Opinions on “top” pediatric programs

[chickenlittle17]

Advertisement - Members don't see this ad

What are people’s opinions on programs at CHOP and BCH? Are these programs best left untouched because of a malignant rep and catering more towards fellows? Or have people enjoyed their training there? Any thoughts appreciated.

 

[mvenus929]

I don't have any particular opinion/thought about those specific programs, but in general, I will say it depends on your career goals. If you want to live in that area long term, or are planning on subspecializing, you will likely get good education there. If you're planning on being a general pediatrician in a rural community, probably not the best option for you because you will depend on subspecialists a lot in your training.

 

[BigRedBeta]

I wouldn't say they are malignant, but anyone going there to be a general pediatrician needs to fully consider what the consequences of that decision will be.

Many of the most highly ranked children's hospitals are quintenary referral centers with exceedingly rare pathology. That's ideal for fellows, but not so much for peds residents in my opinion (it certainly is not stuff that shows up on Peds Boards with any regularity). Having done fellowship at a top 10 center, the quote that sticks out to me from one of my residents at the time is one who said "all I learned to do intern year was dose Tacro". That's probably overly dramatic, but is demonstrative of the type of experience you get at these places. There's still bread and butter stuff but it ends up being a much lower proportion of you patient load than it ends up being at other "lesser" places.

More concerning for career development of anyone though is the level of independent decision making these places fail to foster in their graduating residents. While peds residencies are never going to be IM training programs, there are still programs out there that expect residents to develop skills and graduated responsibility because they recognize that some people will be jumping to independent practice a week after leaving the Ivory Tower. When you have a row of fellows to fall behind it's very easy to just go along for the ride as a resident. Sometimes is not even other trainees that are taking jobs from you. I remember interviewing for residencies and some places had techs available to cast and suture patients without the residents ever getting a chance to see those cases. It was pitched as "you'll get to focus on the actual sick kids" while ignoring the fact that those are real, necessary skills to have for a number residents whether they are going on to a fellowship (such as Adolescent or PEM - and there have been at least a couple times I close lacerations in the middle of the night in the PICU rather than call in another service) or to general peds jobs.

 

[tantacles]

I wouldn't say they are malignant, but anyone going there to be a general pediatrician needs to full consider what the consequences of that decision will be.

Many of the most highly ranked children's hospitals are quintenary referral centers with exceedingly rare pathology. That's ideal for fellows, but not so much for peds residents in my opinion (it certainly is not stuff that shows up on Peds Boards with any regularity). Having done fellowship at a top 10 center, the quote that sticks out to me from one of my residents at the time is one who said "all I learned to do intern year was dose Tacro". That's probably overly dramatic, but is demonstrative of the type of experience you get at these places. There's still bread and butter stuff but it ends up being a much lower proportion of you patient load than it ends up being at other "lesser" places.

More concerning for career development of anyone though is the level of independent decision making these places fail to foster in their graduating residents. While peds residencies are never going to be IM training programs, there are still programs out there that expect residents to develop skills and graduated responsibility because they recognize that some people will be jumping to independent practice a week after leaving the Ivory Tower. When you have a row of fellows to fall behind it's very easy to just go along for the ride as a resident. Sometimes is not even other trainees that are taking jobs from you. I remember interviewing for residencies and some places had techs available to cast and suture patients without the residents ever getting a chance to see those cases. It was pitched as "you'll get to focus on the actual sick kids" while ignoring the fact that those are real, necessary skills to have for a number residents whether they are going on to a fellowship (such as Adolescent or PEM - and there have been at least a couple times I close lacerations in the middle of the night in the PICU rather than call in another service) or to general peds jobs.

I agree. I trained (med-peds) at one of these quaternary (I've never heard of quintenary! I think it only goes up to 4! 😛) care centers, and while I think we had a higher level of decision making than many on our inpatient services (no in house attending overnight for general pediatrics, relatively early senioring), it still is just not robust on the subspecialty services. In particular, on those subspecialty services, my time was heavily focused on the complex care population that, granted, needs a lot of care, but I don't think it's what anyone truly imagines. Granted, I think any pediatric residency is going to have its share of bronchiolitis and gastroenteritis, but those kinds of complaints, which require little definitive intervention, rarely require tremendous decision making skills beyond "is this kid sick enough for the PICU or can they stay on 2 L on the floor?"

