Official 2011 IM Rank Order Lists

[NastyNick45]

s

---

Members don't see this ad.

 

[texasguy]

I agree with Texasguy that people posting lists with a variety of different programs would be helpful. I do feel bad that despite a high number of posts on SDN in the past I haven't been that active in the IM thread. So despite the fact that I have a lot of highly discussed programs on my list I'm happy to give my opinion on all of them.

1) UCSF. For me, just the best place I went to for rigorous and varied training. A real three hospital experience with your rotations split roughly evenly across all 3 (the county hospital, an academic center and a VA). Coming from a public medical school I "fit" with the mission and environment here. Also an organized system to get other training outside of clinical medicine, a "minor" if you will (in outcomes research, education, global health, ect.) Also amazing research/clinical opportunities in HIV--which for me was important.
2)BWH. Great residents, PD and faculty. Seems like one of the most supportive programs I went to. Also a 3 hospital system but with far more rotation time spent at BWH than anywhere else. Also probably the best connections to launch any career. Boston is a little chilly but I'm sure I'd survive.
3)MGH. A lot friendlier than I thought. Outstanding comraderie among the residents and I was thoroughly impressed with their abilities on rounds. Not as big a fan of the Bigelow service (every member of the team shares patients instead of you owning 10 or so and covering others when you are on call) or the fact that there is a private service. But people who go here love the Bigelow so I'm sure I would also.
4)Penn. People here rave about the supportive environment and the amazing and receptive PD. I also really like Philly--it seems very livable. Also most of the Penn med students stay and they had the best things to say about a home program of any group. Not a big fan of the docs carrying cell phones instead of pagers (which means they are answering the nurses calls all day despite the level of importance) or the new duty hours plan (basically shift work--6 12hour days a week for interns, admitting every day) but I'd get over it.
5)Columbia. For me, great opportunities in racial disparities and public health research. NYC would be fun. Two attending system is interesting and most of the residents seemed to like it. Having so many patients of one racial background is not ideal but my Spanish would be great by the end.
6)Hopkins. Debated putting this a lot higher, liked it more than I thought I would. Location was really high on my priority list and Baltimore is definitely a big part of the reason that I did not put it higher although the area around Hopkins is not nearly as bad as people make you think. Great comraderie and I really think they can turn a med student into a decent doctor in one year with their grueling marathon of an internship.
7)Duke. They have made a lot of moves in the past years to soften up and the residents seem happy. To me they also seem a little stuck up, more so than places that arguably have more prestige. Also wanted to get to the big city for a while.
8)NW. Really liked this place. Great part of Chicago and the PD is amazing. Very supportive environment but also got the feeling it is a bit cush. If you are interested in cards particularly this is a great option.
9)Cornell. Great part of NYC but I think they are still struggling with their reputation as the hospital of the wealthy in NYC and the program also seems a little cush. The PD is also new so its a little difficult to know what to expect. Residents seem very happy though and great program for hem-onc.
10) UNC. Small but tight-knit group. Residents are given a lot of autonomy. The new call schedule seems interesting and may work really well. If you are looking for smaller cities for residency you can do no better than Chapel Hill. A downside is having to drive 40 minutes to Wake Med for some rotations.
11) UVA. A smaller version of UNC. More residents than UNC but a smaller hospital. Don't have a lot to say about the program except that Charlottesville is small but pretty and the interview day has an excessive number of power points.
12)Vanderbilt. The one place I went I really didn't like. I grew up in the South but this place was far to into putting on the southern charm, just hit me the wrong way (from the nicities, resident laundry service, a catered lunch at the Vanderbilt club to the morning report room that looked like a hunting lodge). That being said great medical record system and resident autonomy. Just not for me.

Hope this helps someone, feel free to PM with questions.

golf and nick - extremely helpful comments for those of us applying next year...thanks!

 

[TX4Lyfe]

golf and nick - extremely helpful comments for those of us applying next year...thanks!

it's helpful but just make sure you take it with a grain of salt. it's ONE person's opinion. everybody has different priorities and gut feelings once they visit. SDN is not the be all end all.

 

[deuce]

...Vanderbilt remains the enigma for me on this list too..I was very impressed with the people, knowledge program and facilities, but it was a bridge too far for me- Im not from the south, Im not married, and this was just too traditional, too southern...I will never question the ability of vandy trained people after my visits though - really good docs, on par with Penn - residents at these places really impressed me with their comments and knowledge at rounds., more so than even JHU, MGH , BW or UCSF...I think Penn and Vandy are way underrated due to geography

 

[jdh71]

...Vanderbilt remains the enigma for me on this list too..I was very impressed with the people, knowledge program and facilities, but it was a bridge too far for me- Im not from the south, Im not married, and this was just too traditional, too southern...I will never question the ability of vandy trained people after my visits though - really good docs, on par with Penn - residents at these places really impressed me with their comments and knowledge at rounds., more so than even JHU, MGH , BW or UCSF...I think Penn and Vandy are way underrated due to geography

Why would you question the clinical ability of anyone simply by virture of where they trained?

Does the Brigham do a chest pain rule out any different than no-name community program?

 

[deuce]

really - if you didn't believe there was a delta in where you trained you wouldn't even be reading this board, let alone commenting...and Ive worked with a number of great FMGS and some real a-holes/idiots who trained at very respectable US hospitals, but Ive clearly seen a much much higher level of average competence among the internists Ive been exposed to who trained at selective distinguished US programs and those that trained outside of US/Western Europe .. closer to 2 orders of magnitude as 1 order of magnitude...thats a pretty big delta; and why should that be at all remarkable given the vast range of standards, selectivity and reseorces between such prorgams ?

I AGREE 100% it makes no difference where one attends medical school, and I agree WITHIN A RANGE the difference is not all that great between the experience you get and the doctor you become from training at certain places (internship and residency, fellowship) and I agree that the difference is more profound in some specialties than others (neurosurg perhaps being the greatest, psych being the lowest) but do you really believe that say a Cleveland Clinic cardiac interventionist is not much more likely to be skilled, experienced and more knowledgable than one who trains at local community hospital , or even (ill choose one form every geographic region so nobody takes umbrage) LOma Linda, ECU, Temple, ST Louis U ? please -I know and you know who you will seek out when you need your first bypass

of course some people exaggerate the difference between various programs impact- but it is easily as fatuous to dismiss manifest and meaningful differences between programs and the impact they can have- may of the most selective programs are better environments to train simply because they have the resources, patient population and can be so selective about their staffs - (would you rather be treated after a train wreck for trauma at Stanford or MGH ? that wasn't so hard was it- and its not simply a brand issue - obviously most people would what to be brought to MGH, and you know what , they'd be right !) that doesn't mean they get it right all the time, or their aren't jerks at say UCSF, but places like JHU don't have people with any less character, people skills or industry than less selective programs -to assert otherwise is vain and/or naive- they certainly have more resources, a broader group of patients, and you are surrounded and being trained by uniformly ambitious and almost uniformly bright people who also had access to these advantages, and these training environments accumulate these advantages and compound them over decades;

all I said was that Vandy and Penn residents really impressed me as much or more than other top ranked places, geography aside- despite attempts to make distinctions between these level programs, they are every bit as auspicious and impactful places to train as Hopkins, BW, MGH etc, BUT that doesnt mean ether are not significant differences in the quality, impact and output of programs say within the first 100 programs, and doubtlessly the first 50, and arguably within the top 20 (top meaning the most selective programs). even if distinctions between the top 5,10 or even 15 are meaningless

its specious to convert that into an excuse for a diatribe about elitism - yes where you train does make a difference on what doctor you emerge /become, and all things being equal (as they are otherwise) I would rather have a physician, and be trained by physicians, who are more dedicated, industrious, intelligent, knowledgeable, and experienced - becoming a doctor is not a random, generic process, nor is it soley what you as an individual put into the training process - if it were it would have been industrialized and turned over the physician extenders long ago OR left as an apprenticeship pre/flexner-

and if you believe practicing quality medicine is a matter of plugging patients into rule out templates and not thinking, I cant gainsay your argument...but who will be the doctor who picks up my dissecting aneurysm when I am 42, ie the outliers, the subtlties etc?

