Duke vs. University of Washington

[XenonFTW]

I created a new account because my prior account was too identifiable for match questions. I am struggling between ranking Duke vs. University of Washington first in my rank list and need some input.

Duke's pros:
- excellent clinical exposure/case complexity
- smaller residency class size, good camaraderie and interview vibes
- possibly best regional and cardiothoracic experiences
- cost of living low
- easy commute

cons:
- Durham, though now a nice small city, is still small and would get boring

UW pros:
- Seattle is an excellent city, good balance between cost of living and city-life/culture
- Better outdoor activities than Durham
- ICU experience good, includes neuro-ICU
- bicycle-friendly commute

cons:
- bigger class size, easier to feel lost in the mix
- involves traveling to more hospital sites (still within bicycling range though)

Any additional thoughts from current residents or applicants who visited either institution?

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[nimbus]

Duke's pros:
- excellent clinical exposure/case complexity
- smaller residency class size, good camaraderie and interview vibes
- possibly best regional and cardiothoracic experiences
?

Enough said.

Though we have many excellent partners from UW.

 

[shewmie]

Current UW resident here. UW was my #1 but I ranked Duke in my top 3 (I, ultimately, wanted a city with more to do and program with more ICU/peds).

I would argue the complexity/case mix for UW is tough to beat considering the variety of sites give you experience working with different populations in very different environments (Harborview - underserved population/trauma, UWMC - academic/quarternary care center, vasculopath vets at the VA, zebra farm at Seattle Children's, and several community hospitals with more bread and butter cases for PP experience). UW patients ranked in the top 3 for complexity nationwide (Emory and Stanford were other 2). Even the sites furthest away are within about 10-15 mins driving (I usually bike/bus to all but the VA and SCH - 10-15% of our rotations).

Duke and UW have a wide catchment area so you see a bunch of stuff, but I wanted to see more (real) trauma, so the Harborview experience was more important to me. I also liked the larger class size since there's almost always another resident who's likely free and willing to join you on an adventure whether it be to the nearest microbrewery or hiking trail. Plus, the program feels smaller since the class is split among different sites. You have to take some initiative to get the experience you want (no hand-holding), but there are plenty of opportunities/resources available.

UW
-Regional: it lagged for several years (surgeons leaving) but is getting better again. There are 3 dedicated regional rotations at UWMC, VA, and Harborview with possible senior electives at VM and our ambulatory surgery center (Roosevelt)
-CT: The service has gotten a lot busier this year. I made all my numbers for cardiac/thoracic in one month and still have at least one more month next year (can/will do an additional month as well). Most of the cases are redos/multiple valves/LVADs/TAVRs, with an occasional straightforward CABG.
-ICU: 6 months over 4 yrs (categorical) - MICU, SICU, TraumaICU, NeuroICU, possibly CTICU

Duke (from what I remember)
-definitely cheaper cost of living
-relatively more elective CA-3 year

Ultimately, you'll get great training at either place. Most things are minor differences, really, but I think location will be the biggest factor since you (hopefully) won't be working in the hospital all the time. I know I'm not. I'm actually heading out to the rainforest over on the Olympic peninsula right now. Good luck!

 

[sunnyINphilly]

UNIVERSITY OF WASHINGTON MEDICAL CENTER

DEPARTMENT OF ANESTHESIOLOGY AND PAIN MEDICINE


APPLICANT INFORMATION SHEET


I. PROGRAM OVERVIEW


PROGRAM SIZE:

-> 150 attendings. See Department Website.

- 29-30 residents/year,

- 3 chief residents (1 each for UWMC and HMC, 1 for VA/SCH); 1 academic chief resident

- 2 program coordinators

- PD, + Associate PD + residency co-director each provide additional specific oversight of CBY, CA1 and CA2 years separately.


CRNAs:

- 2 CRNA programs through UW:

UWMC: ~38 CRNAs

HMC: ~35 CRNAs

VA: ~3-4 CRNAs

SCH: 5-6 CRNAs



RESIDENCY PATHWAYS:

- Categorical (all 4 years at UW): 23-24 residents

- Advanced (1st year elsewhere*, CA1-3 at UW): 2 residents

- Critical Care Pathway: 2 residents

- Bonica Scholar Pathway: 2 residents


OTHER PROGRAMS IN AREA: Virginia Mason



II. EDUCATION AND TRAINING


LOCATIONS (time spent): UWMC (~40% ), Harborview (HMC) (~40%), VA (<10%), Children’s (SCH) (10%).

* UW covers the WWAMI region, which represents ~15% of the United States in terms of area


* UWMC: Tertiary/Quaternary care center. This is where you get the majority of your ASA3+ patients.

Surgeries: Emphasis on CT/transplant/ENT/gyn/ortho

ORs: 25 ORs (not including offsite/NORA cases)


*HMC: Level 1 trauma center for the vast majority of the WWAMI region, easily considered one of the best trauma centers nationwide for the bready and diversity of cases they have. The Medic One program was born here.

- Surgeries: HEAVY emphasis on orthopedic/Nsurg

- ORs: 25 ORs (not including offsite/NORA cases)


*SCH: Likely the best program on the west coast IMHO.

- You spend 3 months as a CA2 and 1 month as a CA3, which is more than the average 2-3 months at other programs.

- ORs: 15 (not including offsite/NORA cases)


See Department Website for more information regarding case breakdown.
Residents average 1200 cases (including ICU patients, pain consults, patients/procedures) by the end of their residency.


SCHEDULES (NON-CALL):

- Average weekly work hours varies by rotation (45-55 hours), with some weeks going into 60s/70s depending on the type of call schedule you are on. Very rarely if ever are there work hour restrictions being pushed

- OR start time: 0730 (except Weds d/t grand rounds à 0830)

- Average day: 0730 - 4-530pm (for non-call residents).


