Malignancy of Hopkins/Osler?

[MCATMAN45]

I couldn't find anything specifically on this... hopefully I'm not posting a duplicate.

Is the Hopkins/Osler program malignant? I had a great interview experience there, and despite my preconceptions that it would be a cutthroat place, it didn't seem that way. Granted, I was only there for a few hours, but the residents at the pre-interview dinner seemed surprisingly... normal.

Could it be the case that this uber-selective place is in fact a nurturing environment to train?

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[choirboy]

I had a pretty dissimilar interview experience - interviewed the week before Christmas, our resident dinner was very sparsely attended because two firms were having their Holiday parties that night. The one resident at our table seemed like zero fun, and admitted that the main reason he went to JHU for residency was because it was the best place he could get in. It soured me before the interview ever started, and pre-disposed me to not like the place. That said, if you like the stand and deliver presentation style, I'm sure you learn a ton - having the same attending for 6 months your intern year sounds pretty nice.

 

[NOsquid]

Could it be the case that this uber-selective place is in fact a nurturing environment to train?

Unlikely.

 

[Doctor4Life1769]

I had a pretty dissimilar interview experience - interviewed the week before Christmas, our resident dinner was very sparsely attended because two firms were having their Holiday parties that night. The one resident at our table seemed like zero fun, and admitted that the main reason he went to JHU for residency was because it was the best place he could get in. It soured me before the interview ever started, and pre-disposed me to not like the place. That said, if you like the stand and deliver presentation style, I'm sure you learn a ton - having the same attending for 6 months your intern year sounds pretty nice.

unless you have a cut-throat attending for those 6 months.

 

[Smoof5]

The term "malignant" is all in the eye of the beholder and has this "your co-interns are out to get you" and "SAR's are making you pick up their dry-cleaning" connotation. Hopkins is not this way. You are supported. If you have life or work issues the program and PD Dr. Desai are unwavering in their support of your education and happiness. This program will have an excellent future with him at the helm.

Hopkins-Osler is a hard-working program where as an intern you are the bulk of the hospital medicine admissions. A few months in, you are the only overnight doctor for your service (aka Firm). What happens is that some of those nights can be stressful and in the morning you are scrambling to get things ready for formal rounds. Because of this intern year you rather quickly become competent, efficient, and soon thereafter confident in managing NSTEMI's, GI bleeders, CKD lung flashers, DKA-ers etc. At Hopkins from 8pm-8am no one sees these sometimes very sick patients until formal rounds. As a result your JAR/SAR years are more relaxed and dedicated to learning the data/studies of why things are done, not just that an intervention should be done.

Intern who thrives at Hopkins -- loves medicine, independent, can deal w/ stress (you will be stressed, not by "malignant" things, but by the responsibility)
Intern best served training elsewhere -- would like to ease into medicine, do not feel comfortable being alone and in charge from the get-go.

To be clear the latter is not a sign of weakness or similar, this is just how people are and for all you M4's applying truly think about how independent you want to be. All this being said the SARs know an ungodly amount of medicine (most of my co-interns do as well) because of this process. This is why fellowships like having Osler grads. The match list reflects that and everyone usually goes wherever they want. Let it be known almost any other academic training program will train you just as well at Hopkins, but what makes it great for training is the A) autonomy and B) variety of patient pathology (at par "sick as hell")

 

[Doctor4Life1769]

Interesting. So, the intern has no one to turn to at night if an admission comes in to at least run their plans over with (i.e. senior res, fellow, attending on call?)

 

[Smoof5]

Yes, I should clarify. There are two nights seniors around that can be paged for assistance/advice. There is also MICU and CCU resident around for help as well. But for your service you are alone and the only one who truly knows those patients. You will at times need to upgrade levels of care for patients that are sicker than they are billed by the ED/transferring hospital and this requires you touching base with MICU/CCU for transfer to an intermediate or intensive care bed. The net of this is help is available, but the decision to seek it out is up to you.

 

[Doctor4Life1769]

Sounds like interns are doing what senior residents at most other programs appear to be doing. I have no bone in this matter, obviously, since I'm not even in IM. But, I can see where starting out the intern would be going "lolomgwtfwut?!"

