Apoplexy__

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There's plenty of talk on this sub-forum of finding the most cush PGY-1 years possible. How do people determine whether a program is cush or not without knowing someone who went through the program?

All I understand about what determines this is:
-Community > Academic?
-Few inpatient/ICU months (<8?)
-Many elective months (>3?)

Any other components to the discussion, or resources to use to find out?
 

Gadofosveset

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There's a lot of hidden variability.
One program's ICU may be less burdensome than another program's floor month.
One program's electives may be more work than another's.
One program's prelim program may be less effort than their transitional program.
Gathering words of mouth is the best use of your time, I think. See if you can contact graduates of the programs you're interested in for their opinions.
 
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Agree with above poster. More electives and less ICU are good signs, but you really have to talk to people who are there or went through the program.

Another indicator is that if a TY seems inordinately competitive (all their prelims are from Harvard, etc), that also gives a clue that it has a reputation for being cush.
 
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Apoplexy__

Apoplexy__

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Thanks guys.

but you really have to talk to people who are there or went through the program.
I keep hearing this. Sorry for needing it to be spelled out, but how exactly does this usually go down? Googling a program, looking for former residents, cold-calling/emailing them, and bluntly asking "hey, was your intern year really chill?"
 
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Ideally you could reach out to alumni from your school who attended/are attending programs you are interested in. Look at your school's match lists from the past few years and start there. :)
 
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DeucesHigh3

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Ideally you could reach out to alumni from your school who attended/are attending programs you are interested in. Look at your school's match lists from the past few years and start there. :)
And if your school *doesn't* have any alumni at those programs (and not simply because of geography), you may well have discovered one of those places that is super-competitive without showing any outward signs as to why...
 
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There are many TYs out there that are TY in name only these days (as in, they function more like prelim medicine programs). And on the flipside, there are prelim medicine programs out there that are more chill than many TYs. You really have to dig into the nitty-gritty and sometimes you'll still not have a good idea of how cush a program is.

You have to read the fine print carefully. There are many programs that advertise a lot of elective time, but what exactly are those electives? A "Cardiology" elective may actually be a cardiac admitting service where you're an intern scut monkey with a rough call schedule that's worse than an ICU month, or it could be a really chill consult service with all weekends off where you work 9am-3pm on most days. Be vary wary of how call works. Find out how routinely you're on jeopardy (the back up call person for sick colleagues) and how often you are going to get pulled on the weekends to cover the wards. Some places have tons of elective time, but you get pulled to cover weekend ICU and ward day or night shifts every weekend or you're on jeopardy so often that you're getting pulled from your electives nonstop.

Also, don't be swayed too heavily by excessive perks. I personally don't care about free food in a crappy cafeteria if I have to be on call every weekend while I'm on elective. Technology perks are nice, but don't let a free tablet blind you either if the program has serious problems. Beware nice locations as well. University of Hawaii's prelim medicine is going to work you like a dog, which is the price you pay for that location. Chicago, NYC, and Cali programs can and will exploit their location to enlist high-quality interns to terrible programs.

Avoid any place that takes pride in treating their prelims or transitional interns "like categoricals". If they're using that language, their priority is clear: they want intern scut monkeys and they don't have a chill program. In a similar vein, it may be a good thing if there isn't a nearby categorical medicine program or if you won't be on the same services as the categorical program. If you are going to be working with hospitalists primarily, the upside is likely shorter hours and less academic BS. If any program prides itself on relying on residents for the bulk of the admitting, then you're going to be over-worked.

So how do you find out if a program is legit cush? Honestly, the interview day and talking to current interns isn't going to yield too much useful information because any program can dress itself up nicely and present yes-man residents who will project a positive image of the program. I know that while I was at my internship, I said lots of nice things about the program even though there were big gaping holes in the cush landscape.

Talk to the alumni from your school from the past couple years. Or the radiology residents at your home institution. It's really hard to find information online about cush TYs because a lot of people play information close to the vest and these programs change so rapidly (several great TYs have shut down in recent years or changed program directors that completely changed the programs). Otherwise, DeucesHigh is right. If there are a bunch of Harvard-grad future-dermies at a program, that's a beacon showing that place to be cush. Expect stiff competition. There are hidden gems all over the country though, you just need to look.
 
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Apoplexy__

Apoplexy__

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There are many TYs out there that are TY in name only these days (as in, they function more like prelim medicine programs). And on the flipside, there are prelim medicine programs out there that are more chill than many TYs. You really have to dig into the nitty-gritty and sometimes you'll still not have a good idea of how cush a program is.

You have to read the fine print carefully. There are many programs that advertise a lot of elective time, but what exactly are those electives? A "Cardiology" elective may actually be a cardiac admitting service where you're an intern scut monkey with a rough call schedule that's worse than an ICU month, or it could be a really chill consult service with all weekends off where you work 9am-3pm on most days. Be vary wary of how call works. Find out how routinely you're on jeopardy (the back up call person for sick colleagues) and how often you are going to get pulled on the weekends to cover the wards. Some places have tons of elective time, but you get pulled to cover weekend ICU and ward day or night shifts every weekend or you're on jeopardy so often that you're getting pulled from your electives nonstop.

Also, don't be swayed too heavily by excessive perks. I personally don't care about free food in a crappy cafeteria if I have to be on call every weekend while I'm on elective. Technology perks are nice, but don't let a free tablet blind you either if the program has serious problems. Beware nice locations as well. University of Hawaii's prelim medicine is going to work you like a dog, which is the price you pay for that location. Chicago, NYC, and Cali programs can and will exploit their location to enlist high-quality interns to terrible programs.

Avoid any place that takes pride in treating their prelims or transitional interns "like categoricals". If they're using that language, their priority is clear: they want intern scut monkeys and they don't have a chill program. In a similar vein, it may be a good thing if there isn't a nearby categorical medicine program or if you won't be on the same services as the categorical program. If you are going to be working with hospitalists primarily, the upside is likely shorter hours and less academic BS. If any program prides itself on relying on residents for the bulk of the admitting, then you're going to be over-worked.

So how do you find out if a program is legit cush? Honestly, the interview day and talking to current interns isn't going to yield too much useful information because any program can dress itself up nicely and present yes-man residents who will project a positive image of the program. I know that while I was at my internship, I said lots of nice things about the program even though there were big gaping holes in the cush landscape.

Talk to the alumni from your school from the past couple years. Or the radiology residents at your home institution. It's really hard to find information online about cush TYs because a lot of people play information close to the vest and these programs change so rapidly (several great TYs have shut down in recent years or changed program directors that completely changed the programs). Otherwise, DeucesHigh is right. If there are a bunch of Harvard-grad future-dermies at a program, that's a beacon showing that place to be cush. Expect stiff competition. There are hidden gems all over the country though, you just need to look.
Great post, thank you so much! Good to know several of those variables to look for.
 
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