worriedwell

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Important question as deadline approaches...

If you could choose to go to either residency in psychiatry, which would it be and why?

Penn or Columbia

Please answer asap! Even if its just a sentence or two. Thanks.
 

sparkle79

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i think it is almost a New York vs Philly question when it comes down to it. Both are great.
 

prominence

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i would give Columbia the edge because it is in NYC
 
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worriedwell

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Thanks for the responses, but I was thinking more along the lines of the feels of the programs that people got if they interviewed there or the impressions they have about each program in a nutshell. I live in NYC now and I'm very ambivalent about leaving but I like Philly a lot and therefore wouldn't be upset about being there (possibly even happy to be there, although New York Psychiatry is a culture in itself that is hard to leave (as snobbish as that sounds). So lets leave city out of the equation unless it relates to the culture of psychiatry training.
 

almost done

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It's an interesting debate because I think Penn is like Columbia-lite. I found them to be very balanced programs with both great therapy training as well as impressive research to be found. I definitely didn't feel that the residents were overworked at either institution (if anything, the workload at both seemed to be very manageable). As others have mentioned, Penn may be weak in the area of child psych, and columbia is not as good in addiction medicine. Columbia has a new chair, so it's not clear what direction he will take them. It appears that one goal is to emphasize schizophrenia research.

The reason I think that Penn is like a mini version is that ultimately, Columbia is still Columbia, and one of the truly elite programs in the country. It will open more doors and carry more prestige once you graduate. How much more, I don't know--it probably depends on how much you want to stay in academic medicine. (And I mean the *real* answer, not the one we all give at interviews ;) )

As was also mentioned, geography is important. And finally, how did you connect with the residents. No one else's opinion can serve as a surrogate for how you found them to be.
 

tomato

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Hi, I would pick Columbia in a second. Most places I went and interviewers I met on the trail had only wonderful things to say about Columbia; not so with Penn, even though I like Penn a lot.

Columbia has enormous resources in training and research. The Washington Heights community service, the psychoanalytical institute, leadership in neuroscience -- it's all there. Residents there seem very well-supported. All of them are getting their top choices for jobs and fellowships. Faculty there are very well connected, and it pays off for residents. As someone else mentioned, I think the new chair is a bit of a wild card, but probably not a gamble in the end. From all I have heard, Columbia has the best all-around reputation in the country.

Penn, although clearly a top program, impressed me negatively in the sense that some fourth years still didn't have jobs. Philly is a great city to live, but perhaps not to practice (one of my interviewers there told me that, actually). Research is clearly a big offering there, so that could be a reason to go.... On the other hand, great program directors, great therapy training (despite the fact that the Institute of Pennsylvania is now closed).

In the end, you couldn't possibly make a mistake by choosing either one to go first. But since you're soliciting opinions, that's mine. Good luck.
 

delusion88

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Philly is a great city to live, but perhaps not to practice (one of my interviewers there told me that, actually).
Did the interviewer provide any explanations? I am not aware of possible job finding difficulties in Philly. Also, since programs are being compared now, would someone care to comment on Hopkins vs McLean? I would really appreciate any information, aside from the cities, which I am familiar with. Thanks. :oops:
 

mdblue

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delusion88 said:
Did the interviewer provide any explanations? I am not aware of possible job finding difficulties in Philly. Also, since programs are being compared now, would someone care to comment on Hopkins vs McLean? I would really appreciate any information, aside from the cities, which I am familiar with. Thanks. :oops:
Malpractice.. :( :(
 

tomato

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Malpractice was one of the reasons mentioned. Otherwise the interviewer said that the faculty was very invested in research, and that in his group there was only one clinician. He said unless I wanted a career there in research, it was probably not the right place to be. Other interviewers there didn't seem to feel that way, though.

