JH Bayview

[mauvespice]

Hi y'all,

Since we are all having fun with the tier-talk today, I thought I would just throw in a question on this program that does not seem to fall in any of the prominent 3 tiers. So based on the info gathered from their website and some remote trickling interview experiences on SDN over the years, this seems to be quite a terrific program. They have been called "hopkins with a heart" in one of the posts, have closely comparable exposure in terms of faculty, research opportunities, MICU/CCU training, electives, overlapping curriculum/didactics etc to JHH residents. Their fellowship placement has been excellent as per: http://www.hopkinsbayview.org/medicine/residency/lifeafterresidency.html. I haven't been to my interview yet and will post more details s/p.

So I wonder,

1) what is it that is holding this program back from being popular amongst top candidates? Is it the tag of being an affiliate? At the risk of starting a controversy - It is classified as a university program on Frieda and perhaps rightfully so, considering the kind of training one supposedly receives. Why is it still considered an affiliate? Why doesn't it get its own place apart like the 3 HMS hospitals which are not considered affiliates of one another?

2) What kind of programs would this one laterally equate to?

3) It does not seem to be entirely primary care as it is often thought of but I am clueless about their strength of the clinical training per se. Could someone be kind enough to comment on this?

Thanks.

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[Scaredshizzles]

Hi y'all,

Since we are all having fun with the tier-talk today, I thought I would just throw in a question on this program that does not seem to fall in any of the prominent 3 tiers. So based on the info gathered from their website and some remote trickling interview experiences on SDN over the years, this seems to be quite a terrific program. They have been called "hopkins with a heart" in one of the posts, have closely comparable exposure in terms of faculty, research opportunities, MICU/CCU training, electives, overlapping curriculum/didactics etc to JHH residents. Their fellowship placement has been excellent as per: http://www.hopkinsbayview.org/medicine/residency/lifeafterresidency.html. I haven't been to my interview yet and will post more details s/p.

So I wonder,

1) what is it that is holding this program back from being popular amongst top candidates? Is it the tag of being an affiliate? At the risk of starting a controversy - It is classified as a university program on Frieda and perhaps rightfully so, considering the kind of training one supposedly receives. Why is it still considered an affiliate? Why doesn't it get its own place apart like the 3 HMS hospitals which are not considered affiliates of one another?

2) What kind of programs would this one laterally equate to?

3) It does not seem to be entirely primary care as it is often thought of but I am clueless about their strength of the clinical training per se. Could someone be kind enough to comment on this?

Thanks.

It is a little hard to compare based on fellowship match lists because I think like half their residents graduated from John Hopkins med school, no? The med school graduation still carries weight for fellowship placement. Add to that letters of rec from Hopkins faculty, and it adds up to an impressive CV.

 

[mauvespice]

It is a little hard to compare based on fellowship match lists because I think like half their residents graduated from John Hopkins med school, no? The med school graduation still carries weight for fellowship placement. Add to that letters of rec from Hopkins faculty, and it adds up to an impressive CV.

Yes thats very true and also one of the reasons why I posted this question. In the sense that, other than Hopkins grads who may know the program well for having rotated there at some point and choose to go there, what do other outsiders think of the program?

 

[gold&black2005]

Have heard nothing but rave reviews for this program, both from current housestaff and Hopkins students. As you mentioned, the fellowship match is pretty ridiculous. Strong, strong general IM training, with the possible exception of heme/onc (per the housestaff). Will report back after I interview there later on...

 

[staup]

I'm a current Bayview resident. You can email me at [email protected] if you have any questions.

It's a smaller program, with about 30 interns and around 15 to 16 residents in the 2nd and 3rd year each. I would say the program suffers a little because it is "community-like", but they consider themselves an academic hospital. It has around 200 medicine beds and growing. The campus itself is huge, larger than hopkins hospital proper, but most of the buildings are used for research. It's about 3-5 miles from hopkins hospital. It was the Baltimore city hospital until hopkins purchased it and revamped everything, including the medicine residency about 25 years ago. It does not have the ultimate prestige of the Osler program, for sure, but is definitely a great program. All the residents on campus and fellows, except for the medicine residency program itself, are hopkins main fellows and residents without exception. It is a huge part of the Hopkins department of medicine, and it is NOT an affiliate.

The one other thing I would comment about is the fellowship track record: It is accurate. There have been two residents in the last 4 years, both trying for gi, who did not match, but they did not apply broadly and didn't have great research. Everyone else matched at one of their top choices. Many stay at hopkins because they don't want to move, it is one of the best places they could go, and they just get offered spots directly because they are known entities.

Also, oncology is not great here because the division is smaller, but those who are interested just do rotations at hopkins main. We are also required to do a leukemia rotation at hopkins main, and you can see the fellowship mathcing does not suffer because of it.

