Duke Vascular Surgery Residency program on ACGME probation

[xkkcdvasc]

I am a general surgery/vascular surgery co-applicant this year and I am about to solidify my program list. I’m applying to almost all integrated vascular surgery this cycle and 10-15 General Surgery programs with different applications.



I was going through integrated vascular surgery programs and noticed that Duke University’s Integrated Vascular Surgery program is on ACGME probation (but not Duke University’s General Surgery program - so it’s not an issue of a sponsoring program or institution being on probation by ACGME).



I spoke with one of my mentors and they said it’s an issue of malignancy, poor leadership and advised not to apply as he wasn’t sure if the program will continue to exist in 12-24 months. I don’t want to push for more details but I am curious if anyone knows any of the details on the program and whether it’s worth to seriously consider it (given its association with Duke General Surgery and all). I would love to train at Duke but realistically can’t match dukes General Surgery program.



I am wondering if anyone has any advice on interviewing at or ranking programs on ACGME probation in a competitive surg subspecialty…. Is it worth it for a mid range applicant for added security?


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[Tenk]

Why do you call someone a mentor if you don’t take their advice? That’s like asking the waiter what to eat and then being like na, you’re wrong.

 

[xkkcdvasc]

Why do you call someone a mentor if you don’t take their advice? That’s like asking the waiter what to eat and then being like na, you’re wrong.

lol ok fair point. I’m asking the forum if it’s worth it for a mid applicant like me to interview/rank the program rather than possibly go unmatched/do a prelim year. What can residents even do if a program loses accreditation? I’d hate to go through another match cycle.

 

[NotAProgDirector]

There's no "right" answer. Obviously the program is in some trouble, and hopefully they are trying to clean it up. The ACGME tries everything it can to avoid closing programs, which is always a last resort. If the program closes while you're a resident there, then you become an "orphaned" resident and usually other programs will expand a bit to absorb you -- however the funding issue for orphaned residents is complicated, and some procedural based programs may have reservations about taking you in transfer if they are concerned that your clinical training is sub-par.

If you match there and they close down before you start, then you just lose your spot.

Whether it's "worth it" to rank them last is completely up to you.

 

[LucidSplash]

Dawn Coleman is the new vascular division chief there. I would expect positive changes in the department based on her leadership.

I know who the PD is, but I don’t have a good read on his personality or leadership style.

IMHO Duke Vascular will continue to fill their programs based on powerhouse name and reputation despite being on probation. I think it unlikely that they would lose their program accreditation status entirely in the next few years.

However, trainees are likely to experience a lot of change and possibly upheaval In the next couple of years as they work through this.

If your choices are not matching at all versus matching here, if I were in your shoes, then I would apply and be prepared to ask some serious polite but probing questions at your interview if you are offered one. Decide about ranking later on.

 

[xkkcdvasc]

Dawn Coleman is the new vascular division chief there. I would expect positive changes in the department based on her leadership.

I know who the PD is, but I don’t have a good read on his personality or leadership style.

IMHO Duke Vascular will continue to fill their programs based on powerhouse name and reputation despite being on probation. I think it unlikely that they would lose their program accreditation status entirely in the next few years.

However, trainees are likely to experience a lot of change and possibly upheaval In the next couple of years as they work through this.

If your choices are not matching at all versus matching here, if I were in your shoes, then I would apply and be prepared to ask some serious polite but probing questions at your interview if you are offered one. Decide about ranking later on.

Thank you so much for your insightful and thoughtful post - it is very helpful for me personally as I go further into residency applications. I noticed they don’t have a full complement of residents - I think - and that may be something to ask about (curious if any residents left the program or maybe the program didn’t fill some of the years - or maybe they egregiously violate work hours because of a smaller class).

everyone made good points re: carefully considering a back-up plan if things don’t work out. I really don’t want to scramble for a different residency position. probably I will rank stable gen surg programs above sus vascular programs

 

[LucidSplash]

Thank you so much for your insightful and thoughtful post - it is very helpful for me personally as I go further into residency applications. I noticed they don’t have a full complement of residents - I think - and that may be something to ask about (curious if any residents left the program or maybe the program didn’t fill some of the years - or maybe they egregiously violate work hours because of a smaller class).

everyone made good points re: carefully considering a back-up plan if things don’t work out. I really don’t want to scramble for a resident position. probably I will rank stable gen surg programs above sus vascular programs

Duke takes 1 integrated vascular resident a year. Right now they have 5 residents listed on their website but 2 are in the lab. They require 2 years of bench research at that program I think, at least that’s how the website reads, referencing a 7-year training program. That would be in line with Duke GS history and focus. Not quite “decade with Dave” but still not surprising for this program to have a bench research requirement.

I’m not sure if that’s been their requirement all along or if it’s relatively new. If it was “optional” before, that may account for the not having any PGY 3 or 5 listed but having 2 residents in the lab. If they are now sending everyone through the lab, the numbers will even out in a couple years.

Would be something to ask about at an interview, for sure.

 

[xkkcdvasc]

Duke takes 1 integrated vascular resident a year. Right now they have 5 residents listed on their website but 2 are in the lab. They require 2 years of bench research at that program I think, at least that’s how the website reads, referencing a 7-year training program. That would be in line with Duke GS history and focus. Not quite “decade with Dave” but still not surprising for this program to have a bench research requirement.

I’m not sure if that’s been their requirement all along or if it’s relatively new. If it was “optional” before, that may account for the not having any PGY 3 or 5 listed but having 2 residents in the lab. If they are now sending everyone through the lab, the numbers will even out in a couple years.

Would be something to ask about at an interview, for sure.

