Surgeryislife

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So I know we are being bombarded with interview invites and for some of us we will have to select which interviews to attend. I want to see if anyone has insight as to how we can evaluate programs. Are the Doximity reviews to be trusted? When we do go to interviews, will the residents be honest if their program has terrible attendings or a toxic environment? I'm worried about not getting an accurate view of the program culture from interviews (or beforehand when choosing which programs to visit).
 

JustPlainBill

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So I know we are being bombarded with interview invites and for some of us we will have to select which interviews to attend. I want to see if anyone has insight as to how we can evaluate programs. Are the Doximity reviews to be trusted? When we do go to interviews, will the residents be honest if their program has terrible attendings or a toxic environment? I'm worried about not getting an accurate view of the program culture from interviews (or beforehand when choosing which programs to visit).
You probably won't see the really pissed off residents. I know I was kept away from interviewees because I thought my residency sucked and made no bones about it. For example -- one day during an afternoon conference when one of the attendings was up there spouting off about how great the program was, a voice was heard in the back saying," And that's why we have to fill on scramble for 3 years running." And on another occasion, when I had had enough BS to last me a lifetime from this one particular attending, I pretty much told her she was delusional if she truly thought we were anywhere near the top of the foodchain in terms of Texas FM residencies. I think I used my famous (or infamous) phrase, "We couldn't teach a bunch of horny BoyScouts what to do inside a Vegas cathouse".

I was never invited to participate in the interview process. But then again, we filled with IMGs of a particular religious persuasion which I'm SURE had nothing to do with the fact that the residency leadership was of the same religious persuasion/country of origin. They were just happy to match after going to the "Harvard" of Pakistan.....and having halal meat catered for the resident lunches.....

To evaluate a residency, I would recommend picking your top 3 and doing an audition month at each one. Hard to hide the dirty laundry for a month.....
 
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No, you generally won't see the pissed-off residents. However, during one of my interviews, as I was being shown around the clinic, one of the residents working nearby came over to shake my hand and introduce himself. As he did so, he leaned forward slightly, looked me right in the eye, and said "Run." My interviewers quickly hustled me away, but not before I noticed the angry looks they shot in this guy's direction. I already had a bad feeling about the place, but that clinched it.
 
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Surgeryislife

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Jan 25, 2013
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You probably won't see the really pissed off residents. I know I was kept away from interviewees because I thought my residency sucked and made no bones about it. For example -- one day during an afternoon conference when one of the attendings was up there spouting off about how great the program was, a voice was heard in the back saying," And that's why we have to fill on scramble for 3 years running." And on another occasion, when I had had enough BS to last me a lifetime from this one particular attending, I pretty much told her she was delusional if she truly thought we were anywhere near the top of the foodchain in terms of Texas FM residencies. I think I used my famous (or infamous) phrase, "We couldn't teach a bunch of horny BoyScouts what to do inside a Vegas cathouse".

I was never invited to participate in the interview process. But then again, we filled with IMGs of a particular religious persuasion which I'm SURE had nothing to do with the fact that the residency leadership was of the same religious persuasion/country of origin. They were just happy to match after going to the "Harvard" of Pakistan.....and having halal meat catered for the resident lunches.....

To evaluate a residency, I would recommend picking your top 3 and doing an audition month at each one. Hard to hide the dirty laundry for a month.....
Gosh I hope it's not the Texas program I'm interviewing at! When you say you hated your residency, though, what about did you hate? You said they can't teach...what can I look for that should be red flags or good signs in terms of how programs teach residents? Have any tips to help me avoid a bad program?
 

JustPlainBill

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Gosh I hope it's not the Texas program I'm interviewing at! When you say you hated your residency, though, what about did you hate? You said they can't teach...what can I look for that should be red flags or good signs in terms of how programs teach residents? Have any tips to help me avoid a bad program?

What did I hate about my residency? How much time do you have?