 

[obiwan]

If SWern was on a coast, would have been higher. You’ll work your a** off here though, maybe not as an intern this year, but trust me, the other two years will be loooooooong hours. Not a program you should go to if you value sleep.

uh, if i'm not working hard, then no intern in the entire country is working hard

 

[jdh71]

really - if you didn't believe there was a delta in where you trained you wouldn't even be reading this board, let alone commenting...and Ive worked with a number of great FMGS and some real a-holes/idiots who trained at very respectable US hospitals, but Ive clearly seen a much much higher level of average competence among the internists Ive been exposed to who trained at selective distinguished US programs and those that trained outside of US/Western Europe .. closer to 2 orders of magnitude as 1 order of magnitude...thats a pretty big delta; and why should that be at all remarkable given the vast range of standards, selectivity and reseorces between such prorgams ?

I AGREE 100% it makes no difference where one attends medical school, and I agree WITHIN A RANGE the difference is not all that great between the experience you get and the doctor you become from training at certain places (internship and residency, fellowship) and I agree that the difference is more profound in some specialties than others (neurosurg perhaps being the greatest, psych being the lowest) but do you really believe that say a Cleveland Clinic cardiac interventionist is not much more likely to be skilled, experienced and more knowledgable than one who trains at local community hospital , or even (ill choose one form every geographic region so nobody takes umbrage) LOma Linda, ECU, Temple, ST Louis U ? please -I know and you know who you will seek out when you need your first bypass

of course some people exaggerate the difference between various programs impact- but it is easily as fatuous to dismiss manifest and meaningful differences between programs and the impact they can have- may of the most selective programs are better environments to train simply because they have the resources, patient population and can be so selective about their staffs - (would you rather be treated after a train wreck for trauma at Stanford or MGH ? that wasn't so hard was it- and its not simply a brand issue - obviously most people would what to be brought to MGH, and you know what , they'd be right !) that doesn't mean they get it right all the time, or their aren't jerks at say UCSF, but places like JHU don't have people with any less character, people skills or industry than less selective programs -to assert otherwise is vain and/or naive- they certainly have more resources, a broader group of patients, and you are surrounded and being trained by uniformly ambitious and almost uniformly bright people who also had access to these advantages, and these training environments accumulate these advantages and compound them over decades;

all I said was that Vandy and Penn residents really impressed me as much or more than other top ranked places, geography aside- despite attempts to make distinctions between these level programs, they are every bit as auspicious and impactful places to train as Hopkins, BW, MGH etc, BUT that doesnt mean ether are not significant differences in the quality, impact and output of programs say within the first 100 programs, and doubtlessly the first 50, and arguably within the top 20 (top meaning the most selective programs). even if distinctions between the top 5,10 or even 15 are meaningless

its specious to convert that into an excuse for a diatribe about elitism - yes where you train does make a difference on what doctor you emerge /become, and all things being equal (as they are otherwise) I would rather have a physician, and be trained by physicians, who are more dedicated, industrious, intelligent, knowledgeable, and experienced - becoming a doctor is not a random, generic process, nor is it soley what you as an individual put into the training process - if it were it would have been industrialized and turned over the physician extenders long ago OR left as an apprenticeship pre/flexner-

and if you believe practicing quality medicine is a matter of plugging patients into rule out templates and not thinking, I cant gainsay your argument...but who will be the doctor who picks up my dissecting aneurysm when I am 42, ie the outliers, the subtlties etc?

Ahhh . . . I was wondering when the elitist douchebag I was going to get all flamey with was going to show up, and today is the day!!

I post in here and care because it is a matter of politics, such is anything in life with regard to why one place is "better" than another. There are very, very few "bad" programs anywhere, even if they were not cool enough for a student of your obvious amazing (ZOMG!!) caliber to even consider. What makes an elite place, an elite place? Is it the clinical training? Hardly!! You're not even close kid. It's the research money and the connection between that spot an another spot. If you really think people at Brigham are better at disgnosing and treating medicine patients, you really have a lot to learn about medicine.

So, I'm sorry to burst your bubble, but you are not a special and unique flower and you will not be a better clinician for having gone to one of the programs on your list as compared to . . . "LOma Linda, ECU, Temple, ST Louis U" [sic].

And FYI I'd MUCH rather have Stanford trauma take care of me than MGH. I'm much more familiar with their Critical Care and I'd rather have the surgeons, anesthesiologists, and medical intensivits who do this for a living every day under a multidisciplinary approach than a bunch of Havard researchers who spend a mere 25% of their time working clinically . . . which is industry standard for physician scientists. Your lack of this knowledge even in your elitist and wrong screed speaks volumes about your ignorance about this and most likely anything else you think you may know anything about.

Might I suggest a little humilty son and be thought and ***** than to open your mouth on a public forum and been known one.

Peace.

 

[Smoof5]

i do enjoy nicely written rants with misspellings, word omissions, and malaprops that manage to slip in sweet vocab like "specious" and "diatribe." Keeps my vocab skills on my toes

Ooooh, "gainsay" as well

really - if you didn't believe there was a delta in where you trained you wouldn't even be reading this board, let alone commenting...and Ive worked with a number of great FMGS and some real a-holes/idiots who trained at very respectable US hospitals, but Ive clearly seen a much much higher level of average competence among the internists Ive been exposed to who trained at selective distinguished US programs and those that trained outside of US/Western Europe .. closer to 2 orders of magnitude as 1 order of magnitude...thats a pretty big delta; and why should that be at all remarkable given the vast range of standards, selectivity and reseorces between such prorgams ?

I AGREE 100% it makes no difference where one attends medical school, and I agree WITHIN A RANGE the difference is not all that great between the experience you get and the doctor you become from training at certain places (internship and residency, fellowship) and I agree that the difference is more profound in some specialties than others (neurosurg perhaps being the greatest, psych being the lowest) but do you really believe that say a Cleveland Clinic cardiac interventionist is not much more likely to be skilled, experienced and more knowledgable than one who trains at local community hospital , or even (ill choose one form every geographic region so nobody takes umbrage) LOma Linda, ECU, Temple, ST Louis U ? please -I know and you know who you will seek out when you need your first bypass

of course some people exaggerate the difference between various programs impact- but it is easily as fatuous to dismiss manifest and meaningful differences between programs and the impact they can have- may of the most selective programs are better environments to train simply because they have the resources, patient population and can be so selective about their staffs - (would you rather be treated after a train wreck for trauma at Stanford or MGH ? that wasn't so hard was it- and its not simply a brand issue - obviously most people would what to be brought to MGH, and you know what , they'd be right !) that doesn't mean they get it right all the time, or their aren't jerks at say UCSF, but places like JHU don't have people with any less character, people skills or industry than less selective programs -to assert otherwise is vain and/or naive- they certainly have more resources, a broader group of patients, and you are surrounded and being trained by uniformly ambitious and almost uniformly bright people who also had access to these advantages, and these training environments accumulate these advantages and compound them over decades;

all I said was that Vandy and Penn residents really impressed me as much or more than other top ranked places, geography aside- despite attempts to make distinctions between these level programs, they are every bit as auspicious and impactful places to train as Hopkins, BW, MGH etc, BUT that doesnt mean ether are not significant differences in the quality, impact and output of programs say within the first 100 programs, and doubtlessly the first 50, and arguably within the top 20 (top meaning the most selective programs). even if distinctions between the top 5,10 or even 15 are meaningless

its specious to convert that into an excuse for a diatribe about elitism - yes where you train does make a difference on what doctor you emerge /become, and all things being equal (as they are otherwise) I would rather have a physician, and be trained by physicians, who are more dedicated, industrious, intelligent, knowledgeable, and experienced - becoming a doctor is not a random, generic process, nor is it soley what you as an individual put into the training process - if it were it would have been industrialized and turned over the physician extenders long ago OR left as an apprenticeship pre/flexner-

and if you believe practicing quality medicine is a matter of plugging patients into rule out templates and not thinking, I cant gainsay your argument...but who will be the doctor who picks up my dissecting aneurysm when I am 42, ie the outliers, the subtlties etc?

 

[deuce]

but that hardly justifies ad hominum screeds, an obsession with spell checkers , and sundry juvenilia just because you want to let off some steam and engage in blog/internet abuse behind an avatar....seriously, calm down or you'll nerve make it through match day/

but why are you being so defensive ? I truly hope you match at Stanford in a few weeks, (but I'm confused, won't that will be very difficult if you ranked ranked ECU, Temple, Loma Linda higher ?! and should we assume you just applied to the 20 programs nearest to your home because all programs are "fine" ?

