med/peds?

[stephcf]

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I'm considering a med/peds residency vs. straight IM - any thoughts on this? If I'm leaning towards internal medicine alone, should I even continue to consider a combined Med/Peds program?

Also, any info on good Med/Peds programs would be appreciated - esp in California, Chicago, NY, Boston, and Philly (big cities).

 

[uncgrad]

Good thing about med/peds: you don't have to choose between kids and adults, which many of the residents I know said was the big draw for them. Good if you want to do primary care but don't want to deliver babies.

Bad things: long and rigorous residency since they stress time in the ICU and inpatient care. If you want to specialize this can be tricky, since you may have to choose adult or peds GI or whatever, although some people do two fellowships and I hear there may be some combined programs but you would have to check it out.

If you think you like adults better and want to specialize, IM may be a better way to go, but only you can decide. Conversely, med/peds allows you to go in a lot of directions so you will have many options after you finish.

I only know that the UNC program is a good one, but not in a big city so can't help you there.

 

[rjg]

I have been considerng med/peds also and am having a hard time figuring out what exactly to do. First, it is difficult to know what programs are good. Since you are trying to complete two residencies in four years, you need to go to a program that will facilitate your education. From what I've heard, you need a strong "dept" head who establishes a med peds presence in the school, since a med peds resident doesn't really belong in med or peds. It would also be nice to have more med peds residents as opposed to fewer. Some programs take two a year--too small. A med peds trained faculty also seems to imply a better program. You also need strong depts so that you get good training. Also, if you don't want to ro subspec, you need a program that will be well respected at other institutions. One IM endo doc told me to forget med peds since no one would give a med peds resident a good fellowship spot. Now, I don't think that this is true, but there is probably something there.

One question that I also have is whether you get adequaly trained in med peds. Any ideas? SOme of the programs that I have looked into/heard about are: Harvard, U. Maryland, U. Rochester, Baylor, Cleveland clinic, San Diego, Duke, U. Alabama. There are a lot of progrms in the NYC/NJ area, but I havn't heard much about them. Unfort, I've heard that Mt sinai's prgrm is actually poor.

I got most of these "good" programs from a med peds guy who was on faculty at Baylor and part of the committee for med peds.
Please post if you hear anything else.

Thanks,
RJG, MSIII

 

[Sheon]

RJG,

Most of your post hit the nail on the head.

A good Med-Peds program has three features:

1) A strong Categorical Medicine program

2) A strong Categorical Pediatrics program

3) A Med-Peds faculty and staff that is active and vigilant about the program.

The only thing wrong about your post is that the NY-NJ area is down to 4 med-peds programs. Mount Siani is the one that people say is the strongest, but this is based on reputation NOT actual learning. To get into Mount Siani, you would have to have a very competitive application.

My thoughts were that in the Northeast the "best" programs were: Rochester (8 slots), Baystate (7 or 8 slots), U of MD (4 slots), and UMDNJ (4 slots).

 

[The Med-Peds Dude]

I have been considerng med/peds also and am having a hard time figuring out what exactly to do. First, it is difficult to know what programs are good. Since you are trying to complete two residencies in four years, you need to go to a program that will facilitate your education. From what I've heard, you need a strong "dept" head who establishes a med peds presence in the school, since a med peds resident doesn't really belong in med or peds. It would also be nice to have more med peds residents as opposed to fewer. Some programs take two a year--too small. A med peds trained faculty also seems to imply a better program. You also need strong depts so that you get good training. Also, if you don't want to ro subspec, you need a program that will be well respected at other institutions. One IM endo doc told me to forget med peds since no one would give a med peds resident a good fellowship spot. Now, I don't think that this is true, but there is probably something there.

One question that I also have is whether you get adequaly trained in med peds. Any ideas? SOme of the programs that I have looked into/heard about are: Harvard, U. Maryland, U. Rochester, Baylor, Cleveland clinic, San Diego, Duke, U. Alabama. There are a lot of progrms in the NYC/NJ area, but I havn't heard much about them. Unfort, I've heard that Mt sinai's prgrm is actually poor.

I got most of these "good" programs from a med peds guy who was on faculty at Baylor and part of the committee for med peds.
Please post if you hear anything else.

