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Anyone know anything about this program? There is very little mentioned in the Interview Impression thread
Loma Linda Program
- Thread starter californiaXRT
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perhaps the reason they have been on probation since 2010?
https://www.acgme.org/ads/Public/Pr.../Search?stateId=5&specialtyId=98&orgCode&city
Interviewed there. I had mixed feelings about the place. They are currently on probation and their faculty were very forthcoming about the reasons. Apparently it had to do with some paperwork issues (resident not accurately logging cases for one) and some previous residents not passing the oral boards (part of the problem was that they had signed up for the boards and not taken them). The pass rate issue is something that takes time to fix because it's a small program and overall pass rate is based on a 10 year average, and the paperwork problems have supposedly all been fixed. Residents are now held more accountable on inservice exams and have been doing well on those. Otherwise it's a very laid back environment with what seemed like a lot of free time and everyone there was very nice. Somewhat of an emphasis on protons though it isn't the only thing they use, and the residents didn't really see it as such a negative because you still learn to treat the disease (regardless of the technology used to do so). The program is about 90 minutes east of LA, not a whole lot going on in Loma Linda itself though. I don't think the patient volume was very high. I put it lower on my list because I'm not as much of a self starter and I'd prefer to see more patients, but for someone who has the discipline to study a lot in their free time when they're not seeing patients it's probably a pretty good place.
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The above post doesn't add up to me...
The ACGME cites nearly every program for paperwork. If you don't file the forms exactly right, you'll get cited. Almost nobody goes through an ACGME review without something getting mentioned. Nobody gets put on probation for it.
There are some bad programs out there with glaring issues that still manage to get approved year after year. So there has to be a real reason behind the probation. Being critically low on certain disease site exposures makes sense. It would explain a lot of the other problems.
Residents not accurately logging cases sounds strange. The only thing I can figure is that they are critically low on certain disease site exposures, and are blaming the low number of cases on incomplete resident logging. Either way, that's something you can get cited for, but not something you're going to immediately get put on probation for unless it's true. I could miss logging cases here and there or I could mis-classify some cases (I'm pretty sure I have!), and nobody will ever know the difference. I always tell applicants that you don't want too much volume, but too little is bad also.
Not passing boards would be easily explained by not having enough exposure to disease sites. The in-service exams have everything to do with written boards, not oral boards which are more practical. Not taking the oral boards for multiple graduates makes no sense. Everyone wants to get board certified, when possible, as soon as possible. If multiple people are registering for the boards and not taking them, then they must be very scared of failing.
The majority of diseases are not treated with protons, or at least it would not be considered a standard treatment option to do so.
The ACGME cites nearly every program for paperwork. If you don't file the forms exactly right, you'll get cited. Almost nobody goes through an ACGME review without something getting mentioned. Nobody gets put on probation for it.
There are some bad programs out there with glaring issues that still manage to get approved year after year. So there has to be a real reason behind the probation. Being critically low on certain disease site exposures makes sense. It would explain a lot of the other problems.
Residents not accurately logging cases sounds strange. The only thing I can figure is that they are critically low on certain disease site exposures, and are blaming the low number of cases on incomplete resident logging. Either way, that's something you can get cited for, but not something you're going to immediately get put on probation for unless it's true. I could miss logging cases here and there or I could mis-classify some cases (I'm pretty sure I have!), and nobody will ever know the difference. I always tell applicants that you don't want too much volume, but too little is bad also.
Not passing boards would be easily explained by not having enough exposure to disease sites. The in-service exams have everything to do with written boards, not oral boards which are more practical. Not taking the oral boards for multiple graduates makes no sense. Everyone wants to get board certified, when possible, as soon as possible. If multiple people are registering for the boards and not taking them, then they must be very scared of failing.
The majority of diseases are not treated with protons, or at least it would not be considered a standard treatment option to do so.
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Did a rotation there and am good friends with an ex-resident. All true.
Program cited for low case numbers which was blamed on underlogging. In fact, most residents were overlogging to meet minimums (and had been doing so for many years). Case load was heavily skewed towards prostate. At least half of all cases logged were low-risk prostates treated with protons. People used to get in trouble on oral boards for not knowing how to do IMRT prostate. A good portion of other cases were proton-specific cases like chordomas. SRS exposure almost non-existent. One resident I met said he had treated more chordomas than brain mets. He also said they met the SRS minimum by logging ocular melanoma cases (treated with protons) as SRS.
