medical students - what are you looking for in a training program?

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loveumms

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I am an academic attending and would love to hear what is important to medical students when looking for a training program.

Lets say you will get good training wherever you go (so that aside), what else is important to you?

Please list them in order of importance.

Thank you so much!

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I am an academic attending and would love to hear what is important to medical students when looking for a training program.

Lets say you will get good training wherever you go (so that aside), what else is important to you?

Please list them in order of importance.

Thank you so much!

I think the assumption that u will get good training wherever u go is horse crap.

So many scutt factories out there. Giving crnas breaks, preops after hours, etc etc.

So not sure how meaningful your survey is... given that this really ought to be the most important factor in residency selection.
 
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I'm not a resident but I believe mentoring is essential. Every resident should have an experienced faculty member they can turn to and who will advocate for their best interests. Even in your early years out of training it is important to have a professional mentor you can bounce ideas off of and guide you when things aren't clear.

Also essential is a large volume of big cases on sick patients and subspecialty exposure.
 
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I am an academic attending and would love to hear what is important to medical students when looking for a training program.

Lets say you will get good training wherever you go (so that aside), what else is important to you?

Please list them in order of importance.

Thank you so much!

Here's a list of things I was looking for in preference although all had an important factor for me. My overall goal in my training was that I am not afraid to work hard for education and I wanted to come out of residency seeing as many different types of cases there were and also build potential as a leader in my future group/practice. My 2 cents:

1. Location. I think the biggest player for anyone. When ranking, I wanted the best program in my location/region. Somewhere at least near family or a place I am familiar with.
2. Variety. I liked a program that had a variety of dedicated hospitals. Peds, cardiac, VA, county were some that I kept in mind. I would ask what variety of cases as well. Population/patient diversity.
3. Camaraderie. I felt like there were programs where residents were very enthusiastic about their program and seemed to really get along with their faculty. I don't mind working hard, but would want to work hard with people that I liked.
4. Fellowships. Showed that the program had enough numbers for given subspecialty to support a fellowship. Also I feel like if I ever wanted "x" fellowship, it's easier to get the connections to in-house fellowship than not. I know there are great residencies out there without fellows essentially and there are positives to that. So this was important to tease out how the fellows interacted with residents during the interview.
5. Stability/leadership. It was important for me to see that leadership was strong from chair and PD. Along with that, seeing that the department of anesthesia was a major player in the hospital system. Just my own way of gauging that was seeing how many of the admin were in major committees of the hospital (ie research, hospital management), how many different places did I see the department (ie ICU presence, per-op clinic, pain, scheduling, etc). Anesthesiologists are usually very relaxed and chill people. I love that. But it's also stereotypical that we are lazy and has lead to training CRNAs and giving perception that anesthesia services aren't as valuable. Seeing leadership taking a stronghold of the department and being strong within the hospital gives a level of respect that is important. Anesthesiologists are physicians first. CRNAs/AAs are here to stay, but new-age anesthesiologists are leaders and we should act like so.
6. Critical Care. I am a bit biased as my early interest is critical care. However, in the grand scheme, I feel like ICU should be an integral part of the anesthesia training. Anesthesiologists are true peri-operative physicians and should have a strong presence in the ICU.
7. Regional. I felt this was where there was most hit/miss. The most common answer to the question to residents "what more training you wish you had" was more regional experience.
8. Research. Although I'm not too big on research, I do know it's value academically. I wouldn't mind joining in a project or 2 to contribute. Also a department that values research helps our training keep abreast on the edge of anesthesia/medicine.
9. Didactics/Boards. I wanted a place with dedicated didactics and board prep. Places that showcased that showed that they were serious about resident education. Clinical smarts is most important but I think book smarts helps us be well-rounded physicians.
10. Mentorship. Having someone to turn to and can ask anything including professional and personal. Both a senior and faculty mentor.
 
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I think the assumption that u will get good training whoever u go is horse crap.

So many scutt factories out there. Giving crnas breaks, preops after hours, etc etc.

So not sure how meaningful your survey is... given that this really ought to be the most important factor in residency selection.

Agreed. There were definitely tiers of places. Yes every program will make me an anesthesiologists in the end, but there were places that were more well-rounded in their training where I saw residents were confident in their skills and being leaders.
 
Working with CRNAs....you'll be doing it the rest of your career so you might as well learn how during residency.
 
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I love that you're asking this question @loveumms !

I'll distill in to a few big buckets. I'm sorry, but these are not rank-ordered... I don't think that's possible!

