Good Residency Programs

[5yrsold]

So am a third year definitely going into pediatrics and am just starting to look around.... was wondering what people have found to be some good peds programs (besides the obvious CHOP, Boston Childrens, and UCSF), including resident happiness.

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[fourthyearmed]

So am a third year definitely going into pediatrics and am just starting to look around.... was wondering what people have found to be some good peds programs (besides the obvious CHOP, Boston Childrens, and UCSF), including resident happiness.

I did an externship at one of the top peds residency programs in the country and hated it. Top program doesn't mean happy residents and it doesn't mean it's the place for you necessarily. My advice is to aim high but make sure you really will be happy there. Look for places you'd like to live first, then assess the programs in that area.

 

[jdog]

So am a third year definitely going into pediatrics and am just starting to look around.... was wondering what people have found to be some good peds programs (besides the obvious CHOP, Boston Childrens, and UCSF), including resident happiness.

Just out of Curiosity, why is UCSF "obviously" one of the best pediatric residency programs? I've never seen it put in the same class at CHOP or Boston Childrens or Texas Childrens or Cincinnati Childrens or other huge quaternary care centers???

 

[edmadison]

Just out of Curiosity, why is UCSF "obviously" one of the best pediatric residency programs? I've never seen it put in the same class at CHOP or Boston Childrens or Texas Childrens or Cincinnati Childrens or other huge quaternary care centers???

Also remember that just because a program is very prestigious doesn't mean you'll be happy or even that you'll get a good education. Look for a solid program where the residents are happy.

Ed

 

[KidDr]

So am a third year definitely going into pediatrics and am just starting to look around.... was wondering what people have found to be some good peds programs (besides the obvious CHOP, Boston Childrens, and UCSF), including resident happiness.

In echoing what's already been said, there are lots of great peds programs out there, and just because a program is "top 3" or "top 10" or whatever doesn't mean it's going to be the best place for you. I know that sounds SO cliche but take it for what it's worth. Programs have personalities, and finding a program that matches your personality goes a long way toward having a great 3 years. If that's at one of the top programs, by all means, go for it. But realize that you can get a great education at many, many programs that aren't in the very top tier.

 

[5yrsold]

so in that train of thought (which totally makes perfect sense), does anybody know of any good programs (with happy residents) to look into in ny/nj or san fran/san diego?

 

[Doctor&Geek]

Just out of Curiosity, why is UCSF "obviously" one of the best pediatric residency programs? I've never seen it put in the same class at CHOP or Boston Childrens or Texas Childrens or Cincinnati Childrens or other huge quaternary care centers???

UCSF doesn't even have a standalone children's hospital.

Yet.

 

[5yrsold]

UCSF doesn't even have a standalone children's hospital.

Yet.

So forget UCSF, it was listed in the same breadth by the head of peds at monty in new york... but where are some good programs?

 

[GeneGoddess]

UCSF doesn't even have a standalone children's hospital.

Yet.

I think stand-alone children's hospitals are overrated.

"Best" places depends on what you want. Pick a place you want to live, and THEN look for programs. I've heard great things about Fairfax-Inova, which is a community hospital outside of DC. What are you looking for?

 

[nicu1377]

UCSF doesn't even have a standalone children's hospital.

Yet.

UCSF is an excellent program. According to US News and World Report, it is among the top 10 pediatric residency programs in the country. It doesn't matter that UCSF does not have a standalone children's hospital. Apparently, Hopkins does not have a children's hospital and their program is in the top three in the nation.

 

[Cameron]

UCSF is an excellent program. According to US News and World Report, it is among the top 10 pediatric residency programs in the country. It doesn't matter that UCSF does not have a standalone children's hospital. Apparently, Hopkins does not have a children's hospital and their program is in the top three in the nation.

A slight correction -- US News does not rank residency programs.
From the US News website:
"Ranked only by reputation, hospitals in these specialties were names by at least 3 percent of the specialists responding to U.S. News surveys in 2002, 2003, and 2004."
The reputation of the hospital does not always reflect the quality of the associated residency program.

 

[SoonerBJJ]

What exactly does "good residency" mean?