I can count the number of times I've managed community acquired pneumonia on one hand. The number of times I've been responsible for ventilator-associated pneumonia or refractory epilepsy in a complex care patient is incalculable at this point.

But here's the thing: I can't compare my experience to the experience others get in more community-based residencies, so maybe, in fact, I've gotten great autonomy compared to other residencies. You only train at one place, and therefore every single person lacks perspective into what it's truly like to be a resident at another institution.

So to answer the original question: Year after year these top programs match top applicants from top medical schools, and they remain highly desirable for many. Should you leave them alone? Well, what are your career goals? What are your location goals? What are your overall priorities and how do they interplay with each other? These are the questions you need to answer for yourself. Look at these places carefully if and when you interview, and make a decision based on these criteria. There's no wrong answer until after the fact, when you're either happy or unhappy with the training that you're getting, so just do your best.

 

[TheSingularity]

CHOP is most certainly "fellow run" which makes it a fantastic place to do subspecialty training.

Residents are largely note monkeys, and likely will not be afforded the opportunity to do procedures.

Ideally you would want to train at a more bread and butter peds type experience then go for the mega ivory tower if you wanted to subspecialize.

Sent from my Pixel 3 using SDN mobile

 

[BigRedBeta]

(I've never heard of quintenary! I think it only goes up to 4! 😛)

If your hospital is regularly courting foreign nationals then you're quintenary
If other major children's hospitals are referring patients to you on the reg then you're quintenary

It's rare air, and I'd say right now the only places that without a doubt fit the designation are CHOP, Boston, Cinci, and Texas Children's...you might consider throwing Lurie Children's and Seattle in that tier (maybe). CHLA, Benioff, Lucile Packard, and UTSW are like quartenary and a half or quintary(-), largely in part due to their locations, but also kind of have a lot of competition from those around them - ie UCSF and Stanford are trying to capture the same patients, UTSW is up against TCH. Children's National (DC) is a special case but probably is in that group as well (more foreign dignitaries but less referrals from US based hospitals). In my opinion Pittsburgh, Utah, Colorado, Nationwide, Michigan, and St. Louis are all quarternary+ (Which probably pisses off the WashUStL crowd to no end), and then there's everyone else. The NYC centers are all trying but face too much competition within the city for any one place to reach that next level in terms of volume plus they get siphoned off from CHOP and Boston. Places like Vanderbilt, Emory, and Phoenix are all robust and doing a ton but still are sending more kids for exceptionally specialized stuff than they're bringing in. UChicago depends a little bit on how they've retained their peds faculty at any particular moment as they have a tendency to get poached by Lurie at times (although at times in the past UC has poached from NW in large waves).

 

[sliceofbread136]

I wouldn't say they are malignant, but anyone going there to be a general pediatrician needs to fully consider what the consequences of that decision will be.

Many of the most highly ranked children's hospitals are quintenary referral centers with exceedingly rare pathology. That's ideal for fellows, but not so much for peds residents in my opinion (it certainly is not stuff that shows up on Peds Boards with any regularity). Having done fellowship at a top 10 center, the quote that sticks out to me from one of my residents at the time is one who said "all I learned to do intern year was dose Tacro". That's probably overly dramatic, but is demonstrative of the type of experience you get at these places. There's still bread and butter stuff but it ends up being a much lower proportion of you patient load than it ends up being at other "lesser" places.

More concerning for career development of anyone though is the level of independent decision making these places fail to foster in their graduating residents. While peds residencies are never going to be IM training programs, there are still programs out there that expect residents to develop skills and graduated responsibility because they recognize that some people will be jumping to independent practice a week after leaving the Ivory Tower. When you have a row of fellows to fall behind it's very easy to just go along for the ride as a resident. Sometimes is not even other trainees that are taking jobs from you. I remember interviewing for residencies and some places had techs available to cast and suture patients without the residents ever getting a chance to see those cases. It was pitched as "you'll get to focus on the actual sick kids" while ignoring the fact that those are real, necessary skills to have for a number residents whether they are going on to a fellowship (such as Adolescent or PEM - and there have been at least a couple times I close lacerations in the middle of the night in the PICU rather than call in another service) or to general peds jobs.

this is so spot on. There are so many cooks in the kitchen that there are so many fall backs and it’s so easy to get lazy and complacent.

personally I don’t feel well prepared. You need that fear of failure to spur you into confidence

 

[SurfingDoctor]

Bottom line:
Big name =\= Better education

Go where you get the best feel.