Thanks,
RJG, MSIII

I'm a Med-Peds Program Director and lurk about this time of year.

Lets assume some programs are very, very good, most very adequate, & a few pretty bad; just like medical students & the residents they become, but I digress. "Excellent" is like asking for a day at the beach without the sunburn or sand.

You need a program where the residents do feel as though they belong. Large programs have their own special set of problems, as do small programs, so to discount small programs out of hand without at least a cursory look makes little sense.

Cleveland Clinic closed their program several years ago.

Currous comment re. endo, as one of my residents will do adult endo next year. Most of us in practice would find the question about the adequacy of training amusing. Certainly both the American Board of Internal Medicine and the American Board of Pedratrics feel the training is adequate. I imagine a Med-Peds trained attending at Baylor should should have been adequately trained.

Hope this helps a little.

 

[nycmedpeds]

"There are a lot of progrms in the NYC/NJ area, but I havn't heard much about them. Unfort, I've heard that Mt sinai's prgrm is actually poor."

As a current Mt Sinai med-peds resident I am sorry I let this go by without responding. The Sinai program is undoubtably one of the best and happiest programs in the hospital. While we do produce a number of general med-peds docs, we are somewhat unique in sending folks on to highly competitive fellowships. In the last few years, residents have gone onto peds h/o at memorial-sloan kettering, adult h/o at columbia, a/i at the mayo clinic, ID at duke just to name a few. We have combined clinic, a dedicated combined program director, and a quality patient mix.
Moreover, unlikely any Med-Peds program in the country were in New York City!!!
Who ever said we're "actually poor" may only be referring to the cost of living in New York. 😀 But with theater, restaurants, sports, et. al. who wouldn't be poor? Our residents and our program stack up with any in the nation. 👍

 

[The Med-Peds Dude]

I'll cross-post this in the other Med-Peds thread.

The first meeting of the Philadelphia Med-Peds Society will be on Tuesday,

September 27th at 7pm in the Blumle Life Sciences Building (Room 100). Come
hear residency directors from 5 of the Philadelphia area Med-Peds programs
in
an informal Q&A, where you can learn more about Med-Peds and speak with the
directors of various programs individually. In addition, Dr. Allen
Friedland,
the President of the National Med-Peds Residency Program, will also be
answering questions. This is an excellent opportunity to learn more about an
exciting residency choice. You will also get the chance to meet students
from
the other four Philly med schools who are interested in Med-Peds. And of
course, food will be served! If you are interested in attending or have any
other questions, please RSVP at [email protected] so I know how much
food to order.
Thanks and hope to see you there!

Benjamin D'Souza, MSIII
President, The Philadelphia Med-Peds Society
President, Clowns for Medicine (Jefferson Clowns)

 

[RuralMedicine]

I have been considerng med/peds also and am having a hard time figuring out what exactly to do. First, it is difficult to know what programs are good. Since you are trying to complete two residencies in four years, you need to go to a program that will facilitate your education. From what I've heard, you need a strong "dept" head who establishes a med peds presence in the school, since a med peds resident doesn't really belong in med or peds. It would also be nice to have more med peds residents as opposed to fewer. Some programs take two a year--too small. A med peds trained faculty also seems to imply a better program. You also need strong depts so that you get good training.

I'm a recent Med-Peds grad [I only on occasion still introduce myself as the resident err I mean Med-Peds attending on call 😉] and I would agree with much of what you're saying. I do agree that program directors can make or break programs to an extent in all residencies, but perhaps especially in Med-Peds. Some Med-Peds programs still do not have a separate program director but instead exist as an extension of either Medicine or Peds, I do think this is a disadvantage. A strong program director can "set the tone", in the institution I trained Med-Peds is very respected and we frequently hear that Med-Peds residents bring unique contributions to the team and are strong residents as a group from attendings and fellow residents. I think our dynamic program director has a lot to do with this. As far as the size issue I think that may be relative to an extent, I trained in a large Med-Peds program but the categorical programs at this institution are large as well. I think the key is having a large enough Med Peds presence at the institution, more than the total program size. As most programs rotate in 3-4 month blocks (allows you to see all seasons on Peds) the Med Peds intern class is usually cut in half with half on Medicine and half on Peds so I suppose in a two resident program you could be the only Med-Peds on your half. I did rank a program that took 2 residents a year so I didn't consider it a detriment. I still doubt it would have been but I'll never know as I matched at my first choice program which happened to be large. I will echo the strong Medicine AND strong Pediatrics programs sentiment. Many programs are strong in one area and weak in the other, however there are a bunch of programs that are strong in both. The institution I trained in was very strong in both, although perhaps slightly stronger in Peds on paper. From a clinical experience and practice standpoint however, the Medicine program was even stronger.

