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Jackson Memorial- General Surgery
- Thread starter vicryl
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i knew someone there recently- they told me they felt well trained
seems pretty old school. they dont advertise much, its like a vortex culture- for the south floridians. you get sucked in from medical school, stay for residency and then practice in S Florida. it has a very large catchment/referral basin-
would like to visit oneday
seems pretty old school. they dont advertise much, its like a vortex culture- for the south floridians. you get sucked in from medical school, stay for residency and then practice in S Florida. it has a very large catchment/referral basin-
would like to visit oneday
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I just saw this post and remembered a thread i started with this user name a while back. JMH is a very strange program. They sell you the idea (during interviews, talks, etc.) that it is a great training hospital, that you will do a tremendous amount of operations and that there is a wide variety of cases. However I must emphasize that this is not completely true.
You spend a good portion of your day doing B$!T work, like calling for results of labs that were done 24 hours before, calling shelters for patient discharge, calling pathology for results 2 months after a procedure (this is not BS), calling consults that never come..., and basically making the system work. Nurses are extremely lazy and you basically have to do their work if you want your patient to get what he needs. All these put together force you to stay in the hospital way more than the 80 hours you are supposed to. Ohhh, and if you don't speak Spanish or at least have an idea of it, you shouldn't train here because it will be impossible to interact with any of the patients (I feel in an island where the occasional English speaking tourist stops by).
You never see the OR as a 1st year ; as 2nd year you may close some bellies. Third years do a suboptimal number of operations. PGY-4 and chiefs definitely operate more, but keep in mind, they are always doing with an attending that tells them where, what and how to cut (even if it is a procedure that they have done multiple times like a lapchole). this is not really learning by doing but rather by watching do. In fact, their total number of procedures Is low when compared to other programs. the academic activities are mediocre to say the least; does not really seem like a university program.
However, i do recommend this program if you want to do trauma surgery. It is oriented towards this specific goal. you are on call Q3 when in trauma and I think you spend at least 1.5 years of your total 5 in trauma. Your autonomy is basically existent only in trauma (you have a fellow working with you and some attendings do scrub in every procedure) but during you elective services (surgonc, hepatobiliary, colorectal, vascular, PRS, transplant, endocrine, CT) you are either assisting the fellow or assisting the attending. This program is incredibly good at teaching you how to baby sit and take care of your post-op patient, you will excel in this aspect if you come here.
You can probably tell that I am not too happy with the program. I am actually trying to change programs or specialties. however it has been hard because they are really not willing to help. I really regret the day I ranked JMH 3rd. NOT EVEN THE FACT THAT I AM IN MIAMI MAKES UP FOR THIS MONUMENTAL MISTAKE.
You spend a good portion of your day doing B$!T work, like calling for results of labs that were done 24 hours before, calling shelters for patient discharge, calling pathology for results 2 months after a procedure (this is not BS), calling consults that never come..., and basically making the system work. Nurses are extremely lazy and you basically have to do their work if you want your patient to get what he needs. All these put together force you to stay in the hospital way more than the 80 hours you are supposed to. Ohhh, and if you don't speak Spanish or at least have an idea of it, you shouldn't train here because it will be impossible to interact with any of the patients (I feel in an island where the occasional English speaking tourist stops by).
You never see the OR as a 1st year ; as 2nd year you may close some bellies. Third years do a suboptimal number of operations. PGY-4 and chiefs definitely operate more, but keep in mind, they are always doing with an attending that tells them where, what and how to cut (even if it is a procedure that they have done multiple times like a lapchole). this is not really learning by doing but rather by watching do. In fact, their total number of procedures Is low when compared to other programs. the academic activities are mediocre to say the least; does not really seem like a university program.
However, i do recommend this program if you want to do trauma surgery. It is oriented towards this specific goal. you are on call Q3 when in trauma and I think you spend at least 1.5 years of your total 5 in trauma. Your autonomy is basically existent only in trauma (you have a fellow working with you and some attendings do scrub in every procedure) but during you elective services (surgonc, hepatobiliary, colorectal, vascular, PRS, transplant, endocrine, CT) you are either assisting the fellow or assisting the attending. This program is incredibly good at teaching you how to baby sit and take care of your post-op patient, you will excel in this aspect if you come here.
You can probably tell that I am not too happy with the program. I am actually trying to change programs or specialties. however it has been hard because they are really not willing to help. I really regret the day I ranked JMH 3rd. NOT EVEN THE FACT THAT I AM IN MIAMI MAKES UP FOR THIS MONUMENTAL MISTAKE.
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sorry to hear that
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In defense of Jackson (and I say this as someone who is now leaving), residents do really run the show outside of the OR in many cases. "Trauma" rotations also involve doing G-surg cases during the day and handling evening emergencies. I rarely saw attendings scrub in on G-surg cases on this rotation being done by a chief. The chiefs usually TA the 2nd year through these cases. A lot of trauma is also handled with minimal to zero attending intervention (this includes some of the operative trauma),
As for the social complexity of your everyday life (dealing with the patients AND the hospital), it's certainly not for everyone. Getting things done can definitely be MUCH more difficult than it needs to be.
Our chiefs were also logging as many cases as chiefs in similar types of residency programs, so I'm not sure why the OP thinks otherwise. Operative experience is definitely top heavy.
As for the social complexity of your everyday life (dealing with the patients AND the hospital), it's certainly not for everyone. Getting things done can definitely be MUCH more difficult than it needs to be.