There has to be a transition phase. Where a senior res on call is right there the initial month (or 2) before you throw the intern out there on their own... I can only imagine that the intern likely does page the on call res for advice as much as possible (or so I'd hope). After those initial months, I can see the intern being a tad more comfortable.

Sounds like there's no babying going on here. I could probably hang... sounds like an awesome challenge, and I love challenges. Stark difference to the IM program at my hospital, all I'mma say.

 

[Smoof5]

Yes exactly, there is a transition gradient from a dedicated Firm SAR in the office around up until Sep/Oct at which point the dedicated SAR tends to not be in the Firm office, and then they scale back from four to two overnight SARs for all four of the Firm interns. When the SARs go away you get a little as you said, but you deal. And there is always your pick of four SARs around to bother, but at this point I rarely use them overnight and I would not consider myself a "rockstar" who can diagnose everything. The true educational value is learning to independently assess who is sick and to I get them stable by the morning. The complete diagnosing often takes the light of day when lab/vital sign trends are evident, outside records are obtained, and collateral information from family is available +/- a patient that is more awake and can better explain what his chief complaint actually is. Challenging? Yes. But manageable albeit sometimes stressful. That's key with ranking JHH high. You are saying I like the fire. Don't come here because of reputation, fellowship match, etc. Come here because you welcome the heat. If come for rep only, you will be miserable and a poor intern from out of the blue burnout.

 

[Doctor4Life1769]

Cool.

BTW, you may want to update your status from "med student" to "resident"

We earned it.. just like we've earned the long coats. Enjoy your time... I'll be passin' gas in 4-5 months.

 

[Smoof5]

Ahhhhhhh, well not to burst any bubbles but an Osler intern doesn't earn their long white coat until s/p intern year

 

[Doctor4Life1769]

 

[thisisnotareal]

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[Smoof5]

It's just a coat.

 

[Danbo1957]

No amount of glamor on their fellowship match list is worth that kind of environment. Plus Baltimore is a (the?) peri-rectal abscess of the country.

Well, that leaves you also out at UTSW, UCSF, Miami-Jackson, Baylor, Chicago, Maimonides, etc. Big city hospitals, big city problems, big city pathology, big city learning.

 

[thisisnotareal]

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[thisisnotareal]

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[Instatewaiter]

I couldn't find anything specifically on this... hopefully I'm not posting a duplicate.

Is the Hopkins/Osler program malignant? I had a great interview experience there, and despite my preconceptions that it would be a cutthroat place, it didn't seem that way. Granted, I was only there for a few hours, but the residents at the pre-interview dinner seemed surprisingly... normal.

Could it be the case that this uber-selective place is in fact a nurturing environment to train?

Surprisingly it is very nurturing. The attendings and residents take care of their own. I cannot tell you how many attendings have offered to write letters for fellowship for me. Don't get me wrong, you are expected to work hard but if you do the work you are rewarded with respect.

The one thing that I found with interviewing was that despite the big name, it wasn't nearly as pretentious as some of the other big names. That was one of the things that made me rank it #1 and I have not been disappointed that I did.

A few months in, you are the only overnight doctor for your service (aka Firm). Because of this intern year you rather quickly become competent, efficient, and soon thereafter confident in managing NSTEMI's, GI bleeders, CKD lung flashers, DKA-ers etc. At Hopkins from 8pm-8am no one sees these sometimes very sick patients until formal rounds. As a result your JAR/SAR years are more relaxed and dedicated to learning the data/studies of why things are done, not just that an intervention should be done.

Intern who thrives at Hopkins -- loves medicine, independent, can deal w/ stress (you will be stressed, not by "malignant" things, but by the responsibility)
Intern best served training elsewhere -- would like to ease into medicine, do not feel comfortable being alone and in charge from the get-go.

Let it be known almost any other academic training program will train you just as well at Hopkins, but what makes it great for training is the A) autonomy and B) variety of patient pathology (at par "sick as hell")

To add to this, I was surprised with just how sick the patients are at Hopkins. Where I went to med school the patients were not nearly as sick. Also, hopkins puts things on the floor other hospitals only put in the unit. Things like flash pulmonary edema requiring bipap ( ie without complete respiratory collapse) or DKA are taken care of in the step down unit by the normal medical team. Most other hospitals put these patients in the ICU.

