How has the presence of fellows affected your experience as a resident, your rank list?

[Silo004]

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Ranking programs now, interested in cardiac and wondering if the presence of fellows on cases at all attenuates the resident experience. Some programs, UVA in particular, tout the lack of fellows as a relative strength, whereas others e.g. UMich are the exact opposite i.e. "we have tons of fellows and we like to take our own."

I know that the fellows are at a completely different level of training. That said, it can't hurt to have one-on-one interaction with attendings as a CA-1.

I am currently leaning towards programs that have fewer fellows, but am having second thoughts now.

 

[Psai]

I can tell you that it's annoying af to have fellows who take all the procedures

 

[Nivens]

I can tell you that it's annoying af to have fellows who take all the procedures

I agree with Psai, when it happens it is annoying, but honestly I feel like getting this granular in your analysis of programs puts you in danger of missing the forest for the trees. I think someone put it rather brilliantly in another thread- picking a program isn't a test question, ie there really isn't a "right" answer. Medical students spend too much energy trying to discern what the "best" program is rather than picking the program that is best for them.

There is so much that goes into your experience as a resident that you cannot comprehend until it is you doing the work that you really need to try to avoid obsessing about details yourself and use the residents' overall satisfaction as a gauge. Find places with a solid reputation in areas you want to live with people that seem like your kind of folk, rank accordingly, crack open a beer, and enjoy the rest of fourth year.

Because trust me, soon the real work begins.

 

[WholeLottaGame7]

It's not the presence or absence of fellows you should be concerned about, it's the ratio of fellows to caseload. Where I trained, we had 12 CT fellows, and I wish there had been more. Other places might have 2 and it might be too many.

You just need to ask residents when you're interviewing if they ever feel like they are missing out because a fellow is taking their cases. Will vary place to place.

 

[deleted697127]

Am going to guess regional but just curious, what procedures are fellows taking from you?

 

[Nivens]

Am going to guess regional but just curious, what procedures are fellows taking from you?

I kind of assumed cardiac, which I guess means lines.

 

[Ronin786]

I echo the above sentiment. Ratio matters more than absolute number or presence. I wish we had more fellows where I train, but I also appreciate the interactions I have with them.

You'll find that attendings have their way of doing things that maybe institution dependent and I find that fellows are just learning their own and can sometimes offer a different perspective.

 

[Robotic Wis-Hipple]

I can tell you that it's annoying af to have fellows who take all the procedures

I can't imagine many places with fellowships (other than regional) have fellows taking procedures. It makes no sense to have a cardiac fellow substaffing a resident in a cardiac case and not have the resident doing all the lines. The fellows at that point don't need lines.

I'll also agree that the ratio of fellows to caseload matters. But I'll also say I think your overall goals matter as well. Want to be a great, well rounded generalist? Maybe go somewhere with zero fellows, problem solved. If you're thinking subspecialist I think going where there is a fellowship can really help you from the networking and home fellowship spots standpoint.

 

[2Fast2Des]

I feel like as a resident when I've been on rotations that once had fellows and then no fellows the next year or so, residents get much more of those bigger cases instead of doing bread/butter or the usual case without the fellows present. In cardiac I was fighting some fellows for iv's and art lines... i would recommend choosing a program if the fellows in the institution were given more supervision/teaching roles than being glorified residents and you having to play second fiddle

 

[AdmiralChz]

In cardiac I was fighting some fellows for iv's and art lines... i would recommend choosing a program if the fellows in the institution were given more supervision/teaching roles than being glorified residents and you having to play second fiddle

Totally agreed, I'm at a place where the focus is on more supervision/teaching roles rather than CA-4-type fellowships - I'm almost done and I can't think of a time where I had to fight a fellow for a procedure unless it's some advanced chronic pain (CESI) or regional technique (LPB) I won't be using out in practice anyway.

I can't even imagine a cardiac fellow taking your lines, if you aren't comfortable with central lines coming out of residency then your program did you an injustice. Same with a-lines, unless they are trying to speed up the pace so you can stay at the head and intubate and go straight in for the CVL.

Now the cardiac fellow inserting the TEE probe and doing an initial exam or focused assessment, I can see/understand. This happens at my place but they are always super chatty and explaining what they are doing.

 

[2Fast2Des]

Totally agreed, I'm at a place where the focus is on more supervision/teaching roles rather than CA-4-type fellowships - I'm almost done and I can't think of a time where I had to fight a fellow for a procedure unless it's some advanced chronic pain (CESI) or regional technique (LPB) I won't be using out in practice anyway.

I can't even imagine a cardiac fellow taking your lines, if you aren't comfortable with central lines coming out of residency then your program did you an injustice. Same with a-lines, unless they are trying to speed up the pace so you can stay at the head and intubate and go straight in for the CVL.

Now the cardiac fellow inserting the TEE probe and doing an initial exam or focused assessment, I can see/understand. This happens at my place but they are always super chatty and explaining what they are doing.

I know nothing about TEE right now but nobody really cares about teaching or showing anything about echo stuff since we're told its for only CA3's and above to worry about knowing. Only sucky thing is the ct fellows also pretty much also give the drugs and do everything so you're relagated to chart duty and drawing up meds.

 

[Robotic Wis-Hipple]

So as a CT fellow I have a few comments;

CT fellows should not be taking your lines except in cases where you've attempted and run into problems. I'm sure there will be an occasional line that your staff of fellow feels should be placed expertly and quickly, but these should be few and far between (Transplants are the most likely scenario). You certainly shouldn't be fending off fellows for PIVs (this is crazy and I'd imagine is more the fellow getting another PIV while you do the art line or neck line for efficiency sake).

As far as TEE goes, if you're on your cardiac rotation you should be focused on the patient, the patient's cardiac pathology, and the anesthetic management of said patient/pathology first and foremost. Yes, the echo is a cool modality and we make some management decisions based upon it, but it is not the anesthetic. Your cardiac learning and experience in managing these patients will pay dividends in all areas of anesthesia regardless of whether you choose to go into CT. Don't miss the forest for the trees.