Our chiefs were also logging as many cases as chiefs in similar types of residency programs, so I'm not sure why the OP thinks otherwise. Operative experience is definitely top heavy.
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I don't think that what Miami_med mentioned is completely accurate.
As i mentioned before, the chiefs are excellent at baby sitting patients. They are probably second to none in that aspect. however, the number they log are NOT COMPARABLE to programs in the area. Do you know that they send us to Mt. Sinai (Miami Beach) to raise our numbers? Remember that the turnover time between cases takes between 1.5-2 hours (if you are lucky) and this plus the social work you have to do slow you down tremendously.
Operative experience, as I said, is good in trauma with a descent degree of autonomy. Whenever there is an operative trauma, the attending usually scrubs in; and I know this because I HAVE DONE THIS ROTATION, NOT AS A STUDENT BUT AS A RESIDENT. The autonomy in other services is poor and Miami_med, as a resident, the other services are actually more than 70% of the entire academic year.
Again, to everybody out there, don't do the mistake that I made. Don't come here to learn by watching. go to some other place to learn by doing.
As i mentioned before, the chiefs are excellent at baby sitting patients. They are probably second to none in that aspect. however, the number they log are NOT COMPARABLE to programs in the area. Do you know that they send us to Mt. Sinai (Miami Beach) to raise our numbers? Remember that the turnover time between cases takes between 1.5-2 hours (if you are lucky) and this plus the social work you have to do slow you down tremendously.
Operative experience, as I said, is good in trauma with a descent degree of autonomy. Whenever there is an operative trauma, the attending usually scrubs in; and I know this because I HAVE DONE THIS ROTATION, NOT AS A STUDENT BUT AS A RESIDENT. The autonomy in other services is poor and Miami_med, as a resident, the other services are actually more than 70% of the entire academic year.
Again, to everybody out there, don't do the mistake that I made. Don't come here to learn by watching. go to some other place to learn by doing.
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I dont have any first hand experience at either place. but I dont think you can fairly compare the experience at a community hospital (mt sinai) to a place like Jackson.
I am sure alot of whats said about Jackson is true, like any other top-heavy big UNivsersity program vs a community program that spreads out the cases and has no fellows.
also, operating without an attending is a very rare experience these days ANYWHERE. even if the staff COULD allow it- the clipboard nurses and the other patient "advocates" would never let it come to reality.
having finished training, and in fellowship now, it isnt as important to operate with noone else in the room as you think it is when you are still training. In fact, I think realizing this, really means you are ready to operate on your own. (run-on sentence that doesnt make sense)
I am sure alot of whats said about Jackson is true, like any other top-heavy big UNivsersity program vs a community program that spreads out the cases and has no fellows.
also, operating without an attending is a very rare experience these days ANYWHERE. even if the staff COULD allow it- the clipboard nurses and the other patient "advocates" would never let it come to reality.
having finished training, and in fellowship now, it isnt as important to operate with noone else in the room as you think it is when you are still training. In fact, I think realizing this, really means you are ready to operate on your own. (run-on sentence that doesnt make sense)
D
deleted89854
As one of the current residents at JMH, I guess I'll bite.
From reading your previous post it sounds like you are an intern 9 months in. I'm not sure that your reading of the way things work at Jackson is accurate. The social work/consult/nursing torture becomes minimal after intern year (because afterwards you have interns for that). Towards the end, you do learn how to game the system and things become much simpler.
Your numbers sound low. By the end of intern year I had around 70 total cases, 40 of which counted as major cases (sebaceous cysts, ports, etc don't count). Not staggering numbers, and not close to what you get at a community place as an intern. Either you are a prelim (who honestly dont get to go the the OR that much), you haven't had your busiest months yet (SICU, Lab month, neurosurgery are all nonoperative months for the most part), or you haven't been persistent enough in getting in there. If an intern tells me they aren't getting in enough I make sure that they do, as long as the floor work gets done. If I don't have a categorical then I try to get the prelims in if they show me something. We are instructed that we need to get the categoricals into the OR as much as possible (by the program director). If that's not the case, then you should ask your chiefs to help you out.
The second year is much different. Except for the five weeks in the TICU and five weeks running trauma resuscitation, your only job is to operate. I don't "close a belly" once in a while. You will do 80-90 scopes (upper + lower), amputations, thyroidectomies and parathyroidectomies (as the primary), gallbladders, hernias,
AV fistulas, some endovascular stuff, and a lot more. Occasionally you end up in a case above your pay grade and the attending walks you through the case. If I don't have cases going on, then I'll scrub in with the chief and the attending and help out, but it's not required.
The Sinai rotations definitely pad our numbers, but I think they send us there more so we can see how an efficient private hospital works. Everything you say about the turnover times is true. 20% of first cases start on time and less than that have a turnover <45 minutes. We don't see any cases there that we wouldn't otherwise. OR staff are shift workers for the most part with no incentive to turn over a room quickly. Now they are working on ways to integrate UM hospital (private) into our schedule somehow, but it's not close to efficient yet. Operating there is fun though, and the staff there is very respectful and considerate (in comparison).
Trauma is semi-autonomous. The chiefs/fellows assist the 2nd/3rd/4th years in the OR for elective/basic cases (there is no general surgery service). Attendings scrub in sometimes, sometimes not, depending on the case (No solo IVC repairs for you). Otherwise they peek in during the critical part of the case, or if you need help. You run trauma as a 2nd/3rd/4th year (or at least the nurses let you think you do), with the attending or the fellows providing you with whatever backup you need. Total trauma in the residency is 2.5 months 2nd year, 2 months 3rd-5th years = 8.5 months total. Categorical interns used to do a month, but they do a month on burns now instead (not sure why).