Also, if you don't want to ro subspec, you need a program that will be well respected at other institutions. One IM endo doc told me to forget med peds since no one would give a med peds resident a good fellowship spot. Now, I don't think that this is true, but there is probably something there.

I would strongly disagree with this statement! Strong applicants get fellowship spots. There is no reason why Med-Peds residents can't be strong applicants; in fact they are often viewed as stronger applicants by programs. I can not think of a single Med-Peds resident from my program who did not get the fellowship they wanted at one of their top choices. I can think of a few Medicine residents who did not get the fellowships they wanted. I have several former colleagues now doing competitive Cardiology fellowships (both IM, Peds, and 2 doing combined Cards fellowships), GI fellowships, Peds Heme-Onc, Endo (combined, and IM) etc.

One question that I also have is whether you get adequaly trained in med peds. Any ideas?

I think if you choose wisely, work hard, and realize that the two disciplines can be approached as a comparative spectrum and that sometimes your training in one will allow you to excel in the other and vice versa you can be more than adequately trained. I'm currently a Med-Peds attending and I feel prepared in both. I really enjoy the mix of both and am fortunate to have the opportunity do both. People who argue against Med-Peds argue that you will pick one or the other and therefore "wasted time" on the other discipline. This is not the case for me. For example yesterday I rounded on my inpatients and ICU patients, walked to my office and saw adults and kids (I think my age spectrum was 7 days to 88 years), admitted a patient from my office to the hospital and did her LP and central line, attended a c-section to resuscitate the baby and admitted the baby to the nursery, etc. It was a good, albeit, long day 🙂 Sure I have my moments of frustration and sleep deprivation but I do love what I'm doing.

Good luck in your Med-Peds search (or your soul searching if Med-Peds is right for you).

 

[The Med-Peds Dude]

...I do agree that program directors can make or break programs to an extent in all residencies, but perhaps especially in Med-Peds. Some Med-Peds programs still do not have a separate program director but instead exist as an extension of either Medicine or Peds, I do think this is a disadvantage. A strong program director can "set the tone", in the institution I trained Med-Peds is very respected and we frequently hear that Med-Peds residents bring unique contributions to the team and are strong residents as a group from attendings and fellow residents. I think our dynamic program director has a lot to do with this. As far as the size issue I think that may be relative to an extent, I trained in a large Med-Peds program but the categorical programs at this institution are large as well. I think the key is having a large enough Med Peds presence at the institution, more than the total program size....

Only a couple of comments today.

First, I'd like to add that having a program coordinator dedicated to the residency is a distinct advantage to all involved. The quality of your interaction with the coordinator before, during, and after the interview may be a good indicator of how organized and helpful he/she will be during your residency. Also, don't annoy the program coordinator; this happens a couple of times each interview season and really does influence ranking, at least in my program.

Second, curious comment re program size. There was actually a proposal a year ago or so to limit the size of combined programs to less than the size of the categorical programs due to a perceived but unproven concern about negative impact on the categorical residencies. Fortunately, that proposal died on the vine.

 

[RuralMedicine]

Only a couple of comments today.

First, I'd like to add that having a program coordinator dedicated to the residency is a distinct advantage to all involved. The quality of your interaction with the coordinator before, during, and after the interview may be a good indicator of how organized and helpful he/she will be during your residency. Also, don't annoy the program coordinator; this happens a couple of times each interview season and really does influence ranking, at least in my program.

I guess I presumed (perhaps incorrectly) that all Med-Peds programs with a Med-Peds program director also had a dedicated coordinator. That said they too can make a big difference and (as I'm sure you know) your program is fortunate to have a wonderful one who was (and I'm sure still is) very helpful.