All rotations except leukemia are all at Bayview. You can go to hopkins main for as many rotations as you want though.


Good luck.

 

[mauvespice]

I'm a current Bayview resident. You can email me at [email protected] if you have any questions.

It's a smaller program, with about 30 interns and around 15 to 16 residents in the 2nd and 3rd year each. I would say the program suffers a little because it is "community-like", but they consider themselves an academic hospital. It has around 200 medicine beds and growing. The campus itself is huge, larger than hopkins hospital proper, but most of the buildings are used for research. It's about 3-5 miles from hopkins hospital. It was the Baltimore city hospital until hopkins purchased it and revamped everything, including the medicine residency about 25 years ago. It does not have the ultimate prestige of the Osler program, for sure, but is definitely a great program. All the residents on campus and fellows, except for the medicine residency program itself, are hopkins main fellows and residents without exception. It is a huge part of the Hopkins department of medicine, and it is NOT an affiliate.

The one other thing I would comment about is the fellowship track record: It is accurate. There have been two residents in the last 4 years, both trying for gi, who did not match, but they did not apply broadly and didn't have great research. Everyone else matched at one of their top choices. Many stay at hopkins because they don't want to move, it is one of the best places they could go, and they just get offered spots directly because they are known entities.

Also, oncology is not great here because the division is smaller, but those who are interested just do rotations at hopkins main. We are also required to do a leukemia rotation at hopkins main, and you can see the fellowship mathcing does not suffer because of it.

All rotations except leukemia are all at Bayview. You can go to hopkins main for as many rotations as you want though.


Good luck.

Hi staup, thank you for posting this information about the program. I did have a few questions and I felt that if I post them here, everyone could benefit from the answers.

Would you consider the program cush? 200 bed seems small-medium sized and the fact that a team of 2 interns and 1 resident stays on call makes it seem pretty relaxed. Please correct me if I am wrong but I think the intern and the resident get upto 2-3 patients each overnight and don't have to cross cover since there is a 2nd intern for that, making time to sleep on call.

Also, with regards to training experience, Osler seems to get the whole gamut of poor underserved - to - blue collar -to - highly complicated tertiary and quaternary referrals making it seem very busy but wholesome in terms of depth and breadth of experiences. From what I have heard, Bayview gets majority of the middle set of blue collar with mostly bread and butter cases. The complicated cases are only in specialties they are famous for i.e. rheum, geriatrics and some pulm?

In terms of doing subspecialty at Osler, how many subspecialty electives do the residents typically take there other than their subspecialty of interest?

Most services like GI, nephro, solid onc, ID/HIV are consult services. Does not having a subspecialty inpatient service compromise one's training?

Finally, How would you evaluate Bayview as a stand alone university-based program excluding the clinical training based support that it gets from Osler? i.e. other than acute leukemia, is there any other aspect of the clinical training that may not be upto par?

Thank you so much, sorry my list is so long

 

[VCMM414]

Most services like GI, nephro, solid onc, ID/HIV are consult services. Does not having a subspecialty inpatient service compromise one's training?

I'm not a Hopkins resident, but GI and ID are consult-only services at many major academic centers across the country. These days I think this is the norm rather than the exception.

 

[staup]

Mauvespice, the program/hopsital is definitely small/medium sized. That being said, I would by no means call the program cush or anything close to that. As far as the patient load, the program follows the ACGME rules with the intern caps (10 or 12 total with 5 to 6 patients per call) and each intern caps every call. In my several years of residency I have only witnessed "not capping" a handful of times. Some interns sleep a handful of hours on call night, some don't, but no one sleeps much more. The resident has a supervisor role and usually sleeps a little more than the interns. You are right in that you do not cross cover on call. That is reserved for a dayfloat/nightfloat team that works separately from the call teams.

There aren't many inpatient subspecialty services, most of everything is grouped into the general medicine service. There is anything imaginable outpatient, which you rotate through.

As far as the patient population, it is mainly poor to lower middle class, with a large white geriatric population, large drug abuse population, and HIV population. There are many greek speaking and some spanish speaking patients. I would agree that hopkins main may have a little more diversity.

Finally, some people do their entire residency at Bayview, some spend an amazingly large time at hopkins depending on what they're interested in and what they want to do. As a categorical resident you have 3 months of elective time your second and third years each, and you can do whatever you want with it. You have less if you are a general internal medicine/primary care resident.


Hope this helps.

 

[gutonc]

Most services like GI, nephro, solid onc, ID/HIV are consult services. Does not having a subspecialty inpatient service compromise one's training?