The language things sucks. Over 40% of our patients speak spanish only, 15% speak Creole only. I've gone from speaking no spanish (except swearing) to speaking enough butchered cuban spanish to get me through a patient interview in the ED. Performing a full H&P might make my head explode. Thankfully there's usually a nurse (who all speak Creole)/observer/prelim intern nice enough to help out. Otherwise you call the interpreter, who are often slow and may or may not speak less english than the patient.
Academics is minimal. You get an hour of basic science conference a week, one hour Grand Rounds, one hour M&M. Depending on the service, there may be journal club. I actually prefer to study on my own time (of which you will have more than enough), but if you're big into powerpoints this isnt the place for you. I'm not sure if we do more/less than other programs in this regard. Most of us do very well on our ABSITE, but I have no idea in terms of numbers/stats.
I remember as a student trying to read these boards for help about this place and seeing next to nothing. The deciding factor for me was an away rotation as a student, during which I had a lot of fun. Otherwise I might not have ranked this place so highly. It's annoying to have to try to sift through all the BS people try to hand you on interviews and online. However, I feel like I'm being honest here. And it's hard to read someone talking smack about a place that I've genuinely enjoyed working.
Holy crap, too much typing. To the OP, if you're a categorical here, talk to your chief about getting to the OR. If that doesn't work out, at least know that next year will be much, much better. You'd be suprised how much people here are willing to help if you ask. For the students, to sum up:
Cons: Big county hospital, lazy and mean nursing (with exceptions, especially the ICUs and trauma), borderline ******ed computer system (finally got full computerized imaging a little more than a year ago - we used to have to walk to radiology to check CXRs), intern year sucks (where doesn't it?), not much lecture, nobody speaks english (except at the VA)
Pros: Big county hospital, large amount of autonomy, more than enough cases (If anything, we need to go to 7 residents/yr to cover these private hospitals), hours aren't awful (I went out to the beach way more than I should have), an entire freaking month of laparoscopic/open skills lab as an intern, research is OPTIONAL (we actually had people fighting to get IN this year).
Feel free to ask/PM/whatever. Will respond once my hands recover from this epic I've just written.
From reading your previous post it sounds like you are an intern 9 months in. I'm not sure that your reading of the way things work at Jackson is accurate. The social work/consult/nursing torture becomes minimal after intern year (because afterwards you have interns for that). Towards the end, you do learn how to game the system and things become much simpler.
Your numbers sound low. By the end of intern year I had around 70 total cases, 40 of which counted as major cases (sebaceous cysts, ports, etc don't count). Not staggering numbers, and not close to what you get at a community place as an intern. Either you are a prelim (who honestly dont get to go the the OR that much), you haven't had your busiest months yet (SICU, Lab month, neurosurgery are all nonoperative months for the most part), or you haven't been persistent enough in getting in there. If an intern tells me they aren't getting in enough I make sure that they do, as long as the floor work gets done. If I don't have a categorical then I try to get the prelims in if they show me something. We are instructed that we need to get the categoricals into the OR as much as possible (by the program director). If that's not the case, then you should ask your chiefs to help you out.
The second year is much different. Except for the five weeks in the TICU and five weeks running trauma resuscitation, your only job is to operate. I don't "close a belly" once in a while. You will do 80-90 scopes (upper + lower), amputations, thyroidectomies and parathyroidectomies (as the primary), gallbladders, hernias,
AV fistulas, some endovascular stuff, and a lot more. Occasionally you end up in a case above your pay grade and the attending walks you through the case. If I don't have cases going on, then I'll scrub in with the chief and the attending and help out, but it's not required.
The Sinai rotations definitely pad our numbers, but I think they send us there more so we can see how an efficient private hospital works. Everything you say about the turnover times is true. 20% of first cases start on time and less than that have a turnover <45 minutes. We don't see any cases there that we wouldn't otherwise. OR staff are shift workers for the most part with no incentive to turn over a room quickly. Now they are working on ways to integrate UM hospital (private) into our schedule somehow, but it's not close to efficient yet. Operating there is fun though, and the staff there is very respectful and considerate (in comparison).
Trauma is semi-autonomous. The chiefs/fellows assist the 2nd/3rd/4th years in the OR for elective/basic cases (there is no general surgery service). Attendings scrub in sometimes, sometimes not, depending on the case (No solo IVC repairs for you). Otherwise they peek in during the critical part of the case, or if you need help. You run trauma as a 2nd/3rd/4th year (or at least the nurses let you think you do), with the attending or the fellows providing you with whatever backup you need. Total trauma in the residency is 2.5 months 2nd year, 2 months 3rd-5th years = 8.5 months total. Categorical interns used to do a month, but they do a month on burns now instead (not sure why).
The language things sucks. Over 40% of our patients speak spanish only, 15% speak Creole only. I've gone from speaking no spanish (except swearing) to speaking enough butchered cuban spanish to get me through a patient interview in the ED. Performing a full H&P might make my head explode. Thankfully there's usually a nurse (who all speak Creole)/observer/prelim intern nice enough to help out. Otherwise you call the interpreter, who are often slow and may or may not speak less english than the patient.