Program director and chairman completely oblivious to the problems with the program. It was well-known that residents were not taking oral boards because they felt unprepared. PD and chair also punitive to anyone who questioned protons. IMRT was bashed routinely, and you couldn't even use the term "SBRT" in conferences or PD would go ape-****. Last interview cycle, the PD apparently chewed out an applicant for asking about SBRT. Planners had no formal training in IMRT and no attending had even used IMRT before it was implemented in the department. Image-guidance in the department is kV on proton gantries. No CBCT. The linacs use port films only. All craniospinal is 2-D. There is no HDR and very little exposure to prostate brachy. Ask your average resident what a SAVI is and they won't know. A former resident approached the PD about the lack of brachy and was basically told "I don't care."
Program cited for low case numbers which was blamed on underlogging. In fact, most residents were overlogging to meet minimums (and had been doing so for many years). Case load was heavily skewed towards prostate. At least half of all cases logged were low-risk prostates treated with protons. People used to get in trouble on oral boards for not knowing how to do IMRT prostate. A good portion of other cases were proton-specific cases like chordomas. SRS exposure almost non-existent. One resident I met said he had treated more chordomas than brain mets. He also said they met the SRS minimum by logging ocular melanoma cases (treated with protons) as SRS.
Program director and chairman completely oblivious to the problems with the program. It was well-known that residents were not taking oral boards because they felt unprepared. PD and chair also punitive to anyone who questioned protons. IMRT was bashed routinely, and you couldn't even use the term "SBRT" in conferences or PD would go ape-****. Last interview cycle, the PD apparently chewed out an applicant for asking about SBRT. Planners had no formal training in IMRT and no attending had even used IMRT before it was implemented in the department. Image-guidance in the department is kV on proton gantries. No CBCT. The linacs use port films only. All craniospinal is 2-D. There is no HDR and very little exposure to prostate brachy. Ask your average resident what a SAVI is and they won't know. A former resident approached the PD about the lack of brachy and was basically told "I don't care."
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If even half of that is true, sounds like the program deserves its probationary status.
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Sounds like a disgruntled ex-resident.
They have continued accreditation now.
https://www.acgme.org/ads/Public/Programs/Detail?programId=7332
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The posts above are describing the program 5 years ago and that is exactly why they went on probation. Since then, many changes have taken place and Loma Linda has a different culture now. Being put on probation was extremely humiliating for the department, and they have invested a lot to make the program more mainstream. I'll list some of the changes:
1. There are new faculty members with training and experience outside of Loma Linda
2. IMRT is routinely used and no longer "bashed."
3. Prostate proton therapy numbers have dropped considerably in the last few years. (This was terrible for business but great for the residency program).
4. The number of cases residents are seeing have increased and less of them are Loma Linda specific proton cases.
5. An educational curriculum is now used and most of the daily conferences are led by residents with oversight by the attendings
6. Having an understanding of the current RTOG protocols is mandatory
7. Outside rotations to learn about HDR and interstitial brachytherapy are mandatory. Outside electives to learn more about SBRT and SRS are highly encouraged. The program director will generally let you rotate almost anywhere if you want more experience in a particle area.
Most programs have some deficiencies that require residents to rotate at other institutions. Loma Linda has acknowledged its deficiencies and have made huge efforts to correct them. The ACGME was pleased and we now have a full accreditation. Please do a rotation and see for yourself. All of the residents are very happy now and Im being completely honest when I say that.
1. There are new faculty members with training and experience outside of Loma Linda
2. IMRT is routinely used and no longer "bashed."
3. Prostate proton therapy numbers have dropped considerably in the last few years. (This was terrible for business but great for the residency program).
4. The number of cases residents are seeing have increased and less of them are Loma Linda specific proton cases.
5. An educational curriculum is now used and most of the daily conferences are led by residents with oversight by the attendings
6. Having an understanding of the current RTOG protocols is mandatory
7. Outside rotations to learn about HDR and interstitial brachytherapy are mandatory. Outside electives to learn more about SBRT and SRS are highly encouraged. The program director will generally let you rotate almost anywhere if you want more experience in a particle area.
Most programs have some deficiencies that require residents to rotate at other institutions. Loma Linda has acknowledged its deficiencies and have made huge efforts to correct them. The ACGME was pleased and we now have a full accreditation. Please do a rotation and see for yourself. All of the residents are very happy now and Im being completely honest when I say that.