With the exception of onc (note my username), I think this is the way things should be in general. I don't think it compromises your training at all to get that experience on a consult service. In fact, I think a generalist IM service with consults actually gives you better overall training. I think the specialty inpatient services often wind up doing one of two things to the detriment of both patients and resident education. Either they pan-consult for everything on the problem list, or (worse in my opinion and my experience in cards) they try to manage everything outside of their specialty themselves, until things go so far off the rails that they have to call in the experts.

One of the reasons I chose the program I did was because it was a generalist + consult model.

 

[mauvespice]

Mauvespice, the program/hopsital is definitely small/medium sized. That being said, I would by no means call the program cush or anything close to that. As far as the patient load, the program follows the ACGME rules with the intern caps (10 or 12 total with 5 to 6 patients per call) and each intern caps every call. In my several years of residency I have only witnessed "not capping" a handful of times. Some interns sleep a handful of hours on call night, some don't, but no one sleeps much more. The resident has a supervisor role and usually sleeps a little more than the interns. You are right in that you do not cross cover on call. That is reserved for a dayfloat/nightfloat team that works separately from the call teams.

There aren't many inpatient subspecialty services, most of everything is grouped into the general medicine service. There is anything imaginable outpatient, which you rotate through.

As far as the patient population, it is mainly poor to lower middle class, with a large white geriatric population, large drug abuse population, and HIV population. There are many greek speaking and some spanish speaking patients. I would agree that hopkins main may have a little more diversity.

Finally, some people do their entire residency at Bayview, some spend an amazingly large time at hopkins depending on what they're interested in and what they want to do. As a categorical resident you have 3 months of elective time your second and third years each, and you can do whatever you want with it. You have less if you are a general internal medicine/primary care resident.


Hope this helps.

This certainly helps, thank you.How do you like the Aliki?

 

[mauvespice]

With the exception of onc (note my username), I think this is the way things should be in general. I don't think it compromises your training at all to get that experience on a consult service. In fact, I think a generalist IM service with consults actually gives you better overall training. I think the specialty inpatient services often wind up doing one of two things to the detriment of both patients and resident education. Either they pan-consult for everything on the problem list, or (worse in my opinion and my experience in cards) they try to manage everything outside of their specialty themselves, until things go so far off the rails that they have to call in the experts.

One of the reasons I chose the program I did was because it was a generalist + consult model.

Oh i c, that makes sense. The subspecialty inpatient services I have been on generally have a two 2nd or 3rd yr resident+ fellow or rarely an intern +senior resident+ 2 fellows and they are generally comfortable managing other non-subspecialty related issues; if not they consult. I was under the impression that the subspecialists have a lower threshold of consulting to other services if the problem is out of their subspecialty and not trivial. But then again, the subspecialty admission criteria are pretty selective. For instance,where I have been, the patients admitted in GI are young Crohn's/UC patients with no other significant PMH other than this OR a severe cirrhotic with hepatorenal syndrome awaiting transplant OR a patient with radiation proctitis requiring repeated careful scopes to control his rectal bleeds. They try their best to send (or rather not accept) multisystem cases who don't require repeated GI watchover/endoscopy from medicine.
I have learned a lot with this model, one gets to see the whole picture and the course of disease in the patient and the first hand impact of decisions and interventions. I'm sure perspectives differ at the medical student level vs the fellow/subspecialist level where tunnel view/snapshot view may be all you would like. It might be less busier too? I look forward to trying the consult model as well

 

[staup]

Mauvespice, the Aliki program is an amazing initiative and idea, although I think it would be difficult to sustain in private practice. That being said, the program is operating a training program and trying to install an example into it's residents which will hopefully them in many ways in their future practice. I think it does and is worthwhile, even if it might be impractical to completely duplicate in a very busy practice. In today's world of kicking patients out the door as soon as it is medically feasible because of money reasons, it is a breath of fresh air.

 

[mauvespice]

Mauvespice, the Aliki program is an amazing initiative and idea, although I think it would be difficult to sustain in private practice. That being said, the program is operating a training program and trying to install an example into it's residents which will hopefully them in many ways in their future practice. I think it does and is worthwhile, even if it might be impractical to completely duplicate in a very busy practice. In today's world of kicking patients out the door as soon as it is medically feasible because of money reasons, it is a breath of fresh air.

Yes in that sense they are innovative. Is the teaching on Aliki different/special as compared to other rotations? Is it more primary care based?

 

[TX2007]

I heard that the IM program was strong and well-known even when it was Baltimore City Hospital. Does anybody know the history of the program pre-Hopkins?

 

[UTSW2010]

History of Bayview (JHU med students always rotated at Bayview, even before JHH was built):
http://www.hopkinsmedicine.org/dome/0404/centerpiece.cfm