 

[tantacles]

If your hospital is regularly courting foreign nationals then you're quintenary
If other major children's hospitals are referring patients to you on the reg then you're quintenary

It's rare air, and I'd say right now the only places that without a doubt fit the designation are CHOP, Boston, Cinci, and Texas Children's...you might consider throwing Lurie Children's and Seattle in that tier (maybe). CHLA, Benioff, Lucile Packard, and UTSW are like quartenary and a half or quintary(-), largely in part due to their locations, but also kind of have a lot of competition from those around them - ie UCSF and Stanford are trying to capture the same patients, UTSW is up against TCH. Children's National (DC) is a special case but probably is in that group as well (more foreign dignitaries but less referrals from US based hospitals). In my opinion Pittsburgh, Utah, Colorado, Nationwide, Michigan, and St. Louis are all quarternary+ (Which probably pisses off the WashUStL crowd to no end), and then there's everyone else. The NYC centers are all trying but face too much competition within the city for any one place to reach that next level in terms of volume plus they get siphoned off from CHOP and Boston. Places like Vanderbilt, Emory, and Phoenix are all robust and doing a ton but still are sending more kids for exceptionally specialized stuff than they're bringing in. UChicago depends a little bit on how they've retained their peds faculty at any particular moment as they have a tendency to get poached by Lurie at times (although at times in the past UC has poached from NW in large waves).

Definitely also my hospital. Either that or quaternary+. We probably don't have as many international transfers as other hospitals, but we are definitely getting them regularly.

 

[ChipperChop]

Having done fellowship at a top institution but residency in a smaller program I do see a difference.

At the top institution with triple the number of residents they see a whole lot more complex cases and get to rotate and learn so much more from the specialists. There was no shortage of bread butter peds ether. The small program was still quality. Does the general per reallt need to know how to manage vent settings in a post transplant- no. If you’re prepping for fellowshup then maybe it matters.

But the interns all come in pretty incompetent in either place

 

[chickenlittle17]

Thanks all

 

[SurfingDoctor]

Not UTSW anymore...at least not related to CHD.

 

[sella.turcica]

Not UTSW anymore...at least not related to CHD.

Why?

 

[SurfingDoctor]

Why?

They lost their program to Dell’s who recruited their staff away.

 

[Step Up]

What are people’s opinions on programs at CHOP and BCH? Are these programs best left untouched because of a malignant rep and catering more towards fellows? Or have people enjoyed their training there? Any thoughts appreciated.

If your goal is fellowship training, I wouldn't consider residency reputation as a much of a factor in your decision-making. At least in neonatology it doesn't seem to matter where your went to residency, in terms of training and help with getting into a desired fellowship. The differences in training during residency between fellows matters extremely little. What matters at the end of the day is your training during fellowship and your experience after fellowship. I assume this is similar for most other sub-specialities.

 

[Skittsie13]

If your goal is fellowship training, I wouldn't consider residency reputation as a much of a factor in your decision-making. At least in neonatology it doesn't seem to matter where your went to residency, in terms of training and help with getting into a desired fellowship. The differences in training during residency between fellows matters extremely little. What matters at the end of the day is your training during fellowship and your experience after fellowship. I assume this is similar for most other sub-specialities.

What helps determine who gets into top fellowships, if residency reputation doesn't?

 

[mvenus929]

What helps determine who gets into top fellowships, if residency reputation doesn't?

I imagine it depends a lot on the subspecialty of choice, but my residency program is relatively unknown outside the region that it's in, but we have people going to 'top' fellowships in several fields (Cards, NICU, PICU, heme/onc, Endo, Allergy, GI). It's likely more a factor of what research/activities you've done, what connections you have (yes, you can have connections without going to a 'top' residency), your goals for fellowship, and 'fit' on interview day (cause fellowship interviews are worlds different than residency interviews--it's much more like faculty interviews).