Second, curious comment re program size. There was actually a proposal a year ago or so to limit the size of combined programs to less than the size of the categorical programs due to a perceived but unproven concern about negative impact on the categorical residencies. Fortunately, that proposal died on the vine.

Interesting! I believe the program I graduated from is one of the largest, however our categorical IM and peds programs are even larger. My impression (based on programs I interviewed at and other friends doing Med-Peds or IM elsewhere) was that larger Med-Peds programs tended to exist at institutions with larger categorical programs as well. I'm not sure how Med-Peds adversely impacts categorical residents other than to perhaps keep them honest. But honest physicians are never a bad thing! I did always find it interesting that my IM colleagues considered Peds the "dark side" and vice versa with some Peds colleagues.

 

[ekydrd]

I am an intern in the med-peds program at University of Louisville. This is also a very strong program and is a seperate entity from either IM or Peds depts. We have a great director who took over last summer, and has the program headed in a very positive direction. We will even be opening our very own med-peds clinic sometime next year.

Graduates of this program have gotten some top fellowship spots, so whoever said that doing med-peds would keep you from getting a fellowship needs to look a little deeper at who gets selected. They have, for the most part, had to choose between IM or peds, but at least one I know of was able to basically do both adult and peds GI at the same time (or close to it). Most graduates go into primary care however.

And as for the size of our program... there are 5 1st year slots offered, with preference going to UofL grads. This makes this program, while not the biggest, an adequate size for effective training. And Louisville is a pretty big city too!! Bigger than this country girl is used to.

Good luck to all the 4th years

 

[Lioness78]

I just applied to a lot of med-peds programs in the East Coast because I was not aware of how competitive this process will be. Reading all the emails I was definatly sure this is the route for me. My questions are: How do i know which program offer combined fellowship opportunities? because I would prefer to apply to them also.
Also what is the ranking on the Med-Peds programs? it seems that everyone has a different opinion.
What is the major difference between schools?
What are some negative attributes I should look for when I interview?
When school only have a few residents like 2 or 3, is the work load more or do they work with the other IM or Peds residents.

I appreciate the help.... sorry about all the questions.

 

[irlandesa]

I'm an IM resident at UMass, and the med-peds residents here have a seperate M/P clinic, but do wards rotations with the regular medicine and peds residents. I believe it is the same at Baystate, which also is a very strong program. The Med-Peds program director (Dr. Salomonides) at UMass is very smart and just a great person; attends on both Medicine and Peds services during the year..
Based mostly on hearsay, here are my takes on the reputations of Med/Peds programs in New England (from top down): Harvard (4 spots-2 do IM at MGH, 2 at BWH), Tufts-Baystate (8 spots), Brown-RIH (4 spots), UMass (2-4 spots)=UConn (5-6?), Yale-New Haven (no idea)=Maine Medical Center(3 spots), Yale-Bridgeport.

 

[The Med-Peds Dude]

I just applied to a lot of med-peds programs in the East Coast because I was not aware of how competitive this process will be. Reading all the emails I was definatly sure this is the route for me. My questions are: How do i know which program offer combined fellowship opportunities? because I would prefer to apply to them also.
Also what is the ranking on the Med-Peds programs? it seems that everyone has a different opinion.
What is the major difference between schools?
What are some negative attributes I should look for when I interview?
When school only have a few residents like 2 or 3, is the work load more or do they work with the other IM or Peds residents.

I appreciate the help.... sorry about all the questions.

1. Officially, no one offers combined fellowships. These are negotiated on a case by case basis with the individual fellowship directors. You might look for places that have a history of doing this, or consider contacting Med-Peds physicians who have done fellowships in your area of interest. This should give you a headstart: http://www.medpeds.org/fellowship_guide.htm

Remember, if you are a superior student/future resident, it matters less where you train. Honestly, a superior resident at a community program will still have choices when it comes time to look for fellowships.

2. If you've never looked here - http://www.medpeds.org/guide.htm - please do. Rules are strict enough that you will get adequate or better training at almost every program. The one, most important, absolutely essential question to ask yourself is, "will I like working with these people for 4 years"? If you don't feel the people are happy, or if you are uneasy, you might consider not ranking the program. After that, then you can sort out the academic calendar, lectures, quality of call rooms, reputation of program (which no one can agree on except perhaps for the very best and very worst), commute, cost of housing, geographical location, job opportunities for spouse if you have one, and so on.

