I'm only an MSII, but I've got a buddy going into surgery with the intent of doing peds surgery, and he's gotten me really interested in it. We were chatting the other day, and he said something I found curious: That if you're going to do a competitive fellowship (like peds surg) that you NEED to go to a hospital that actually has that fellowship to do your residency (I guess with the intent of flipping right over into the fellowship once finished with the residency). I disputed this; don't programs see this as "inbreeding"? I would think that most programs would discourage this, and want their students to go elsewhere, and want their fellows to come from other institutions. Thoughts?