Help: What To Look For In A Residency Program??

[regulator2000]

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Hi i would like to get your help on forming a list on WHAT TO CONSIDER IN A RESIDENCY PROGRAM.

example: do hospitals off prematches, if they have a night float system, is there a good amount of diversity in the residency... etc...

please add what you think are important determinants, and which were imp. to you. thanks!!

 

[Trifling Jester]

Find out who draws the blood cultures, labs, sets IV's etc. You want a hospital who has the ancillary services to do that. Stay way from the hospitals where residents are pushing patients around to x-rays, cat scans etc. Good ancillary is key - you don't want to be stuck with the menial scut on top of all the other paperwork scut you'll be forced to deal with.

Find out which programs give you free meals and have well stocked call rooms with clean linens etc. You don't want to worry about where your food is coming from or how you're gonna get clean sheets while you're on call. See how late the cafeteria is open and how the residents get food late at night when things finally slow down enough for there to be time to eat.

Find out how good the social workers are at getting patients placed. You don't want a service full of rocks who should really be in a SNF or NH, that just adds time to rounds and makes for additional paperwork.

Find out if the program takes their own residents for fellowships. If they don't then obviously the program must not be highly though of, even in their own institution.

Ask the residents how well the program adheres to work hour rules. Do they attendings shorten rounds for the residents when they're post-call? Or are you stuck hearing about the etiology of a low potassium after you've been awake all night admitting 10 patients? Do you cap after a certain number of admits?

Get an example schedule from one of the interns to find out how many ward months you do compared to how many electives you have. 6-8 ward months is probably average (at least in the south). 10 ward months and you should start getting suspicious of whether you're there to learn or to be an H&P and admit order machine.

Get all your answers from the residents, and don't trust anything the PD tells you without verifying it first.

-The Trifling Jester

 

[regulator2000]

great pointers. thanks. whats an PD?

 

[JayneCobb]

great pointers. thanks. whats an PD?

Program director. But also try to meet the PD and the DME, as the DME has just as much influence over you as the PD.



I then looked at the hospital. there are several things which a hospital needs (IMHO) to make a great IM program.

Trifling Jester made a great start, but some other things I personally looked for in a program were

• Lots and lots of ICU beds
• neurosurgery (not necessary, but would be nice for ICU experience)
• most subspecialties in house with the hardest ones being Endocrine and Rheum to find (although these do tend to be out pt specialties.)
• retention rates - there are programs out there who fire residents for no damn reason.
• Harrison's/Cecil's Reading club
• Journal club
• Daily didactics (preferably with Attending interaction)
• allow away electives (you'd be surprised at how many do not because it costs them money if you're gone)
• have most rotations in house.

I'll expound on this latter, but I've got some reading to finish up tonight.

 

[Trifling Jester]

great pointers. thanks. whats an PD?

PD = program director. He's the one who holds all the cards. He decides who get's canned, who graduates, and who becomes chief.

Oh, and about the fellowships. You want to find out if they take their own residents for the competitive fellowships (cards and GI). It's totally meaningless if they tell you they take their own for fellowships but what they really mean is "yeah, we take our own residents for rheumatology and ID." (not that there's anything wrong with rheum or ID, just that they're not very competitive right now)

I'd be a bit skeptical of programs that offer pre-matches unless you're 100% sure you want that program. They're normally offering you a prematch because they know they won't fill their slots through the match. If they know in advance that they can't fill through the match then it makes you wonder why that is...

My program doesn't have night float. I sort of think it would be a plus, but then maybe it's just me thinking the grass is greener on the other side.

Beware of hidden costs. Some programs will make you pay for things like scrubs, white coats, prescription pads, etc. Some even have the gall to expect you to pay for parking. WTF? I get paid $7/hour and I'm supposed to pay for the priviledge of parking my car there? Hell no.

Some of my friends are at programs that have private patients. They all hate it. You have to call the private attending and ask him for his plan. You don't really contribute to the patients management decisions and you basically serve as a scut monkey for patient's "real" doctor. The point of residency is to learn to be a doctor by formulating your own plan of action, not transcribing someone else's orders. Stay away from programs that have you round on/take care of private patients.

Diversity.... This was totally meaningless to me. I couldn't care less how diverse the residents were as long as I got along with them. They could be 100% white guys, or a big group of Indian FMG's, or 100% hot chicks (Ok... who am I kidding here 🙂, but as long as I could relate to them it wouldn't matter to me in the least. I'd concentrate more on whether or not you could "hang out" with those residents than on whether they have a few residents from each ethnic group. The dinner/social greet is a good way to gauge this.

