Insight into academic programs

[Ophthoseidon]

Hi everyone,

I'm about 3 weeks into my pediatrics rotation and like a LOT more than I expected to. I'm just wondering if I do decide to do it in the long run, what kind of requirements (step scores, AOA, clinical grades, research, etc.) are needed to be considered at the larger academic institutions (CHOP, Boston, Seattle, UCSF, Stanford, Colorado, Mott's). I looked around a bit but didn't seem to see a lot of people talking about it. I only found 1 or 2 mildly useful threads. Thanks!

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[WheezyBaby]

Like any competitive program, everything matters, to what extent is program dependent. Not a whole lot more to it. Some programs might have a 240 cutoff, some a 250. Some might require or strongly favor aoa, some might not. In general, I think us md, 240+, aoa, and strong (and published) research should put you into consideration for most places. I'm med peds though, so my peds specific experience is more from my peds colleagues

 

[2018Duke]

Like any competitive program, everything matters, to what extent is program dependent. Not a whole lot more to it. Some programs might have a 240 cutoff, some a 250. Some might require or strongly favor aoa, some might not. In general, I think us md, 240+, aoa, and strong (and published) research should put you into consideration for most places. I'm med peds though, so my peds specific experience is more from my peds colleagues

A 250 cutoff? Seriously? Wow. There aren't many ENT/ortho/rad onc programs with that type of cutoff.

 

[WheezyBaby]

A 250 cutoff? Seriously? Wow. There aren't many ENT/ortho/rad onc programs with that type of cutoff.

I typed that up quickly and in retrospect I more so think 230-240 cutoffs by and large. 250 i think is likely an average at a fair number of places. My experiences is also colored by coming from a nonbrand name md without regional connections to most of the top programs, so the people I know in peds who got several interviews at those programs were maybe a little more solid from a numbers standpoint than applicants with some other intangibles. In general though I don't think people matching a competitive program in any field are all that different from one another in qualification

 

[2018Duke]

I typed that up quickly and in retrospect I more so think 230-240 cutoffs by and large. 250 i think is likely an average at a fair number of places. My experiences is also colored by coming from a nonbrand name md without regional connections to most of the top programs, so the people I know in peds who got several interviews at those programs were maybe a little more solid from a numbers standpoint than applicants with some other intangibles. In general though I don't think people matching a competitive program in any field are all that different from one another in qualification

Got it. Thanks for the explanation.

 

[Marie0123]

I can only speak for one of the top tier programs mentioned above, but they don't have a USMLE cutoff. As long as you pass, you have a shot at an interview (but the rest of your application better be darn strong).

 

[oldbearprofessor]

This type of information is not exactly published, but most of the top 10-20 ranked (not an indicator of quality of course...) would have relatively few folks below 215-220 and median step 1 of 230-240 with the very top ranked program having medians around 240 or a few points higher. Having said that, there tends to be a number of these programs that focus a good bit on Step 2 and accept somewhat lower step 1s. A step 1 of 215 and step 2 of 240 would not rule one out of most top programs if the application is otherwise strong.

 

[BigRedBeta]

I would strongly caution against assuming that these top name programs are inherently better places to train than programs with less stringent requirements - your long term career goals may be far better served elsewhere.

See this thread: http://forums.studentdoctor.net/threads/disappointed-in-pediatric-intern-year.1132819/ as a warning sign for not considering fit/learning style/interests and overall satisfaction with a program

For example, if you were suddenly considering becoming a general pediatrician, going to some place like CHOP or Boston where more than 85% of their grads end up in fellowship may not be the best option for you.

If you are unsure of your career course and need exposure to a lot of different subspecialties, than the big names (that now function as quaternary or even quintenary referral centers) might be helpful - though it's not clear to me that seeing the rarest of the rare is more valuable than good bread and butter subspecialty problems.

 

[SurfingDoctor]

Having trained and practiced at large academic centers, I would second BigRedBeta's point. I would disagree with the assumption that bigger, higher ranked, academic institutes train better residents or have better educational opportunities. Certainly, from a 1000 foot view, the programs will say that and others will assume that, but those names and ranks have essentially nothing to do with training or education. Have been at several of those places, often the emphasis (from a hospital standpoint, which is what those rankings are) are based on things that have nothing to do with training. For instances, NIH funding, nurse to patient ratios, number of hospital-acquired infections. Hospitals and university system invest in a lot of money to make these components of the ranking increase for their own hospital system, however these do not translate into education experiences for residents. I have seen great residents/trainees at the programs I have been at, and I have seen some poor resident/trainees who I wouldn't recommend to colleagues. Additionally, I have seen larger programs disincentivise residents ownership of patients because the larger systems have NP, PA, fellows and many other trainees. That's not to say the larger academic centers aren't good programs, they are, but I don't think they are better or offer better training than the rest. The ACGME is pretty clear about what is required to train someone in pediatrics and every ACGME accredited program follows the requirements. Thus the training experience is more or less, similar to all places. In the end, you should apply to the place 1) where you want to live and a place you will enjoy outside of the hospital 2) where you like the people you encounter 3) where you get a good feeling from (after all the interview is only 1 day). If name of a hospital means a lot to you, that's fine and you should apply where you want, just don't assume name/rank equals better training/education.

