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education vs. service in residency

Discussion in 'Internal Medicine and IM Subspecialties' started by drjitsu, Dec 8, 2008.

  1. drjitsu

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    First time poster here...

    I'd like to hear from some current house staff on their balance of education and service in their program and how they feel it's effecting thier training.

    Honestly, in this department, I'm having a hard time deciding what I want. This most clearly came into focus recently, as I just interviewed at Michigan and Mayo-Rochester. Both are excellent programs with impressive match lists. However, the house staff at Michigan definitely work harder with a front loadeed program. I believed this was what I really wanted until I visited Mayo, where the call is q6 and more spread out, and they're preaching a balance between education and service. In other words, Mayo sounded more cush, and I'd say the general consensus is just that.

    So, my question to some current house staff is, what do you think of this blend at your institution? It would be great to hear from some people at JHU, Penn, and UW as I have upcomming interviews there, as well as Mich, having been there and loved it. Do those at the more traditionally "malignant"/east coast programs feel cheated on education and overburdened by useless scut and paperwork? On the flipside, do those at Mayo, NW and other traditionally more "cush" programs feel cheated on patient load and the "getting your hands dirty/down in the trenches mentality". Do those with an emphasis on education through conferences feel that the conference are helpful and worthwhile, or do you wish you were seeing more patients? Do those that are getting killed with case load wish you had more time for conferences and just to sit and read about your patients?

    Most of all, how do you feel this blend of education and service is effection your end product as a physician?

    I know I'll get alot of "this is a personal decision" and all that. But like I said, I really don't know what I want. Originally I though I would really like a frontloaded, hardcore, down and dirty residency for the once in a lifetime experience, but I'm recently thinking about the end result.

    Any feedback/opinions are most appreciated.
     
    #1 drjitsu, Dec 8, 2008
    Last edited: Dec 9, 2008
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  3. firstdoc101

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    WOW, great question! No reply here for you as I am an MS4 as well. But would like to hear anyone's take on this as I feel like I am in a similar conundrum!
     
  4. muscles

    muscles student of the month
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    I am a current michigan resident. When making my rank list decision, I also was torn between michigan and mayo (ended up ranking mich 1 and mayo 3). I did feel that, at michigan, you spend more time in the hospital (q4 v. q6). However, the program is by no means malignant - I hope that nobody leaves michigan thinking that it is. The program director truly is a class act, very approachable, friendly and genuinely interested in the well being of his residents.
    Furthermore, although you may spend more time in the hospital, Michigan's program is incredibly family friendly. You get ~ 5 weeks off throughout the year, including 5 days over the holidays (either christmas or new year), you get a 7% bonus each fall. In addition, there are several mechanisms in place to ensure that you are not overworked during your time in the hospital:
    -resident assistants who do all your busywork (obtaining outside records, scheduling procedures, follow-up appointments, etc)
    -discharge coordinators who handle all specifics regarding placement etc
    -we cap at 8 patients (the ACGME standard is 12)

    Having said everything I just did, I loved Mayo clinic and would have been happy there. I really don't think you could go wrong.
     
  5. drjitsu

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    Just to be clear, I really do not want to get into a discussion of malignancy. That is being discussed amply on another thread. I really do not feel that any of these programs are "malignant".

    I would really like to have a discussion as to how residents, really in any program, feel the blend of service and education is impacting their progression as a physician.

    I would also love to have current medical students weigh in on their thoughts, as this decision will surely shape how we learn, practice medicine, and teach the next generation.

    thanks
     
  6. ceftazidime

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    I'm also a 4th year student and am pondering over the same question. I'm leaning more towards programs that place a heavy emphasis on education, however. I just think it would be more beneficial to have more time to research and really understand your patient's condition and treatment plan, rather than being forced to rush through multiple patients while running on minimal sleep. At least this is how I think it should be for medicine... for procedure-oriented specialties like surgery, ENT, etc, I would probably opt for a more heavy patient-load to gain hands-on experience.
     
  7. dragonfly99

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    Well, that is a great question.
    I think you don't want to go somewhere that is TOO cush, in the sense of not getting enough admissions, especially if the place has a weenie MICU and CCU with not very many sick patients. When I was a med student I was all hard core and ended up picking a medicine residency that worked me hard. I think it was good education but I would definitely say that sometimes (particularly during intern year) there was a glut of too many admissions and too much scut work that wasn't necessarily making me "smarter". Also, sleep and study time are important. So perhaps I might pick slightly differently if I were to go back, but basically I know that I got a good residency education.

    One thing you need to look at for wherever you go is what is the internal medicine board pass rate? This is publicly posted (can google it or should be able to). This really should be well >90%, hopefully 95% or more. If it's not, that means the residents either aren't that good, and/or the teaching isn't good. Fellowship match lists also show how well regarded the medicine program is by other programs throughout the country, which is important if you want to subspecialize.
     
  8. TommyGunn04

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    This is an interesting philosophical question about residency training in general, for which there is no single correct answer. As you mention, some programs have gone farther in one direction than others, but as long as a certain degree of oversight is provided so as to avoid compromising patient safety, both are viable training strategies. Much of the decision is an individual one, which is more reflective of your optimal learning style than anything else.

    For me, there's nothing more instructive than seeing and taking care of a patient with a particular medical problem. If I read about it but don't see it a few times, I have much more difficulty retaining the knowledge. So while it would certainly be easier to take q6 call, have more days off, eliminate overnight call, etc., I personally feel that I have greatly benefitted from having taken q4 call and admitted more patients. The easier way is not always the best one, and most of the worthwhile things in life aren't easy. That said, there must still be a fair balance....if housestaff are expected to admit every single medicine patient in the hospital and are used more as hospital servants then things have clearly gone too far in the service direction. While that may sound extreme, some programs have done this, and continue to do so. I think my program (Duke) has done an incredible job of balancing service and education, whereby the residents are protected with hard caps and pressure-release valves of sorts, to maximize educational value and avoid the slave labor phenomenon.

    I guess the take home message of my post is this: some programs may be going too far from their "service" mission such that their educational one is actually suffering as well, in terms of their being too restrictive about patient volume to ensure that residents see enough cases.
     

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