3. Med-Peds residents are part of the parent progams of IM and Peds. Workload is independent of the number of Med-Peds residents. There is no Med-Peds inpatient service. Strictly and specifically prohibited, in fact.

Hope this helps.

 

[RuralMedicine]

Med-Peds residents are part of the parent progams of IM and Peds. Workload is independent of the number of Med-Peds residents. There is no Med-Peds inpatient service. Strictly and specifically prohibited, in fact.

Hope this helps.

True but when you go to a large enough institution that you can put together Med-Peds power teams for ward months they're awesome! 😎

Many programs do have Med-Peds continuity clinics (where I trained does). Our program also used to require a Med-Peds office preceptorship in 3rd or 4th year, it turned into an elective when we did some reshuffling in the Medicine block schedule to better accomodate ACGME work hours.

 

[The Med-Peds Dude]

True but when you go to a large enough institution that you can put together Med-Peds power teams for ward months they're awesome!

Even in a smaller program, lots of fun for me to staff 2 med-peds on a service.

 

[Lioness78]

Even in a smaller program, lots of fun for me to staff 2 med-peds on a service.

Thanks for all the info.
When do Med-Peds Program usually start interviewing? Many of my Peds friends have already received interview offers and I have only received two. I applied almost 4weeks ago.

 

[yobabydoc]

Thanks for all the info.
When do Med-Peds Program usually start interviewing? Many of my Peds friends have already received interview offers and I have only received two. I applied almost 4weeks ago.

What does it take to get an interview from Harvard? Any word on which programs to stay away from? Anyone heard of U of Minnesota's program?

 

[pedsid]

Here's a question for you ...

medpeds.org has several combined fellowships listed.

When I was checking out the UNC program they listed an alumni who did a fellowship at Emory/CDC ... it looked like a combined program in ID at Emory and the EIS at the CDC. Anyone know anything about that? I know this is a pretty specific quesiton.

I'm pretty torn on what to do for a living. Love peds ... medicine okay. Love to do procedures, don't want surgical lifestyle. Don't want to do primary care. So do I do peds + subspecialty (6 years) or med/peds + fellowship seems like it could be 7 to 8 years. And what if I don't want to be an "expert" in CF of congenital heart defects?

It also seems like there are only a couple of programs who have a dedicated med/peds director who is med/peds trained ...

Any thoughts?

 

[pedsid]

anyone out there?

Here's a question for you ...

medpeds.org has several combined fellowships listed.

When I was checking out the UNC program they listed an alumni who did a fellowship at Emory/CDC ... it looked like a combined program in ID at Emory and the EIS at the CDC. Anyone know anything about that? I know this is a pretty specific quesiton.

I'm pretty torn on what to do for a living. Love peds ... medicine okay. Love to do procedures, don't want surgical lifestyle. Don't want to do primary care. So do I do peds + subspecialty (6 years) or med/peds + fellowship seems like it could be 7 to 8 years. And what if I don't want to be an "expert" in CF of congenital heart defects?

It also seems like there are only a couple of programs who have a dedicated med/peds director who is med/peds trained ...

Any thoughts?

 

[The Med-Peds Dude]

Here's a question for you ...

medpeds.org has several combined fellowships listed.

When I was checking out the UNC program they listed an alumni who did a fellowship at Emory/CDC ... it looked like a combined program in ID at Emory and the EIS at the CDC. Anyone know anything about that? I know this is a pretty specific quesiton.

I'm pretty torn on what to do for a living. Love peds ... medicine okay. Love to do procedures, don't want surgical lifestyle. Don't want to do primary care. So do I do peds + subspecialty (6 years) or med/peds + fellowship seems like it could be 7 to 8 years. And what if I don't want to be an "expert" in CF of congenital heart defects?

It also seems like there are only a couple of programs who have a dedicated med/peds director who is med/peds trained ...

Any thoughts?

