Hidden Gem residency programs?

[misteratoz]

What programs stood out to you in a surprisingly positive way? I'm not talking about places like Brigham and Duke, but otherwise solid programs that aren't mentioned in the same breath the big dogs.

I'm struggling with these ones:

-University of Virginia: Very strong clinical training, awesome people through and through, very solid research infrastructure, well-connected faculty, great location (I loved Charlottesville). 1/2 do PP, 1/2 do fellowships and seemingly get their picks.

-Cedars-Sinai: People dump on this program but clinically it's hard to argue with the volume of everything you'll get here. 8 floors of ICU, more hearts and OB than anywhere else in the country, huge regional volume (and one of 2 programs to get an accredited regional fellowship next year), fantastic exam prep, sunny LA...I could get used to that. I got the impression (talking to residents and fellows) that the 1:1 was blown way out of proportion. Very little bench research but don't care much for that.

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[abolt18]

University of Kentucky. (In Lexington)
Seriously nothing but good vibes from the interview experience. PD is as resident-centric as it gets. Great education structure. Doing just about any big sick case you can do. I walked in knowing nothing and having no expectations. I walked out pleasantly surprised and happy to rank it highly.

 

[Psai]

Rochester. Probably gets looked over because of location but it's a solid program filled with great people. Not the best place if you're single though.

 

[anbuitachi]

Mount Sinai

 

[Psai]

Mount Sinai

Zero points for figuring out which program he's at

 

[hockey10]

Penn state is definitely a hidden gem, awesome training, great residents, awesome faculty, exposure to just about anything and a cheap place to live. Pm me with any questions about the program.

 

[Noyac]

How about Univ of New Mexico?

 

[deleted162650]

How about Univ of New Mexico?

We'll see what choco has to say about that. . .

 

[26B]

Penn state is definitely a hidden gem, awesome training, great residents, awesome faculty, exposure to just about anything and a cheap place to live. Pm me with any questions about the program.

When I interviewed, several residents complained about the complete lack of moonlighting and often working 70+ hour weeks. Only 3 residents made it to our dinner, which suggests the work hours they spoke of may in fact be true. What are your thoughts?

 

[Bru]

I also heard they were on the heavy side. Per one resident --"We [the residents] are the main workforce in the OR".

I was indifferent to the lack of moonlighting TBH.

Other than that, I actually liked the program. Nice hospital, people were super nice. A little on the rural side for me but that's preference.

 

[hockey10]

When I interviewed I also didn't like that I couldn't moonlight there, but now I'm glad I don't have the option. I enjoy going home and seeing my family, there will be plenty of time to make some money. Sure, we do work around 60 hours a week, somesrimes 65, but I'd rather work hard now, see just about everything and be ready for whatever comes into the room. We get a really good experience here and I would still choose Hershey again. The reason only 3 residents made dinner was probably because we usually only have 3 there.

 

[Southpaw]

I trained at UVA. Extremely solid all the way around. You'll be prepared for anything and everything as you graduate. If you want to go to fellowship you'll go where you want provided you're a solid resident. Nemergut is as well connected as they come, and a great guy.

There are lots of great training programs out there. Kentucky seemed like a 'hidden gem' when I interviewed.

I'm happy to answer questions about UVA via PM if you have them, but I'm almost certain everything was answered on your interview day.

 

[chocomorsel]

We'll see what choco has to say about that. . .[/QUOT

 

[chocomorsel]

We'll see what choco has to say about that. . .

Oh hell no!!! You know me too well Salty.

Honestly, that rabid bitch that used to be the PD is no longer the PD. Instead she is higher up as director of education or some **** like that. In other words she is still around and can probably continue to make someone's life miserable.

The new PD, was a couple of years ahead of me in training. He seems ok, but he did seem drink her Cool Aid when she was in charge and he was just an assistant professor. So I don't know how he is as a PD. The cardiac rotation apparently improved immensely since I left and they brought in a new CV anesthesiologist and surgeon who were just starting out in my last few months. Strong regional, OB and pediatric experience. The peds docs are awesome.

But I am a few years out now. So I can't say for sure. That place used to be laid back, but not while I was there. Maybe it is again? Who knows?