Lets stipulate there are not many "bad" university programs out there, I never said there were, but seriously, there are very few excellent (or even very good) community hospital programs unless you are content to and triage/field or well adult ambulatory medicine, and more to the point, there are very few truly outstanding programs out there regardless of venue, and most of them just happen to be on most peoples (dare I say even yours ) top 20-30 list.

You seem to want to distort what I say to tout your political agenda - thats fine, if it makes you feel better , two legs bad, four legs good, we are all above average, and isn't it pretty to think so Jake ?

so, no mas.... Im going to focus on relating to real people the next two weeks rather than acting out on this board and practicing to be thought police.

BTW- loved the animation of the 17 year old acting his age )

 

[infarct]

Yo is this dude serious? Lol

really - if you didn't believe there was a delta in where you trained you wouldn't even be reading this board, let alone commenting...and Ive worked with a number of great FMGS and some real a-holes/idiots who trained at very respectable US hospitals, but Ive clearly seen a much much higher level of average competence among the internists Ive been exposed to who trained at selective distinguished US programs and those that trained outside of US/Western Europe .. closer to 2 orders of magnitude as 1 order of magnitude...thats a pretty big delta; and why should that be at all remarkable given the vast range of standards, selectivity and reseorces between such prorgams ?

I AGREE 100% it makes no difference where one attends medical school, and I agree WITHIN A RANGE the difference is not all that great between the experience you get and the doctor you become from training at certain places (internship and residency, fellowship) and I agree that the difference is more profound in some specialties than others (neurosurg perhaps being the greatest, psych being the lowest) but do you really believe that say a Cleveland Clinic cardiac interventionist is not much more likely to be skilled, experienced and more knowledgable than one who trains at local community hospital , or even (ill choose one form every geographic region so nobody takes umbrage) LOma Linda, ECU, Temple, ST Louis U ? please -I know and you know who you will seek out when you need your first bypass

of course some people exaggerate the difference between various programs impact- but it is easily as fatuous to dismiss manifest and meaningful differences between programs and the impact they can have- may of the most selective programs are better environments to train simply because they have the resources, patient population and can be so selective about their staffs - (would you rather be treated after a train wreck for trauma at Stanford or MGH ? that wasn't so hard was it- and its not simply a brand issue - obviously most people would what to be brought to MGH, and you know what , they'd be right !) that doesn't mean they get it right all the time, or their aren't jerks at say UCSF, but places like JHU don't have people with any less character, people skills or industry than less selective programs -to assert otherwise is vain and/or naive- they certainly have more resources, a broader group of patients, and you are surrounded and being trained by uniformly ambitious and almost uniformly bright people who also had access to these advantages, and these training environments accumulate these advantages and compound them over decades;

all I said was that Vandy and Penn residents really impressed me as much or more than other top ranked places, geography aside- despite attempts to make distinctions between these level programs, they are every bit as auspicious and impactful places to train as Hopkins, BW, MGH etc, BUT that doesnt mean ether are not significant differences in the quality, impact and output of programs say within the first 100 programs, and doubtlessly the first 50, and arguably within the top 20 (top meaning the most selective programs). even if distinctions between the top 5,10 or even 15 are meaningless

its specious to convert that into an excuse for a diatribe about elitism - yes where you train does make a difference on what doctor you emerge /become, and all things being equal (as they are otherwise) I would rather have a physician, and be trained by physicians, who are more dedicated, industrious, intelligent, knowledgeable, and experienced - becoming a doctor is not a random, generic process, nor is it soley what you as an individual put into the training process - if it were it would have been industrialized and turned over the physician extenders long ago OR left as an apprenticeship pre/flexner-

and if you believe practicing quality medicine is a matter of plugging patients into rule out templates and not thinking, I cant gainsay your argument...but who will be the doctor who picks up my dissecting aneurysm when I am 42, ie the outliers, the subtlties etc?

 

[Smoof5]

Cool as a cucumber buddy-boy/girl.

It's just hard to follow or buy into an argument someone (anyone) is making when the text is sort of all over the place. A rant comes off as a rant when presented that way is all I'm saying, whereas a measured response that doesn't try too hard is usually more useful for and well received by most forum readers.

 

[jdh71]

but that hardly justifies ad hominum screeds, an obsession with spell checkers , and sundry juvenilia just because you want to let off some steam and engage in blog/internet abuse behind an avatar....seriously, calm down or you'll nerve make it through match day/

but why are you being so defensive ? I truly hope you match at Stanford in a few weeks, (but I'm confused, won't that will be very difficult if you ranked ranked ECU, Temple, Loma Linda higher ?! and should we assume you just applied to the 20 programs nearest to your home because all programs are "fine" ?

Lets stipulate there are not many "bad" university programs out there, I never said there were, but seriously, there are very few excellent (or even very good) community hospital programs unless you are content to and triage/field or well adult ambulatory medicine, and more to the point, there are very few truly outstanding programs out there regardless of venue, and most of them just happen to be on most peoples (dare I say even yours ) top 20-30 list.

You seem to want to distort what I say to tout your political agenda - thats fine, if it makes you feel better , two legs bad, four legs good, we are all above average, and isn't it pretty to think so Jake ?

so, no mas.... Im going to focus on relating to real people the next two weeks rather than acting out on this board and practicing to be thought police.

BTW- loved the animation of the 17 year old acting his age )

1. Where was the ad hominem? Please point it out for the group. This will be interesting because non occurred, but it will be a good exercise for you because everything can be an opportunity to learn.

2. I've already matched. Matched to my number one years ago. I'm blowing off steam, nor do I have an agenda. I'm responding to you elitist asshattery.

3. I went to med school at Loma Linda and I'd put anyone coming out of their IM program up against one of Osler's marines any day of the week. Let me try this again, and this time I think I'll slow it down some, and avoid using any of the "big" words: the relative ranking of academic programs is because of academic politics, NOT clinical training. Fellowship connections are simply better, there is more opportunity for research, and a possible academic career. That is it.

4. I have no idea what "political agenda" you think I have. You could also spell this out for the rest of the group, because I'd more than a little interested to find out. I don't know if everyone is above average - a claim I have not made - but I do know you're not special. There is a difference. Perhaps this is lost on you?

5. Tell all the "real people" I say hello.

 

[jdh71]

Yo is this dude serious? Lol

Based on his follow up post. Yes. Yes he is, unfortunately. Tools like this kid are part of why internal medicine occasionally makes me want to chew off my own leg.

 

[deuce]

than to spend your evenings on this board trying to put Loma Linda on a par with Hopkins ?...strong work !..

Im sure (hope ?) you are a good doctor, but Im also quite certain you would have been even better trained at Hopkins - so would I - I wasnt accepted there as med student but that doesn't make me assume they were wrong, that it was no better than my school - Im confident the students they choose over me deserved it - I deal with it and move on; I suggest you do as well

rebuttal as requested

1. I don't believe I have called you names, and have tried to address the points you have raised that are not personal;but labelling me as a "douchebag" and "tool" is certainly a way to avoid dealing with the points I raise, and it most certainly is ad hominem argument (did you take any logic , let alone philosophy , courses in college ?)
2. Your agenda is manifest- you seem have an obsession to try to level all distinctions in training, perhaps even take down others whose "perceived" success you somehow feels threatens you ? all I said to start this "discourse" with you was I was impressed with Vandy and Penn, much more so than the usual suspects and tiresome list people post on this board (BW, UCSF, MGH, JHU) which I feel based on my interviews this winter are not really thoughtful and are a priori
3. I never said I was special - you raised that issue - (do you not feel special then ? who cares - why does one have to feel special anyway ? ) And just who in your mind is 'special" (are we to presume you feel no one is special, better, different ? Im cool with that aspirationally, but that doesn't make me deny what is in from of my face/reality test)
4. so people who attend /train at elite institutions are not "real people ? ? thats pretty cold bro- and dehumanizing by definition - I sure hope I don't match at an "elite " program or I will no longer be human...thats a pretty high price to pay
5. Im glad you matched at your number 1 choice, that's awesome ; we should all be so lucky (just remember though that doesn't make you "special" of course)..now that you are an MD with patient responsibilities and supervising interns/students Im sure we'd feel better though if you transfer the energy and time you have invested on this board into being the very best doctor you can be and proving your thesis instead of haranguing mS4s facing match day.