I am from a mid-size residency program that isn't on any of the publicized top 10 lists. Over half of our residents go on to fellowship at some of the largest and most prestigious programs in the country. I have several friends that are fellows at the hospitals with the "top 10" residency programs and they laugh at how inept the residents can be. Some may be able to list all the diagnostic criteria of some obscure syndrome, but they cannot make autonomous decisions in patient care. They wouldn't know the first thing to do in a code situation and God help the patient if there weren't fellows or attendings around if a patient needed central veinous access or intubation. Lucky for them (and their patients) there is always a fellow or attending around. However you cannot learn the nitty-gritty of patient care watching over a fellow's shoulder.

Whether you are going in to general pediatrics or on to fellowship, I advocate going to resident-run program without fellows. When fellows are present it becomes a fellow-run program, thus removing patient responsibility from the resident. Fellows have priority for procedures and decision-making. By their nature most fellows are more aggressive and will direct care rather than letting the resident function with autonomy, as an attending may be more likely to do.

We have fellows in endo, genetics and neonatology. While the endo and genetics fellows can be very helpful and may offer another level of learning opportunity for the resident, fellows in neonatology, PICU, ER, etc will by definition have some conflict of interest with the resident when they are trying to learn too. Until the fellow feels completely competent in procedures, etc they will always get the first opportunity. Fellows in these areas of higher acuity will tend to direct the resident more than a confident attending may.

I did most of my NICU rotations without a fellow present. I feel completely confident in the PICU, NICU and ER because I have been thrown in to the mix with full responsibility for my patients. I was in direct communication with my attendings when I needed their counsel or assistance.

A program with this model of learning will produce general pediatricians or fellows that leave with confidence in their ability to handle nearly any situation. Having fellows as a back stop is a crutch that makes sure residents never feel fully responsible for their own decision. Even if you're going out to the country to set up a quiet general pediatrics practice, wouldn't you like to know you can put in a femoral line or a chest tube in a pinch?

I am now going to a fellow-run fellowship. As I have said I feel completely confident in my ability to make decisions in the heat of the moment and I feel very competent with procedures (complicated intubation, CVL, IOs, UAC/UVC, chest tubes, etc). I wouldn't have achieved this if I were in a program dominated by fellows. I have talked with residents from "top 10" programs and many have echoed these sentiments.

Having the attending who wrote the textbook at your institution doesn't do much good if you cannot walk into his/her office and chat or ask questions. That is the problem with many of the ivory towers of the medical field. Our program boasts first authors, NIH-funded researchers, etc only in smaller numbers than a "top 10" program. The difference is that in a smaller environment I can walk in to any of their offices and they know me by name. To benefit from the great ones you have to have exposure to them and the opportunity to learn from them.

I could go on and on but my point is that the definition of "good program" is very subjective. Don't be fooled into thinking the place you do your residency will make you any better pediatrician than someone from a less well known program. Much of your success as a resident is dependent on your own initiative, regardless of the resources that may be available. Look around and keep your goals in mind when evaluating residency programs. Don't rely on a "top 10 list" to make your interview schedule. You may be sorely disappointed.

 

[nicu1377]

A slight correction -- US News does not rank residency programs.
From the US News website:
"Ranked only by reputation, hospitals in these specialties were names by at least 3 percent of the specialists responding to U.S. News surveys in 2002, 2003, and 2004."
The reputation of the hospital does not always reflect the quality of the associated residency program.

Actually, US News ranks the reputation of schools affiliated with the best programs in addition to the reputation of their corresponding hospitals. If you look under the specialty rankings category, they say the following: "The rankings are based solely on ratings by medical school deans and senior faculty at peer schools.They each identified up to 10 schools offering the best programs in each specialty area. Those receiving the most nominations appear here."

 

[jdog]

Actually, US News ranks the reputation of schools affiliated with the best programs in addition to the reputation of their corresponding hospitals. If you look under the specialty rankings category, they say the following: "The rankings are based solely on ratings by medical school deans and senior faculty at peer schools.They each identified up to 10 schools offering the best programs in each specialty area. Those receiving the most nominations appear here."

Nobody is really answering your question.

There are so many things that should go into your decision. First and foremost are your personal goals. For example, if you know you want to be an office based community general pediatrician who will not attend deliveries and not round in the hospital, then your goals will be totally different than someone who wants to to critical care fellowship.

For example, if you want to do the former, than you do not need to be in a large referral center for your residency where you get exotic cases referred in for very rare diseases, where very complex transplantation, bone marrow transplantation, bariatric surgery, etc. are performed. You probably want something more community based or mid-size with more ambulatory months and less super specialized rotations. For example, a small program may not have a separate ward service for cardiology, neurosurgery, renal patients, bone marow patients, etc. They may have everyone on a general service because most of what they see is general.