 

[chocomorsel]

Oh hell no!!! You know me too well Salty.

Honestly, that rabid bitch that used to be the PD is no longer the PD. Instead she is higher up as director of education or some **** like that. In other words she is still around and can probably continue to make someone's life miserable.

The new PD, was a couple of years ahead of me in training. He seems ok, but he did seem drink her Cool Aid when she was in charge and he was just an assistant professor. So I don't know how he is as a PD. The cardiac rotation apparently improved immensely since I left and they brought in a new CV anesthesiologist and surgeon who were just starting out in my last few months. Strong regional, OB and pediatric experience. The peds docs are awesome. Don't know about the ICU experience. Went thru some changes in the past couple of years. And it sucked when I was there. So I don't know if it's improved or not.

But I am a few years out now. So I can't say for sure. That place used to be laid back, but not while I was there. Maybe it is again? Who knows?

 

[Noyac]

Oh hell no!!! You know me too well Salty.

Honestly, that rabid bitch that used to be the PD is no longer the PD. Instead she is higher up as director of education or some **** like that. In other words she is still around and can probably continue to make someone's life miserable.

The new PD, was a couple of years ahead of me in training. He seems ok, but he did seem drink her Cool Aid when she was in charge and he was just an assistant professor. So I don't know how he is as a PD. The cardiac rotation apparently improved immensely since I left and they brought in a new CV anesthesiologist and surgeon who were just starting out in my last few months. Strong regional, OB and pediatric experience. The peds docs are awesome.

But I am a few years out now. So I can't say for sure. That place used to be laid back, but not while I was there. Maybe it is again? Who knows?

I am quite a few years removed from UNM and therefore, I'm not totally familiar with everyone Choco speaks of. But I will say this, the chair and vice-chair were my two favorite people bar none in my career of anesthesia. They were simple worker bees when they trained me but I will never forget them. I walked out of that hospital knowing how to do adult and pedi hearts alone without blinking. I knew how to do pain management. I could do anything you put in front of me without needing to do a fellowship. My first job found me doing the most hearts of the entire group for the next 3 yrs, over 1200. Not to mention covering the pain clinic 1-3 days a week. I was more prepared to do anything that confronted me than the guys that started with me from the ivory towers. It was sort of a running joke.

As for the rest of the group of attendings. I know about half of them. It is an eclectic mix. None of them would I say are poor or that they don't have something to offer. The best thing about them is that they did cases. They did them solo and they did them with residents. That matters tremendously. And your pedi comfort at graduation will be dialed.

All of this I say with a disclaimer, it's been a while. But the names ther haven't changed much.

 

[sevoflurane]

I am quite a few years removed from UNM and therefore, I'm not totally familiar with everyone Choco speaks of. But I will say this, the chair and vice-chair were my two favorite people bar none in my career of anesthesia. They were simple worker bees when they trained me but I will never forget them. I walked out of that hospital knowing how to do adult and pedi hearts alone without blinking. I knew how to do pain management. I could do anything you put in front of me without needing to do a fellowship. My first job found me doing the most hearts of the entire group for the next 3 yrs, over 1200. Not to mention covering the pain clinic 1-3 days a week. I was more prepared to do anything that confronted me than the guys that started with me from the ivory towers. It was sort of a running joke.

As for the rest of the group of attendings. I know about half of them. It is an eclectic mix. None of them would I say are poor or that they don't have something to offer. The best thing about them is that they did cases. They did them solo and they did them with residents. That matters tremendously. And your pedi comfort at graduation will be dialed.

All of this I say with a disclaimer, it's been a while. But the names ther haven't changed much.

That job down south was getting a tremendous deal on you browski.

 

[sevoflurane]

I am not fellowship trained but do hold advanced echo certification in TEE.

I do peds, ortho/regional, spines, brains, complex hearts, and all the other stuff except for chronic pain (kudos to Noy)

Remember the general surg guys back in the day? I feel like that lineage has died out. They are/were great surgeons- did just about anything.

I hope anesthesia doesn't turn into that.