Academics is minimal. You get an hour of basic science conference a week, one hour Grand Rounds, one hour M&M. Depending on the service, there may be journal club. I actually prefer to study on my own time (of which you will have more than enough), but if you're big into powerpoints this isnt the place for you. I'm not sure if we do more/less than other programs in this regard. Most of us do very well on our ABSITE, but I have no idea in terms of numbers/stats.
I remember as a student trying to read these boards for help about this place and seeing next to nothing. The deciding factor for me was an away rotation as a student, during which I had a lot of fun. Otherwise I might not have ranked this place so highly. It's annoying to have to try to sift through all the BS people try to hand you on interviews and online. However, I feel like I'm being honest here. And it's hard to read someone talking smack about a place that I've genuinely enjoyed working.
Holy crap, too much typing. To the OP, if you're a categorical here, talk to your chief about getting to the OR. If that doesn't work out, at least know that next year will be much, much better. You'd be suprised how much people here are willing to help if you ask. For the students, to sum up:
Cons: Big county hospital, lazy and mean nursing (with exceptions, especially the ICUs and trauma), borderline ******ed computer system (finally got full computerized imaging a little more than a year ago - we used to have to walk to radiology to check CXRs), intern year sucks (where doesn't it?), not much lecture, nobody speaks english (except at the VA)
Pros: Big county hospital, large amount of autonomy, more than enough cases (If anything, we need to go to 7 residents/yr to cover these private hospitals), hours aren't awful (I went out to the beach way more than I should have), an entire freaking month of laparoscopic/open skills lab as an intern, research is OPTIONAL (we actually had people fighting to get IN this year).
Feel free to ask/PM/whatever. Will respond once my hands recover from this epic I've just written.
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Thanks for what seems like an fair and honest assessment meathooks. I'm at a UC school looking to do general (perhaps neuro - haven't decided) and Jackson's at the top of my list. I understand that if you want to get into something insane like a peds fellowship you should go for a very academic place (at my school about 30% of residents go into peds I think). I'm not really interested in that, but if I for example wanted to get into a CT fellowship at UCSF, a plastics program at Columbia or whatever do you think I should go for a more prestigious program than Miami? Or by that point do they recognize that your operative skills/experience may be just as good or better after going through a place as busy as Jackson?
Along the same lines if you want to do research for a year or two do you have to commit before starting, or can you choose to do it later? And do you have a choice of when? (e.g. after year 2 or 3?).
Thanks for the help - much appreciated. Any other residents from there who might have an idea that'd be great too, because with these things I think it's better to get a consensus.
Along the same lines if you want to do research for a year or two do you have to commit before starting, or can you choose to do it later? And do you have a choice of when? (e.g. after year 2 or 3?).
Thanks for the help - much appreciated. Any other residents from there who might have an idea that'd be great too, because with these things I think it's better to get a consensus.
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JMH is the third largest hospital in the country and logs ~20,000 operations a year. The program I'm headed to is half the size and performs 6,000 more. I'm only a medical student and can only speak to what I've observed here. I will say that the interns are abused on many rotations, they rarely operate, the nursing is the worst I've ever seen (and I used to be in nursing), and the didactics are non-existent. Language isn't a problem because so many other people are willing to translate. It's certainly frustrating, but you can always find a nurse, med student, janitor, roommate, or family member to translate. Trauma and burn are amazing rotations. You'll see a lot and do a lot. I don't know about the sub-specialty side.
D
deleted89854
I don't think anyone here really has any issues getting the fellowships they want. People match here into pretty much whatever fellowship they would like (seems like a lot go into plastics). I don't think the issues with getting a fellowship revolve around prestige so much as whether the attendings have the connections necessary to get you interviews for the spot you want, but I'm not far enough along to say that with certainty. It seems like our chiefs get whatever interviews they are interested in.
The people who are interested in research make it known at some point during their second year, and they are willing to send three per year max. This year four wanted to go, but the chairman didn't want to be in the position of forcing someone into the lab in the future when four people tried to return from research. So now three per year max, 2 minimum. If too many are interested, highest absite scores win (I'm guessing the same applies if not enough are interested as well). Research is always after second year.
I don't think looking at total operations performed per hospital is helpful. I think you have to look at what kind of cases you're getting. For example, no hepatobiliary fellows means residents graduate with at least 20 liver/pancreas cases (I think the required amount is 5/3). Same applies to vascular. Also the numbers you mentioned don't include the VA or UMH. I know most of our chiefs graduate with >1000 cases easily.
I don't think the categorical interns here get worked all that bad. I didn't find it especially difficult. There are a couple of painful rotations (plastics and onc can hurt), but overall it's not too bad. The prelims get it worse than we do (they have vascular, hepatobiliary, and trauma to contend with). By the end I just wanted the paging to stop and the floor work to be over. My numbers were not abnormal for my class - must of us operated a decent amount as interns.
As bad as the nursing seems, it's no where near the northeast. Not even close. Ask an intern in New York how many IVs or blood draws they did during intern year, how many foley catheters they put in. I think I started seven IVs intern year, and they all got EJs. I think some of the students here lack perspective. Do an away rotation at Bellevue or Metropolitan and then you'll kiss the nurses' feet when you get back.
Hope that helps. I'll try and keep it short after this.
The people who are interested in research make it known at some point during their second year, and they are willing to send three per year max. This year four wanted to go, but the chairman didn't want to be in the position of forcing someone into the lab in the future when four people tried to return from research. So now three per year max, 2 minimum. If too many are interested, highest absite scores win (I'm guessing the same applies if not enough are interested as well). Research is always after second year.