On the other hand, if you want to do more of a fellowship type deal, you might want to be in a place where you do see complex and exotic things more often, because as a pediatric consultant in a subspecialty, you will be called to consult on complicated patients. If you show up for fellowhip and you have never seen a bone marrow transplant patient before, or never seen a patient with an exotic seizure disorder, etc, than it will make things more difficult. If you want to get in on a research project so when you go for your fellowship interview you show that you have done some research, it is easier if you are at a place that has a lot of research going on and someone can easily and with no hassle get you in on a project that will require minimal work on your part.

If you are not really sure what you want to do with your life at this point, which most don't, pick a place that will keep your options open. I.E. dont' to to a very small program that offers limited services.

I will go ahead and answer your question about what are the "best" residency programs by REPUTATION. Although the guy from Oklahoma raises some good points, I think you need to keep in mind that places with a good reputation probably have these reputations for a good reason, that they are good hospitals that train solid residents.
While I am sure he is receiving great training, he is speaking about things that he does not have direct experience with.
For example, they do not have cardiology fellows, and we do at my program. So that must mean that residents at his program are putting in pacemakers, doing catheter ablation, doing EP studies.
Trust me, big name places have plenty of codes, lines, intubations, etc. to go around for residents to get plenty of procedures. I am at a "big" program which Oklahoma mocks and I have put in 2 UAC and UVC and 3 intubations in the last week in NICU.

I will just list a bunch of programs which are probably A list inationally n reputation.
CHOP, Boston Childrens, Hoplkins, Texas Childrens, Denver Childrens, Cincinnati Childrens, Childrens Memorial, Pittsburgh Childrens, New York Presbytirian, St Louis Childrens, U Washington, UCSF, LA Childrens.

I am originally from the southeast and as you can see from list above, there is a bias nationally against the SE because a lot of elitism exists. In the SE the top programs would be in no order, UNC, Duke, Emory, Vanderbilt, UAB, UVA. Other places with good rep but less prestige are South Florida, MCG, Wake Forest, UT Memphis.

I don't know much at all about the western U.S. so will defer there.

Hope this helps.
Just talk to people that you actually know and trust. Just use my post as a guide to talk to others since you don't know me.

 

[SoonerBJJ]

I agree with much of what jdog has said. I believe that regardless of what your career goals may be you should avoid smaller programs that lack variety and broad subspecialty care. To be a well rounded general pediatrician you need exposure and experience with both the bread and butter pediatrics and the subspecialties. If you plan to be attending deliveries then good NICU (level 1-3) experience is a must.

You do not have to be at a "top 10" program to get this kind of experience. There are hundreds of hospitals around the country that have busy general peds wards and full subspecialty care. The difference in one with fellows and one without is that you will be responsible for their care rather than the fellow. When fellows are in the equation the attending' priority (whether it is obvious or not) is educating the fellow in whom he/she has a vested interest. This detracts from the learning experience in my opinion, but others may disagree.

I agree that if research or fellowship are goals then you should find a residency where there is active research that is available to the uninitiated resident. However it is possible to get into any pediatrics fellowship without research experience if you are otherwise qualified.

The places with good reputation have developed their reputation for reasons other than the quality of the residents they train. Published rankings are largely based on subjective criteria that do not reflect any objective measures of the "quality" of the residents. Often rankings reflect the academic reputation of faculty, funding dollars, size and volume, etc. These things do not directly correlate with the quality of the residents. Being a prolific author in the medical literature does not always correlate with being a good teacher. You cannot learn from the faculty who hide in the ivory towers simply by being on the same campus. When looking into a program see how accessible the faculty are to the residents.