 

[sevoflurane]

I interviewed at UNM. Great f'n location. Gun and knife club if I remember correctly = great trauma.
Shy on hearts, which is why I didn't go there. That was back in 2003 tho.

 

[Hoya11]

What programs stood out to you in a surprisingly positive way? I'm not talking about places like Brigham and Duke, but otherwise solid programs that aren't mentioned in the same breath the big dogs.

I'm struggling with these ones:

-University of Virginia: Very strong clinical training, awesome people through and through, very solid research infrastructure, well-connected faculty, great location (I loved Charlottesville). 1/2 do PP, 1/2 do fellowships and seemingly get their picks.

-Cedars-Sinai: People dump on this program but clinically it's hard to argue with the volume of everything you'll get here. 8 floors of ICU, more hearts and OB than anywhere else in the country, huge regional volume (and one of 2 programs to get an accredited regional fellowship next year), fantastic exam prep, sunny LA...I could get used to that. I got the impression (talking to residents and fellows) that the 1:1 was blown way out of proportion. Very little bench research but don't care much for that.

Loved UMDNJ but did not attend. Schedule seemed great. Cases seemed great. Location is great (obviously not Newark itself)

Ill put in a plug for Tufts where I did attend. Great place to do residency IME. Live in boston, great cases not just Harvard zebras, good schedule with at least 2 weekends off per month, nonmalignant atmosphere, little hand holding

 

[GravelRider]

I am not fellowship trained but do hold advanced echo certification in TEE.

I do peds, ortho/regional, spines, brains, complex hearts, and all the other stuff except for chronic pain (kudos to Noy)

Remember the general surg guys back in the day? I feel like that lineage has died out. They are/were great surgeons- did just about anything.

I hope anesthesia doesn't turn into that.

Unfortunately, I think anesthesia is already turning into that. Every specialty is becoming that way. Internists used to treat everything until you needed a procedure, dialysis, or chemotherapy. Now primary care has turned into a coordination of specialists. Anesthesia is following that path as well. Look at the posting for a "transplant" fellowship. Really? A fellowship to learn how to transfuse blood and read a TEG? The problem is with the corporatization of medicine, the people in the administrations want to see certificates and use that as a marketing tool. These hidden gem residency programs where you learn how to be a truly well-rounded anesthesiologist are becoming fewer and fewer because in many cases you need to do a fellowship anyway.

We are losing true generalists...in primary care, in surgery, and now in anesthesia. It's bad for the profession and it's bad for patients.

 

[Noyac]

That job down south was getting a tremendous deal on you browski.

Tell me about it. I was a dumb newb. But I also gained a tremendous amount from their exploitation of me. .

 

[teacher2md]

I interviewed at UNM. Great f'n location. Gun and knife club if I remember correctly = great trauma.
Shy on hearts, which is why I didn't go there. That was back in 2003 tho.

What do you think the # of cases that a resident would need in hearts to have a 'strong' cardiac exposure?

I know the ACGME minimum is 20--do you think 40 is strong? 60?

Does doing more cases==better experience, or does the type of cardiac case matter more?

 

[Noyac]

What do you think the # of cases that a resident would need in hearts to have a 'strong' cardiac exposure?

I know the ACGME minimum is 20--do you think 40 is strong? 60?

Does doing more cases==better experience, or does the type of cardiac case matter more?

Too many variables.
It all depends on the individual resident, the attendings, the surgeons, the quality of the service. The list goes on and on.

 

[chocomorsel]

I am quite a few years removed from UNM and therefore, I'm not totally familiar with everyone Choco speaks of. But I will say this, the chair and vice-chair were my two favorite people bar none in my career of anesthesia. They were simple worker bees when they trained me but I will never forget them. I walked out of that hospital knowing how to do adult and pedi hearts alone without blinking. I knew how to do pain management. I could do anything you put in front of me without needing to do a fellowship. My first job found me doing the most hearts of the entire group for the next 3 yrs, over 1200. Not to mention covering the pain clinic 1-3 days a week. I was more prepared to do anything that confronted me than the guys that started with me from the ivory towers. It was sort of a running joke.

