Factors to Weigh for Residency Selection

[Relentlessrook18]

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Just wondering what is important for choosing a good residency match?

Does it come down to the curriculum? People? Quality of education? All of the above? Haha

Would just like to hear what people considered to make their own selections.

Thanks!

 

[witzelsucht]

Its wherever you are going to be happy. All residencies are going to provide the same baseline education and same breadth of experiences. Unless there is one very specific population you want to have exposure to (AIDS, Amish, Hassidic, etc. ) it shouldn't matter. Curriculum gonna be the same. Quality of education? You are gonna learn by reading.

 

[JustPlainBill]

Its wherever you are going to be happy. All residencies are going to provide the same baseline education and same breadth of experiences. Unless there is one very specific population you want to have exposure to (AIDS, Amish, Hassidic, etc. ) it shouldn't matter. Curriculum gonna be the same. Quality of education? You are gonna learn by reading.

Ahh, beg to differ --- yes, the specified curriculum is the same but how the specifications are met are as vast and varied as the human mind can conceive ---

So things to consider:

1) Do you like the area? Can you find reasonable housing close by (important on post call days and home call) in a neighborhood you would feel safe/want to live in
2) Do the residents seem happy? Can you talk to all of them or do they have some that they hide on "off service" rotations that never seem to be available when you're there?
3) How many procedures do the residents actually get -- ask to the see the procedure logs of more than 1 resident -- see if you can observe a few biopsies (both shave and punch), joint injections, OB procedures (cryo, implanon) that THE RESIDENTS are doing unsupervised (means they've been signed off) -- also check to see if they can let you observe hospital procedures that THE RESIDENTS are doing unsupervised, including central lines, paradentesis/thoracentesis, ABGs, etc.; suturing, stapling, treating shoulder dislocations, setting fractures, casting/splinting/wound treatment/starting IVs
4) Look at how freely the residents ask questions, especially the interns -- check the interactions with the attendings -- do the residents seem comfortable, do they call them by their first name?
5) Ask if they've put a resident on probation? how do they handle problem children? what's their plan for a resident who's struggling? How often in the last 4-5 years have they had a resident not graduate? Transfer? What's their coaching process?
6) if they're opposed -- how are they treated by the specialists -- go rotate with some of the residents who are on off-service rotations and see how they're treated?

that should do it for a start

 

[Doctor4Life1769]

Ahh, beg to differ --- yes, the specified curriculum is the same but how the specifications are met are as vast and varied as the human mind can conceive ---

So things to consider:

1) Do you like the area? Can you find reasonable housing close by (important on post call days and home call) in a neighborhood you would feel safe/want to live in
2) Do the residents seem happy? Can you talk to all of them or do they have some that they hide on "off service" rotations that never seem to be available when you're there?
3) How many procedures do the residents actually get -- ask to the see the procedure logs of more than 1 resident -- see if you can observe a few biopsies (both shave and punch), joint injections, OB procedures (cryo, implanon) that THE RESIDENTS are doing unsupervised (means they've been signed off) -- also check to see if they can let you observe hospital procedures that THE RESIDENTS are doing unsupervised, including central lines, paradentesis/thoracentesis, ABGs, etc.; suturing, stapling, treating shoulder dislocations, setting fractures, casting/splinting/wound treatment/starting IVs
4) Look at how freely the residents ask questions, especially the interns -- check the interactions with the attendings -- do the residents seem comfortable, do they call them by their first name?
5) Ask if they've put a resident on probation? how do they handle problem children? what's their plan for a resident who's struggling? How often in the last 4-5 years have they had a resident not graduate? Transfer? What's their coaching process?
6) if they're opposed -- how are they treated by the specialists -- go rotate with some of the residents who are on off-service rotations and see how they're treated?

that should do it for a start

I'm curious as to how many FM programs have their residents doing all these procedures and are calling their attending by their first names? Not being facetious but I'm genuinely curious. I know my program if any procedure is to happen in clinic, signed off or not, faculty preceptor has to be present even if they aren't physically doing anything.

 

[JustPlainBill]

I'm curious as to how many FM programs have their residents doing all these procedures and are calling their attending by their first names? Not being facetious but I'm genuinely curious. I know my program if any procedure is to happen in clinic, signed off or not, faculty preceptor has to be present even if they aren't physically doing anything.

Good point --

1) In terms of calling attendings by their first name -- I guess I was trying to point out, is the atmosphere relaxed or broomstick up the backside formal?

2) Procedures unsupervised -- So there are several flavors of procedures --- Are the attendings fumbling through the procedures themselves and the residents watch (as in my case where I trained) or are the attendings confident enough in their residents that they let them do a thoracentesis unsupervised as a PGY2 (as in the IM program where I did my training) or ICU procedures unsupervised (central lines, ABGs, etc) again the IM program where I was at ---

for family medicine -- yeah, until I know the resident can do it by themselves and have done a few, I'm not going to let them do something that can get them into trouble (a bit rare in outpatient medicine) but I will say I'm not confident yet in my outpatient procedures since I had so few during my training -- removing a sebaceous cyst - yeah, I'd supervise that but let the resident drive ---

What you want to avoid is where the residents either A) get so few procedures that they really can't do anything after training or B) the "procedure training" consists of watching attendings doing everything ---does that make sense?