NSTEMIs often come to the floor.

Interesting. So, the intern has no one to turn to at night if an admission comes in to at least run their plans over with (i.e. senior res, fellow, attending on call?)

Like above, if there is concern, you can call the MICU or CCU resident. Any patient who needs an upgrade (to IMC/stepdown) gets seen and if the intern is concerned we come see the patient and run through the plan. The first few months, the interns have a resident with them in addition to the MICU/CCU residents. Around Sept-Oct, they start taking call "alone" but with ample backup if they need it.

Indeed. No matter how supportive their game face is, the fact that they are proud to say that you have not yet earned your long coat is as big of a red flag as they come. The only thing that could make that more flagrantly disrespectful is if only Hopkins Medical School grads got the long coat for intern year. I somehow hadn't heard about the short coat continuity until interview day and I was appalled. No amount of glamor on their fellowship match list is worth that kind of environment. Plus Baltimore is a (the?) peri-rectal abscess of the country.

Are you really getting worked up about a 15 inches of fabric? Honestly an intern hasn't earned their long white coat. The US governement feels the same way which is why you have to complete internship to practice independently. Plus the long coat is kinda a pain in the ass. It keeps getting caught in chairs when I stand up.

If you really think Baltimore is on par with an average big city, I feel sorry for the way your life must have been thus far. You don't need to be some self-flagellating ring-kissing self loathing scut monkey to get good training.

Baltimore isnt a bad city to do residency in. I've been pretty happy here. If you can only live in a city like NYC then don't come to Baltimore... it is a smaller city. But let's be honest, during residency you're not going to have a ton of time to enjoy whatever city you end up in anyway.

thisisnotareal... why so angry? Did hopkins make fun of you on the playground or something?

 

[Apollyon]

Plus Baltimore is a (the?) peri-rectal abscess of the country.

Take your pick - either "Balti-less", or "Bodymore, Murderland".

 

[jdh71]

Hopkins doesn't sound so bad. I would have liked to train in a model like that.

The coat thing is stupid and "frat-boy". You don't have to "earn" a coat. It's just a coat and if it meant anything you wouldn't see every other person wearing one too.

Putting patients on non-ICU floors isn't about how "hard-core" an institution and it's doctors are. It's pure and simple a nursing issue. The reason simple DKAs go to the unit in many institution is simply because of the Q1 glucose checks and nursing ratios on other floors probably don't allow them to check like they should so those floor don't allow a patient that needs Q1 checks. Same with NSTEMI that require a heparin gtts - some floors simply refuse to do them for cardiac patients which means they patient has to go to a CCU. It's pretty stupid, but it's the nurses the screw it all up.

Baltimore is a ****-hole. Sorry. Sure, it's not Detroit, and it may not be a big enough ****-hole to keep someone form going there. I didn't do residency in a glamorous city, and it wasn't that big of a deal to me, but it did kind of suck in some ways.

 

[thisisnotareal]

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[Instatewaiter]

You don't need someone to stomp on your junk for 3 years to make you a good doctor.

I had a good chuckle at this.

I
If it was a "blinded" interview day (you read about or visit that without seeing the name or fellowship match list) it would go unfilled. There are plenty of other places you can get amazing training without dying a little inside, despite what the dozens of "rank these places in order of prestigiousness " threads will tell you.

Kinda like the "Is Duke Malignant" thread, I think Hopkins draws the kind of person that wants that kind of training that is going to push you. A lot of people don't. I know I am a lazy bastard who wouldn't learn nearly as much if I wasn't pushed and challanged. I get complacent very quickly.

I didn't find it over-the-top though and have been happy here. Perhaps others wouldn't. I can think of 1 out of the 40 residents in my class who is unhappy. The others are pretty happy with the program, the support and the training.

If others have questions, feel free to PM me.

 

[mjl1717]

Oh. Oh!

 

[obiwan]

I never interviewed at Hopkins but it seems like it gets a lot chiller for JAR/SARs.