 

[Step Up]

What helps determine who gets into top fellowships, if residency reputation doesn't?

It would be nice to hear a response to this question from someone who participates in fellowship candidate reviews. I wish I could provide you with an accurate answer, but since I'm a fellow and I'm not involved in candidate selection, my answer is merely conjecture. I assume residency reputation is a factor, but only a minor one. All programs want to train strong clinicians, while the "top" programs also pride themselves on training future leaders in the field. Therefore, the "top" programs I assume would value a candidate who shows promise in a certain academic area (such as research, education, QI, public health, etc). The "top" program will also have the luxury of choosing the candidate more likely to succeed, e.g. presents themselves well on the interview day, appears smarter on their resume, has better letters of recommendation, etc.

 

[SurfingDoctor]

For ranking I primarily consider step scores (though that is going away), extracurricular activities and clear life goals. Interviews are helpful too since most applications are similar on paper.

FYI.

 

[DOAZ31]

If your hospital is regularly courting foreign nationals then you're quintenary
If other major children's hospitals are referring patients to you on the reg then you're quintenary

It's rare air, and I'd say right now the only places that without a doubt fit the designation are CHOP, Boston, Cinci, and Texas Children's...you might consider throwing Lurie Children's and Seattle in that tier (maybe). CHLA, Benioff, Lucile Packard, and UTSW are like quartenary and a half or quintary(-), largely in part due to their locations, but also kind of have a lot of competition from those around them - ie UCSF and Stanford are trying to capture the same patients, UTSW is up against TCH. Children's National (DC) is a special case but probably is in that group as well (more foreign dignitaries but less referrals from US based hospitals). In my opinion Pittsburgh, Utah, Colorado, Nationwide, Michigan, and St. Louis are all quarternary+ (Which probably pisses off the WashUStL crowd to no end), and then there's everyone else. The NYC centers are all trying but face too much competition within the city for any one place to reach that next level in terms of volume plus they get siphoned off from CHOP and Boston. Places like Vanderbilt, Emory, and Phoenix are all robust and doing a ton but still are sending more kids for exceptionally specialized stuff than they're bringing in. UChicago depends a little bit on how they've retained their peds faculty at any particular moment as they have a tendency to get poached by Lurie at times (although at times in the past UC has poached from NW in large waves).

Could you elaborate more on UChicago and their tier in the pediatric world?

 

[miacomet]

Wherever you go, please get training in how to care for sick children, not just outpatient pediatrics. There are many jobs where you will have to attend deliveries and admit patients. Peds residency is really in crisis with their insane emphasis on development. It's a medical residency, not social work.

 

[sliceofbread136]

Wherever you go, please get training in how to care for sick children, not just outpatient pediatrics. There are many jobs where you will have to attend deliveries and admit patients. Peds residency is really in crisis with their insane emphasis on development. It's a medical residency, not social work.

At the same time when some one is actually sick you tend to get pushed to the side.

 

[PTPoeny]

At the same time when some one is actually sick you tend to get pushed to the side.

Less so in a place with no fellows. I went to a smaller residency and then a larger fellowship and it was definitely the right path for me.

On a side note, I don't think any peds residency gives more preparation for outpatient peds rather than inpatient.

Post edited as part of it was written to go in a different thread.

 

[miacomet]

Less so in a smaller place with no fellows. I went to a smaller residency and then a larger fellowship and it was definitely the right path for me. At the same time I don't think there are enough sick kids across the country to train every pediatric resident to intubate. And the residents that are interested in practicing rural pediatrics where they are expected to intubate as a general pediatrician are concentrated into some of the smaller residencies in or near rural areas. It isn't the fault of residency that NIPPV and better NRP protocols (not intubating active, well appearing babies born with mec) has drastically reduced the total number of children being intubated each year.

Anesthesia rotations are unlikely to fix the problem either. Not that many tiny neonates are having surgery. As a PICU fellow doing my anesthesia rotation I got a lot of tubes, but the one population they wouldn't let me intubate was the neonates. I found this slightly funny as a resident I was attending deliveries without an attending.

On a side note, I don't think any peds residency gives more preparation for outpatient peds rather than inpatient.

