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.....