Our residents are able to assist the faculty in pacemaker placement, caths, EP studies, etc. There is no fellow to compete with for cath lab time with the attending. A very close friend of mine is a third year cardiology fellow at what is regarded as a "top 3" fellowship program. She assures me that the residents involvement with the cardiology patients is minimal at best. They have NO direct responsibility for patient care. The residents are so used to having a cardiology fellow around that at the first hint of a "cardiac issue" they call the fellow for help, rather than problem solving and investigating upon their own initiative. When codes occur (as I know they do in large hospitals) the PICU fellow is at the bedside almost immediately to run the show. I also have a close friend that is a PICU fellow in the program that I will be joining next year and she is amazed at how little initiative and autonomy the residents display while on call in the PICU. The residents are generally very intelligent and will be well prepared for boards, but they do not act autonomously in the PICU. When it comes to vent changes, fluid adjustments, electrolyte corrections, etc EVERYTHING comes to her first. This is in stark contrast to her experience as a resident doing all of this on her own. I won't belabor the point, this is simply a different model of learning and you must decide where you would feel most comfortable.

As long as you are at a program with sufficient volume then you will have the opportunity to play the role of the fellow as a resident. In our case I consider myself lucky that we have such large volume and variety, especially in regards to subspecialty services. For example when on the cardiology service our residents are directly responsible for management. When in the PICU we make the minute to minute decisions. The same applies for all services that would have a fellow in another program. Again I won't belabor the point any longer.

jdog I believe you have mistaken my intentions if you think I have mocked any program. I am simply presenting an alternative perspective for the medical student considering pediatrics residency. I hope I haven't offended you.

 

[oldbearprofessor]

When fellows are in the equation the attending' priority (whether it is obvious or not) is educating the fellow in whom he/she has a vested interest.

You cannot learn from the faculty who hide in the ivory towers simply by being on the same campus. When looking into a program see how accessible the faculty are to the residents.

hi - this is an interesting discussion. I actually think from my experience (primarily NICU not PICU) that the presence or absence of fellows is a relatively small factor itself in determining the learning experiences of residents both educationally and procedure-wise. The fellows often do more teaching to residents of both than anyone else. Other factors that are more important in an NICU setting include the patient mix and how they are transported. For example, if nurse practitioners do all transports then babies are likely to come already intubated with lines in place. Also, the amount of time spent at different types of neonatal services (delivery room, level 1,2, 3, etc) makes a big difference.

I did want to deny that my priority, obvious or not, is to educate fellows at the expense of resident education. The overwhelming majority of my time on rounds, and from what I have observed, that of my colleagues, is spent in direct education of residents. I have a vested interest in ensuring that residents are well-trained and like neonatology. Fellow education often comes from answering (or failing to answer...) the questions that the residents can't and from supervising the residents and nurse practitioners.

As far as hiding in ivory towers, I agree that this won't help the resident. The key here is to find out whether the academic faculty are doing teaching rounds. Most do. A few don't if they are fully NIH funded. Even here it isn't obvious because JUNIOR facutly, with K08's, may have as much or more protected time and do less clinical work than the more senior faculty.

Ultimately, I think we can all agree that finding the best program for an individual depends on the individuals needs and how they are met by program design and operation. Choosing a program, or rejecting one, solely based on reputation scores in magazinces, size, the presence (absence) of fellows, etc, isn't the best way.

Off to go teach residents

Regards

OBP

 

[SoonerBJJ]

Another good post by OBP. I will clarify my position on fellows in the unit (NICU or PICU). The resident learns more about the nitty gritty of patient care when they have primary responsibility for the patient. I am not talking about education about pathophysiology, principles of management, etc. I am talking about the fine details of patient-specific fluid orders, vent changes, nutrition, med schedules, etc. This has been the criticism my friends have had for the residents they have encountered in other institutions. They may have been taught well about larger principles but when it comes to putting them into practice with specific patients and actually giving the order they are deficient. This is where the fellow comes in to play. Aggressive fellows want to be involved in patient care and consider it part of their teaching role to tell the residents exactly what to order. They compensate for the resident's deficiency and the resident leaves without learning to make autonomous decisions. A better model in my opinion is for the attending/fellow to teach the principles and allow the resident to learn to apply those principles to their own patients. By their nature fellows are less likely to allow such independence, whether it is their own assertiveness, initiative, lack of confidence or whatever.

 

[sgd]

To answer your question.
I am a happy 2nd yr at SUNY Buffalo. We are a free standing children's hospital. I think we have a excellent program that trains you for either gen peds or any subspecialty. The program is medium in size and we have fellowships in most fields.
Residents are happy here. We have a good schedule and have friendly attendings who are top notch and willing to teach.

I know some of my friends are happy at LIJ in queens, NY. Also I rotated at Robert Wood Johnson in NJ as a med student and found it to be a nice program.
-Good Luck