 

[cabinbuilder]

I concur with the procedure part of things. You need to be confident and comfortable with doing procedures unsupervised BEFORE you get out of residency. Once you get out everyone is so super busy that to get training after the face is very difficult to do. Most times your colleagues are too busy as well with their own practices to help you. OR you are in the boonies by yourself and need to be up to speed alone before you are out there and realize that OH **** moment that you haven't a clue what to do becuase you 1) have never seen it or 2) have never done it.

I know I had a few of those moments in the middle of nowhere with eye injuries and am frantically looking on uptdate or calling someone to know what to do. Not a nice position to be in.

 

[Doctor4Life1769]

Good point --

1) In terms of calling attendings by their first name -- I guess I was trying to point out, is the atmosphere relaxed or broomstick up the backside formal?

2) Procedures unsupervised -- So there are several flavors of procedures --- Are the attendings fumbling through the procedures themselves and the residents watch (as in my case where I trained) or are the attendings confident enough in their residents that they let them do a thoracentesis unsupervised as a PGY2 (as in the IM program where I did my training) or ICU procedures unsupervised (central lines, ABGs, etc) again the IM program where I was at ---

for family medicine -- yeah, until I know the resident can do it by themselves and have done a few, I'm not going to let them do something that can get them into trouble (a bit rare in outpatient medicine) but I will say I'm not confident yet in my outpatient procedures since I had so few during my training -- removing a sebaceous cyst - yeah, I'd supervise that but let the resident drive ---

What you want to avoid is where the residents either A) get so few procedures that they really can't do anything after training or B) the "procedure training" consists of watching attendings doing everything ---does that make sense?

Gotcha. Makes sense.

I know a lot of times my faculty call each other by first name and even when talking to us refer to other faculty by first name. I'm sure it'd be cool but I just can't ever get myself to do that.

With regards to inpatient procedures - the only folks doing thoracentesis or paracentesis are the IR guys and CT/trauma/surg folks doing thoras. Same with chest tubes. We get minimal hands on experience with both. I can certainly do art lines and central lines and ABGs on my own but that's mainly because of my former training in a different specialty. Intubate as well. The residents here don't intubate or do art lines (RT/anesthesia domain) but they do place central lines. Those procedures can be done more frequently however on ED rotation with actual supervision from ED docs or surgeons.

I personally don't feel all that comfortable with fracture management. But, I'm spending some time moonlighting in urgent care to get that experience. Anything complex related to the eyes -- I'm much more inclined to refer after the initial eval. No colonoscopy experience, and personally, I wouldn't be doing those anyway. I feel like times have changed with regards to doing everything, but I get the impression you do a lot more out West than in the East. I could be wrong though.

 

[Relentlessrook18]

Thanks everyone! Great tips! If anyone has any other perspectives, keep them coming!

 

[VA Hopeful Dr]

Residents cannot bill for unsupervised procedures. What would end up happening with us is once we were signed off on them, the attending would stand in the corner and talk to the patient while we did whatever it was we were doing - technically being supervised, but essentially left to our own devices.

 

[SLC]

I'm curious as to how many FM programs have their residents doing all these procedures and are calling their attending by their first names? Not being facetious but I'm genuinely curious. I know my program if any procedure is to happen in clinic, signed off or not, faculty preceptor has to be present even if they aren't physically doing anything.

Signed off, we can do certain procedures without faculty present. Things like Nexplanon's, NG tubes, etc.

But most stuff, like joint injections and I think IUD's and stuff like that, faculty is present all the time to my knowledge.

We do call the faculty by first names, they have made sure of that.

 

[Doctor4Life1769]

Signed off, we can do certain procedures without faculty present. Things like Nexplanon's, NG tubes, etc.

But most stuff, like joint injections and I think IUD's and stuff like that, faculty is present all the time to my knowledge.

We do call the faculty by first names, they have made sure of that.

We do inpatient procedures without faculty presence
Outpatient procedures require faculty present so they may bill as VA mentioned.
Even if given permission to call an attending by first name, I personally have a hard time to doing that as a resident. However, that's cool

 

[SLC]

Even if given permission to call an attending by first name, I personally have a hard time to doing that as a resident. However, that's cool

I'm the same way, but our faculty are quick to remind us to call them by their first names. Some of them seem moderately annoyed when we don't use their first names. The hospitalists that supervise one of our inpatient teams are generally more into us calling them by Dr. Lastname however.

 

[SLC]

And with respect to ABG's, is this a procedure that people usually need to be signed off on? Is it normally even really considered a "procedure"?

 

[organdonor]

For me it was opposed or not, location, pay, "fit," food, moonlighting, what former residents are now doing, daily vs weekly didactics, and what EMR is used. Everyone has their own criteria.

 

[Xorthos]

I based mine off of:

1. How the residents interacted with me and each other.
2. How nice the faculty was
3. Opposed vs. Unopposed
4. Procedure availability
5. Location / Cost of living
6. How the specialists seem towards residents
7. Can I wear scrubs
8. Free food
9. Gym available?
10. How nice is the call room / Lounge / How well does the hospital take care of Residents?


The last few things seem petty, but when you're fishing through 4-5 programs that seem almost identical, those can really impact your list.

 

[styphon]

What I think is most important:
Talk to residents, especially when an attending/senior resident isn't in earshot. Find out if they are happy, what they like, what they dislike. Each person has their own likes/dislikes so take it with a grain of salt.