(BTW 15,000 posts ? get a life "mahn"..)

Im outta here..this is the last rise you'll elicit from me...

 

[golftrippy]

Deuce, you have really ramped it up a bit in the last few weeks. I'm not trying to come down on you...just chill a little. Who cares how Harvard med students ranked BW vs. MGH (didn't you, like myself, put UCSF #1?) and also I have to agree that while prestige is something its not everything, and its particularly not nassociated with training a clinician on routine internal medicine (for example, UTSW vs. BW--I would give the nod to UTSW for training competence in bread and butter medicine). Then again, this is like the pot calling the kettle black, I mean look at my list, I obviously value prestige, but I know it isn't and it shouldn't be everything. I am confident that bread and butter medicine is taught well almost anywhere. Anyway, good luck, hope to see you at UC!

 

[cardsorbust]

than to spend your evenings on this board trying to put Loma Linda on a par with Hopkins ?...strong work !..

Im sure (hope ?) you are a good doctor, but Im also quite certain you would have been even better trained at Hopkins - so would I - I wasnt accepted there as med student but that doesn't make me assume they were wrong, that it was no better than my school - Im confident the students they choose over me deserved it - I deal with it and move on; I suggest you do as well

rebuttal as requested

1. I don't believe I have called you names, and have tried to address the points you have raised that are not personal;but labelling me as a "douchebag" and "tool" is certainly a way to avoid dealing with the points I raise, and it most certainly is ad hominem argument (did you take any logic , let alone philosophy , courses in college ?)
2. Your agenda is manifest- you seem have an obsession to try to level all distinctions in training, perhaps even take down others whose "perceived" success you somehow feels threatens you ? all I said to start this "discourse" with you was I was impressed with Vandy and Penn, much more so than the usual suspects and tiresome list people post on this board (BW, UCSF, MGH, JHU) which I feel based on my interviews this winter are not really thoughtful and are a priori
3. I never said I was special - you raised that issue - (do you not feel special then ? who cares - why does one have to feel special anyway ? ) And just who in your mind is 'special" (are we to presume you feel no one is special, better, different ? Im cool with that aspirationally, but that doesn't make me deny what is in from of my face/reality test)
4. so people who attend /train at elite institutions are not "real people ? ? thats pretty cold bro- and dehumanizing by definition - I sure hope I don't match at an "elite " program or I will no longer be human...thats a pretty high price to pay
5. Im glad you matched at your number 1 choice, that's awesome ; we should all be so lucky (just remember though that doesn't make you "special" of course)..now that you are an MD with patient responsibilities and supervising interns/students Im sure we'd feel better though if you transfer the energy and time you have invested on this board into being the very best doctor you can be and proving your thesis instead of haranguing mS4s facing match day.

(BTW 15,000 posts ? get a life "mahn"..)

Im outta here..this is the last rise you'll elicit from me...

Owned.

 

[Doctor&Geek]

Deuce... ...didn't you, like myself, put UCSF #1?)...

If my guess is correct, and JDH is a current UCSF resident, Mr. Deuce had best be hoping not to match there.

 

[deuce]

somehow though I don't think you'll need it, and you will be a good doctor no matter where you train as you can be objective and thoughtful unlike some residents who stalk this board apparently (and we both know you are more likely to better doctor after spending time on Parnassus than "any old program"; )

and yes I DO know a number of UTSW docs- they are SUPERB -arguably as good if not better than say UCSF products, but Im sorry ; I know its not PC, but UTSW and say Loma Linda are hardly comparable-(there Ive said it again, Im a bad person- no , Im just not a "real person" I guess); where you train within reason makes little difference, this is however a significant difference; differences do exist no matter how painful it may be to acknowledge them)

PS- I wouldn't be caught "dead" though at UTSW, probably because I WOULD be dead (from overwork, sleep deprivation) ....like JHU its gratuitously difficult, like its some thoughtless, atavistic point of pride...

BTW- lets get off this point- I AM seriously/genuinely curious/ interested if anyone found hidden gems on their interview trips - the "surprises" for me were Penn and Vandy, but I recognize that these are hardly "unknowns"- when I was making out my list nobody was able to advise as to great (not just very good ) but less selective/known that are flying under the radar/less selective...the point im making is it was harder to decide what would be the last 2 programs to interview at rather than what was at the top of your rank list..and this is true for most applicants I suspect

 

[DrVanNostran]

Memories of p53 and bigfrank are popping my head.

 

[jdh71]

than to spend your evenings on this board trying to put Loma Linda on a par with Hopkins ?...strong work !..

Straw man. The irony. It burns my eyes and the and the goggles . . . they do . . . NOTHING!!!

Im sure (hope ?) you are a good doctor, but Im also quite certain you would have been even better trained at Hopkins - so would I - I wasnt accepted there as med student but that doesn't make me assume they were wrong, that it was no better than my school - Im confident the students they choose over me deserved it - I deal with it and move on; I suggest you do as well

Do they teach the super secret basic science there? The stuff we don't get in our "regular" text books?

1. I don't believe I have called you names, and have tried to address the points you have raised that are not personal;but labelling me as a "douchebag" and "tool" is certainly a way to avoid dealing with the points I raise, and it most certainly is ad hominem argument (did you take any logic , let alone philosophy , courses in college ?)

Did you take any logic or philosphy? All I did was insult you. There was no ad hominem. I adressed your silly points AND I insulted you. An ad hominem only occurs when the insult is the the argument itself.

I'll allow you to educate yourself

2. Your agenda is manifest- you seem have an obsession to try to level all distinctions in training, perhaps even take down others whose "perceived" success you somehow feels threatens you ? all I said to start this "discourse" with you was I was impressed with Vandy and Penn, much more so than the usual suspects and tiresome list people post on this board (BW, UCSF, MGH, JHU) which I feel based on my interviews this winter are not really thoughtful and are a priori

My argument that folks doing an IM residency generally have the same initial general medicine training clinically is not a political statement, nor is it an "agenda". I'm not threatened by anyone.

3. I never said I was special - you raised that issue - (do you not feel special then ? who cares - why does one have to feel special anyway ? ) And just who in your mind is 'special" (are we to presume you feel no one is special, better, different ? Im cool with that aspirationally, but that doesn't make me deny what is in from of my face/reality test)

Your whole posting here screams you think you're in some better class than many other people applying because you get certain interviews. I'm not the only one who has noticed this. I hope you'll note the OTHER replies you've gotten here. You see it's been said that ass-holes exists, they really do, and occasionally you actually run into one, but if you start running into like 3 or 4 or 5 in rapid sucession, then these are not the ass-hole, you are. Think about it. I'm really trying to help you out here.

4. so people who attend /train at elite institutions are not "real people ? ? thats pretty cold bro- and dehumanizing by definition - I sure hope I don't match at an "elite " program or I will no longer be human...thats a pretty high price to pay

Huh? Are you even paying attention? You're the one who said you were going to take your ball, go home, and interact with "real people" as opposed to online people. I said to tell them hello. Connect those dots, son. I might suggest going back and re-reading within context. As someone who MUST be supper smart by virture of where he was invited to interview, I am really surprised this wasn't more clear to a genius such as yourself.

5. Im glad you matched at your number 1 choice, that's awesome ; we should all be so lucky (just remember though that doesn't make you "special" of course)..now that you are an MD with patient responsibilities and supervising interns/students Im sure we'd feel better though if you transfer the energy and time you have invested on this board into being the very best doctor you can be and proving your thesis instead of haranguing mS4s facing match day.

(BTW 15,000 posts ? get a life "mahn"..)

The implication that I post on the forum must mean that I am 1) a bad resident and 2) someone who doesn't have a life. I enjoy this online community. I spend a lot of time in here and other places trying to help out, as well as killing time with friends I've met here. You're just mad because you're getting owned.

Im outta here..this is the last rise you'll elicit from me...

I'm betting not. You painted yourself in a corner now, because any further response to me and you've self owned yourself clown.

 

[jdh71]

Owned.

Are you ******ed?

Don't answer that question, because it is rhetorical.

