Inbreeding

[Big Lebowski]

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I just matched at Indiana University....after finishing medical school at Indiana University....after finishing undergrad at Indiana University.

I've been quite happy here...and wouldn't have ranked IU if I didn't think I would get could training here. However, I was a bit apprehensive since I've been in the Indiana system so long.

I'm curious to get peoples' opinions about this. How do you feel about doing the majority or all training in a single location? Has anyone had good or bad experiences with either staying or leaving a program where you attended med school? What do you think are some advantages/disadvantages for staying/leaving for residency?

 

[edfig99]

I think this is a great question. I think about this all the time every time I meet someone who's "inbred" at whatever institution I'm at. I did not go into residency at my med school hospital, though I am taking an attending position at the place where i did my residency.

There are some obvious advantages to staying within a familiar system -- a lot of wheels have been greased, you know what is where, and who to talk to, and who's good for xxx and who to stay away from...it's that level of comfort that can make PGY1 year just a little less painful (don't get me wrong, PGY1 year is always painful, but knowing the system is like applying EMLA cream -- doesn't hurt as much, but you know that they're doin' something). Plus hopefully during med school you got to buddy up with the most important people at the institution -- the unit secretary, and the charge nurse. plus if you are interested in future fellowship opportunities, schools tend to be faithful to their own, since they know exactly what they're getting.

A disadvantage may be you just limit yourself to seeing how one group of people manages things, and so inbreeding can lead to a loss of perspective... it's important to make sure your education and training are broad, and inbreeding can lead to "well that's just the way we do things here."

my attendings who have been inbred have no regrets, and they love what they do...that's ultimately the most important thing, wherever you train.

Originally posted by Big Lebowski
I just matched at Indiana University....after finishing medical school at Indiana University....after finishing undergrad at Indiana University.

I've been quite happy here...and wouldn't have ranked IU if I didn't think I would get could training here. However, I was a bit apprehensive since I've been in the Indiana system so long.

I'm curious to get peoples' opinions about this. How do you feel about doing the majority or all training in a single location? Has anyone had good or bad experiences with either staying or leaving a program where you attended med school? What do you think are some advantages/disadvantages for staying/leaving for residency?

 

[docB]

I understand how you would be most concerned about the effect of your inbred status on your education (that sounds insulting but I sure you know what I mean in this context) but I think that the faculty is more important. If the entire faculty did their residency at your house then the training can be affected. Dogma goes unchallenged. Grudges, rivalries etc. can linger. I'd say you want a faculty made up of 30-40% inbreds. That tells you that the place is nice enough to be attractive to grads but there are enough outside folks around to keep things honest.

 

[njbmd]

Hi there,
I am currently in a residency where this year, all categoricals were medical students from UVa except one. While this makes for in-breeding in terms of the incoming intern group, the faculty is from fairly diverse backgrounds and locales which will impact more on my training than the incoming intern class. One of the reasons that I am very pleased to be at UVa is that the surgery faculty is pretty diverse coming from places like University of Minnesota, Lahey Clinic, University of Michigan, Penn, UVa, Duke, Harvard, Northwestern and UT-San Antonio. In terms of technique, I can really see a difference in style of teaching and surgical approach among the faculty.

If all of your faculty were grads of IU and trained in residency at IU, I could see where you might be concerned about inbreeding. In that case, doing fourth year electives at diverse locales would have been a way to see different perspectives and you still will be in good shape.

Still, I loved coming into this program from a medical school that didn't send too many grads to UVa. It made me feel like a pioneer and I feel that I made a great decision. I am sure that you will thrive for the same reasons being in a program that is in familiar settings. At least you won't have to waste valuble sleep time figuring out where to find the neat spots in town and you can show your fellow interns from out of town, some of the great things about IU. Good luck and congratulations on the match!

njbmd

 

[triathlete411]

I am also guilty of inbreeding. Having gone to undergrad and medical school at UNC, I will be starting my general surgery residency here in June. I really struggled with this decision for a while, but in the end I realized I will get excellent training here and I can always do a fellowship elsewhere (but probably won't 🙂)

njbmd - I loved UVa. It was my number two choice and I know I would have been happy there. However, I think it can be a little disconcerting to the upcoming year's applicant pool if 3 out of the 4 categoricals are from UVa. They might question their chances. During my interview day there, Dr. Schirmer made the comment that none of the interns in your class were from UVa, but that he hoped to change that with this class. He certainly wasn't kidding. I think comments like Dr. Schirmer's are double-edged swords. On one hand, I admire the fact that UVa looks out for its own, but on the other hand, I knew my chances for matching there had just decreased by at least 25%.

By the way, from where is the non-UVa intern?

 

[droliver]

Depending upon the quality of your training program, inbreeding is not neccessarily a bad thing. If you scan the CV's @ most of the top programs you usually see 2/3's or more did their general surgery or subspecialty fellowship @ that institution. Just a quick count of my staff of 36 full time clinical faculty had 20 that did their residency or fellowship here (there were another 6 who had trained here who have taken academic promotions elsewhere in the last 2 years)


As far as keeping your own students, I think has become much more important for programs as the total number of applicants fell over the previous decade. If you have a large program (8-10+ spots a year) & you don't keep some of your own students, there is a good chance you either won't match or you'll have to extend interviews to people who would not have met your screening criteria in the past

 

[DocWagner]

In certainly depends on the system you are in.

Big...the IU system is huge (went undergrad there...did PT school there), and is unlike most residency systems. So there is a huge advantage to that. Furthermore, the residency programs are pretty diverse with residents from all over the place, allowing for a bit of diversity as well. I know that most residencies are quite aware the negative stigma that inbreeding provides, and they do their best to avoid these problems. So consider yourself lucky, as it sounds that you were valuable enough for them to hold on to you rather than consider you an inbred Hoosier!
Personally, I left Indy for KC and St. Louis for med school and my rotations...and I enjoyed the change of scenery, plus there is the advantage of adaptation (of which I am now an expert). But don't sweat it, you are in a good program in a good town.