Gauging programs' reputation

[mrbreakfast]

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So the interview trail has been going well, and I've been lucky to interview at a number of programs at which I think I could be happy. However, I'm having a pretty tough time actually putting these programs in a discrete order.

A program's reputation is important to me, in the sense that I am aiming for a strong fellowship followed by an academic position, ideally at a large hospital. I don't care as much about research prowess, but want to go to a program that will sufficiently impress fellowship directors. I also have no particular strong interest yet and thus want a balanced program. Issue is I have no idea which programs are significantly better than others and which are basically equivalent.

People say outside of the top few, the top 30 or so programs are basically interchangeable in terms of rep. I know doximity/US News are bad sources, so want to ask the experts of SDN. Thus, of the following programs, which are significantly "better/worse" enough for anyone who would care to actually care?

In alphabetical order:
-Case Western
-Cleveland Clinic
-Cincinnati
-Colorado
-Duke
-Michigan
-Ohio State
-Pittsburgh
-Thomas Jefferson
-Vanderbilt
-Virginia (UVA)

E.g. I know CCF and Michigan are excellent programs, and have heard UVA is well-regarded, but are the rest essentially interchangeable, or is there an obvious tier or two within them?

Again, I don't want a ranking or anything (which I realize is arbitrary) and realize I'll get a great education at each. I also realize many other factors go into the decision, and will not base my rankings on reputation alone. I'm just curious if any programs stand out in particular on either end of the spectrum.

I will also pick the brains of my faculty mentors, but am a bit hesitant as this list does not include my "safeties," among which is my home program...

Thanks!

 

[Thama]

Most of those programs are probably pretty interchangeable and will look good on a resume. I don't think that CCF and Michigan are in a different tier or whatever that means from the bulk of that list at all. I don't think I'd put Jeff or OSU in the same group as the rest, IMO. Depending on what you want to do later, certain programs stick out, e.g. Pitt for NIR, Cincinnati for stroke, Case for neurostimulation and prion disease, Vandy for movement, CCF for exclusively treating royal families of oil-producing nations (I kid... sorta). If you don't know what you want, then all of those will look pretty good on a resume for fellowship. Rank the places high that give you good vibes in a place where you want to spend 4 years of your finite existence.

 

[GuillainMollaret]

I agree with Thama, most of those places are going to be viewed as essentially the same, reputation-wise. Those are all pretty solid programs with their own unique strengths and weaknesses. Location and gut feeling should be what you go by i.e. go where you think you'll be happiest. You also want to go to a place with good clinical volume and resident autonomy (this can be more difficult to gauge by an interview, but you should be talking to residents about this).

I interviewed at many of the programs on that list as well as more "elite" programs not listed. The only major difference was a stronger focus on research and an academic trajectory at those bigger name places. I'm not sure how much different the overall clinical training really is compared to many of the programs on your list.

For anyone else reading, unless you're going into an academic career and chasing research grants plus want to be on a coast, then I really don't think it matters where you do residency, as long as it's at one of the top 30 or so programs (which many on the OP's list fall under).

 

[mrbreakfast]

Thanks all. In terms of reputation, this is pretty much the top of my list. I'm not particularly interested in research and have geographical preferences, so realize these aren't the "top" programs.

A big difference seems to be in amount of "early" electives (PGY2/3), which seems to be a major selling point - for those who've completed residency, is that worth what it's chalked up to be?

 

[GuillainMollaret]

Thanks all. In terms of reputation, this is pretty much the top of my list. I'm not particularly interested in research and have geographical preferences, so realize these aren't the "top" programs.

A big difference seems to be in amount of "early" electives (PGY2/3), which seems to be a major selling point - for those who've completed residency, is that worth what it's chalked up to be?

Most places are front loaded with inpatient rotations and tend not have much elective time PGY2. You should have a decent amount of elective time PGY-3/4. No or minimal elective time during PGY-3 would be a red flag in my opinion, although I don't remember any programs where that was the case.

As long as you have a couple of clinic blocks during PGY-2 where you can get exposure to some of the outpatient subspecialties, I'm not so sure elective time during PGY-2 is all that advantageous, especially if it's coming at the expense of less elective time during the senior years. The earliest fellowships don't start accepting applications until late fall or early winter of PGY-3, so you still have plenty of time to explore different areas in the first part of PGY-3. Many of my co-residents seemed to decide on fellowships near the end of PGY-2 or early PGY-3 without much difficulty. Finally, as a senior resident, you have a better idea of career trajectory, strengths/weaknesses, etc. and you can make more informed decisions on how to best spend your elective time.

I'd also be weary about how programs define elective time. For example, some places may not have separate EEG or EMG months and you are expected to use your "elective" time to complete those rotations. At other places, your elective time is truly whatever you want it to be with very little in terms of rules or limitations.

 

[mrbreakfast]

As long as you have a couple of clinic blocks during PGY-2 where you can get exposure to some of the outpatient subspecialties, I'm not so sure elective time during PGY-2 is all that advantageous, especially if it's coming at the expense of less elective time during the senior years. The earliest fellowships don't start accepting applications until late fall or early winter of PGY-3, so you still have plenty of time to explore different areas in the first part of PGY-3. Many of my co-residents seemed to decide on fellowships near the end of PGY-2 or early PGY-3 without much difficulty. Finally, as a senior resident, you have a better idea of career trajectory, strengths/weaknesses, etc. and you can make more informed decisions on how to best spend your elective time.

I'd also be weary about how programs define elective time. For example, some places may not have separate EEG or EMG months and you are expected to use your "elective" time to complete those rotations. At other places, your elective time is truly whatever you want it to be with very little in terms of rules or limitations.

Both of these points are great advice I hadn't thought of, so thanks! In particular it didn't occur to me that you pretty much should count EEG/EMG blocks and elective blocks similarly.

I'm leaning outpatient right now so evaluating programs for that, but I'll have to re-check the schedules for EEG/EMG blocks. Also good to know elective time during PGY4 is useful (as opposed to just being "nice") as the non-frontloaded programs have sold that aspect hard.

 

[Jimmy B]

Agree with the above. Unless you're trying to be an academic physician at a top ranked facility who is super-duper funded with R01's your residency training doesn't make much of a difference. This is coming from someone who trained at an ok program but matched at a very well-respected fellowship program and is now at a highly regarded institution as a faculty member.

 

[mrbreakfast]

For example, some places may not have separate EEG or EMG months and you are expected to use your "elective" time to complete those rotations.

Just to follow up on this: out of curiosity, approximately what's a "good amount" of time to spend on EEG/EMG in residency? I realize this depends on personal preference partially, but in looking at schedules I'm seeing anywhere between nothing and 5-6 months, which is obviously a lot. For example, is a few weeks of each sufficient, or if I'm looking at a program with a lot of elective time but no dedicated neurophysiology blocks, should I mentally be penciling in 3-4 months of EEG/EMG rotations?

 

[Jimmy B]

Just to follow up on this: out of curiosity, approximately what's a "good amount" of time to spend on EEG/EMG in residency? I realize this depends on personal preference partially, but in looking at schedules I'm seeing anywhere between nothing and 5-6 months, which is obviously a lot. For example, is a few weeks of each sufficient, or if I'm looking at a program with a lot of elective time but no dedicated neurophysiology blocks, should I mentally be penciling in 3-4 months of EEG/EMG rotations?

The ACGME requirement is 3 months minimum I think