It looks like they are missing either a PGY-3 or PGY-5 (not super clear from the roster online), but that roster may not be updated. and like you said, research may be a new requirement and changed the timeline for residents. also looks like their faculty and maybe PD changed significantly in last few years (just guessing as a lot of recent fellowship grads are listed as faculty). kinda seems like the program was (is?) unstable for 2-3 years and ended up on probation. Also their rotation schedule as listed on ACGME website doesn’t necessarily correlate with what’s posted on the website, so it’s hard to figure out where the residents actually go.

wonder if anyone will do a sub I there and may have insider info

 

[LucidSplash]

It looks like they are missing either a PGY-3 or PGY-5 (not super clear from the roster online), but that roster may not be updated. and like you said, research may be a new requirement and changed the timeline for residents. also looks like their faculty and maybe PD changed significantly in last few years (just guessing as a lot of recent fellowship grads are listed as faculty). kinda seems like the program was (is?) unstable for 2-3 years and ended up on probation. Also their rotation schedule as listed on ACGME website doesn’t necessarily correlate with what’s posted on the website, so it’s hard to figure out where the residents actually go.

wonder if anyone will do a sub I there and may have insider info

Honestly, as a mid-tier candidate, just apply. See what happens. Don’t spend too much time perseverating on this particular program.

Join this year’s Google Spreadsheet and you may find local students willing to comment on the local culture there.

 

[hippieskippy]

At this point, you don't even know if they'll interview YOU lol

 

[droliver]

If your a self described mid tier candidate this whole discussion is academic, as you're not matching vascular at Duke in a reality based discussion even if the program is a dumpster fire

 

[hippieskippy]

If your a self described mid tier candidate this whole discussion is academic, as you're not matching vascular at Duke in a reality based discussion even if the program is a dumpster fire

Not totally true. Plenty of people do away rotations and impress the right people despite being subpar candidates.

With that said, even in the "best case scenario" in which you apply to the program and receive an interview, I would think twice about ranking it. I feel compelled to elaborate.

Program directors seem powerful when you're a resident. But once you're done you realize - the only power they truly have is the power to torch your career. If there's a power-tripping psycho running the show, they're going to want to exercise their power.

If a program is on probation, it is virtually guaranteed to have a significant amount of toxicity. Otherwise, residents could have brought up issues to the PD long before it reached the ACGME's office.

Do you want to put your career in the hands of a toxic PD? The question isn't really "do I want to train in vascular surgery at a midtier program vs. a 'high-tier' on probation?" The quesiton is "do I want to train in vascular surgery at a place that has a significantly higher likelihood of derailing my career?"

You would think that because they're on probation, they would be on their best behavior. But I have personal experience with a residency program that went on probation - PD retaliated/ruined a couple careers, flew off the handle and wailed about how it's all so unfair, and now everyone is so scared of getting their career ruined that probably no one will talk at the next ACGME visit.

Long story short, I wouldn't apply to a program on probation. It's just not worth it. It is very, very rare for a program to be on probation. It means the residents were so fed up that they put their careers on the line. And it means the ACGME confirmed that they had a right to be fed up.

If you still apply to a program on probation, you can't be helped. If your career is ruined it's entirely your fault.

 

[guytakingboards]

Not totally true. Plenty of people do away rotations and impress the right people despite being subpar candidates.

With that said, even in the "best case scenario" in which you apply to the program and receive an interview, I would think twice about ranking it. I feel compelled to elaborate.

Program directors seem powerful when you're a resident. But once you're done you realize - the only power they truly have is the power to torch your career. If there's a power-tripping psycho running the show, they're going to want to exercise their power.

If a program is on probation, it is virtually guaranteed to have a significant amount of toxicity. Otherwise, residents could have brought up issues to the PD long before it reached the ACGME's office.

Do you want to put your career in the hands of a toxic PD? The question isn't really "do I want to train in vascular surgery at a midtier program vs. a 'high-tier' on probation?" The quesiton is "do I want to train in vascular surgery at a place that has a significantly higher likelihood of derailing my career?"

You would think that because they're on probation, they would be on their best behavior. But I have personal experience with a residency program that went on probation - PD retaliated/ruined a couple careers, flew off the handle and wailed about how it's all so unfair, and now everyone is so scared of getting their career ruined that probably no one will talk at the next ACGME visit.

Long story short, I wouldn't apply to a program on probation. It's just not worth it. It is very, very rare for a program to be on probation. It means the residents were so fed up that they put their careers on the line. And it means the ACGME confirmed that they had a right to be fed up.

If you still apply to a program on probation, you can't be helped. If your career is ruined it's entirely your fault.

Not advocating for the OP to do anything in particular but I will say this is a great reply and useful perspective to consider.

 

[SurgeDO]

Why would you want to match at a program that is on ACGME probation? In my experience with programs like this in my specialty, the underlying root of the problem for these programs comes down to a lack of case volume and poor surgical experience.

Who cares about the name associated with the program if you’re not going to graduate as a competent surgeon?

 

[xkkcdvasc]

hey everyone,

Thank you all so much for your input - all excellent things to consider. I am on a sub-I right now, so I appreciate everyone’s help in thinking things through.

 

[xkkcdvasc]

I finished an away rotation and met with a mentor in vascular surgery prior to drafting my ERAS application. I am not applying to Duke after getting updated on what's happening there. If anyone is in the same position as me (applying vasc), PM and I can relay you some information if it helps you make a decision.

 

[hippieskippy]

I finished an away rotation and met with a mentor in vascular surgery prior to drafting my ERAS application. I am not applying to Duke after getting updated on what's happening there. If anyone is in the same position as me (applying vasc), PM and I can relay you some information if it helps you make a decision.

Wise choice. I appreciate your update.