How do you know if a residency is "good"

[imaverickl]

Is there a book or something that will give objective data about the quality of a residency program. How am I supposed to know what program to strive for? I mostly would like to stay in Texas, but I don't know how to evaluate the programs. Little help.

Clint

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[whuppit]

what kind of markers/warning signs can you think of if a residency is bad?

 

[Winged Scapula]

The truth is - you don't, at least not until you get there. And what might be good for you, won't necessarily be for someone else. There are no books which have a formal ranking system or evaluations; and besides, once a book gets published, the data is already outdated.

Unfortunately, some residents will not tell you the truth about their program - leading you to believe everything is hunky-dory and OTOH, some will only tell you bad things (ie, many review sites only contain negative information), leading you to believe that a particular program is a hell-hole.

First you must decide what is important to you - this usually falls along the lines of geography, a more research oriented vs community practice type of residency and family issues (ie, does the community provide job opportunities for your spouse, is there a lively singles scene if that's what you want, etc.).

Secondly, you should talk to residents at your current program as well as faculty and get their feel for what programs you might be interested in, and what their take is on the programs. Be aware that many faculty may be out of date as to what the program is really like (especially if they trained there 20 years ago), and that residents won't really know unless they rotated there, went to medical school there or have a close friend there.

Thirdly, if you are thinking about a competitive fellowship after general surgery training, choosing a program which has exposure to that specialty (but not necessarily a fellowship in that field) is a bonus - it gets you exposure to the field and its practitioners.

When you interview at a program, if there is a social event the night before, try and go - see how many residents attend, see how they interact with each other. This requires reading between the lines and observing human behavior, not necessarily believing what you hear.

Finally, if you are the type that finds academic ranks important, while there are no formal rankings for surgical residencies, there are several threads herewith which offer conventional wisdom on which ones are respected. Keep in mind that these tend to weigh heavily towards university, academic programs and not community or private practice ones which can be excellent and may be the best choice for you.

In Texas, the programs often mentioned as the "heavy hitters" are obviously Parkland (especially for Trauma), UTSW (especially for Plastics), Baylor in Houston, and of course, MD Anderson for Surg Onc. Scott and White has a good rep as well, and U of Houston has been reamed rather thoroughly here. Check the forums for some info on specific programs. Here's a link to a recent thread...http://forums.studentdoctor.net/showthread.php?t=329557

 

[boston]

There is little objective info available. Board pass rates, operative case numbers of graduates, fellowship placement are objective things you can look at. Even these things are of debatable value (small sample size).

Beyond that, it will come down to your own gut feeling about the program and word-of-mouth second-hand information. It is an imperfect process at best. If you have a particular interest (say transplant or peds), you can get a sense for whether a program is strong in that department. Many programs appear put on their best face on interview day and seem similar to each other. It is hard to get to know what a program is really like without spending more time there. Just take everything with a grain of salt and try to read between the lines on interview day.

 

[Winged Scapula]

what kind of markers/warning signs can you think of if a residency is bad?

Maybe these aren't signs that a residency is "bad" but should be red flags:

- how often are people leaving the program? If there are senior level positions available every year, this is more important than seeing how many interns leave for anesthesia and pathology residencies - that's common. Having to fill a PGY4 spot is not.

- is the program on probation and for what? The ACGME data set is not always updated (ie, you can be on probation for violations from years ago), and it may be for things that aren't even relevant to you (ie, residents not turning in their logs, or the program not supplying all the data, etc.)

- residents who don't show up for social events, interviews etc. If you are scheduled to interview somewhere, and you know they have 20 residents - you should be a bit suspicious if you only meet 5 of them. The majority of residents should at least make an appearance to these functions, especially the senior residents.

- of course, the call schedule and work hours stuff is important, but you will find it difficult to learn the truth about these things. You'll often get much better information from a non-surgical resident at the same program - if you can ask a senior Anesthesia resident, they often have an idea of how the surgery program works and how many hours the residents put in.

- senior residents with upwards of 1200 cases logged; too many cases is not necessarily a good sign ( as a matter of fact, the ACGME will look askance at too many cases, as a sign that you are working too many hours)

- senior residents who do not stay on at the same program for fellowships or come back as attendings; this is a soft sign. But often people who are happy in residency will tend to stay on for further training or as a career.

This should get you started...

 

[whuppit]

thanks!

 

[RxnMan]

Maybe these aren't signs that a residency is "bad" but should be red flags:

- how often are people leaving the program? If there are senior level positions available every year, this is more important than seeing how many interns leave for anesthesia and pathology residencies - that's common. Having to fill a PGY4 spot is not.

- is the program on probation and for what? The ACGME data set is not always updated (ie, you can be on probation for violations from years ago), and it may be for things that aren't even relevant to you (ie, residents not turning in their logs, or the program not supplying all the data, etc.)

- residents who don't show up for social events, interviews etc. If you are scheduled to interview somewhere, and you know they have 20 residents - you should be a bit suspicious if you only meet 5 of them. The majority of residents should at least make an appearance to these functions, especially the senior residents.

- of course, the call schedule and work hours stuff is important, but you will find it difficult to learn the truth about these things. You'll often get much better information from a non-surgical resident at the same program - if you can ask a senior Anesthesia resident, they often have an idea of how the surgery program works and how many hours the residents put in.

- senior residents with upwards of 1200 cases logged; too many cases is not necessarily a good sign ( as a matter of fact, the ACGME will look askance at too many cases, as a sign that you are working too many hours)

- senior residents who do not stay on at the same program for fellowships or come back as attendings; this is a soft sign. But often people who are happy in residency will tend to stay on for further training or as a career.

This should get you started...

Dr. Cox - I'm just starting to look at surgery, but what a well-thought-out post! Thanks!

 

[DNASplicer]

Thanks for the post. The information is very helpful. My interview trail begins this week with the bulk in Dec and I WILL remain cool and collected... Much easier to do when organized!