-The Trifling Jester

 

[ChildNeuro]

I would get a good feel of the program by visiting the place. I would see what support the program gives to residents indirectly by asking about stuff in the above post like clean sheets in the call rooms, free food in cafeteria, or more importantly the availability of food at night when on call, ability to do away electives, night float system, and ask about if there is food at noon lectures, an in-house phlebotomy team, how are the nurses like to work with (you should probably ask current residents than the PD this as residents are closer to nurses).

My basic litmus test is really to go to the hospital cafeteria, see what type of food/menu they have, talk to whatever resident or nurses is hanging out there, and then observe in the cafeteria for ten minutes, see if people are busy, laughing or look stressed. The places with the least stressed residents in my experience are the hospitals with good cafeterias open a large amount of the day with good food. You have to feed the army well first before wining the war.

 

[2008md]

Just wanted to say thank you to all those that have posted! This is a very useful topic and any additional input would be great.

 

[Trifling Jester]

My basic litmus test is really to go to the hospital cafeteria, see what type of food/menu they have, talk to whatever resident or nurses is hanging out there, and then observe in the cafeteria for ten minutes, see if people are busy, laughing or look stressed. The places with the least stressed residents in my experience are the hospitals with good cafeterias open a large amount of the day with good food. You have to feed the army well first before wining the war.

That's a good idea. I'd go a step further and seek out the resident who is on call on the day that you visit. After his fifth or sixth admit he'll be grumpy and annoyed at admitting another bogus atypical chest pain/noncompliant CHFer,COPDer or wino who won't go home. If you ask a stressed out resident about his program he'll give you the real skinny on what's up, without any window dressings. If you ask the residents at the get-together they may be more relaxed, the stress of call becoming a faint memory, and also might be wary of giving you their true opinion in front of other residents.

-The Trifling Jester

 

[ChildNeuro]

That's a good idea. I'd go a step further and seek out the resident who is on call on the day that you visit. After his fifth or sixth admit he'll be grumpy and annoyed at admitting another bogus atypical chest pain/noncompliant CHFer,COPDer or wino who won't go home. If you ask a stressed out resident about his program he'll give you the real skinny on what's up, without any window dressings. If you ask the residents at the get-together they may be more relaxed, the stress of call becoming a faint memory, and also might be wary of giving you their true opinion in front of other residents.

-The Trifling Jester

Yeah, I agree, residents at get togethers sort of feel they have to play up the program too, i.e. maybe they get a free lunch, and like you said the PD or fellow residents can be listening in, in addition to having post-call euphoria that they survived another call. I saw one deft interviewee during a tour of the IM ward actually sneak-off from the "tour", and talk to a student and resident who were working, boy did they give her the lay of the land! They told her how the program sort of skirts around the 80-hr work week by using a combination of "short-call" and "long-call" and instances where you are informally required to stay longer. The residents giving the tour couldn't mention this due to their attending chaperones. . .

 

[regulator2000]

anyother suggestions??

 

[JayneCobb]

• What restrictions do they place on residents (i.e. can you dictate, can you prescribe some narcotics in clinic, do they restrict any medications you may give in house)
• Are the teaching attendings purely academic or are they private practice docs who also teach.
• how efficient is the DME staff at maintaining records.
• quality of the nursing staff (What I wouldn't give to be at a magnet hospital now)
• What does the hospital NOT have
• What is the general patient population (rich, poor, white, minority, insured, indigent, etc)
• What specialty clinics are associated with the program (Ryan White, DM, etc)

 

[lfcdoc]

-support staff: ask the residents if the nurses are good, do the blood draws get done, who does them etc.
-patient caps: both how many you can admit on call and cap on how many you can carry
-how protected didactic time is: do the residents make it to noon coference and morning report ever
-and then I'd just like to second how impt. having SW to help with placement is
-fellowship placement: how many match and where

 

[regulator2000]

ifcdoc... good tips...

what number is good, when considering how many pts an intern can cap at and how many he can carry? what should we look for??
and is SW for social worker??

 

[NotAProgDirector]

How about a wicked cool program director, like me?

 

[lfcdoc]

ifcdoc... good tips...

what number is good, when considering how many pts an intern can cap at and how many he can carry? what should we look for??
and is SW for social worker??

1 and 2. Most programs allow you to take 5 new admits on a call night, this is normal and doable. Also, find out if ICU transfers count towards your admitting cap. At the program I did med school at they didn't count so you could take 5 new admits plus 2 ICU transfers, where I now do residency they do count. I'd say 5 new admits, including ICU transfers is a good cap. In regards to your total patient cap (total # of pts you can carry) no program can have you carry more than 12, this is regulated, so anything below that is good. At my program the cap is 8 or 9, which is as good, or better, than the other programs I had interviewed at.

3. Yes, SW is social work