problems, but there have been a lot of benefits as well. THIS IS NOT A MALIGNANT PROGRAM (and this is coming from a whiny over-sensitive freak). If you need a hug mr. duke marine, just let me know (i'm a little worried if someone in my class actually feels that way - maybe I just live in my happy little lala land).
- and Art, I sure like you too stranger....and TommyGunn - I'm terribly curious who you are in real life.
S
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what concerns me the most about the reaction to duke marine's post is the level of defensiveness coming from the other residents at the program, and the way you guys are just dismissing or discrediting everything he's saying. he's just giving his opinion, and he has every right to, and to see his classmates write condescending things like "didn't you have anything else to do on christmas than be sad and bitter" and mocking him with lines like "if you need a hug mr. dukemarine..." just lend credence to the type of environment he was complaining about. what you guys have shown in this thread is that if you're a resident at duke and complain or say something to make duke look bad, your colleagues will team up against you and attack...you say something that exposes the flaws of the program and you get lambasted by your classmates. if these boards weren't anonymous, i can see how he'd be punished, just like he said.
sounds like a lot of drama to me...drama that i wouldn't want to deal with and all of it coming from the duke residents "duking" it out on this thread, no less.
sounds like a lot of drama to me...drama that i wouldn't want to deal with and all of it coming from the duke residents "duking" it out on this thread, no less.
I don't know about that--if I were proud of my school and someone was bashing it, I think I would get a little defensive also. I'm not going to base my decision on where to rank the program based on what's said on this forum, I pretty much decided I was going to rank Duke highly after getting a feel for the program myself. I didn't think it was malignant at all--in fact, it was one of the friendliest places I interviewed at. Yeah I'm sure it's tough, but I wouldn't expect anything less. Just my two cents.
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mcindoe,
WTF are you talking about? Have you even read the posts in this thread? Giving my impression of the program and saying that I have never heard of these terrible things is not defensive. I said that it made me sad to think that people feel that way about Duke. It would make me sadder if things like that truly happened here. Not only have I not heard of these things...but often the chiefs will give B-ball tickets to people who get pulled or make a sacrifice for the team. I think Carol like myself was upset by the tone of dukemarines comments rather than the content. I guess in the end I am willing to defend or be defensive about people I care a great deal about.
WTF are you talking about? Have you even read the posts in this thread? Giving my impression of the program and saying that I have never heard of these terrible things is not defensive. I said that it made me sad to think that people feel that way about Duke. It would make me sadder if things like that truly happened here. Not only have I not heard of these things...but often the chiefs will give B-ball tickets to people who get pulled or make a sacrifice for the team. I think Carol like myself was upset by the tone of dukemarines comments rather than the content. I guess in the end I am willing to defend or be defensive about people I care a great deal about.
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I go with what art said. and to be completely honest knowing Art and myself, as well as having a darn good guess who tommyg is - we are all pretty nice people. Perhaps tone doesn't translate well via the internet, but whoever duke marine may or may not be, I would certainly ask them what they were upset about in the real world too; and I wouldn't let them give what I saw as misinformation to applicants while sitting at a table over lunch or dinner, so why would I here! I would really hug duke marine if those sentiments are sincere - I think that we are here to help each other out. I feel supported, and I am sorry if s/he does not.
I knew there was a reason that I gave up forums - too much BS, and drama generation for me. I will not try to give out information and then get slapped in the face by a stranger. Happy to discuss Duke with anyone - just feel free to PM me as I have plenty of time on my hands for the next 5 weeks or so, but i politely withdraw and leave the informing part of this thread in the able hands of my colleagues. For those of you coming to interview in the tail end of the season, I look forward to meeting you.
zzz
I knew there was a reason that I gave up forums - too much BS, and drama generation for me. I will not try to give out information and then get slapped in the face by a stranger. Happy to discuss Duke with anyone - just feel free to PM me as I have plenty of time on my hands for the next 5 weeks or so, but i politely withdraw and leave the informing part of this thread in the able hands of my colleagues. For those of you coming to interview in the tail end of the season, I look forward to meeting you.
zzz
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well i wasn't planning on posting anything else. but now i've read carol and art's reply i do have a few things to say.
first of all, there's no need for rudeness or sarcasm on this forum. i was just trying to present my opinion about the program. and it is one happened to be shared by quite a few duke residents/interns. although it may not be what you would liked to read i hope you would at least respect it, for i'm a duke resident just like you.