I don't think looking at total operations performed per hospital is helpful. I think you have to look at what kind of cases you're getting. For example, no hepatobiliary fellows means residents graduate with at least 20 liver/pancreas cases (I think the required amount is 5/3). Same applies to vascular. Also the numbers you mentioned don't include the VA or UMH. I know most of our chiefs graduate with >1000 cases easily.
I don't think the categorical interns here get worked all that bad. I didn't find it especially difficult. There are a couple of painful rotations (plastics and onc can hurt), but overall it's not too bad. The prelims get it worse than we do (they have vascular, hepatobiliary, and trauma to contend with). By the end I just wanted the paging to stop and the floor work to be over. My numbers were not abnormal for my class - must of us operated a decent amount as interns.
As bad as the nursing seems, it's no where near the northeast. Not even close. Ask an intern in New York how many IVs or blood draws they did during intern year, how many foley catheters they put in. I think I started seven IVs intern year, and they all got EJs. I think some of the students here lack perspective. Do an away rotation at Bellevue or Metropolitan and then you'll kiss the nurses' feet when you get back.
Hope that helps. I'll try and keep it short after this.
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I doubt anyone has much info but I was wondering if anyone had an opinion on the cardiothoracic fellowship at U of M. Training? case load? cutting edge stuff? anything would be helpfull.
A couple of friends did an extern@ JMH. They decided not to apply there because residents were "abused and op experience was not that great". They said that even some residents suggested applying somewhere else.
Again, I did not rotate there but this is what I was told. I know it differs from what meathooks wrote, but in this type of situation i think it is better to know all stories.
Again, I did not rotate there but this is what I was told. I know it differs from what meathooks wrote, but in this type of situation i think it is better to know all stories.
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Does anyone know if a strong osteopathic applicant has a prayer at JMH? I had heard they are pretty unwilling to look at DO applicants.
Never been there only know what I have heard from those that have been there and what I am reading now.
First, I think if turnover is as bad as noted;I would tend to agree with the poster about low numbers & 80 hrs. You can not get high volume experience if your turnover is that innefficient unless you are staying extra late to get your cases.... add to that blocks of time non-OR for "education". That is just what the math is.
Second, I have never heard of it being an academic powerhouse. On the contrary, it seems as if you get no real benefits of academia and no benefits of community type programs. Kind of the wrong parts of both systems.....
Third, with few exceptions trauma gets old. You can get good trauma experience at any level one center or even alot of level 2. I wouldn't go to a program if its primary claim is good trauma experience. I would further suggest folks avoid any program in which the primary learning and operating occurs on trauma. Yes, most programs have increased and earlier autonomy on trauma. But, if folks primary hands on is trauma.... avoid that program. Trauma situation is not where you should be learning meticulous dissection and oncologic principles.
Fourth, in general, I haven't heard very much good about Florida nursing.... see "first" above. If you are doing nurses job, have innefficient turnover, etc.... hard to believe high end operative experience & volume. Now, add to that waiting for interpreter or late family conference when translating family member arrives.
Fifth, your going to "academic" program/etc... but padding your numbers by rotating out at community program.
I think all I have read here and between the lines, what others have written, and speaking to colleagues, I would be concerned. Miami is a hard place. Patients are sick, high poverty high hepatitis, high HIV, high indigent.... probably low gratitude. Miami is currently as a state in financial trouble.... who do you think will be the low cost labor?
JAD
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I think yes. Prestige gets prestige. I may be wrong, but I don't think Miami is held in the same category as some of the more prestigious programs.
Miami aside, I think you should look at a programs make-up/composition of residents, and the recent (last five years) graduating classes:
1. did they pass their boards
2. did they match into prestigious/competitive fellowships (i.e. straight as opposed to being stuck doing burns or hand before getting plastics... etc..)
3. What did they have to do to get into their fellowship .... i.e. 2 yrs research? If they did research, did they have to go elsewhere?
4. Stable well named program director/chair? Stable subspecialty divisions?
5. Accreditation
If a program doesn't have a track record of piping folks into plastics or pedes, you are more likely to NOT be the first.
JAD
JAD, I don't really feel that you are qualified to give your opinion about a program you have no experience with and are only going on what you've read here.
Surgonco has a very skewed opinion of the program. He was a prelim intern from overseas who was trying to get a spot in the US. Due to his sub-par performance on many rotations, attitude that he knew more than senior residents, and refusal to accept that he had to do "intern" work, he was not offered a second year prelim or categorical spot.
I am a categorical second year resident and I am very happy with the program. My case numbers as an intern were not great, but intern year is about learning how to be a doctor, not how to operate like a chief. You can't expect to be doing complex cases! I did approximately 60 major credit cases and a little less than 90 total. So far as a second year in month 3, I only need 10 more scopes to be done! I am doing plenty of cases that are at my "level" such as chole, appy, AVF, vascular bypasses, hernias, thyroids/paras, in addition to more senior cases such as colectomies, lap adrenals, and the such.
Every program has their weaknesses, and I am not claiming that we have none. Nurses could be better, OR turnover time was very bad but is improving, and BIG SHOCKER - intern year sucks! I know of programs that have interns doing 150+ cases, but they have NO IDEA how to take care of a patient because their ARNP/PAs are doing everything.
I don't know of many places where a resident does 4-6 Whipple's a week like we do during our 4th-year 2 month hepatobiliary rotation, nor where you have the opportunity to crack a few chests in the ED a week.