1) During my first month on wards, there was literally no help/instruction from the seniors, period. I was given incorrect information by my senior whom I made the mistake of trusting one time. I presented it to the attending who called me on it and chewed me out. While I was trying to recall where I got the info, I turned to the senior and then remembered they had given it to me. When I called her on it, she shrugged her shoulders, got that goofy little "Oh, I'm busted" smile and said "Sorry" but never owned up to it in front of the attending. In another instance, my senior ordered some iron replacement incorrectly on my patient during rounds and when we got there, it was discovered, I took the heat and again, they never owned up to it. They were constantly making changes to the management plan and never telling the interns what was done -- this always seemed to be done between the times we rounded on our patients and attending rounds. They also would sit there and chit chat with night float until around 9 pm, never cut us loose to go home and get some sleep -- we had to be there at 05:30 to get rounds/notes done by 0800. So, most of us interns flailed, surprisingly we didn't kill anyone (that I know of) -- I made the mistake, when asked about it during our class block, of giving them my honest opinion. That was verboten. If you didn't say publicly that we were the best program, things were great, you were quickly blackballed. In my program, the PD had a reputation for picking an intern in each class to ride hard and put away wet -- trying to either make you quit/transfer or fire you. Guess who got chosen?

2) The objective of the residency was stated as turning us into the best FM docs in the area. When I asked what they meant by that, I was told in an open forum that they wanted to produce as many FM docs as they could so that we could feed referrals back into the university hospital system. I'm not a referral monkey and they pretty much lied to me to recruit me. The attraction was that I wouldn't have to move my family. I had plenty of other options are some really good programs but got caught with a bait and switch. One of my former professors from med school was on faculty at the time and pitched it as a good place making changes for the better. Later on down the line, they were moved out and all of us who came in believing what we were told were thrown under the bus.

3) The attendings were flat out incompetent. I witnessed an attending completely screw up a paracentesis and wind up having to use the 18 gauge draw needle to penetrate the abdomen when they didn't know how to use the kit properly. Rather than show some integrity and admit they didn't know, they clustered around and came up with that solution. We had no one who was competent to do inpatient procedures until a new grad was hired during my senior year. Quite frequently we would watch NEJM videos before going in and attempting procedures OR we would consult the IM residency procedure service. No I am not kidding.
One time we had a bilateral PNA patient who was diabetic with CHF and needed 6L of O2 -- the attending panicked and called the IM attending who passed it to the IM Chief Resident who transferred it to one of the IM floor teams who passed it to one of their interns and the patient was managed --- yeah, that looked real good.

4) I was physically abused one night on an Ob continuity delivery. slapped upside the head when I forgot to put in a FHT in my note.

There's a metric ton of other stuff that I won't go into because all it does is piss me off.

So, how to judge a residency? Well --- first thing I'd do is see if they fill all the time or do they have to scramble fill. Are there a boatload of IMGs -- both in faculty and in the residency classes. Ask to see a random residents procedure logs -- I'd do it from each class. Find out if it's a competitive residency -- meaning are they the only one in the hospital or are there other programs that you have to compete against for training (i.e. ob/gyn residency which means you won't get complex deliveries), are they FM focused or are you just a scutwork monkey for the other residencies (example: during ortho, are you taught FM appropriate office procedures or are you just more or less shadowing ortho residents -- for gen surg -- are you being taught/allowed to do lumps and bumps, taught about wound care, sutures, natural course of wound healing, what can go wrong, etc. or are you a surgery residency scut monkey?); Are you getting a good, broad spectrum of patients in clinic and not just DM/HLD/HTN, how's your derm rotation -- do you have someone who can actually teach or just a slimeball who always tells their cute, young patients, "How can I improve upon perfection?", do you have to compete for derm procedures? Ward medicine -- are you getting an appropriate level of complexity, how's the icu situation -- do you follow your patients into the icu? are you doing icu procedures? how's your peds? are you seeing the spectrum or just doing well child visits all the time? how does your ER experience work -- do you get to chose to treat/street or admit and follow as an inpatient? Finally, are the residents ok? Do you get to meet everyone in all the classes? how many people who originally matched finished at that residency or do they have a lot of transfers?

Trust your gut feel -- I strongly considered switching my match order the night before we had to lock in -- my wife and I discussed it and elected to keep the list the way it was rather than change it up in the heat of the moment. Should have listened to my gut....but it's ok, God proved Himself strong in that experience and my family didn't have to move. I'm out now and life is good.

Again, your mileage may vary, no warranties expressed or implied.....
 
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Surgeryislife

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What did I hate about my residency? How much time do you have?