As for the rest of the group of attendings. I know about half of them. It is an eclectic mix. None of them would I say are poor or that they don't have something to offer. The best thing about them is that they did cases. They did them solo and they did them with residents. That matters tremendously. And your pedi comfort at graduation will be dialed.

All of this I say with a disclaimer, it's been a while. But the names ther haven't changed much.

You had a strong cardiac experience? That must have been a long time ago. Cardiac was not their strong point for many years. That's why residents were shipped out to Houston and later to San Diego. Pain management was Ok. If I had done more electives in that department then I guess I could have come out strong in it. But had minimal interest in it.

Now I understand more about you.

 

[Noyac]

You had a strong cardiac experience? That must have been a long time ago. Cardiac was not their strong point for many years. That's why residents were shipped out to Houston and later to San Diego. Pain management was Ok. If I had done more electives in that department then I guess I could have come out strong in it. But had minimal interest in it.

Now I understand more about you.

Yes, I always volunteered for the cardiac cases and I did extra months in both cardiac and pain. My chief year was basically all cardiac and pain.

So please fill me in, what do you understand about me?

 

[GlowInTheDark]

University of Oklahoma really surprised me.

 

[sevoflurane]

What do you think the # of cases that a resident would need in hearts to have a 'strong' cardiac exposure?

I know the ACGME minimum is 20--do you think 40 is strong? 60?

Does doing more cases==better experience, or does the type of cardiac case matter more?

The more the better.
The more complex the better.

 

[Ezekiel2517]

What do you think the # of cases that a resident would need in hearts to have a 'strong' cardiac exposure?

I know the ACGME minimum is 20--do you think 40 is strong? 60?

Does doing more cases==better experience, or does the type of cardiac case matter more?

Unless you're going into cardiac, hearts are overrated. Do more big vascular and thoracic cases as a resident. More challenging and you'll get more out if it

 

[sevoflurane]

Unless you're going into cardiac, hearts are overrated. Do more big vascular and thoracic cases as a resident. More challenging and you'll get more out if it

Ya... if you think doing a double valve, EF of 25% + ESRD + rip roaring PA HTN needing some flolan + is in HIV remission overrated... then cool.

Kudos to you bro.

Plenty of complex hearts out there... and if you have the opportunity to learn from them you should. You will become more comfortable handling big cases in and out of the CT OR.

 

[GravelRider]

Ya... if you think doing a double valve, EF of 25% + ESRD + rip roaring PA HTN needing some flolan + is in HIV remission overrated... then cool.

Kudos to you bro.

Plenty of complex hearts out there... and if you have the opportunity to learn from them you should. You will become more comfortable handling big cases in and out of the CT OR.

You sure that wasn't the A-line plugged into the wrong cable?

 

[Hoya11]

Ya... if you think doing a double valve, EF of 25% + ESRD + rip roaring PA HTN needing some flolan + is in HIV remission overrated... then cool.

Kudos to you bro.

Plenty of complex hearts out there... and if you have the opportunity to learn from them you should. You will become more comfortable handling big cases in and out of the CT OR.

certain people love these kinds of cases

i personally think that it seems like an awful lot of effort, risk,discussion, and resources poured into a situation with minimal long term benefit. I wonder if this kind of case would be done in a coutry with a non-capitalistic healthcare model

 

[deleted162650]

That pt needs hospice - not a double valve.

 

[AdmiralChz]

Ya... if you think doing a double valve, EF of 25% + ESRD + rip roaring PA HTN needing some flolan + is in HIV remission overrated... then cool.

Kudos to you bro.

Plenty of complex hearts out there... and if you have the opportunity to learn from them you should. You will become more comfortable handling big cases in and out of the CT OR.

Eh, even as a (future) cardiac guy myself this an outlier. More and more it would be rare for a new grad to actually do these cases, almost all cardiac jobs have fellowship as a strong preference if not a requirement - and few genaralists would be thrilled about doing this case if not downright uncomfortable.

Big vascular cases? Any anesthesiologist should be prepared to handle for the most part.