1 - location. there's just no way around this one for some of us. I have lived many places in the country and have a strong sense of the type of place that makes me happiest (and with the limited free time of residency, that becomes even more important to me).
2 - program's dedication to my training. this is a big bucket: "culture of education" (there to learn, not provide cheap labor)... autonomy (giving learners freedom to stay at their "edge" vs letting them fail/drown alone... didactics (quantity and quality)... etc.
3 - program's ability to drive my future career. again, complex: "name brand" vs geographical region vs additional opportunities to grow during training (often a function of a department's statue within the hospital and broader college of medicine or university).
4 - culture. how do people treat people? what traits and behaviors are valued? what are not? these questions apply equally to interactions within the department and to the department's relationship with the rest of the hospital
 
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Culture / how program treats residents is my deciding factor. there are many good programs out there. But I want to know that my PD has my back and best interest. Other things may not be perfect but I want to know at least the program tries to help the residents. I understand some things are beyond a program directors power to really change
 
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I think the assumption that u will get good training wherever u go is horse crap.

So many scutt factories out there. Giving crnas breaks, preops after hours, etc etc.

So not sure how meaningful your survey is... given that this really ought to be the most important factor in residency selection.


That was the assumption for THIS question only, not a statement because believe me, not all programs will train you to handle your work like a boss.

I'm sorry but I think learning how to be collegial with CRNAs early in your career is important - whether you like it or not, in the future most of us will be working with them. If you as a resident want CRNAs to give you breaks then you should be willing to do the same - the whole "I am better then that" is just plain old ridiculous. Additionally, pre-ops are a part of your job as an attending so learning how to do them well will serve you well.
 
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What I feel important in any great institution is the following:


1. Regional, Cardiac, Peds, Trauma, Transplant exposure and A LOT of it. This if by far the most important factor of any residency. No… they are not all the same. If CRNAs are picking off those cases you are in the WRONG program. They need to be doing the easy cases while the residents are doing the very difficult ones. If this ratio is reversed in any way there is a problem with the academic institution- move on.

2. Mentors that will sit with you and TEACH you the fine details of anesthesia and all the subspecialties. I have great memories of getting interrogated to death on anesthesia at 3 am. Hard to keep focused, but great mini lectures that taught resilience while my adrenals were down.

3. Education. You need to have formal lectures, simulation labs, subspecialty learning experiences, guest speakers etc. The program needs to EXCITE and MOTIVATE the resident to be the best they can be. Along with this comes NOT finishing at 6pm on a non call day only to go run around the hospital to pre-op 4 patients. This should be a time to go home decompress and read about the cases of the day or the following day. Most practices look at the patient the DOS. If those pre-ops get you home at 8:30pm it is very hard to read up on that very special arterial switch procedure that requires you to be in the hospital by 6:30am to set up drips, etc. The best learning is that which comes with preparation and reflection/debriefing.

4. Location. Ultimately, if you want to work in a particular region, then doing a residency in that locale can be helpful but not imperative. This isn’t absolutely necessary, but helpful.

5. Treat your residents with respect and let them change the plan for learning purposes. You want to do a case a different way? Give your residents room to do that. Airway, drugs, tiva, etc. Knowing how to do a case 10 different ways builds a great foundation for the resident anesthesiologist and empowers them to be great. Did a bunch of retrogrades and lightwand intubations during my residency. Always knew the attendings that would say "hell yeah... let's do that". Made a big difference in my eyes even though I rarely if ever do these anymore- it made my day when I had these types of academic attendings.

6. Fellowships



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That was the assumption for THIS question only, not a statement because believe me, not all programs will train you to handle your work like a boss.

I'm sorry but I think learning how to be collegial with CRNAs early in your career is important - whether you like it or not, in the future most of us will be working with them. If you as a resident want CRNAs to give you breaks then you should be willing to do the same - the whole "I am better then that" is just plain old ridiculous. Additionally, pre-ops are a part of your job as an attending so learning how to do them well will serve you well.
Yes, knowing how to work with nurses is imperative.
Relieving a nurse for lectures is a "never occurrence".
Luveumms, I love your "train you to handle your work like a boss" statement.
I personally would not go to a program that has an srna program as well. No way, no how.
I wouldn't give up one second of my education for the sake of a nurse. They can go to those programs that make a killing off training nurses.
Other than that, look at what Sevo said. That's quality.
 
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That was the assumption for THIS question only, not a statement because believe me, not all programs will train you to handle your work like a boss.

I'm sorry but I think learning how to be collegial with CRNAs early in your career is important - whether you like it or not, in the future most of us will be working with them. If you as a resident want CRNAs to give you breaks then you should be willing to do the same - the whole "I am better then that" is just plain old ridiculous. Additionally, pre-ops are a part of your job as an attending so learning how to do them well will serve you well.

Somehow you managed to simultaneously condescend your peer and rationalize the scutting out of the future of our profession day in and out in just a few sentences.

Cool though that your residents learn how to be collegial with CRNAs from day 1. Sounds like an epic program.

No wonder our profession is circling the drain...these r the people training our residents.
 