1) During my first month on wards, there was literally no help/instruction from the seniors, period. I was given incorrect information by my senior whom I made the mistake of trusting one time. I presented it to the attending who called me on it and chewed me out. While I was trying to recall where I got the info, I turned to the senior and then remembered they had given it to me. When I called her on it, she shrugged her shoulders, got that goofy little "Oh, I'm busted" smile and said "Sorry" but never owned up to it in front of the attending. In another instance, my senior ordered some iron replacement incorrectly on my patient during rounds and when we got there, it was discovered, I took the heat and again, they never owned up to it. They were constantly making changes to the management plan and never telling the interns what was done -- this always seemed to be done between the times we rounded on our patients and attending rounds. They also would sit there and chit chat with night float until around 9 pm, never cut us loose to go home and get some sleep -- we had to be there at 05:30 to get rounds/notes done by 0800. So, most of us interns flailed, surprisingly we didn't kill anyone (that I know of) -- I made the mistake, when asked about it during our class block, of giving them my honest opinion. That was verboten. If you didn't say publicly that we were the best program, things were great, you were quickly blackballed. In my program, the PD had a reputation for picking an intern in each class to ride hard and put away wet -- trying to either make you quit/transfer or fire you. Guess who got chosen?

2) The objective of the residency was stated as turning us into the best FM docs in the area. When I asked what they meant by that, I was told in an open forum that they wanted to produce as many FM docs as they could so that we could feed referrals back into the university hospital system. I'm not a referral monkey and they pretty much lied to me to recruit me. The attraction was that I wouldn't have to move my family. I had plenty of other options are some really good programs but got caught with a bait and switch. One of my former professors from med school was on faculty at the time and pitched it as a good place making changes for the better. Later on down the line, they were moved out and all of us who came in believing what we were told were thrown under the bus.

3) The attendings were flat out incompetent. I witnessed an attending completely screw up a paracentesis and wind up having to use the 18 gauge draw needle to penetrate the abdomen when they didn't know how to use the kit properly. Rather than show some integrity and admit they didn't know, they clustered around and came up with that solution. We had no one who was competent to do inpatient procedures until a new grad was hired during my senior year. Quite frequently we would watch NEJM videos before going in and attempting procedures OR we would consult the IM residency procedure service. No I am not kidding.
One time we had a bilateral PNA patient who was diabetic with CHF and needed 6L of O2 -- the attending panicked and called the IM attending who passed it to the IM Chief Resident who transferred it to one of the IM floor teams who passed it to one of their interns and the patient was managed --- yeah, that looked real good.

4) I was physically abused one night on an Ob continuity delivery. slapped upside the head when I forgot to put in a FHT in my note.

There's a metric ton of other stuff that I won't go into because all it does is piss me off.

So, how to judge a residency? Well --- first thing I'd do is see if they fill all the time or do they have to scramble fill. Are there a boatload of IMGs -- both in faculty and in the residency classes. Ask to see a random residents procedure logs -- I'd do it from each class. Find out if it's a competitive residency -- meaning are they the only one in the hospital or are there other programs that you have to compete against for training (i.e. ob/gyn residency which means you won't get complex deliveries), are they FM focused or are you just a scutwork monkey for the other residencies (example: during ortho, are you taught FM appropriate office procedures or are you just more or less shadowing ortho residents -- for gen surg -- are you being taught/allowed to do lumps and bumps, taught about wound care, sutures, natural course of wound healing, what can go wrong, etc. or are you a surgery residency scut monkey?); Are you getting a good, broad spectrum of patients in clinic and not just DM/HLD/HTN, how's your derm rotation -- do you have someone who can actually teach or just a slimeball who always tells their cute, young patients, "How can I improve upon perfection?", do you have to compete for derm procedures? Ward medicine -- are you getting an appropriate level of complexity, how's the icu situation -- do you follow your patients into the icu? are you doing icu procedures? how's your peds? are you seeing the spectrum or just doing well child visits all the time? how does your ER experience work -- do you get to chose to treat/street or admit and follow as an inpatient? Finally, are the residents ok? Do you get to meet everyone in all the classes? how many people who originally matched finished at that residency or do they have a lot of transfers?

