MICU at Stanford vs SCVMC

[vomer]

Hi Everyone--

This is kind of a specific question, but I wanted to ask for some advice on the matter. I am currently a 3rd year student trying to schedule 4th year electives--I only get 2, so I have to make them count!

Well I am trying desperately to return to the California Bay Area first of all. I have an interest in fellowships--Cards vs Endocrine vs Critical Care.

So after looking at the available rotations, my question/concern is this: in order to do an MICU month at Stanford, students apparently do the actual rotation at Santa Clara Valey Medical Center. I thought what a great chance to do the rotation at SCVMC but still generate a letter of rec for Stanford--the concern is that am I really auditioning for Stanford or SCVMC? Obviously Stanford is my first choice--can anyone help sort the matter out for me????

Also has anyone done the rotation--any feedback would be greatly appreciated.

Toodles,
Vomer

 

[AJM]

If you are interested in the Stanford program, then I think you should do your MICU rotation at Stanford. The Valley is a great place with excellent teaching, but the Valley MICU attendings are not Stanford faculty (they have much more say with their own residency program than with Stanford), and the Stanford critical care fellows and medicine residents do not rotate down to the Valley MICU.

So basically, if you do your MICU rotation at the Valley, you are really auditioning for the Valley residency program, not the Stanford program.

Just as a note - Stanford medical students are required to do a month of ICU, so you may have a difficult time scheduling the Stanford MICU rotation. A good alternative rotation that is not required for Stanford students is the a sub-I on the Inpatient Cardiology rotation, which is a combined CCU/inpatient cards service. You could get some critical care, and lots of cardiology with that rotation, but it is a lot of work (probably more than the MICU).

 

[pigchen]

Hi, I am also interested in returning to bay area for residency in internal medicine. Would you any other good rotations at Stanford? Any good attendings? Thanks.

 

[AJM]

Hi, I am also interested in returning to bay area for residency in internal medicine. Would you any other good rotations at Stanford? Any good attendings? Thanks.

It kind of depends which specialties you're interested in. Any of the consult rotations are great -- especially in the realm of getting maximal "face time" with the attending. Your interaction with the residents on consult services can be variable, since the consult services don't always have residents or interns on service every month. Particularly good consult rotations are cardiology and pulmonary (both consult services offer great teaching and excellent attendings), but it depends which specialties you might be interested in. Other good services are endocrine and rheum, but you will either need a car or be able to carpool with the fellow or resident on service -- both services cover consults and clinics at both Stanford and the Palo Alto VA (5 minute drive from each other).

ID and GI are also good, but incredibly busy services with long hours. The plus side for those two is that there is almost always at least one medicine resident or intern assigned to each service since they are so busy. The fellow on service will also very much appreciate your help. ID in particular has some great attendings and offers a lot of teaching. GI is variable depending who the attending is on service at the time.

There are also several inpatient rotations you can do if that's more your style. A big pro of doing an inpatient month is that you are guaranteed to have a lot of contact with the medicine interns and residents, and you are able to go to more of the medicine conferences (as opposed to the subspecialty conferences). This way you can get slightly more face time with people in the residency program. The biggest cons are that it is usually more work, you have to take call, and you work somewhat less closely with an attending than you do on consults. Good inpatient rotations that I would recommend for visiting students would be Hematology or Oncology. Both of them are primarily inpatient services, but also do inpatient consults. You also go to clinic 1-2 afternoons a week -- so it's an opportunity to meet and work with more attendings than you otherwise would get a chance to on a straight inpatient month. You will work pretty closely with the housestaff (there are 2 residents, 1 intern, and a fellow on each team), and function basically as a sub-I. (You also get weekends off -- a big plus).

Let me know if you have any other questions.

 

[pigchen]

Thanks so much for the great info. Cardiology at Stanford is not open during summer. Would you recommend doing it at PAVAMC? Or I should just pick endo/ID at Stanford?

Other qs: Can you commend on the internal medicine programs in the bay area? Thanks!

 

[AJM]

Thanks so much for the great info. Cardiology at Stanford is not open during summer. Would you recommend doing it at PAVAMC? Or I should just pick endo/ID at Stanford?

Other qs: Can you commend on the internal medicine programs in the bay area? Thanks!

you could certainly do cards at the PAVA. The attendings there are Stanford faculty, and it's the same fellows and residents. I actually can't comment on the quality of the rotation, because I haven't recently talked with anyone about it. I have met some really good cards attendings at the VA, though.

I would suggest picking a subspecialty in which you have the most interest, since you'll probably do a better job in an area in which you're interested, and therefore make a better overall impression.

I don't know very much at all about the bay area IM programs. Stanford and the Santa Clara Valley program are the only ones that I really know anything about. The Valley is an excellent program with a more primary care focus, and much less focus on the subspecialties. Most of the residents will end up in primary care, with a few who go on to do fellowships. The attendings are great to work with there, and they do a lot of teaching. The program overall is a very resident-oriented program (as opposed to a fellow-oriented program), although they do work closely with many of the Stanford fellows in various specialties who rotate down there.