You really need to do your due diligence to get out out the residency program everything you can. I am at a community hospital and because of that I get to treat everything. Rather than problems going to specialty services, other than surgery, it all goes to medicine. Because of that I have had exposure to many, many different medical problems and I am also able to be proficient in bread and butter issues like chf, diabetes, etc. The population you are exposed to is also a big factor. If you are in rich suburbia where everyone does what they are supposed o then ou will not see anything. However, because I am in a poor area, I get to see pathology that is only seen in text books. Not only that but you need to communicate with e attending a, show them that you have an interest. In addition, because of the population, I was also able to treat malaria and some other tropical diseases that once again is not seen in other institutions.
When you are looking at programs you need to take into account these things. Look for what the population is in the area the hospital services. When you are in your interview ask about the pathology that is seen. If most of your patients are geriatric from nursing homes, you will get good at geriatric medicine and be able To handle polypharmacy but what about other pathology that is non existent in the older population.
Just like a medical school interview, where you are interviewing the school, in your residency interview, you are interviewing the program. Also you will need to be proactive. In my program, I wanted an OMM table so that the DO residents can treat the MD residents to not only keep up the skills, but also to show the MD residents and to teach the medical students. The table arrived last week. When it comes to research, this is an AOA requirement for internal medicine. This does not mean bench work. This also includes clinical research. Some of the projects in my program include, but are not limited to
1) does proper sleep hygiene reduce the incidence of Icu relegated delirium
2) does education about hospice increase the chance it will be used.
3) does a more comprehensive sign out reduce medical errors
4) does pro calcitonin reduce the amount of time antibiotics are used
You need to be heard. If you hear from residents that they are not then maybe that is not the program for you. If you would rather just get through residency and be a little country bumpkin doctor then put the miminum out there.
You get out of something what you put into it. A university setting is not always the best. There are a lot of fellows that will run things. Where in a community hospital, it becomes your house.