Funny, peds anesthesia learns to intubate kids. So does NICU.

 

[PTPoeny]

Funny, peds anesthesia learns to intubate kids. So does NICU.

Yes, but not in a peds residency.

Sorry, post edited as I thought the comment I was responding to was in a different thread.

 

[BigRedBeta]

Could you elaborate more on UChicago and their tier in the pediatric world?

Of the places I've listed, UChicago is probably the best at meeting its mission of filling the needs of the underserved. Their location on the South Side is hugely important to the needs of their surrounding community. That location also means they do a better job than Lurie at training their residents in terms of gen peds stuff. I think it's an absolutely great place for peds training.

But in terms of meeting my designations of Quintenary/Quarternary +/Quarternary/Tertiary...they wax and wane. I get the sense (and this is entirely my opinion) that depending on who the department chair is and mix of division heads, they have a really hard time trying to figure out their place in terms of meeting the needs of the underserved around them and providing uniquely specialized care that isn't being done at other centers.

Being in Chicago, they can recruit exceptionally talented physicians and researchers because people want to live in the city, but seem to have a harder time retaining them than other places. The competition in the city likely contributes to those retention issues, as Lurie/NW has no hesitation in poaching those doing something unique and Rush/UIC/Cook County has similar missions in meeting the underserved, while Loyola doesn't prioritize academic production to the same degree. And if you want to live a more suburban experience, you can work at either the Advocate locations. There are also a number of adult hospitals that still have peds floors in them so they are constantly hiring people who just want clinical work. In other words, faculty can readily find other spots in the area to tailor their job description towards a more idealized set of circumstances. Want to be a pioneer and create the next set of cutting edge treatments? NW wants you. Think that your department is worried too much about research production when there is a huge urban population of kids needing basic care? UIC or Cook County can let you focus on that. Tired of commuting in from Oak Park or Evanston (where you moved because the public schools are good) to the South Side, Loyola or Advocate will let you take care of patients closer to home.

 

[ftcm68]

What are people’s opinions on programs at CHOP and BCH? Are these programs best left untouched because of a malignant rep and catering more towards fellows? Or have people enjoyed their training there? Any thoughts appreciated.

Once specific area to ask about is PICU coverage. For example if PICU fellows are in house overnight - they run all codes/management. All codes, 24 hours a day, local children's hospital - the PICU fellow comes running. You only have to bag until "PICU gets here."

This is unlike what med-peds co-residents tell me. Residents are the only ones in house in the MICU. They run the codes all night. Vent management. Pressors. Central lines. For chest tubes, they call surgery.

As someone above mentioned "You need that fear of failure to spur you into confidence"

Caveat: how much do you need to know much about pressors or chest tubes or placing A-lines in gen peds?

 

[ftcm68]

What helps determine who gets into top fellowships, if residency reputation doesn't?

This: "It's likely more a factor of what research/activities you've done, what connections you have (yes, you can have connections without going to a 'top' residency), your goals for fellowship, and 'fit' on interview day (cause fellowship interviews are worlds different than residency interviews--it's much more like faculty interviews)." was spot on from my experience

Less so this from what I've seen: "For ranking I primarily consider step scores (though that is going away)"

 

[ftcm68]

What are people’s opinions on programs at CHOP and BCH?
Positive. Volume, research, faculty - some of the best in the world. Many positives.

Are these programs best left untouched because of a malignant rep and catering more towards fellows?
I didn't know they had a malignant reputation. If you see above, multiple reasons to keep an open mind and check them out.
The vibe I catch there is "we're the best." But if you're part of the "we" you're on the in-side and I imagine supported/listened to. But would have to ask folks who trained there to be certain.

I think the malignant word needs a little more definition. Do you mean overworked?
A "high volume" residency might intrinsically be considered "malignant" even if admins try to be supportive and make changes.

 

[mvenus929]

Once specific area to ask about is PICU coverage. For example if PICU fellows are in house overnight - they run all codes/management. All codes, 24 hours a day, local children's hospital - the PICU fellow comes running. You only have to bag until "PICU gets here."

This is unlike what med-peds co-residents tell me. Residents are the only ones in house in the MICU. They run the codes all night. Pressors. Shock. Lines. Chest tubes.