art, just because you haven't heard doesn't mean things didn't happen. just last week, one of the resident (not intern) was berated to tears by one of the chief. and it was for the stupidest thing. i can't name names for obvious reasons. we don't get upset about hard work because that's what we signed up for. what we get upset about is the lack of support and worse the automatic accusations of being lazy/stupid everytime when something goes wrong. with a few exceptions the duke chiefs are never on your side. and worse they like to make a small incident into a big deal and make an example out of you so they could look like the "competent chief". there were occasions where the original person who brought up the issues were shocked and even angered by the ways things were dealt "i only asked him to mention it to the residents, there was no need for the punishment". and as for the program director, she does it in real style. after all the accusaions and punishments are given out, she then offers you the number to the hospital support line and her cell phone. oh please call if you feel stressed out. hahaha, are you for real? is this some kind of sick joke? wasn't you the one that caused all our miseries in the first place.
art you know what the chiefs call the durham regional hospital (DRH)? the durham rehab hospital. i'm sure the joke's lost on those who were sent there.
there's more but i'll stop the story telling here.
duke's a good program and there's no doubt about it. if you are good, hard working, do as told and don't ask questions, you'll do very well here. and if you miss a few of the qualities mentioned above but happen to kiss behind really well, you'll do great too. but unfortunately not everyone's like that. and at duke as i mentioned there's a two tiered system. if you're a part of the inner circle, you are set for life. but if you are not, well life may not be so kind to you and you'll be made to feel it's all your fault in the first place. unfortunately despite it being a big program, there's no room for dissident opinions in the "duke marine". and you know what i'm starting to feel this way too on this forum.
if you are applying to duke i would have a real good look around too. duke's a top 10 program but i think (although i may be wrong) there are other top 10 programs out there that are not so mean spirited.
anyways, this is how i feel about it one and half years into the program. carol you asked me if i didn't have anything better to do other than being sad and bitter on christmas day. well, letting go of the juvenileness ofw the comment this is what i have to say. if i was sad and bitter on christmas day didn't that just add more weight to my opinion about the program?
first of all, there's no need for rudeness or sarcasm on this forum. i was just trying to present my opinion about the program. and it is one happened to be shared by quite a few duke residents/interns. although it may not be what you would liked to read i hope you would at least respect it, for i'm a duke resident just like you.
art, just because you haven't heard doesn't mean things didn't happen. just last week, one of the resident (not intern) was berated to tears by one of the chief. and it was for the stupidest thing. i can't name names for obvious reasons. we don't get upset about hard work because that's what we signed up for. what we get upset about is the lack of support and worse the automatic accusations of being lazy/stupid everytime when something goes wrong. with a few exceptions the duke chiefs are never on your side. and worse they like to make a small incident into a big deal and make an example out of you so they could look like the "competent chief". there were occasions where the original person who brought up the issues were shocked and even angered by the ways things were dealt "i only asked him to mention it to the residents, there was no need for the punishment". and as for the program director, she does it in real style. after all the accusaions and punishments are given out, she then offers you the number to the hospital support line and her cell phone. oh please call if you feel stressed out. hahaha, are you for real? is this some kind of sick joke? wasn't you the one that caused all our miseries in the first place.
art you know what the chiefs call the durham regional hospital (DRH)? the durham rehab hospital. i'm sure the joke's lost on those who were sent there.
there's more but i'll stop the story telling here.
duke's a good program and there's no doubt about it. if you are good, hard working, do as told and don't ask questions, you'll do very well here. and if you miss a few of the qualities mentioned above but happen to kiss behind really well, you'll do great too. but unfortunately not everyone's like that. and at duke as i mentioned there's a two tiered system. if you're a part of the inner circle, you are set for life. but if you are not, well life may not be so kind to you and you'll be made to feel it's all your fault in the first place. unfortunately despite it being a big program, there's no room for dissident opinions in the "duke marine". and you know what i'm starting to feel this way too on this forum.
if you are applying to duke i would have a real good look around too. duke's a top 10 program but i think (although i may be wrong) there are other top 10 programs out there that are not so mean spirited.
anyways, this is how i feel about it one and half years into the program. carol you asked me if i didn't have anything better to do other than being sad and bitter on christmas day. well, letting go of the juvenileness ofw the comment this is what i have to say. if i was sad and bitter on christmas day didn't that just add more weight to my opinion about the program?
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Having been a Duke EM resident, after doing prelim IM at a much more brutal, inner-city NYC hospital, I saw it from a little different light.