Surgonco has a very skewed opinion of the program. He was a prelim intern from overseas who was trying to get a spot in the US. Due to his sub-par performance on many rotations, attitude that he knew more than senior residents, and refusal to accept that he had to do "intern" work, he was not offered a second year prelim or categorical spot.
I am a categorical second year resident and I am very happy with the program. My case numbers as an intern were not great, but intern year is about learning how to be a doctor, not how to operate like a chief. You can't expect to be doing complex cases! I did approximately 60 major credit cases and a little less than 90 total. So far as a second year in month 3, I only need 10 more scopes to be done! I am doing plenty of cases that are at my "level" such as chole, appy, AVF, vascular bypasses, hernias, thyroids/paras, in addition to more senior cases such as colectomies, lap adrenals, and the such.
Every program has their weaknesses, and I am not claiming that we have none. Nurses could be better, OR turnover time was very bad but is improving, and BIG SHOCKER - intern year sucks! I know of programs that have interns doing 150+ cases, but they have NO IDEA how to take care of a patient because their ARNP/PAs are doing everything.
I don't know of many places where a resident does 4-6 Whipple's a week like we do during our 4th-year 2 month hepatobiliary rotation, nor where you have the opportunity to crack a few chests in the ED a week.
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Now, I can totally understand your desire to defend and protect your chosen institution, and I'm even guilty of doing that with SLU in the past, but really? Come on, man...we all know that your work environment is malignant. It doesn't take first hand knowledge when you have multiple similar stories......I remember someone from Duke saying the same thing, examples one and two......we're just not buying it.
So, you guys hire crappy prelims? It doesn't matter. Very few residents still involved with a program are willing to step up and reveal it's dirty laundry. When they do, five other new users pop up to defend the place anyway.
Biased or not, we value input from a person who worked there and didn't like it, just as much as we value yours.
I can't help but be skeptical that you went from almost no OR experience as an intern to being the primary surgeon on Lap Adrenals as a PGY-2 three months into the year.
You're right, there are other programs that suck with higher operative numbers. I agree that intern year should be more about being a good doctor than doing whipples. Still, you just confirmed 3 of the main concerns from previous posts, which I bolded above.
I'm sorry, I'm just not seeing unique and excellent opportunities. I think it's perfectly fine for you to provide some info on your program, but don't pee on our heads and tell us it's raining. Try to give us a real account of life there....truthfulness is extremely valuable when trying to attract potential residents....you'll still have plenty of people willing to face the malignancy in exchange for the trauma experience or fellowship opportunities. But, if you lie to them, you'll end up with a bunch of unhappy residents posting their "lies" about your hospital on SDN.
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I got a little wordy, there. I guess my main point is that if we disallow any outside opinions of a program, we end up with nothing but a dichotomous mix of biased ad bitter sob stories and unrealistic puffed up propaganda.
Now, I reserve the right to say these things until someone comes on here and bashes KU Wichita, at which point I'll swear that they are FOS and my place is completely awesome.
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I regret to inform you that I am not a prelim and that I did my medschool here in the US. I am not the person you are referring to in your post: BTW, he left because he was "tired of the program", athough he really was an A**.
I know some Miami residents browse this forum every now and then, so i will try to avoid giving comments that may identify me and make my stay here worst than what it is.
I COULD NOT DIAGREE MORE WITH WAS SAID! This program is a self-proclaimed good program with excellent surgical experience. If you want to spend your life doing trauma and babysitting ICU patients, you should come here because this is what we do most of the time. If you want to do any other surgery, consider going somewhere else. My operative experience here is mediocre at best.
PGY 4s do a rotation called E2 in which there is a ton of hepatobiliary cases. It was not mentioned, though, that during this rotation you are observing our very respected, very loveable, respectful, attending do most of the surgery. I invite the previous poster to scrub into one of his surgeries and observe how much you learn with said attending. Don't forget that doing 3 whipples a week for 2 months does not make up for the operative experience we lack! BTW, there is a reason why we are sent to Sinai to do our rotation... have you asked why?
Again, This is a great program if you want to do trauma and if you want to babysit patients. In my opinion, we are second to none in this aspect; otherwise try not to come here. Your numbers ARE NOT GREAT (my second year cases are done with chiefs that are still working on their numbers + I only get to close the patient; not fair to log something like this) and from what I can tell, they are not going to be spectacular. Hours are VERY VERY VERY long, not because of great experience but because of poor turnover times, poor overall hospital system. In fact, reading this whole discussion, I can tell that I am not alone and many have noticed the same. I invite students to do an extern or a rotation as a SubI (if you are from UM) and experience the chaotic environment we live here. I really don't care working more than 80 hours a week but when I do 90 hours every week JUST BECAUSE I AM DOING THE SOCIAL WORK (AND I AM NOT AN INTERN ANYMORE), pushing other sevices to see my patients,etc. i wonder if I my surgical skills are improoving.
PM me if you have questions about this program. I am not going to be very specific because I am trying to leave desperately and knowing the malignancy that surrounds this place, this can cause me more trouble. I also think tha prospective applicants should be adequately informed of what is happening here so that they avoid doing a catastrophical choice...just like I did.😡
I know some Miami residents browse this forum every now and then, so i will try to avoid giving comments that may identify me and make my stay here worst than what it is.
I COULD NOT DIAGREE MORE WITH WAS SAID! This program is a self-proclaimed good program with excellent surgical experience. If you want to spend your life doing trauma and babysitting ICU patients, you should come here because this is what we do most of the time. If you want to do any other surgery, consider going somewhere else. My operative experience here is mediocre at best.