As someone above mentioned "You need that fear of failure to spur you into confidence"

Caveat: do you need to know much about pressors or chest tubes or placing A-lines in gen peds? Nope

I think this is going to depend on the culture of the program. My residency program didn't have fellows, but did have a PICU attending in house 24/7, and the senior residents on the Hospitalist service were still the ones to run the codes unless we specifically called the PICU attending for back-up (I can tell you as a resident overnight receiving the post-ROSC kids from the floor, the attending frequently didn't go until much of the management was already in motion). But codes in peds are also VERY different than codes in adults. They're less frequent, more likely to be respiratory in origin....

 

[Carolinagirl007]

They lost their program to Dell’s who recruited their staff away.

Can you please expound? I have a co resident that would like to know before applying. Thank you in advance.

 

[SurfingDoctor]

Can you please expound? I have a co resident that would like to know before applying. Thank you in advance.

I was wrong it wasn’t Dell’s, it was some other hospital in Dallas. I don’t know which hospital in Dallas, whichever had the most births, was essentially referring CHD to UTSW. That hospital (Medical City?) decided they were tired of losing revenue and recruited away nearly all the CT surgeons, crippling UTSWs CHD program. Mind you, this is all second hand info, but one of the people in my group got recruited away and is gonna be their CVICU director (or something, haven’t talked to them in awhile).

 

[ftcm68]

I think this is going to depend on the culture of the program. My residency program didn't have fellows, but did have a PICU attending in house 24/7, and the senior residents on the Hospitalist service were still the ones to run the codes unless we specifically called the PICU attending for back-up (I can tell you as a resident overnight receiving the post-ROSC kids from the floor, the attending frequently didn't go until much of the management was already in motion). But codes in peds are also VERY different than codes in adults. They're less frequent, more likely to be respiratory in origin....

It's fair to call it culture. For us, it was cooked into policy. If a code is called, the PICU fellow (and attending during the day) will automatically come. Not as back-up. As you mentioned, most codes are respiratory in origin, so by the time you've listened and ordered stat XR and labs, PICU is there asking for the 3min of management so far.

And procedures, there's certainly opportunity to put in central lines, but the default is the PICU fellow.
Intubations - both PICU and NICU fellows need to get signed off (esp since meconium babies lost the automatic indication in the NICU)
I don't think there's a single pediatrics resident in our program history who has put in a chest tube.

Also beyond codes and the PICU, there's acuity in the ED. Peds residents can run a lower acuity trauma, chest compressions, bag, push adenosine, etc. But again ED PEM fellow, or again PICU fellow or peds surgery are all there to intubate. Many chefs in the tertiary kitchen.

Not everyone is interested in managing the above, but if you're interested in independent/critical care/hands on practice- ask about procedures like central lines, intubations, chest tubes, running codes, ultrasound training. I imagine that type of program in pediatrics is the exception rather than the rule

 

[Stone Cold]

I imagine it depends a lot on the subspecialty of choice, but my residency program is relatively unknown outside the region that it's in, but we have people going to 'top' fellowships in several fields (Cards, NICU, PICU, heme/onc, Endo, Allergy, GI). It's likely more a factor of what research/activities you've done, what connections you have (yes, you can have connections without going to a 'top' residency), your goals for fellowship, and 'fit' on interview day (cause fellowship interviews are worlds different than residency interviews--it's much more like faculty interviews).

To what extent "away rotations" help cracking a top tier peds fellowship, particularly if your away rotation is also in a top program?

 

[mvenus929]

To what extent "away rotations" help cracking a top tier peds fellowship, particularly if your away rotation is also in a top program?

I mean, it's going to depend a little bit on the subspecialty, but generally, away rotations are discouraged because it's not all that competitive to go into a field, and the chance that you wow them in person more than you wow them on paper is low. I'm at a program in the top 10 for my specialty, but am also in a specialty where half the positions go unfilled every year. Compare that to Cardiology or PICU, where they do fill their positions, and it may be a little more challenging to break into a 'top tier' fellowship position without something else.

That said, if you're in a residency program where you don't have great exposure to a particular subspecialty, an away can give you a better sense of whether or not you would actually enjoy that specialty, and may provide letters or research opportunities not available at your home institution.