 

[jdh71]

I know its not PC, but UTSW and say Loma Linda are hardly comparable-(there Ive said it again, Im a bad person- no , Im just not a "real person" I guess); where you train within reason makes little difference, this is however a significant difference; differences do exist no matter how painful it may be to acknowledge them)

Yes. You have said a lot of things (read: pulled them out of your ignorant ass). How is the traing at Loma Linda "hardly" comparable to UTSW? It's a pretty bold and douchbag statement. Now back it up cowboy.

 

[zestdoc]

.

 

[nene1985]

1. Baylor Houston
2. University of Maryland
3. UNC
4. UT San Antonio
5. University of Tennessee - Memphis
6. Texas A&M
7. UTSW
8. Baylor Dallas
9. LSU- New Orleans
10. George Washington
11. VCU
12. Jackson Memorial/ University of Miami

I am no rockstar, but I am happy with my list

 

[testicLfestival]

really - if you didn't believe there was a delta in where you trained you wouldn't even be reading this board, let alone commenting...and Ive worked with a number of great FMGS and some real a-holes/idiots who trained at very respectable US hospitals, but Ive clearly seen a much much higher level of average competence among the internists Ive been exposed to who trained at selective distinguished US programs and those that trained outside of US/Western Europe .. closer to 2 orders of magnitude as 1 order of magnitude...thats a pretty big delta; and why should that be at all remarkable given the vast range of standards, selectivity and reseorces between such prorgams ?

I AGREE 100% it makes no difference where one attends medical school, and I agree WITHIN A RANGE the difference is not all that great between the experience you get and the doctor you become from training at certain places (internship and residency, fellowship) and I agree that the difference is more profound in some specialties than others (neurosurg perhaps being the greatest, psych being the lowest) but do you really believe that say a Cleveland Clinic cardiac interventionist is not much more likely to be skilled, experienced and more knowledgable than one who trains at local community hospital , or even (ill choose one form every geographic region so nobody takes umbrage) LOma Linda, ECU, Temple, ST Louis U ? please -I know and you know who you will seek out when you need your first bypass

of course some people exaggerate the difference between various programs impact- but it is easily as fatuous to dismiss manifest and meaningful differences between programs and the impact they can have- may of the most selective programs are better environments to train simply because they have the resources, patient population and can be so selective about their staffs - (would you rather be treated after a train wreck for trauma at Stanford or MGH ? that wasn't so hard was it- and its not simply a brand issue - obviously most people would what to be brought to MGH, and you know what , they'd be right !) that doesn't mean they get it right all the time, or their aren't jerks at say UCSF, but places like JHU don't have people with any less character, people skills or industry than less selective programs -to assert otherwise is vain and/or naive- they certainly have more resources, a broader group of patients, and you are surrounded and being trained by uniformly ambitious and almost uniformly bright people who also had access to these advantages, and these training environments accumulate these advantages and compound them over decades;

all I said was that Vandy and Penn residents really impressed me as much or more than other top ranked places, geography aside- despite attempts to make distinctions between these level programs, they are every bit as auspicious and impactful places to train as Hopkins, BW, MGH etc, BUT that doesnt mean ether are not significant differences in the quality, impact and output of programs say within the first 100 programs, and doubtlessly the first 50, and arguably within the top 20 (top meaning the most selective programs). even if distinctions between the top 5,10 or even 15 are meaningless

its specious to convert that into an excuse for a diatribe about elitism - yes where you train does make a difference on what doctor you emerge /become, and all things being equal (as they are otherwise) I would rather have a physician, and be trained by physicians, who are more dedicated, industrious, intelligent, knowledgeable, and experienced - becoming a doctor is not a random, generic process, nor is it soley what you as an individual put into the training process - if it were it would have been industrialized and turned over the physician extenders long ago OR left as an apprenticeship pre/flexner-

and if you believe practicing quality medicine is a matter of plugging patients into rule out templates and not thinking, I cant gainsay your argument...but who will be the doctor who picks up my dissecting aneurysm when I am 42, ie the outliers, the subtlties etc?

Man deuce, you really got epically owned. Jdh has an excellent point, and he crushed you with his almighty fist of logic. Jdh knows, as do we all, that all doctors are created equal. No one is better or worse at various programs, or at least if they are, you can’t tell by their credentials in the slightest. For example take these two candidates:

Physician 1
Trained at top schools, crushed the MCAT, all steps, and all shelfs, while showing a consistent pattern of excellence throughout life. Most evaluators in his college, med school, and residency said he was the best they’ve ever seen. In his spare time he balances hobbies with continually learning medicine. He goes to a top residency program based on his pattern of excellence and his choice to be around what he perceives are like-minded people. He also enjoys the research opportunities present at this major research institution because he wants to move medicine forward. Though as you can see, he got in not because of merit, but because of “politics.”

Physician 2
Most IQ tests he took placed him at or just above mental ******ation. After struggling to get a 2.2 GPA in undergrad and a 12 on the MCAT, a Caribbean med school reluctantly takes him. He fails step 1 and 2 on the first try, then barely passes. Does his rotations at many community hospitals, with mediocre or very poor evals. He believes that vaccines cause autism, that swallowing gum will make it stay in your system for seven years, and that if you cross your eyes for too long they might stick that way. He eventually ends up going to a small community IM program no one ever heard of. Other programs didn’t want him, “politics” kept him out.

Assuming they both finish residency around the same time, we can expect the exact same quality of medicine to be practiced from each, ok son. For example son, a chest pain rule out is the same across the board, therefore medicine is the same across the board and will be practiced in more or less the same way. There are no secrets, no magic! And if a patient has a difficult to diagnose disease, each of the above physicians is clearly equally likely to nail it, son. And since textbooks are standard, it’s only perfectly logical that people at MGH are reading textbooks just as frequently as people at Podunk community hospitals. And since we already know that the relative IQs of both are equal – obviously, I don’t think I have to justify that at all – then we can assume they will retain the same amount after reading, ok sport? C’mon kiddo, this is clear as day, elders like us see past the veneer of politics into what real medicine is all about: assuming that quality is completely uniform, or at least immeasurable. And IM board pass rates of programs? Utterly meaningless, as are all standardized tests.

Child, to think otherwise, that quality of physicians differs and may actually be even a little bit measurable, is political BS and makes you an elitist a-hole. Youngster, why are you the only one that can’t see this? We’re just trying to save you from your douchebagery, cowboy. To think that any difference exists between Physicians 1 and 2 in the above example is preposterous nonsense, champ. Clearly the people at Hopkins, UCSF, MGH, etc. are just researchers who don’t actually know medicine, son, just how to write grants and talk about how cool they are. It’s some meaningless private club. And when they write the very same textbooks and journal articles that dictate how the world practices medicine, don’t give them any credit, at least not as trainers and teachers of medicine that may improve your education more than some Joe Schmo random doc. Small tiny child, let me explain this to you in terms even you can understand, there is absolutely no difference between the people at the “best” programs or the “worst.” To draw any other conclusion, that maybe even a flicker of generalities can be established between people at programs, will get you nailed on here, so don’t even try. Tools like you make me want to bite off my own genitals.

Oh and if you ever get a chance to go to the congo and you happen to get malaria or break your leg or something, no worries. You’ll be taken care of by some of the finest FMGs. Please don’t tell me you also actually think foreign trained people aren’t as well educated too. Though an elitist like yourself would probably have the gall to actually think that American physicians are better trained than their 3rd world counterparts. Jerk. Seriously, what’s wrong with you? The congo has excellent medical care and I’d feel completely safe being treated there by some of the finest medical geniuses. Every single IM program in the world is exactly the same in training. Everyone is equal. No one is better or worse. Suck on that you classist. Over and out. Peace.

 

[jdh71]

 

[jdh71]

You can all even continue creating new troll accounts for the event!

 

[testicLfestival]

You can all even continue creating new troll accounts for the event!

When I first started reading these things I thought the definition of troll was anyone who said something someone else didn't like or think was true. The term gets tossed around with the slightest breeze. People are very sensitive. Then I learned a more formal definition "someone who posts inflammatory comments with the hope of provoking others emotionally.” First, I think as the term is used on SDN, I was actually right the first time. And second, if we use the more formal definition, I'd say people who claim that training is equal across the board is a much more controversial assertion.

But whatever, let’s get back to the topic at hand, ranking. But just so everyone knows, whether you go to JHU or community hospital of Kansas, they’re exactly the same for training purposes, so really this rank thread doesn’t matter.