SCHEDULES (CALL):

UWMC and HMC: Numbering system (#1-7 at UWMC and HMC, #1-3 at SCH).

- Call Residents 1 and 2 (and 3 at HMC) are the nightfloat coverage [~6pm-7am the next day]

- With the exception of 1,and 2, the higher the number, the earlier you are relieved from the call pool to go home.

- #5-7 usually 5-8pm, #3 and 4 usually 8-10pm

- Your general OR rotations typically have a week of nightfloat every 1-2 months. They last 3-4 nights in length, with the rest of the week (3-4 days) off. With some exceptions – 6 on/6 off as a CA3 at HMC.

- Efforts are made to attach your nightfloat to one of your vacation weeks, to allow for more consecutive days off.

SCH: Numbering system (1-3)

à #2 and 3 are “late day call,” with #3 usually staying until 6-7 pm and #2 staying until 9-10pm.

à Call shifts ion consecutive days (e.g. #2 Monday, #1 Tuesday, post-call Weds)

VA: As a CA2 or CA3, you are on a rotating schedule with the CA1 VA SICU intern. As a senor resident you can expect to take call q5 or sometimes q6 when you are on your regional/general anesthesia months there.


DIDACTICS:

- Biannual “Retreats” during CBY year (if categorical resident)

- CA1: 1st 2 months: qWednesday (full day) x 2 months; qWednesday ~q3-4 weeks after that

- CA2-3: q3-4 weeks on a Wednesday, +board review/oral board practice

- qThursday PBLD or QI conference

- qWednesday Grand Rounds

- Electronic access to most major anesthesia textbooks (pdf files)

- Multiple Dropbox links with study materials, question banks, flashcards going around

- Intraoperative teaching – Topic Cards; attendings are very good with teaching the core material that is covered in the Boards (UWMC, SCH) and flexible in allowing different techniques (i.e. airway management) (HMC)



III. WHILE AT WORK…


RECORD KEEPING:

EHR:

- UW/HMC: Cerner PowerChart (ORCA) + CORES Rounding System

- SCH: CIS (just like ORCA) + CORES

- VA: CPRS, resident-drive rounding system intermittently in use


Anesthesia Record:

- UWMC/HMC: AIMS/Merge (formerly DocuSys), may change within next 2 years

- SCH: Paper-charting until April 2015, then electronic charting

- VA:


OR SUPPORT:

- 6-7 anesthesia technicians at each hospital:

-- Very helpful and timely at each location (especially with CT cases at UWMC – the best)

- Break System: AM (15min), Lunch (30min), Afternoon (15min), Dinner (30min)


MEALS:

UWMC+HMC: You’re given some money on your card for every 12 consecutive hours you work (and successfully and timely log into your duty hours report).

SCH: 1 free meal per regular day shift; 2 free meals per night call shift. Their midnight breakfast is amazing.

VA: Free frozen food while on call at night


PARKING:

UW: Parking garage is ~1/2 mile away from the OR area of the hospital (some walking outside). $7/day (pre-tax deduction from your salary)

HMC: Parking garage is right next to the hospital, but is $9/day (also pre-tax deduction)

SCH: Free parking after you’ve been oriented (outside parking lot), 3 min walk from OR area of hospital



BENEFITS, Other:

- 5 meeting days (2 travel days)

- Academic Fund: $500/year

- Basic Exam Prep 1 weekend/month with program director

- Mock Oral Exams through the department every year (+ on VA and neuroanesthesiology rotations)

- Daycare for children

 

[bcat85]

Current Duke resident here. I would agree with your assessment of the strengths of the Duke program. CT is truly excellent here. We have a ton of volume here, including aortic cases, transplants, VADs, PTE's, and virtually everything else. We also do a lot of complicated thoracic--extrapleural pneumonectomies, tracheal resections, etc. Because of the way the call system is structured on CT, the residents get to do many of the complex cases during the week, and are often off on the weekend.

Regional is also excellent. We have several attendings who have authored textbooks on regional anesthesia, we get early block experience as CA-1's, and we have 2 or 3 dedicated block months as CA-3's.

A couple of other things that I think are under appreciated here:

I think that the peds experience is actually quite excellent. That came as a bit of a surprise to me because of the lack of a dedicated pediatrics hospital. We only have 1 peds fellow here, and they spend a portion of their time doing the pediatric heart cases. We don't do a lot of straightforward peds (we have maybe 1-2 days a week of tonsils, urology, ophtho), but we do a lot of complex peds--CDH repairs, transplant, tumor resections, complex neuro, etc.

The residency culture at Duke is also fantastic. We do have slightly smaller class sizes (14 residents/year), but we all get along well and spend a lot of time together on the weekends. The camaraderie is great, and the department is also quite supportive (they gave us a social budget last year to plan residency get-togethers).

Overall, I've had a fantastic experience at Duke, and would definitely come back here again. Feel free to PM if you have any questions. Best of luck!

 

[Ezekiel2517]

for God sakes, they're both great programs, are on completely opposite sides of the country, one's a big city and one's not.....how can you not have a preference one way or the other? You're gonna have to make a lot tougher decisions than this everyday as an anesthesiologist

 

[Orin]

It's a lot easier to make decisions that don't really affect you directly.

You know how they make all those parallels between anesthesiologists and pilots? Well unlike pilots, if our patient crashes, we're still alive.

At that stage, even though they probably know subconsciously what they want to do and what they should do, it's just tough to pull the trigger.

FWIW, the OP seems to suggest a preference for UW over Duke but needs rationale support for that decision because, like OMG, Duke!