 

[SurfingDoctor]

Don’t do away rotations as a resident. It will only make you look bad as all the other residents will be able to navigate their home system while you fumble around and will be of no benefit to you.

 

[GoSpursGo]

Don’t do away rotations as a resident. It will only make you look bad as all the other residents will be able to navigate their home system while you fumble around and will be of no benefit to you.

I agree with this. Unless you're truly at a rural program where you would otherwise have no potential exposure to your specialty of interest, I don't think there's any reason to go out of your way to do this. And frankly, if you're coming from a program that rarely matches residents into a competitive specialty like cardiology/PICU/etc, you need to discuss very early on with your PD about how to best support your career goals. The answer might be going to present your research at a conference specific for that specialty rather than trying to finagle an away rotation.

 

[Stone Cold]

I mean, it's going to depend a little bit on the subspecialty, but generally, away rotations are discouraged because it's not all that competitive to go into a field, and the chance that you wow them in person more than you wow them on paper is low. I'm at a program in the top 10 for my specialty, but am also in a specialty where half the positions go unfilled every year. Compare that to Cardiology or PICU, where they do fill their positions, and it may be a little more challenging to break into a 'top tier' fellowship position without something else.

That said, if you're in a residency program where you don't have great exposure to a particular subspecialty, an away can give you a better sense of whether or not you would actually enjoy that specialty, and may provide letters or research opportunities not available at your home institution.

I agree with this. Unless you're truly at a rural program where you would otherwise have no potential exposure to your specialty of interest, I don't think there's any reason to go out of your way to do this. And frankly, if you're coming from a program that rarely matches residents into a competitive specialty like cardiology/PICU/etc, you need to discuss very early on with your PD about how to best support your career goals. The answer might be going to present your research at a conference specific for that specialty rather than trying to finagle an away rotation.

Thanks for that info. I'm an IMG currently in a mediocre residency program in NYC and I'm kinda undecided between NICU & PICU for my fellowship. NICU in my program is great and PICU is alright. Given my IMG status which already puts me at a disadvantage to get into top tier fellowships, I might have an opportunity to pursue an away PICU rotation at a top-5 program here in NYC. I don't really wanna do an away NICU rotation since my program is pretty good in that regard. While I am into research, I thought an away rotation and making contacts for future LoR's in a top tier program would help me gain some points apart from whatever's on paper

 

[girlofgrace7]

Wherever you go, please get training in how to care for sick children, not just outpatient pediatrics. There are many jobs where you will have to attend deliveries and admit patients. Peds residency is really in crisis with their insane emphasis on development. It's a medical residency, not social work.

I feel like the opposite is true in many cases, especially in major centers.

I did residency at Arkansas Children's (only children's hospital in the state; big catchment area, lots of specialists and fellows, etc) but fellowship at a quaternary plus program. In residency, our class was split about 1/2 and 1/2 gen peds and subspecialty fellowships after, which I felt represented the amount of inpatient/outpatient and bread and butter/rare cases we saw.

Coming to the quarternary plus program, I feel like their residents see a lot of medically complex kids, but everything ends up referred to specialists (because the specialists are easily accessible). Their residents do a TON of inpatient time, and bread and butter cases go to a hospitalist only team inpatient and usually community providers outpatient. I'm in DBP, and I can tell you the residents (and most of the attendings) here don't feel comfortable doing things like prescribing stimulants or discussing poor sleep hygiene (it ends up referred to DBP), which were things I felt very comfortable with in residency. Same goes for non-DBP things (we precept in the gen peds clinic half a day a week in our first year of fellowship)... I was shocked when they told me they refer to pulm to start/manage Flovent and get PFTs.

So, that being said, I'd look for a program with good balance in residency. As other posters have said, it's most important that the program be a good fit for you and your goals.

 

[SurfingDoctor]

Thanks for that info. I'm an IMG currently in a mediocre residency program in NYC and I'm kinda undecided between NICU & PICU for my fellowship. NICU in my program is great and PICU is alright. Given my IMG status which already puts me at a disadvantage to get into top tier fellowships, I might have an opportunity to pursue an away PICU rotation at a top-5 program here in NYC. I don't really wanna do an away NICU rotation since my program is pretty good in that regard. While I am into research, I thought an away rotation and making contacts for future LoR's in a top tier program would help me gain some points apart from whatever's on paper

It won’t. No person is going to write some glowing LOR for a resident who is rotating for 1 month from a different hospital system (unless you’ve know that person for about 2 years before and after the rotation).