 

[jdh71]

When I first started reading these things I thought the definition of troll was anyone who said something someone else didn't like or think was true. The term gets tossed around with the slightest breeze. People are very sensitive. Then I learned a more formal definition "someone who posts inflammatory comments with the hope of provoking others emotionally.” First, I think as the term is used on SDN, I was actually right the first time. And second, if we use the more formal definition, I'd say people who claim that training is equal across the board is a much more controversial assertion.

But whatever, let’s get back to the topic at hand, ranking. But just so everyone knows, whether you go to JHU or community hospital of Kansas, they’re exactly the same for training purposes, so really this rank thread doesn’t matter.

So what you're saying is that you didn't create a new account for the sole purpose of replying to me in this thread in the manner that you did? Interesting.

Would you like to tell me how the clinical training of general internal medicine at Hopkins is that much different than a community hospital in Kansas?

 

[texasguy]

Clearly the people at Hopkins, UCSF, MGH, etc. are just researchers who don’t actually know medicine, son, just how to write grants and talk about how cool they are. It’s some meaningless private club. .

yeah, no chip on this guys shoulder at all...

 

[deuce]

I didn't realize that this would be in question, although apparently it is. I would assert there is obviously a very broad range in the quality of physicians; if anyone disagrees I would suspect they have been 1) fortunate to have avoided all the low level FMGS from less developed nations practicing in this country, as well as poorly trained supervised lazy thoughtless american grads or 2)never been exposed to a really exceptional doctor. No matter where we've gone to med school, Im confident that not the case. Ive personally seen amazing feats performed at destitute inner city hospitals and real screw ups at harvard teaching hospitals.

so if there are demonstrable and very significant differences in the quality of physicians, what ARE the inputs/crucible that make that great physician ? I believe the important personal characteristics are imbedded prior to medical school, but its really really hard to assert that these qualities are not at least as evident/prevalent in Harvard, Duke , Penn med students/housestaff as they are say Loma Linda, Yale or Podunk U. Becoming an excellent doctor requires you bring the right stuff to the table, but also to be taught by outstanding, knowledgeable, dedicated (yes ambitious in the sense that they strive for excellence) mentors/housestaff, see a broad variety of sick patients with graduated and extensive autonomy, etc. , and a reasonable education/service environment/support structure. That will happen at say both UCSF and UTSW (although the latter will get less sleep probably !)... I don't know precisely where the cut off is, its probably not black or white, but it is a continuum within reason; and maybe the poster is correct that Loma Linda (using this institution as a place holder) trainees are closer in quality to Hopkins grads than many imagine, but to assert they are better than Hopkins trained physicians is bizarre and unconstructive (its also incoherent and internally inconsistent to assert all are equal, but the turn around and insist program X is better than an environment with an order of magnitude greater resources, patient base, etc, almost counterintuitively as its lower "ranked")

Before this back and forth I never realize how deep some of the scars are from the trauma and stress of all the years of pre med. med school and match for some (many ? ) med students - I regret that I seem to have inadvertently touched this nerve, and I am reminded (but didn't need to be) that yes I am not special, but I have been very fortunate to avoid this trauma that seems that make otherwise (presumably?) bright people say silly and embarrassing and regrettable (let alone unprofessional) things. JDH I wish you nothing but great success and more importantly peace in your career, and if you have to come to this board to vent so you can employ every ounce of compassion toward your patients I understand and embrace that better now.

I would end by insisting that one of the things that characterizes our best medical institutions training environments is precisely that they DONT accept anything less than excellence - if any of us rise to that level, it will be recognized eventually, and be facilitated, (perhaps greatly so) but not determined , by where we train.... and Somehow I don't think the residents - even any arrogant ones - are slacking tonight at JHU, MGH etc; quite the opposite..Regardless of where posters are training - or will train next year- thats something we can all aspire to -lets not denigrate/rip each other up-


and Nene - tells us more about Maryland ! thats a long way from the Lone star state - you must have been really impressed to rank it 2 ove programs like UTSW- (obviously it wasn't the barbecue or low taxes!) - what stood out for you ?

 

[jdh71]

I didn't realize that this would be in question, although apparently it is. I would assert there is obviously a very broad range in the quality of physicians; if anyone disagrees I would suspect they have been 1) fortunate to have avoided all the low level FMGS from less developed nations practicing in this country, as well as poorly trained supervised lazy thoughtless american grads or 2)never been exposed to a really exceptional doctor. No matter where we've gone to med school, Im confident that not the case. Ive personally seen amazing feats performed at destitute inner city hospitals and real screw ups at harvard teaching hospitals.

so if there are demonstrable and very significant differences in the quality of physicians, what ARE the inputs/crucible that make that great physician ? I believe the important personal characteristics are imbedded prior to medical school, but its really really hard to assert that these qualities are not at least as evident/prevalent in Harvard, Duke , Penn med students/housestaff as they are say Loma Linda, Yale or Podunk U. Becoming an excellent doctor requires you bring the right stuff to the table, but also to be taught by outstanding, knowledgeable, dedicated (yes ambitious in the sense that they strive for excellence) mentors/housestaff, see a broad variety of sick patients with graduated and extensive autonomy, etc. , and a reasonable education/service environment/support structure. That will happen at say both UCSF and UTSW (although the latter will get less sleep probably !)... I don't know precisely where the cut off is, its probably not black or white, but it is a continuum within reason; and maybe the poster is correct that Loma Linda (using this institution as a place holder) trainees are closer in quality to Hopkins grads than many imagine, but to assert they are better than Hopkins trained physicians is bizarre and unconstructive (its also incoherent and internally inconsistent to assert all are equal, but the turn around and insist program X is better than an environment with an order of magnitude greater resources, patient base, etc, almost counterintuitively as its lower "ranked")

Before this back and forth I never realize how deep some of the scars are from the trauma and stress of all the years of pre med. med school and match for some (many ? ) med students - I regret that I seem to have inadvertently touched this nerve, and I am reminded (but didn't need to be) that yes I am not special, but I have been very fortunate to avoid this trauma that seems that make otherwise (presumably?) bright people say silly and embarrassing and regrettable (let alone unprofessional) things. JDH I wish you nothing but great success and more importantly peace in your career, and if you have to come to this board to vent so you can employ every ounce of compassion toward your patients I understand and embrace that better now.

I would end by insisting that one of the things that characterizes our best medical institutions training environments is precisely that they DONT accept anything less than excellence - if any of us rise to that level, it will be recognized eventually, and be facilitated, (perhaps greatly so) but not determined , by where we train.... and Somehow I don't think the residents - even any arrogant ones - are slacking tonight at JHU, MGH etc; quite the opposite..Regardless of where posters are training - or will train next year- thats something we can all aspire to -lets not denigrate/rip each other up

There's no "trauma" here I got into the medical school I wanted on the first try. I got the exact residency I wanted. I got the exact fellowship I wanted. My response to you has nothing to do with you getting what I wanted, but with you being an elitist douchebag. One that can't even keep together what the actual argument is here . . .

The fact that you could actually write all of what you've said with a straight and serious face frightens me. I'm actually horrified that people like you exist. I mean you hear about your kind, but then to actually run into one . . . I'm not entirely sure what kind of "trauma" (or small penis) you've had to encounter that has necessitated your overcompensation is such large amount here, but I really feel bad for you. I'd bet a dollar it really sucks to be you and most people don't even really like you much.

The irony not to mention the temerity of your last statement after all you've already said here in this thread is something I'd find funny, if it wasn't so ****ing sad, pathetic, and intellectually dishonest.

Good luck at UCSF

EDIT: Urban dictionary is your friend

 

[TheIM]

I can't believe you guys feel like you are better doctors-to-be (or just better than other people) based on where you went to medical school... Elitist and condescending are only very mild terms to describe your views.

I've never heard anyone at UCSF express this opinion outright, but it makes me wonder...

 

[deuce]

nobody is suggesting that the med school you attend makes you a better person, or a difference - esp a US med school - in the quality of doctor you will be -

the issue is whether where you train for residency/fellowship, certainly up to a point, will make a difference in the quality of medicine you will / will be able to practice. Several of us feel it is highly relevant, esp at the margins broadly defined - others feel its irrelevant, or the margins are so narrow as to be moot.

After you review the thread with this in mind, let readers of this thread know what you think, and what inputs you believe make the difference between great and less than great docs

 

[gutonc]

All users are reminded to keep the discussion civil and on-topic.