PGY 4s do a rotation called E2 in which there is a ton of hepatobiliary cases. It was not mentioned, though, that during this rotation you are observing our very respected, very loveable, respectful, attending do most of the surgery. I invite the previous poster to scrub into one of his surgeries and observe how much you learn with said attending. Don't forget that doing 3 whipples a week for 2 months does not make up for the operative experience we lack! BTW, there is a reason why we are sent to Sinai to do our rotation... have you asked why?
Again, This is a great program if you want to do trauma and if you want to babysit patients. In my opinion, we are second to none in this aspect; otherwise try not to come here. Your numbers ARE NOT GREAT (my second year cases are done with chiefs that are still working on their numbers + I only get to close the patient; not fair to log something like this) and from what I can tell, they are not going to be spectacular. Hours are VERY VERY VERY long, not because of great experience but because of poor turnover times, poor overall hospital system. In fact, reading this whole discussion, I can tell that I am not alone and many have noticed the same. I invite students to do an extern or a rotation as a SubI (if you are from UM) and experience the chaotic environment we live here. I really don't care working more than 80 hours a week but when I do 90 hours every week JUST BECAUSE I AM DOING THE SOCIAL WORK (AND I AM NOT AN INTERN ANYMORE), pushing other sevices to see my patients,etc. i wonder if I my surgical skills are improoving.
PM me if you have questions about this program. I am not going to be very specific because I am trying to leave desperately and knowing the malignancy that surrounds this place, this can cause me more trouble. I also think tha prospective applicants should be adequately informed of what is happening here so that they avoid doing a catastrophical choice...just like I did.😡
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oh, and the lap adrenals that WARiOFL metions, pbbly were done with the endocrine fellow and the endocrine attending: THEY WILL NEVER BE DONE BY THE SECOND YEAR...you may "close" and if the fellow is mercyful, you will do a couple thyroids with his assistance.
Actually, I think I made my reply fairly benign but quite clear I never attened and am basing my comments on my communications with individuals that have attended that program as well as the comments being said here in this thread:
I encourage you to be proud of your accomplishments. Your posts shows your loyalty
However, the comments not really refuted here support the points of concern everyone has raised and/or confirmed....
I will say, IMHO a total 60 major credit and 90 total after 15 months does not equate:
"doing plenty of cases that are at my "level" such as chole, appy, AVF, vascular bypasses, hernias, thyroids/paras, in addition to more senior cases such as colectomies, lap adrenals, and the such".
If you are DOING "plenty" why have you only taken major credit for 60 in 15 months.... is it because you are holding hook and/or more senior residents are taking credit to catch up on limited operative exposure.... Miami would not be unique in such a scenario. It occurs around the country in numerous programs. There are actual guidelines on how much one must do to be eligible to take credit according to the ABS. As long as residents log cases because they need numbers and attendings and/or environment does not allow true "surgeon" level participation programs will never correct. As they never correct, folks will complain and those trapped in their chosen program will defend. We all get it. We understand your circumstances. Finally, great for you that you've done most of the colonoscopes & EGDs... again, your there to be a surgeon and it seems you have spent more time scoping (operating the scope) then operating the patient.
JAD
PS: it really does all come back down to the math... extrapolate the turn-over & work hours; doesn't really add. Extrapolate 60 major credit in 15 months to a total of sixty months; doesn't really add.... Extrapolate the city of Miami's current financial circumstances; doesn't really add. As I stated, buyers beware and take a hard look with concern. Maybe you will find a diamond.... but be careful.
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deleted89854
I guess since someone decided to unearth this thread, I'll contribute a little bit.
In terms of the malignancy, I remember hearing before I left medical school that this place was going to be brutal and my life would be nonexistent. Honestly, I just haven't seen it. There are definitely a couple of attendings who fit into that category (including a certain special hepatobiliary attending), but they are in the minority. Have I gotten chewed out before? Definitely. However, for the most part the attendings have been supportive and have taught me a lot.
Again, I'm not really in a position to comment on experience in a community hospital. For my part, my second year I logged about 400/270 total/major cases. I also don't recall a whole lot of "stand-and-watch". If I get called in to close or have minimal involvement, I don't log it (I thought you have to have done like 50% or something?). Surgonco is correct about the fellow being present for the lap adrenals. However, I only scrubbed with the fellow for a H&N case if he was going to walk me through it without the attending (and managed to get 20 such cases without him).
As I mentioned before, the residency here entails 8.5 months of trauma. It's a pretty hefty amount, but this also includes general/acute surgery. You aren't really babysitting trauma patients the entire time (unless you're a second year on trauma red). We also see a lot more operative trauma than most. For example, we have had fifty operative traumas (the fun kind) in the past 2 months. Around 25 gunshots, with 13 of those occurring in the past two weeks. I don't think we crack chests in the ED every week, but it's not uncommon (or all that effective btw). As far as the ICU is concerned, you do one month in the SICU as an intern, 5 weeks in the TICU as a second year, and 2 months in the SICU as a third year. That's 4.25 months. Not a whole lot.
I don't really think it's fair to extrapolate intern year + 3 months (one of which was spent doing scopes) to five years of residency, just as multiplying your chief year x 5 would probably be overstating things a bit. In reality it's probably somewhere in between. I haven't looked at the all of the chiefs' case logs, so I can't say for sure. In terms of matching, last year we had 2 go to trauma (here), three to plastics (1 long island, 1 here, 1 ?), and one to pedi at USC (on condition of a pedi CC year). One of the current chiefs is matched to pedi at hopkins, another to vascular in NYC somewhere, and I don't know about the rest.