 

[NurWollen]

Thanks for that info. I'm an IMG currently in a mediocre residency program in NYC and I'm kinda undecided between NICU & PICU for my fellowship. NICU in my program is great and PICU is alright. Given my IMG status which already puts me at a disadvantage to get into top tier fellowships, I might have an opportunity to pursue an away PICU rotation at a top-5 program here in NYC. I don't really wanna do an away NICU rotation since my program is pretty good in that regard. While I am into research, I thought an away rotation and making contacts for future LoR's in a top tier program would help me gain some points apart from whatever's on paper

Honestly, I don't think being an IMG will hold you back too much in PICU, and definitely not in NICU. Both specialties have plenty of IMGs match every year. There might be a few top programs that'll be out of reach, but if you're otherwise a reasonably strong applicant, you'll hace plenty of options. Especially in NICU, which isn't as competitive as PICU (but PICU is attainable for you still, I think.)

Sent from my SM-G930V using SDN mobile

 

[Oso]

Especially in NICU, which isn't as competitive as PICU (but PICU is attainable for you still, I think.)

Oh, I always thought NICU was more competitive than PICU? Though I've never directly looked at the stats and I guess it doesn't really matter either way

 

[DoctorMahba]

For reference, did medical school at tertiary/Quaternary, residency at Quaternary/Quaternary+, and working in academic pediatric program with residency and medical school that is secondary/tertiary. On arriving as a faculty member, the residents in my current work area had more autonomy and code / acuity experience than I did, with possibly the exception of some NICU procedures but that is also more of a NICU management shift (less meconium intubations, more bubble CPAP etc). The residents where I joined as faculty had FAR more exposure to gen peds patients, again more/earlier autonomy, more across the board exposure to the life of an average specialist (most specialists in the US do not PRACTICE in quarternary research heavy academic institutions) in order to help choose their field, and higher board pass rate. As said above, there are pros / cons for each setting.
In terms of fellowship, remember that MANY fellowships are not that competitive in pediatrics - its a buyers market. Attaching the most recent data summarized from 2019 and the longer NRMP source data.

 

[ftcm68]

I was shocked when they told me they refer to pulm to start/manage Flovent and get PFTs.

But flovent... Really?

These are great points:
-No person is going to write some glowing LOR for a resident who is rotating for 1 month from a different hospital system (unless you’ve know that person for about 2 years before and after the rotation).
-Don’t do away rotations as a resident. It will only make you look bad as all the other residents will be able to navigate their home system while you fumble around and will be of no benefit to you.
-The answer might be going to present your research at a conference specific for that specialty rather than trying to finagle an away rotation.

Also from 2020 data posted matched IMG applicants:
44/231 - 19% NICU
29/195 - 14.9% CCU


But risk/reward scenarios:
-you don't rotate at said top reputation program, and with your current application, top place/others do/don't interview you (unknown odds)
-you rotate at top program, you look like a fool, they don't offer you an interview, you don't get a letter from anyone (worst case outcome)
-you rotate at top program, and you clearly "know your stuff" and work hard (in spite of EPIC - might be worth knowing if they use same EMR), they offer you an interview, and a positive letter (good outcome)
-you rotate at top program, and they love you, they offer you an interview/rank you, and writing you a glowing letter, get more interviews out of it (best outcome?)

Some people have described an away as a 30 day interview. Always on, with every staff member. If people tend to like you more over time, might be a good fit. If people like you less over time, strictly avoid (also maybe think about why that's happening...)

In any case, with current scenario - presenting/abstract accepted at a research conference (more like "zooming") for speciality or publishing is still the gold standard in academic medicine - so you can do this in all cases. Actually, one strategy for your away rotation might be to find a mentor/project (which academic clinician doesn't have work that could be done by someone willing?). That could benefit your research skills, their project, your application - all wins. Unless again, you don't do a good job/work hard - in which case, why stress yourself out at a top tier?