Hmmm. ID, procedures, CF, CHD. Maybe you'll need 4 years just to sort them all out 😉

I don't know about the specific combo you mention. A fair number of Med-Peds subspecialists have done ID, so there's a good body of experience out there. But again, there are no real combined fellowships, only programs who at one time agreed to share a fellow and were able to reassure both certifying boards about the curriculum. All such arrangements must be approved prospectively.

Where did you get the info about program directors. I believe the number is about 2/3 of all programs have a dual trained director. Or so ABP and ABIM would have me think.

 

[The Med-Peds Dude]

Thanks for all the info.
When do Med-Peds Program usually start interviewing? Many of my Peds friends have already received interview offers and I have only received two. I applied almost 4weeks ago.

I think when everyone else does. How many did you apply to? If you haven't heard, might be time to very politely beat the bushes. I think we sent out our 1st invitations 3 weeks ago.

 

[Lioness78]

I think when everyone else does. How many did you apply to? If you haven't heard, might be time to very politely beat the bushes. I think we sent out our 1st invitations 3 weeks ago.

I applied to 25. What do you mean "beat the bushes"?

 

[The Med-Peds Dude]

I applied to 25. What do you mean "beat the bushes"?

pick up the phone & meekly make inquiries.

 

[Lioness78]

pick up the phone & meekly make inquiries.

Thanks..

 

[yobabydoc]

Hey new med-peds grad,

Care to share which program you graduated from?

 

[megacolon]

I have a couple questions I wanted to ask you,

First one would be where you are at, but that wouldn't be fair and I wouldn't expect you to answer anyway so I won't ask 🙂

The second question would be, what are good ways to assess the strength of the individual departments when you interview. What are things that you as a program director use to evaluate and measure the strength of your own program?

Next when it comes down to it, how exactly do you rank students? I mean, you can get a general sense of things, but when it comes to ranking one good applicant over another, is it more just the vibe/impression from the student that makes a difference?

Thanks for your previous comments, they have been very helpful and insightful.

 

[The Med-Peds Dude]

I have a couple questions I wanted to ask you,

First one would be where you are at, but that wouldn't be fair and I wouldn't expect you to answer anyway so I won't ask 🙂

The second question would be, what are good ways to assess the strength of the individual departments when you interview. What are things that you as a program director use to evaluate and measure the strength of your own program?

Next when it comes down to it, how exactly do you rank students? I mean, you can get a general sense of things, but when it comes to ranking one good applicant over another, is it more just the vibe/impression from the student that makes a difference?

Thanks for your previous comments, they have been very helpful and insightful.

Glad to know I've been a little helpful.

Strengths - ask residents, faculty interviewers. You can reword this by asking what they would improve if possible. I get asked this by at least 50% of interviewees. Be suspicious if people can't think of any weaknesses (be prepared to answer similar questions about yourself!). Common indicators include board pass rate, filled/unfilled in recent matches, retention, resident satisfaction, fellowship placement for those interested, and so on. Remember that in smaller programs, one or two bad years can destroy some of these numbers, so feel free to be nosey as to why people left, etc (personal experience 🙁 ). One smaller program in the south comes to mind - had an excellent PD and good education, but suffered in recruiting due to location.

Some programs apply scores and weights to different parts of the application and then add up the numbers. I'd say we use a little more in the way of fuzzy logic, interviewers apply a score after they interview that pretty much sums up the application as a whole. Fairly good agreement among interviewers, surprisingly enough. People obsess over board scores, but this is a small part of the puzzle. Making a good/bad impression during the interview accounts for much of the decision. Usually the top and bottom third of the list is easy to determine. Can be tough to sort out and rank the middle, as all would be near equally desirable academically, so 'impression/vibe' have a role - you start thinking about who would be get along with other residents, be receptive to corrective feedback, and so on. We've knocked very academically strong applicants way down (or even off) the list based on observed behavior.

That's it, more or less.

 

[megacolon]

Thanks again. Hearing that helps relieve some of the preinterviewing anxiety. Who knows...maybe we'll get to interview each other in the next few months. =)

 

[The Med-Peds Dude]

Thanks again. Hearing that helps relieve some of the preinterviewing anxiety. Who knows...maybe we'll get to interview each other in the next few months. =)

Not sure I'm on your list.

 

[RuralMedicine]

Hey new med-peds grad,

Care to share which program you graduated from?

Actually I kind of like my anonymity 😉