I feel like I've been honest about the problems with the program (language, turnover, etc). I'm really trying to avoid sugar-coating this place. Maybe I caught some breaks in terms of working with good fellows, having support on trauma (we occasionally get ER rotators to lighten the load), or something, but my experience does not resemble that of Surgonco. Maybe he got screwed, or I got lucky. Either way, I've unintentionally written an epic about this place again. Hope this is helpful.
In terms of the malignancy, I remember hearing before I left medical school that this place was going to be brutal and my life would be nonexistent. Honestly, I just haven't seen it. There are definitely a couple of attendings who fit into that category (including a certain special hepatobiliary attending), but they are in the minority. Have I gotten chewed out before? Definitely. However, for the most part the attendings have been supportive and have taught me a lot.
Again, I'm not really in a position to comment on experience in a community hospital. For my part, my second year I logged about 400/270 total/major cases. I also don't recall a whole lot of "stand-and-watch". If I get called in to close or have minimal involvement, I don't log it (I thought you have to have done like 50% or something?). Surgonco is correct about the fellow being present for the lap adrenals. However, I only scrubbed with the fellow for a H&N case if he was going to walk me through it without the attending (and managed to get 20 such cases without him).
As I mentioned before, the residency here entails 8.5 months of trauma. It's a pretty hefty amount, but this also includes general/acute surgery. You aren't really babysitting trauma patients the entire time (unless you're a second year on trauma red). We also see a lot more operative trauma than most. For example, we have had fifty operative traumas (the fun kind) in the past 2 months. Around 25 gunshots, with 13 of those occurring in the past two weeks. I don't think we crack chests in the ED every week, but it's not uncommon (or all that effective btw). As far as the ICU is concerned, you do one month in the SICU as an intern, 5 weeks in the TICU as a second year, and 2 months in the SICU as a third year. That's 4.25 months. Not a whole lot.
I don't really think it's fair to extrapolate intern year + 3 months (one of which was spent doing scopes) to five years of residency, just as multiplying your chief year x 5 would probably be overstating things a bit. In reality it's probably somewhere in between. I haven't looked at the all of the chiefs' case logs, so I can't say for sure. In terms of matching, last year we had 2 go to trauma (here), three to plastics (1 long island, 1 here, 1 ?), and one to pedi at USC (on condition of a pedi CC year). One of the current chiefs is matched to pedi at hopkins, another to vascular in NYC somewhere, and I don't know about the rest.
I feel like I've been honest about the problems with the program (language, turnover, etc). I'm really trying to avoid sugar-coating this place. Maybe I caught some breaks in terms of working with good fellows, having support on trauma (we occasionally get ER rotators to lighten the load), or something, but my experience does not resemble that of Surgonco. Maybe he got screwed, or I got lucky. Either way, I've unintentionally written an epic about this place again. Hope this is helpful.
I would agree, you don't log holding hook or skin closure as primary surgeon. You could log holding hook as FA.
I didn't buy the story of the frequent number of ER chest cracking....
the Florida Board of Medicine would probably be taking a close look at you if your program was doing that number.
I agree a straight extrapolation is silly. I mention it out of hyperbole. However, playing catch-up by a multiple of 5x during chief year comes right back to the rule violations. Your chief year should be time to do major cases. That means long cases. That means there are limits on how many real chief level cases you can actually do as "surgeon". That number will be adversely impacted if you are catching up on your junior level cases of laparoscopy/etc... Again, straight extrapolation not realistic, but the implied math should raise concerns..... at any program with a potential paradigm as described.
I think the issues you raised should be of concern. Turn-over issues will compound one's ability to "do a case". It will take more time for a junior surgeon (aka resident) to do the case as surgeon. Add to that extra time turnover slowing down your attendings flow..... Then add to it having to do the nurses and social workers jobs.
If your grads have obtained the fellowships as listed, that is good.
JAD
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is there a difference between how they treat their categoricals Vs how they treat their prelims? can anyone shed some light on this.
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deleted89854
Categorical interns have a month of lap/open skills lab, while prelims do not. Also, some of the rotations differ. Prelims do hepatobiliary and vascular, which are not categorical intern rotations. Also, categoricals normally get priority in terms of getting to the OR.
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what about specifically their exposure to trauma. I read that this program is the place to be for trauma. Will a prelim get the exposure mentioned above in the other posts or will they be too busy doing scut?
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deleted89854
Prelims do a month on one of three trauma teams. For the most part, they manage the floor patients. Teams are q3 but each have 2 interns, so the interns can be q6 if they choose - covering all 3 trauma teams' patients while on call. On your "off" call, you can get as much exposure to trauma in the resus bay or OR as you like. We normally average between 10-15 level ones a day, with a bad day having 20-25. Usually about 1 or 2 of the traumas is operative, but you'll likely observe the operative traumas since the senior resident gets priority on those.
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What was described before is accurate. there are plenty of traumas. that translates into huge teams. and guess who will take care of the patients? so, in general, during your trauma rotation, you will be taking care of the entire trauma floor, not operating. and even if you stay after your call for some op experience, is unlikely that you will do much...some I & Ds, washouts, butt abscesses...PM me if you want to know more about it...
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anyone have any insight into this program? I know this is an old thread but cultures do change
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Now asking in 2022, any thoughts on this program? Lol