 

[deleted162650]

Unless you're going into cardiac, hearts are overrated. Do more big vascular and thoracic cases as a resident. More challenging and you'll get more out if it

The value in doing hearts as a resident is not in learning how to do a cardiac case - if you want to hearts during your career then you really owe it to yourself to do a fellowship. Cardiac cases in residency teach you:

1) How to put a sh*tty heart to sleep without killing them
2) A basic understanding of echocardiography - at least enough to drop a probe on a non-cardiac case and figure out why your pt is crumping
3) A chance to really polish your line placing monkey skills since it's probably the only stretch in residency where every single one of your patients will get lined up
4) Familiarity with the various gtts - both uppers and downers that you don't often need outside the heart room until you really need them

 

[sevoflurane]

Haha... I think we got a little off topic here.

I will respond to some comments above because I feel obligated to. It is more of an ethical diacussion tho. In this particular case:

What if the patient was 35 y/o and had a couple bad cards dealt to her?

What if the patient had a previous EF of 60% and her acute process was somewhat reversible?

What if immediately after CPB this patient cut her Pa pressures in half due to her new MV?

What if the patient was D/c'd 1 week later and besides doing the dialysis thing 3 times a week is doing excellent?

To the point of the thread:
You DO want as much of that cardiac experience as you can get for all the reasons that salty mentioned and then some.

R/L/B vads... why? Cuz might get them for an ulnar release procedure at your PP gig- I certainly have.

Transplant? Yeah you want to see that too.

Arterial Switch with coronary reimplantation?...- yes.

VV/VA ECMO? Yes. You want to know that because it's utilized often and gaining more momentum.

Coagulopathies and TEGs for emergent cases? Yes.

Honestly the list just goes on and on.

Academic centers deal with a lot of stuff and that's the time to capatilize on that experience.

-Stay later and pick up that awesome case you may never see again... that's my advice.

Here is one from my own residency:

16:00- Done with my day not on call.
16:15- I hear of a liver tx coming to the OR.
16:16- I ask the academic board runner if I can do the case.
16:17- He says only if you do the entire case.
16:45- Inducing a hepatorenal mess of a case that was an awesome learning experience.

Don't do them now, but won't forget that night.

 

[Ezekiel2517]

The value in doing hearts as a resident is not in learning how to do a cardiac case - if you want to hearts during your career then you really owe it to yourself to do a fellowship. Cardiac cases in residency teach you:

1) How to put a sh*tty heart to sleep without killing them
2) A basic understanding of echocardiography - at least enough to drop a probe on a non-cardiac case and figure out why your pt is crumping
3) A chance to really polish your line placing monkey skills since it's probably the only stretch in residency where every single one of your patients will get lined up
4) Familiarity with the various gtts - both uppers and downers that you don't often need outside the heart room until you really need them

Yah I know, thanks professor. I've done hearts solo in PP. I was simply responding to the poster who seemed to think its better to do a ton of hearts in residency. I stated my opinion. Which is simply that one shouldn't sacrifice their experience doing challenging cases they'll likely be doing as an attending (unless doing cardiac fellowship as I stated ) for just getting their numbers up on their cardiac cases. Personally, I did a ton of hearts in residency and afterwards actually wished I had done more thoracic. Christ, this place.

 

[sevoflurane]

Well shoot man. Sorry you are offended.
If you say things like "cardiac is overrated" and "vascular and thoracic is more challanging" what do you think some of us are going to say?

Major vascular... aka suprarenal AAA and thoracic... aka DLT and potential quick bleeding badness is important too, but c'mmon.

How about Brains? Major endocrine? Surg-Onc? Peds-Onc?

The point is, all the good cases are important.

I wouldn't crap on cardiac if you're not going into it. Do ALL the cool cases if you can.

 

[Katheudontas parateroumen]

I'll put one in for Loma Linda. They have all the accredited fellowships. I don't know many places in the entire country can say that. So you're set in terms of fellowship placement. Loma Linda sees lots of peds, has a transplant service except for lung I believe, and you'll see lots of trauma. Cost of living is lower for CA. Anesthesia department is high up and valued in the hospital. They have a brand new hospital being built as well.

 

[WholeLottaGame7]

Arterial Switch with coronary reimplantation?...- yes.