"4040" is not all rosy as TommyGunn paints it - the pay had to go up to have more people do it last year. If no one signed up, at least once there was a SAR (a 3rd year) that was assigned to do it, without being paid (I can tell you who it is). In addition, there were 3 types of people who did 4040 - the diligent, who did the right thing; the lazy bastards, who did every- and anything they could to do as few admissions as possible; and the Duke über-brainies that would use the most convoluted arguments not to admit (I can tell you two - and the main arguments were "this patient doesn't need to be admitted!" - with the implied, "Are you REALLY that stupid?" - or, "this patient is TOO sick/not appropriate for general internal medicine").
And I like to think I know just a little of what I'm talking about, as I was (I think) the only off-service resident to be named in the SAR graduating dinner in the spoof program (because of my penchant to "call it like I see it", and I would say "hey, I have an interesting (or "such a GREAT") case for you!", in my exuberant manner - but, at the same time, if it was not so scintillating or soft, I would tell them that, too).
As far as punitive time in the ED, nope, didn't happen. Wish it did, but it was hard enough to get the scheduled people to show up on time, or make a dent in the patient load. There were more than half of the IM residents that would make a storied effort, especially those that would work the patient up, then give the pt follow-up in that resident's own clinic, but those in the minority made more of an impression, such as those that would see 4 patients in 12 hours - and ask to leave early. Some of the IM residents really liked being in the ED, but those were the same that had a zeal for whatever rotation they were on (one female resident jumped RIGHT into trauma, and was good at it - but that was typical for her), others hated every second, and then there were the in-betweeners who realized it was a **** sandwich, but knew they had to eat it, so they bit right in.
It's an RRC requirement for primary residencies (surgery, IM, peds, ob/gyn) to do time in the ED, and surgery & ob/gyn can get around it by consulting, but, since IM doesn't have that luxury (since most EM problems are general IM-adult problems, and, as such, if they need to be admitted, they go to IM), working in the ED is part of the deal, like it or not. People that were at Duke before there was an EM program noticed the difference - after EM started, there was nothing left to do - any test that was needed was either done, resulted, and evaluated, or ordered and performed, and not evaluated yet - leaving the admitting teams with little to do except data-mining; patients had their central lines, their bloods drawn, LP's done, paracenteses performed. Dr. McNeill and Dr. Muir asked Dr. Clem, the EM division chief, to leave something for the IM residents to do. As of June 30, there was a PGY-2 (now 3) IM resident that had never done an LP.
There is still a residual sentiment among IM that EM (and EM residents) are substandard (which is manifested and reinforced by med students who've been conditioned to the same), but we learned that it was easier to bend like a reed when the IM resident was being overbearing or unreasonable ("sure, we can order a ceruloplasmin level"), as long as that would get them to see the patient. To have someone do a "punitive" ED shift defeats the educational purpose, and would be more of a hindrance than any help.
"4040" is not all rosy as TommyGunn paints it - the pay had to go up to have more people do it last year. If no one signed up, at least once there was a SAR (a 3rd year) that was assigned to do it, without being paid (I can tell you who it is). In addition, there were 3 types of people who did 4040 - the diligent, who did the right thing; the lazy bastards, who did every- and anything they could to do as few admissions as possible; and the Duke über-brainies that would use the most convoluted arguments not to admit (I can tell you two - and the main arguments were "this patient doesn't need to be admitted!" - with the implied, "Are you REALLY that stupid?" - or, "this patient is TOO sick/not appropriate for general internal medicine").
And I like to think I know just a little of what I'm talking about, as I was (I think) the only off-service resident to be named in the SAR graduating dinner in the spoof program (because of my penchant to "call it like I see it", and I would say "hey, I have an interesting (or "such a GREAT") case for you!", in my exuberant manner - but, at the same time, if it was not so scintillating or soft, I would tell them that, too).
As far as punitive time in the ED, nope, didn't happen. Wish it did, but it was hard enough to get the scheduled people to show up on time, or make a dent in the patient load. There were more than half of the IM residents that would make a storied effort, especially those that would work the patient up, then give the pt follow-up in that resident's own clinic, but those in the minority made more of an impression, such as those that would see 4 patients in 12 hours - and ask to leave early. Some of the IM residents really liked being in the ED, but those were the same that had a zeal for whatever rotation they were on (one female resident jumped RIGHT into trauma, and was good at it - but that was typical for her), others hated every second, and then there were the in-betweeners who realized it was a **** sandwich, but knew they had to eat it, so they bit right in.