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Had an attending that loved the Shikani stylet. He "made" me use it on all our cases. This particular attending became a good friend and shared some after hour dinners and drinks with his family and my wife on many occasions. Great dude. Always doing different stuff than the rest of the department.

Grasshopper then...

Now a bonfied, black belt super ninja Shikani user and love it-
Crank the flows up and part the great salivary drool and as an added bonus maybe get a little apneic oxygenation while you are at it. :thumbup:

Haha... how time flies.
But love my little ancient AW tool.
Had one at my last practice and used it all the time.

Wonder if it's even taught anymore in academic departments. Glidescope stole all the fun out of a lot of great AW devices. Good times.
 
What I feel important in any great institution is the following:


1. Regional, Cardiac, Peds, Trauma, Transplant exposure and A LOT of it. This if by far the most important factor of any residency. No… they are not all the same. If CRNAs are picking off those cases you are in the WRONG program. They need to be doing the easy cases while the residents are doing the very difficult ones. If this ratio is reversed in any way there is a problem with the academic institution- move on.

2. Mentors that will sit with you and TEACH you the fine details of anesthesia and all the subspecialties. I have great memories of getting interrogated to death on anesthesia at 3 am. Hard to keep focused, but great mini lectures that taught resilience while my adrenals were down.

3. Education. You need to have formal lectures, simulation labs, subspecialty learning experiences, guest speakers etc. The program needs to EXCITE and MOTIVATE the resident to be the best they can be. Along with this comes NOT finishing at 6pm on a non call day only to go run around the hospital to pre-op 4 patients. This should be a time to go home decompress and read about the cases of the day or the following day. Most practices look at the patient the DOS. If those pre-ops get you home at 8:30pm it is very hard to read up on that very special arterial switch procedure that requires you to be in the hospital by 6:30am to set up drips, etc. The best learning is that which comes with preparation and reflection/debriefing.

4. Location. Ultimately, if you want to work in a particular region, then doing a residency in that locale can be helpful but not imperative. This isn’t absolutely necessary, but helpful.

5. Treat your residents with respect and let them change the plan for learning purposes. You want to do a case a different way? Give your residents room to do that. Airway, drugs, tiva, etc. Knowing how to do a case 10 different ways builds a great foundation for the resident anesthesiologist and empowers them to be great. Did a bunch of retrogrades and lightwand intubations during my residency. Always knew the attendings that would say "hell yeah... let's do that". Made a big difference in my eyes even though I rarely if ever do these anymore- it made my day when I had these types of academic attendings.

6. Fellowships



hqdefault.jpg

You did retrogrades on patients for fun??
 
What I feel important in any great institution is the following:

5. Treat your residents with respect and let them change the plan for learning purposes. You want to do a case a different way? Give your residents room to do that. Airway, drugs, tiva, etc. Knowing how to do a case 10 different ways builds a great foundation for the resident anesthesiologist and empowers them to be great. Did a bunch of retrogrades and lightwand intubations during my residency. Always knew the attendings that would say "hell yeah... let's do that". Made a big difference in my eyes even though I rarely if ever do these anymore- it made my day when I had these types of academic attendings.


hqdefault.jpg

Unfortunately the Trachlight is no longer even available unless you stockpiled.
It's a drawback to train at a program that also trains CRNA's. The SRNA's will look to you as their equal since they are learning in the same OR's.

Trachlight™ end of life announcement
 
I'm sorry but I think learning how to be collegial with CRNAs early in your career is important - whether you like it or not, in the future most of us will be working with them. If you as a resident want CRNAs to give you breaks then you should be willing to do the same - the whole "I am better then that" is just plain old ridiculous.

I disagree with this except for the first statement. Respect for and collegiality with advance practice nurses is obviously important, not just in a professional sense but also as part of being a decent human being. But residents shouldn't be part of a labor force to get CRNAs their breaks. (Keep in mind that ACGME will have something to say about this practice if they hear about it.)

The exception might be if the specific academic activity for a senior resident is to do a pre-attending day filling the role of supervision. There's value in learning to run the board, manage people, and direct midlevels and other people. It's absolutely true that if the job market has a lot of ACT models (it does) then residency should incorporate some amount of training to step into the lead role of an ACT. Unless the resident is also directing the preop and the entirety of intraop care, there is NO APPROPRIATE ROLE for them as lunch breakers. Period. It's just labor extraction.

When residents are in the ICU it would be unthinkable for them to cover a bed so the ICU RN can go get coffee or lunch or attend some meeting.


I trained at a program with SRNAs, and later went back there to be an attending. It was a non-issue. They never take good cases, blocks, or other procedures from residents. (The exception might have been OB, but the volume is so high there's no shortage of epidurals and sections.) They never do cardiac or cranis or the sick ex-lap from the ICU. They have out rotations at other hospitals without residency programs to get their numbers in those areas.