Random question. Are there any non-peds fellowship people out there doing peds hearts? I know adult CT people train to do peds hearts, because my residency had 12 CT fellows and 1 peds fellows, and they all rotated through the peds heart room. But while several of the peds fellows went on and do peds hearts now, none of the adult CT people do (and tend to actively avoid peds patients).

I assume that is probably true across most other academic places, but was just wondering what it's like in private practice. Any CT people doing peds hearts from a CT fellowship without peds training?

 

[AdmiralChz]

Random question. Are there any non-peds fellowship people out there doing peds hearts? I know adult CT people train to do peds hearts, because my residency had 12 CT fellows and 1 peds fellows, and they all rotated through the peds heart room. But while several of the peds fellows went on and do peds hearts now, none of the adult CT people do (and tend to actively avoid peds patients).

I assume that is probably true across most other academic places, but was just wondering what it's like in private practice. Any CT people doing peds hearts from a CT fellowship without peds training?

Peds hearts is pretty specialized and mostly in academic centers (although maybe there are some in PP), you can get there either from Peds or via CT. Depends on what you'd like to be doing when outside of the peds heart room (adult hearts vs general peds) - we have both at our institution.

 

[sevoflurane]

Random question. Are there any non-peds fellowship people out there doing peds hearts? I know adult CT people train to do peds hearts, because my residency had 12 CT fellows and 1 peds fellows, and they all rotated through the peds heart room. But while several of the peds fellows went on and do peds hearts now, none of the adult CT people do (and tend to actively avoid peds patients).

I assume that is probably true across most other academic places, but was just wondering what it's like in private practice. Any CT people doing peds hearts from a CT fellowship without peds training?

Ohh I'm sure it happens at certain shops.
At least it used to be like that to some degree. I'm guessing not any more though. Typically, you do a peds fellowship and then do some one on one in the pedi heart room before they let you go solo.

I can see it happening if you do 6 months of pedi hearts as part of your CT fellowship.

If you do a CT fellowship, you're going to get these patients status post correction in PP.

 

[WholeLottaGame7]

Ohh I'm sure it happens at certain shops.
At least it used to be like that to some degree. I'm guessing not any more though. Typically, you do a peds fellowship and then do some one on one in the pedi heart room before they let you go solo.

I can see it happening if you do 6 months of pedi hearts as part of your CT fellowship.

If you do a CT fellowship, you're going to get these patients status post correction in PP.

Oh no I know, I do peds hearts, and that's how I did it, and how most of the people I know who do peds hearts did it. I just didn't know what it was like out in PP.

At our institution we basically divide up by surgeons. If our congenital surgeon is doing the case, the peds anesthesia people do the case, regardless of age. Which means I've done some 30, 40, 50 year olds for things like ASDs, PAPVR, etc. If an adult surgeon is doing the AVR for a 16, 17, 18 year old with a bicuspid valve, the adult CT people do it.

 

[projectpat]

In the South, sleeper picks include UAB and Wake Forest. Excellent training. Location will depend on the individual's preference.
Up North, Mt. Sinai and UPMC. Excellent training. Positive morale. Strong leadership. Also heard good things about Penn State. Some may not consider these programs as "hidden gems" because they're all well known in the community, however they're all strong programs and everyone should know about them.

 

[Katheudontas parateroumen]

.

 

[j bones]

What's the word on Virginia Mason?

 

[pgg]

Arterial Switch with coronary reimplantation?...- yes.

Random question. Are there any non-peds fellowship people out there doing peds hearts? I know adult CT people train to do peds hearts, because my residency had 12 CT fellows and 1 peds fellows, and they all rotated through the peds heart room. But while several of the peds fellows went on and do peds hearts now, none of the adult CT people do (and tend to actively avoid peds patients).

I assume that is probably true across most other academic places, but was just wondering what it's like in private practice. Any CT people doing peds hearts from a CT fellowship without peds training?

Coincidentally, I'm an adult cardiac fellow now, and did an arterial switch on a 5 day old a couple days ago. We get a month of peds cardiac. I don't see myself doing it post-fellowship, and I'm pretty sure none of my co-fellows have aspirations in that direction either ...