 

[Ophthoseidon]

I'm glad you guys brought that up. I in no way meant to imply that I wanted to just go to the highest ranked program possible. Just some of my ideal locations to live (Seattle, Denver, etc.) happen to have great hospital systems that i'd be interested in. At this point I'd most likely do a fellowship, and I thought the general consensus was that it's best to go to a larger university program if that was your goal.

 

[BigRedBeta]

If going on to fellowship, yes, you want an academic program, and I'd suggest going to a place with fellowships (for role-models and an understanding of what life is like as a fellow). But SurfingDoctor's point about patient ownership is an important one - those big name places often have resources for silly things like suture techs or an NP in the ED who does nothing but splint fractures, leaving the trainees to garner knowledge about these things on the margins.

Let me give you an example. I went to a high quality residency program, but it was by no means a huge name, and it was in a rather undesirable geographic location. In the NICU, it was expected that the interns always took the first shot at umbilical lines, with the help of their senior resident. After a month in the NICU at the University Hospital and another month in the Newborn nursery (where your overnight calls included going to all NICU deliveries) most interns had done between 8-20 sets of lines. This was important because as a second and third year resident you were expected to teach/assist the interns with their lines and to be self sufficient in line placement when you were covering the surgical NICU at the children's hospital. The neo fellows were available for assistance after that, or in the case of babies that needed emergent/urgent lines. Most graduating residents had completed/supervised between 30-50 sets of lines by the end of residency. My best friend in residency went on to a neonatology fellowship and was dismayed to find many (big name) places on the interview trail where line placement was the job of the fellow...she had already done that and while not a waste of her time to continue to build that skill, it was a major strike against those programs when she could be using that time to learn other skills or think about other problems.

Similarly, one of the guys who was my chief resident when I was a PGY-2, went on to a PICU fellowship at one of the biggest names there is in pediatrics. He loved it for fellowship, but told many of the residents there (one of whom ended up being a cardiology fellow where I did my PICU fellowship so we talked) that if he done residency there he would have never gone on to a PICU fellowship because he would have never gotten the ownership of his patients (procedural or otherwise) that he needed to fall in love with the PICU.

To be clear, these examples are only what was right for these two people. YMMV. A big part of choosing a residency program is knowing yourself, your learning style, and what's important to you.

 

[Majal]

But does going to a "big name" institution for residency make it easier to match at another big name institution for fellowship?

 

[mvenus929]

But does going to a "big name" institution for residency make it easier to match at another big name institution for fellowship?

The field is not as large as you think it is. It is even smaller for fellowship. Sure, going to a 'big name' institution may make it easier for you to get research and thus be more competitive for fellowship, but my program has sent people to fellowship at some major children's hospitals, and we are virtually unknown outside of the region and have 2-3 fellowship programs here (ED, Child Abuse, +/- ID). So if you make it a point to get involved at whatever institution you end up at and make your application strong, you will have a shot at the big programs.

 

[oldbearprofessor]

If going on to fellowship, yes, you want an academic program, and I'd suggest going to a place with fellowships (for role-models and an understanding of what life is like as a fellow).

This is one we're going to have to disagree about, both for the reasons of patient ownership you describe in detail and because in my experience both personally and as an attending in settings with and without fellows, this is not necessary. Choice of residency should be primarily about other factors including location. Fellowship experiences in one place don't serve that much of a role-model experience. Much of that can be accomplished by other means such talking to recently completed fellows or talking to fellows on the interview trail. Lots of fellows come from places that did not have fellows in that field (and fellows in other fields are uncommonly role-models) and adapt to fellowship fine.

Concur with several above that going to a big name residency is of marginal, but some benefit in getting fellowship, again, not a big enough factor to be the determining aspect.

 

[BigRedBeta]

This is one we're going to have to disagree about, both for the reasons of patient ownership you describe in detail and because in my experience both personally and as an attending in settings with and without fellows, this is not necessary. Choice of residency should be primarily about other factors including location. Fellowship experiences in one place don't serve that much of a role-model experience. Much of that can be accomplished by other means such talking to recently completed fellows or talking to fellows on the interview trail. Lots of fellows come from places that did not have fellows in that field (and fellows in other fields are uncommonly role-models) and adapt to fellowship fine.

Concur with several above that going to a big name residency is of marginal, but some benefit in getting fellowship, again, not a big enough factor to be the determining aspect.

Fair enough. My thought is that it's just nice to have seen what fellow life is like, even if it's in a different specialty (to a degree - seeing a development peds fellow in action isn't going to help a future PICU fellow that much, but watching a heme/onc fellow may be quite beneficial to a future pulm fellow). By no means, is the experience going to be congruent, but for me, I felt that it eased my transition from resident to fellow by having seen fellows interact with attendings, lead rounds, teach my co-residents, etc. It helped me develop my own style and I was able to take things I liked (and avoid those I didn't) from multiple different fellows in a variety of specialties.