It's a serious social faux pas with ACGME for a SRNA to be taking educations opportunities from residents. I don't doubt that some programs out there do it, but it's not OK and it doesn't have to be that way. Having residents give breaks to CRNAs in the name of efficiency or being friendly is not OK.


Additionally, pre-ops are a part of your job as an attending so learning how to do them well will serve you well.

This is true.

But as sevo noted in his excellent post above, finishing at 6 PM on a non-call day only to run around the hospital banging out consent paperwork for the next day's schedule ... that isn't good for anyone.


The bottom line is that there's an implied contract in being a resident that we all know and understand: in return for an education, sometimes the resident is needed to just perform labor in order to get the day's work done and the patients cared for. That's OK. But good programs limit low-educational-yield labor extraction because they make deliberate decisions and have sufficient staff to minimize their dependence on resident labor. Bad programs view residents as labor first and trainees second.

The line between the two is fuzzy but you can't deny that the line exists.

If a resident is routinely doing preops at 7 PM or giving breaks to CRNAs, you've got to ask
- why are non-call residents needed to keep the ORs running past 5 PM?
- why aren't CRNAs giving breaks to CRNAs?
- why aren't the attendings who are supposed to be supervising the CRNAs giving breaks?
If the answer to any of these is "the work won't get done without the residents doing those tasks" then the reality is simply that the department is poorly managed, understaffed, and/or unconcerned with the quality of the residency program.

These problems can't be fairly dismissed by pretending that the arrangement is somehow good for the residents.
 
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I disagree with this except for the first statement. Respect for and collegiality with advance practice nurses is obviously important, not just in a professional sense but also as part of being a decent human being. But residents shouldn't be part of a labor force to get CRNAs their breaks. (Keep in mind that ACGME will have something to say about this practice if they hear about it.)

The exception might be if the specific academic activity for a senior resident is to do a pre-attending day filling the role of supervision. There's value in learning to run the board, manage people, and direct midlevels and other people. It's absolutely true that if the job market has a lot of ACT models (it does) then residency should incorporate some amount of training to step into the lead role of an ACT. Unless the resident is also directing the preop and the entirety of intraop care, there is NO APPROPRIATE ROLE for them as lunch breakers. Period. It's just labor extraction.

When residents are in the ICU it would be unthinkable for them to cover a bed so the ICU RN can go get coffee or lunch or attend some meeting.


I trained at a program with SRNAs, and later went back there to be an attending. It was a non-issue. They never take good cases, blocks, or other procedures from residents. (The exception might have been OB, but the volume is so high there's no shortage of epidurals and sections.) They never do cardiac or cranis or the sick ex-lap from the ICU. They have out rotations at other hospitals without residency programs to get their numbers in those areas.


It's a serious social faux pas with ACGME for a SRNA to be taking educations opportunities from residents. I don't doubt that some programs out there do it, but it's not OK and it doesn't have to be that way. Having residents give breaks to CRNAs in the name of efficiency or being friendly is not OK.




This is true.

But as sevo noted in his excellent post above, finishing at 6 PM on a non-call day only to run around the hospital banging out consent paperwork for the next day's schedule ... that isn't good for anyone.


The bottom line is that there's an implied contract in being a resident that we all know and understand: in return for an education, sometimes the resident is needed to just perform labor in order to get the day's work done and the patients cared for. That's OK. But good programs limit low-educational-yield labor extraction because they make deliberate decisions and have sufficient staff to minimize their dependence on resident labor. Bad programs view residents as labor first and trainees second.

The line between the two is fuzzy but you can't deny that the line exists.

If a resident is routinely doing preops at 7 PM or giving breaks to CRNAs, you've got to ask
- why are non-call residents needed to keep the ORs running past 5 PM?
- why aren't CRNAs giving breaks to CRNAs?
- why aren't the attendings who are supposed to be supervising the CRNAs giving breaks?
If the answer to any of these is "the work won't get done without the residents doing those tasks" then the reality is simply that the department is poorly managed, understaffed, and/or unconcerned with the quality of the residency program.

These problems can't be fairly dismissed by pretending that the arrangement is somehow good for the residents.

At my residency program, we do our own pre ops after the day finishes, and the call team does the rest of the preops (for rooms with no residents, or residents who are off)
Idk aabout other programs but if non call residents are getting out <=5pm , it seems like a pretty chill program to me.. Our avg case end/relief time for residents is about 550 i believe. id say it's a pretty strong program
 
the Shikani stylet

I loved that thing in residency. Haven't seen one since. I think I may have been the only one to ever bust it out of it's briefcase (you know, the kind that looked like it should be handcuffed to someones wrist). The perfect tool for pts with limited mouth opening.
 
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