 

[fibrillator]

So what you're saying is that you didn't create a new account for the sole purpose of replying to me in this thread in the manner that you did? Interesting.

Would you like to tell me how the clinical training of general internal medicine at Hopkins is that much different than a community hospital in Kansas?

A community hospital in Kansas will refer out complicated cases. Jhu will take any patient. You are exposed to sicker pts and more variety of pathology at Jhu. And you are expected to handle it. This makes you a confident, more experienced doc when difficult diagnoses or treatments come your way. I think that s universally accepted.

 

[jdh71]

A community hospital in Kansas will refer out complicated cases. Jhu will take any patient. You are exposed to sicker pts and more variety of pathology at Jhu. And you are expected to handle it. This makes you a confident, more experienced doc when difficult diagnoses or treatments come your way. I think that s universally accepted.

The original discussion started here:

...Vanderbilt remains the enigma for me on this list too..I was very impressed with the people, knowledge program and facilities, but it was a bridge too far for me- Im not from the south, Im not married, and this was just too traditional, too southern...I will never question the ability of vandy trained people after my visits though - really good docs, on par with Penn - residents at these places really impressed me with their comments and knowledge at rounds., more so than even JHU, MGH , BW or UCSF...I think Penn and Vandy are way underrated due to geography

My response:

Why would you question the clinical ability of anyone simply by virture of where they trained?

"ZOMG. That person trained at a community program. They suck at medicine. Owned. Lawl."

You see, you cannot question someone's ability unless you've actually had a chance to see it. Now not all doctors are created equal. You'll have amazing docs coming out of community programs despite their lack of exposure to transplant patients for instance, and you'll have bone heads come out of elite programs as well. I was addressing an asinine categorical error bound up with a touch of psychological narcissim and elitism, NOT making the claim that all trained IM physicians are the same . . . I find it interesting that you all continue to argue this strawman despite my pointing out this was not my argument more than once.

And if what you all really thought was: all you needed to become a great doctor was exposure to wild and diverse pathology, then you'd all be clamoring to get into USC, Cook County, and SUNY Downstate . . . but you're not . . . why not?

Part of what makes a UCSF a UCSF, is the clinical training. The county, the U, the VA . . . and it would be my personal opinion that this is the best kind of recipe you can hope for in a training program, clinically. However, this is simply not enough to make the categorical assumption that a doc coming out of there is good and one coming out of anywhere else is no good.

What makes the top programs top is much more than clinical training - it is the academics. The research. The world experts. The tertiary and even quaternary referal that places like Hopkins and UCSF and Mayo get on a regular basis. It the entire milieu that comes together to make these places what they are, and none of that equals "better physician" by itself.

I hope this clears this up.

 

[deuce]

as training centers - in theory and historically probably yes, currently and actually, no- in a word, funding, resources and staff - Bellevue, Philly General (now defunct) used to be the most sought after residency slots in the country prior to WW2 for example, but most county hospitals are bordering on financial collapse and residents perform too many ancillary services to max out on their education/time to study/reflect/attend conferences/take electives, and there are too few faculty with sufficient protected time to devote to teaching .... Thats the big difference between say JHU/MGH and Grady, Boston Medical/City, LA County, Kings County, Cook County etc, even Parkland, SFGH. same 1,000 beds, trauma center, severity of pathology, same autonomy, more back up, deeper benches, more resources, less scut, more didactics time, and far more unusual cases as well.

That doesn't mean these aren't great places to train, it does mean you will be working much harder doing non educational tasks and have less broad exposure to cases, less time to study and sleep, fewer people to teach you.

 

[texasguy]

most county hospitals are bordering on financial collapse and residents perform too many ancillary services to max out on their education/time to study/reflect/attend conferences/take electives, and there are too few faculty with sufficient protected time to devote to teaching .... Thats the big difference between say JHU/MGH and Grady, Boston Medical/City, LA County, Kings County, Cook County etc, even Parkland, SFGH. same 1,000 beds, trauma center, severity of pathology, same autonomy, more back up, deeper benches, more resources, less scut, more didactics time, and far more unusual cases as well.

excellent point, deuce.

that being said, how can we judge which programs will have faculty with more protected time to devote to teaching and mentoring, especially for those of us who want to stay in academics? and similarly, which programs will give US more time to study/learn/find time to associate ourselves w/ a lab in which to do any kind of research rather than simply logging long hours on the wards...

 

[Instatewaiter]

If my guess is correct, and JDH is a current UCSF resident, Mr. Deuce had best be hoping not to match there.

There is no one from loma linda at UCSF.

I went to med school at Loma Linda and I'd put anyone coming out of their IM program up against one of Osler's marines any day of the week. Let me try this again, and this time I think I'll slow it down some, and avoid using any of the "big" words: the relative ranking of academic programs is because of academic politics, NOT clinical training.

You've got to be joking. I know you are trying to make a point and thought the same thing too before residency. However, after seeing the difference between the clinical acumen of the seniors where I went to medical school and where I am now a resident it is astounding- and the IM program I came from is a pretty decent program. Those big name programs are big named because they offer the best clinical training too, not just because they have strong research.

Would you like to tell me how the clinical training of general internal medicine at Hopkins is that much different than a community hospital in Kansas?

1) Hopkins/MGH/insertbigprogram has the clinical leaders in the field. The community program in Kansas has people who couldn't get a job elsewhere... so they're in Kansas. So instead of some third rate clinician, you get the best clinical instructors. I was astounded that there really was such a difference between the attendings where I went to med school and where I am in residency.

2) Big Programs attract the best and brightest residents, nurses etc from around the country. That makes you better

3) At these programs, the patients are much sicker. Those floor/step down patients at say Hopkins would be in the ICU in the community hospital in Kansas and the ICU patients would get sent out. You are exposed to a higher acuity of cases.

4) The cases no one can figure out, get sent to a place like hopkins to get figured out

5) Many things just arent offered at a community program so you aren't exposed to many things in your training: end stage liver/heart/lung/kidney failure, new endoscopic treatments.

6) Having seen what gets done in the community, I can say definitively the care is very, very different at a tertiary/quarternary care center

 

[jdh71]

excellent point, deuce.

that being said, how can we judge which programs will have faculty with more protected time to devote to teaching and mentoring, especially for those of us who want to stay in academics? and similarly, which programs will give US more time to study/learn/find time to associate ourselves w/ a lab in which to do any kind of research rather than simply logging long hours on the wards...

You'll have to ask residents, especially the kind wanting to stay in research. Mentoring is a tricky bitch, as I'm sure you know being a PhD. You can pick a big name, but if he spends all of this time traveling the world giving lectures, sitting on boards, and editing journals, you may not get the kind of time you're looking for.

The culture and support for research by residents will be different at different programs, and the only way to know is to dig, ask question, and eventually interview and see if the fit seems right.

Though research specific tracks have it spelled out how much time can be used by a program for any given resident on a research track for wards versus lab.

 

[deuce]

and why places like the usual suspects end up at the top of many peoples lists - most of these IM programs are associated with hospitals that are very financially viable as they draw a large paying referral base - and are associated with a well endowed medical school- you probably need a tight academic focus to keep the money making, private practice or community hospital orientation in check (which tend to put places like Cleveland clinic and cedars sinai at a relative disadvantage compared to say the otherwise comparable Mayo and UCLA as an ideal training venue), so institutional solvency is not everything - some places with great marquees and medical school affiliations struggle a bit because the hospital is the weak link financially largely due to location and surrounding demographics (you can imagine how much better off Columbia presbyterian would be in palo alto and how much worse off stanford would be in upper harlem) and places like Penn, UCSF are able to balance things out and overcome having to treat many poor people by having huge research funding support to cross subsidize clinical training even if only indirectly; being the only referral game in town helps competition wise for patients (although the harvard hospitals seem to defy that , but Boston is very much a one off town in this regard due to its international referral base, 96% plus patents with insurance, ability of all hospitals to charge high fees, and huge research dollars going to all four main harvard hospitals - e.g., BIDMC would seem to be a simple tony community hospital en face , but its research dollars would put it among the top twenty medical schools; so its hardly your "fathers " usual community hospital; it resembles Yale NHH, Vanderbilt far more than Newton Wellesley, Summit, Fairfax Innova or even Cedars- Sinai)

you get the hang of this matrix if you get to see a broad mix of programs/locations in your interviews; so apply broadly and keep your eyes open ; one thing I do know, you are not apt to see these distinctions if you convince yourself going in that they don't exist -being objective, and keeping an open mind is important, in this process as in all things in medicine.

