silly? FAR superior?🙄 ok, i'll bite.
dude, when they were passing out that kool-aid you just went ahead and started downing by the pint! it is daft to think that everything is rosey in durham...
first, my point was that you are just not in the duke icu as an intern- there is a difference in acuity and learning. as i said you are at the va icu as an intern (not drh)...
As a current Duke resident and an enormous fan of the program, I'd be remiss not to comment here. I don't mean to hijack this thread and turn it into a Duke discussion, but there are several factual inaccuracies being propagated here, and several unfair assumpations as well. I could go on and on for pages about the virtues of this program, but I'll try to be brief.
But first, a preface to my comments. Ultimately, I think the important take-home message for these last days of the rank-list process should be that the nitty-gritty details of a program's rotation structure really should NOT be the determining factor in your rank list. In other words, I wouldn't worry about ICU time, number of call months, etc....every program is so different that you really can't make direct comparisons fairly, so you just end up making decisions based on inaccurate information and/or assumptions. This is crystal clear based on the numerous inaccuracies in some of the above posts. What's far more important, on the other hand, is how you're treated, how you're valued, what kind of support you have, what sort of an educational climate you're in, what kind of resources and funding support are available, and ultimately, what kind of people you'll be working with. And in this regard, it's impossible to go wrong with Duke. The culture here is quite different as compared so many of our peer / "ivory tower" institutions. I'd also like to add that despite what happened with the match, our intern class is incredibly strong, and will no doubt continue the tradition of excellence at Duke, both in terms of EBM strength, quality of clinical skills, and great fellowship matches. Just because someone had to scramble doesn't mean they're somehow bad candidates; it's incredibly difficult to match into certain competitive specialties!
For those who can't resist the nitty-gritty though (and I too was guilty of this during the match process) I should make some corrections here. First, Duke interns do NOT rotate through any VA ICU, as was stated incorrectly above. Here's the general critical care structure, roughly speaking:
-intern year = 4 weeks of Durham Regional ICU, 4 weeks of Duke CCU (the former being non-call and more procedure-based learning, and also incredibly well-liked by recent intern classes)
-JAR year = 6 weeks of Duke MICU, 4 weeks of Duke CCU (both overnight call; some may do a few weeks of VA CCU instead)
-SAR year = 4 weeks of VA MICU, and some do a few weeks of Duke or VA CCU as well, depending on your interests
What doesn't come through in this schedule though is the reasoning behind it, and the acuity of illness you'll face as an intern at Duke. Ultimately, an intern isn't ready to be in the Duke MICU, especially right out of 4th year. It's not at all uncommon for there to be 15 ventilated patients out of the 16 beds, 8 of whom are managed by each resident, while also doing consults on the floor/ED and carrying one of the code pagers. It's an unbelievable learning experience that would just be too much for the great majority of interns, no matter how good they might be. But this doesn't mean interns miss out on critical care. We have patients out on the wards that would be unit-worthy at most hospitals, and owing to the quality of our nursing staff and housestaff we take great care of these people and do so safely (but we could certainly use more MICU beds, which is true at most hospitals these days). In other words, it's not at all fair or accurate to assume that Duke interns somehow don't learn how to take care of sick patients just because they don't rotate through the Duke MICU. Rather, most of us would argue that we're better off with our current system, as the 2nd years gain much more from the ICU experience than they would as interns, and come out of the 2nd year more well-prepared to manage sick patients beyond just the intern-level. The capstone ICU experience, then, is the VA MICU one, whereby as a 3rd year you get to run the 8-bed MICU at the VA, with no fellow there at night. This is one of the most rewarding rotations for us, and is incredibly well-liked. And if you ask a fellowship program director about the clinical prowess of Duke residents, chances are they'll extoll it in several of the fellows they've matched from our program, and will often tell you how sought-after we are for this reason, in addition to our unsurpassed EBM training (this happens a lot on the fellowship interview trail actually).
I'm not in any way dismissing your feelings and intuitions about Duke, but it's important to have accurate information when making such an important decision. I'd also caution against any assumptions about the match at Duke this year. I've heard from several of those who are "in the know" that we actually had unprecedented interest in the program this year, especially in terms of people doing second-looks, writing first-choice letters, etc. The quality of applicants has apparently been quite phenomenal this year as well (from the mouth of several people who did the majority of the interviews for our program). Now, this shouldn't affect how anyone ranks us...you should always rank based on your own preference, regardless of how you think a program will rank you...but it's probably not wise to assume that this won't be a great match year for us, and to then use this assumption in your decision-making process. With the applicants I've met and the things I've heard, we're actually geared up for what is likely to be one of the best matches we've ever had! One of our largest weaknesses in the recent past, in my mind, is our failure to more actively discuss the countless strengths and unique features of our program. This year, that all changed, with the new website and re-designed interview process, and it looks like we're poised to reap the rewards.
So don't count Duke out!
🙂
And if anyone has specific questions about the program, don't hesitate to ask. I'd be happy to help.
(also, the comment about Duke not having a "GIM department" really isn't true; we have a division of general internal medicine that's housed within the Department of Medicine. While technically not a "department," most places I've been to don't have a GIM "department" either, and some of this is just semantics. I'm not sure what to say about GIM faculty leaving either...it's just not true! Every med center has some people come and go, but it's not like there's been some sort of mass exodus. In fact, we have a well-established, very respected GIM group, with several members doing incredible health services research, among other things. We also have an exploding hospitalist group, many of whom are teaching faculty for our program, and are among some of the most well-loved.)