It's an RRC requirement for primary residencies (surgery, IM, peds, ob/gyn) to do time in the ED, and surgery & ob/gyn can get around it by consulting, but, since IM doesn't have that luxury (since most EM problems are general IM-adult problems, and, as such, if they need to be admitted, they go to IM), working in the ED is part of the deal, like it or not. People that were at Duke before there was an EM program noticed the difference - after EM started, there was nothing left to do - any test that was needed was either done, resulted, and evaluated, or ordered and performed, and not evaluated yet - leaving the admitting teams with little to do except data-mining; patients had their central lines, their bloods drawn, LP's done, paracenteses performed. Dr. McNeill and Dr. Muir asked Dr. Clem, the EM division chief, to leave something for the IM residents to do. As of June 30, there was a PGY-2 (now 3) IM resident that had never done an LP.
There is still a residual sentiment among IM that EM (and EM residents) are substandard (which is manifested and reinforced by med students who've been conditioned to the same), but we learned that it was easier to bend like a reed when the IM resident was being overbearing or unreasonable ("sure, we can order a ceruloplasmin level"), as long as that would get them to see the patient. To have someone do a "punitive" ED shift defeats the educational purpose, and would be more of a hindrance than any help.
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What is it about Duke? I'm not talking about their IM program, their ED, their, etc. It's basically the only university in the US that people either love or hate, both with a passion. There's nobody out there who things that Duke is an OK place (anthropology, physics, basketball, dining halls, whatever). I declined my IM interview there last year so can't say anything about it first-hand but I've never met anyone in any sphere of my life who is lukewarm on that place.
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Are you serious "duke marine???" I'm just about speechless at this point. Are we even talking about the same program??? Are you really from Duke, or just making up stuff to try to make the program look bad? I've been at Duke for several years and my experience has been nothing but positive, and absolutely nothing like what you described.
I can't imagine what happened to you to make you say such mean-spirited things. It's one thing to be honest and critical, but this is downright character assassination. You're entitled to your opinion, but it's unfair to slander Duke on this board and make peope think it's such an awful place. This is starting to feel really personal, because I feel like I'm part of a great family at Duke, a family that you're insulting. Like I said before, I've been here long enough and talked to enough people to know that such negative opinions like yours are exceedingly rare.
But seriously, you're even bashing Dr. McNeill?! She's the nicest person you could ever meet! Anyone who thinks Dr. McNeill is anything but wonderful and supportive quite clearly has their head up their a#$.
It makes me wonder what you've done and what kind of resident you've been to make you so bitter.
I can't imagine what happened to you to make you say such mean-spirited things. It's one thing to be honest and critical, but this is downright character assassination. You're entitled to your opinion, but it's unfair to slander Duke on this board and make peope think it's such an awful place. This is starting to feel really personal, because I feel like I'm part of a great family at Duke, a family that you're insulting. Like I said before, I've been here long enough and talked to enough people to know that such negative opinions like yours are exceedingly rare.
But seriously, you're even bashing Dr. McNeill?! She's the nicest person you could ever meet! Anyone who thinks Dr. McNeill is anything but wonderful and supportive quite clearly has their head up their a#$.
It makes me wonder what you've done and what kind of resident you've been to make you so bitter.
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I'll back that up - I wasn't even in IM, and I saw things she'd done for residents, and she's leaps and bounds ahead of the snobby, snotty, do-nothing PD I had when I was prelim IM. And that is not even to mention her service to her patients!
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I did my med school at Duke and graduated a few years ago. Certainly my experiences as a med student is limited by the extent of my exposure during the sub-I rotations; but from what I can see, all the residents that I worked with were very happy, they had great camaraderie and in the end, most of them ended up going to places that they wanted to for fellowship. Administration (Dr. McNeill etc.) were equally great during our applications. The only reason for not staying at Duke was that I had gone there for college and medical school and so, I wanted to see new places. Otherwise, Duke is easily one of the best programs you can get your training.
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Are there any FMGs at Duke?
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Yes there are. According to the list handed out on interview day, I see some from Europe, Taiwan, Puerto Rico, among others.
Puerto Rico graduated physicians are not IMG's, PR med school are LCME schools!!
this is all well and good....but umm....still wondering if anybody has gotten any feedback from the program/PD from Duke. Thanks in advance
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wondering this also...no feedback here...has anybody else heard from them?