 

[jdh71]

There is no one from loma linda at UCSF.

The website says differently . . .

EDIT: I graduated with a guy who went there for IM. LLU sends one there every couple of years.

You've got to be joking. I know you are trying to make a point and thought the same thing too before residency. However, after seeing the difference between the clinical acumen of the seniors where I went to medical school and where I am now a resident it is astounding- and the IM program I came from is a pretty decent program. Those big name programs are big named because they offer the best clinical training too, not just because they have strong research.

1) Hopkins/MGH/insertbigprogram has the clinical leaders in the field. The community program in Kansas has people who couldn't get a job elsewhere... so they're in Kansas. So instead of some third rate clinician, you get the best clinical instructors. I was astounded that there really was such a difference between the attendings where I went to med school and where I am in residency.

2) Big Programs attract the best and brightest residents, nurses etc from around the country. That makes you better

3) At these programs, the patients are much sicker. Those floor/step down patients at say Hopkins would be in the ICU in the community hospital in Kansas and the ICU patients would get sent out. You are exposed to a higher acuity of cases.

4) The cases no one can figure out, get sent to a place like hopkins to get figured out

5) Many things just arent offered at a community program so you aren't exposed to many things in your training: end stage liver/heart/lung/kidney failure, new endoscopic treatments.

6) Having seen what gets done in the community, I can say definitively the care is very, very different at a tertiary/quarternary care center

Training is what you make of it. And the difference you speak about are really those that occur at the extreme ends of the clinical spectrum. You're not managing basic pancreatitis for instance any different than anyone else. Bread and butter is bread and butter.

It sounds to me like you've drank the kool-aid and found it much to your liking. It's good for the ego . . .

 

[infarct]

THIS THREAD MAKES ME WANT TO SWALLOW A LIVE SCORPION. Can we please end the *#*# measuring contest. WHO CARES!!?!???!?!

I thought this was about rank lists...

 

[jdh71]

THIS THREAD MAKES ME WANT TO SWALLOW A LIVE SCORPION. Can we please end the *#*# measuring contest. WHO CARES!!?!???!?!

I thought this was about rank lists...

There are some important points being made here, even if things went on a tangent.

The a priori assumption that you are automatically a better physician for doing residency in certain places compared to others isn't going to stimulate a rank list posting by anyone except for those able to put up a list of programs that the clique agrees is good, or you've now demonstrated how much you suck and how horrible physician you are going to be. It's an asinine insult to the thousands of folks who trained at any program outside of the clique's agreed upon "good places".

Hell. Why don't we simply shut down all residency programs except for those at UCSF, Hopkins, Penn . . . everyone else is just learning how to kill people . . .

 

[cardsorbust]

There are some important points being made here, even if things went on a tangent.

The a priori assumption that you are automatically a better physician for doing residency in certain places compared to others isn't going to stimulate a rank list posting by anyone except for those able to put up a list of programs that the clique agrees is good, or you've now demonstrated how much you suck and how horrible physician you are going to be. It's an asinine insult to the thousands of folks who trained at any program outside of the clique's agreed upon "good places".

Hell. Why don't we simply shut down all residency programs except for those at UCSF, Hopkins, Penn . . . everyone else is just learning how to kill people . . .

Fine let's shut down the other killing factories but while we are at it can we please shut down the pretentious nonsense going back and forth. The lists are in everyone. Enjoy life.

Awaiting some intelligent retort that includes ad hugedongicus name-calling such as douchebag, ******ed, etc.

Warmly,
This here pilot flying F18s fueled by tiger blood

My doctor said Mylanta.

 

[NOsquid]

most county hospitals are bordering on financial collapse and residents perform too many ancillary services to max out on their education/time to study/reflect/attend conferences/take electives, and there are too few faculty with sufficient protected time to devote to teaching .... Thats the big difference between say JHU/MGH and Grady, Boston Medical/City, LA County, Kings County, Cook County etc, even Parkland, SFGH. same 1,000 beds, trauma center, severity of pathology, same autonomy, more back up, deeper benches, more resources, less scut, more didactics time, and far more unusual cases as well.

That doesn't mean these aren't great places to train, it does mean you will be working much harder doing non educational tasks and have less broad exposure to cases, less time to study and sleep, fewer people to teach you.

I've seen exceptional teaching at a run-down county hospital, and crappy ancillary services and scut at an academic medical center. Some people like to teach, some don't. I'm sure there are plenty of renowned experts at big academic centers that both dislike and suck at teaching - just doing mandatory clinical duty. In the same way some nurses and social workers suck, some don't. There is something to be said for the general culture of an institution but making a residency choice based on the assumption that "big name" brings with it the best of all these things is silly IMO.

If you meet an exceptional doctor from MGH, chances are he would have been 99% as exceptional had he trained anywhere else. Maybe he did get a rare case and some published research while he was at the cachet residency program, but if you think experience treating tsutsugamushi fever and expertise in micro-RNA makes someone a better doctor you're mistaken IMO. If you enjoy medicine (ie you read), you care about your patients and you are willing to put in the time I think you'll do well.

Personally, some of the most miserable residents I know are at big name programs. They'd do it again, because they want certain fellowships but as far as making your a better doctor...? I highly doubt any of the ones I know would say that.

The community program in Kansas has people who couldn't get a job elsewhere... so they're in Kansas.

Let's not get carried away (no I'm not from the midwest). There are great people everywhere, for many reasons. Family, salary, not wanting to put up with pretentious residents at big name programs...

2) Big Programs attract the best and brightest residents, nurses etc from around the country. That makes you better

This is true and a big attraction I think. But, they also attract their share of exceptional dbags so at some point it becomes a question of the compromises you're willing to make. How motivated are you on your own? Do you need to be pushed by your fellow residents? Might you end up stabbing the next cards-gunner who whips out his calipers to read an EKG (only when staff are watching of course)? I think for the most part people don't struggle with these questions nearly enough during match, it's hard not to go for the "best." To a huge extent I believe the reputation of doctors from these programs is because of the smart people who go there, not because of anything the program is doing. It's an endless cycle that isn't going to break anytime soon.

I don't know why people are so intent on trying to prove that these programs make better doctors? Does it make you feel special? Go there, you'll get a great education and a resume that everyone will respect. But it's quite petty to poop on everyone else...the only thing that's beyond question is the reputation of the top programs and that this will open doors for you. Whether it's deserved or not isn't something we're going to solve on the interwebs.

One man's opinion Get the stick out of your asses people, help the sick/live the dream. We're all doctors! We've spent most of our adult lives trying to be better than everyone because medical education breeds maladjusted gunners who (for the most part) would have trouble making it in the real world...chill!

 

[jdh71]

Fine let's shut down the other killing factories but while we are at it can we please shut down the pretentious nonsense going back and forth. The lists are in everyone. Enjoy life.

Awaiting some intelligent retort that includes ad hugedongicus name-calling such as douchebag, ******ed, etc.

Warmly,
This here pilot flying F18s fueled by tiger blood

My doctor said Mylanta.

Don't hate me because I'm a rockstar from Mars

 

[Instatewaiter]

The website says differently . . .

EDIT: I graduated with a guy who went there for IM. LLU sends one there every couple of years.

Yeah I didn't even look in the intern class since I know you are not an intern. So, where are you a resident?

My guess is USC?

THIS THREAD MAKES ME WANT TO SWALLOW A LIVE SCORPION. Can we please end the *#*# measuring contest. WHO CARES!!?!???!?!

First, watch out you don't get pancreatitis when you swallow that scorpion
Second, SDN would be boring as hell if not for stupid arguments.

How motivated are you on your own? Do you need to be pushed by your fellow residents? I think for the most part people don't struggle with these questions nearly enough during match, it's hard not to go for the "best." To a huge extent I believe the reputation of doctors from these programs is because of the smart people who go there, not because of anything the program is doing. It's an endless cycle that isn't going to break anytime soon.

I think everyone needs to be pushed and a lot of the big name programs are known to "push" their residents. That is what I think makes you be the best doc you can be. But what would I know? Apparently I drank the coolaid already.