Trust your gut feel -- I strongly considered switching my match order the night before we had to lock in -- my wife and I discussed it and elected to keep the list the way it was rather than change it up in the heat of the moment. Should have listened to my gut....but it's ok, God proved Himself strong in that experience and my family didn't have to move. I'm out now and life is good.

Again, your mileage may vary, no warranties expressed or implied.....
Wow! I'm sorry you had such an awful experience, but I'm glad you made it out and are doing well now. Do I ask these questions (about peds, procedures, the "scut" work) directly or should I just be looking at unopposed programs that only have FM residents? I'm afraid bad programs will lie so I want to know of good ways to get info outside of just asking residents and faculty during the interview. Also, where can I find out about if programs have to offer SOAP positions if they don't fill spots? Finally, what's your take on new programs? I've been invited to some interviews at a few new programs so obviously none of the info regarding previous classes will be available...thank you so much for your insight btw. Very helpful things to think about.
 

JustPlainBill

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Wow! I'm sorry you had such an awful experience, but I'm glad you made it out and are doing well now. Do I ask these questions (about peds, procedures, the "scut" work) directly or should I just be looking at unopposed programs that only have FM residents? I'm afraid bad programs will lie so I want to know of good ways to get info outside of just asking residents and faculty during the interview. Also, where can I find out about if programs have to offer SOAP positions if they don't fill spots? Finally, what's your take on new programs? I've been invited to some interviews at a few new programs so obviously none of the info regarding previous classes will be available...thank you so much for your insight btw. Very helpful things to think about.
So, you mentioned Texas -- unless things have changed -- if I had it to do all over again --

1) UT Tyler -- great program, decent community, think JPS lite. used to take good care of the residents. It was 2 hours away so it was a top contender.
2) JPS -- only reason it's number 2 is because it's huge and sometimes the residents run around unsupervised (or that used to be the case)
3) Waco -- again, like Tyler but more of a boonies type of feel, at least for me.
4) Conroe vs Baylor Garland --- Conroe was decent but the program was divided across I45 which made it a pain to get back and forth -- there's no real housing for resident close by that's worth looking at, at least for my tastes. Training was ok but they really were working on improving it. Garland -- nice program but acuity level of patients was a little lite -- trained you to be a decent community physician.

I also interviewed at UTSA and UTSW -- stay the hell away from these programs.

Again, this was in the 2010 ish timeframe.

I would just ask them directly. But I'd also do a month audition rotation at the top 3 I was interested in....as far as checking re: SOAP -- good question that I have no answer for -- you used to be able to pull up stats but I don't know if you can now.
 
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Surgeryislife

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So, you mentioned Texas -- unless things have changed -- if I had it to do all over again --

1) UT Tyler -- great program, decent community, think JPS lite. used to take good care of the residents. It was 2 hours away so it was a top contender.
2) JPS -- only reason it's number 2 is because it's huge and sometimes the residents run around unsupervised (or that used to be the case)
3) Waco -- again, like Tyler but more of a boonies type of feel, at least for me.
4) Conroe vs Baylor Garland --- Conroe was decent but the program was divided across I45 which made it a pain to get back and forth -- there's no real housing for resident close by that's worth looking at, at least for my tastes. Training was ok but they really were working on improving it. Garland -- nice program but acuity level of patients was a little lite -- trained you to be a decent community physician.

I also interviewed at UTSA and UTSW -- stay the hell away from these programs.

Again, this was in the 2010 ish timeframe.

I would just ask them directly. But I'd also do a month audition rotation at the top 3 I was interested in....as far as checking re: SOAP -- good question that I have no answer for -- you used to be able to pull up stats but I don't know if you can now.

Unfortunately I can't do any audition rotations. That's why I'm so nervous about getting scammed

My current interview is Texas Tech in El Paso...

I mostly applyed to west coast programs but also applied to a few in Texas just because they sounded solid.
 

JustPlainBill

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Unfortunately I can't do any audition rotations. That's why I'm so nervous about getting scammed

My current interview is Texas Tech in El Paso...

I mostly applyed to west coast programs but also applied to a few in Texas just because they sounded solid.

I haven't heard anything bad about Tech -- truthfully, I hadn't heard of them, period. Doesn't mean anything but Lubbock was not in consideration as a place to live with my family so I just never looked there. I do know a classmate that wound up being Chief resident out there.
 
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