I can't comment on Hopkins, but I got only positive impressions from MGH/McLean. You can PM me if you'd like.
 

overthinker

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i liked penn's pds a LOT. however, i found the residents uniquely unfriendly. at the lunch, they were all chatting with each other and not only did they make no effort to talk to us, they resisted any of our efforts to start conversations with them. it seemed weird and cliquey and like the mean girls in 4th grade.

columbia's pds are not as approachable or warm, but they are obsessed with the residency program and very committed to its quality. the residents are more thoughtful and approachable. program seems more intense than penn. it's a small point, but i think the medicine part of the pgy1 is ridiculous (way too much, month of icu, no flexibility as far as doing some peds). no inpatient child/adolescent, no va, not a flexible program but really solid and i'd pick nyc over philly any day.
 

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While I acknowledge that Columbia has all kinds of faculty and that some great biological psych research goes on there, I am a bit disturbed by the psychoanalytic dogma that by and large prevails there and in most of NYC. I'm not anti-psychoanalysis, I just want balanced training and evidence-based psychothereapy as much as possible. And I'm surprised to see that Columbia is nevertheless such a highly sought after residency. Has this bothered anyone else? How have you reconciled it with your residency choice?
 

tomato

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I found Columbia to be quite balanced when compared to its peer NYC programs, though I agree that nowhere outside of Manhattan do you find such an emphasis on psychodynamic teaching. This is one person's bias, but I found programs outside of New York, with a few exceptions, to be a bit ahistorical in the sense that the residents were not particularly knowledgeable about dynamics, particularly Freud and Jung. Even if I, like most residents, don't intend to pursue higher level dynamic training, I do think it worthwhile to have as solid an understanding as possible. At Columbia in particular, I didn't get the feeling that their analytical training came at the expense of superb psychopharm training. I got the impression that they do all things well.

nortomaso said:
While I acknowledge that Columbia has all kinds of faculty and that some great biological psych research goes on there, I am a bit disturbed by the psychoanalytic dogma that by and large prevails there and in most of NYC. I'm not anti-psychoanalysis, I just want balanced training and evidence-based psychothereapy as much as possible. And I'm surprised to see that Columbia is nevertheless such a highly sought after residency. Has this bothered anyone else? How have you reconciled it with your residency choice?
 

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I agree with the last post (Nortomaso's), and feel that the problem of being psychodynamically/psychoanalytically-oriented is part of a larger problem of the northeast. I know that I have discussed this elsewhere, but to summarize I think that many programs prioritize specific modalities of therapy (including pharmacotherapy) at the expense of an honest/less biased up-front evaluation or formulation of the patient and the patient's distress. If the focus is mainly therapy(ies), then patients are inevitably shoe-horned into whatever constructs those therapeutic philosophies demand. The risk for this problem increases when a program is dedicated to fewer therapeutic modalities. It seems that if the patient is carefully assessed first without dedication to modalities of therapy, then there is a better chance that the patient's unique circumstances will drive the appropriate therapy. For this to work well in training, however, the assessment-driven program has to give you adequate training in the various therapies that evidence has shown us work.
That being said, I did not visit Columbia, because I could not afford to live in NYC.
I did visit MGH and Hopkins, and I thought they were both really impressive programs. I though the pros of the MGH program included the strength of the various teaching sites, the educational richness of the community, Boston generally, the consistently bright residents, and the dynamic attendings. I also sensed a genuine dedication to excellent training and an overall excitement about the field and its potential.
I was concerned about a few things. I found the residency director to be a bit aloof and lacking warmth, I felt there was a heavily therapy-based approach to psychiatry (albeit in several different modalities), there seemed to be a lack of cohesion of theory in the program overall (which may or may not be a bad thing), and I found the friendliness and, perhaps, satisfaction of the residents to be a bit uneven.
As to Hopkins, I found the formulation-based philosophy refreshing and more common-sense (obviously), I felt the residents seemed more universally friendly and satisfied (and a bit less smug), I liked the fact that the entire second year was inpatient and had specialized services of one attdg/resident, and I liked the fact that the second year was all in one hospital. I sensed there, like @ MGH, a dedication and excitement about training and psychiatry generally. Finally, I felt better about the residency training directors.
I was ambivalent about Baltimore. It is grittier, more violent, and less stimulating than Boston (which is probably why it's more affordable). I was unsure whether I was more concerned or impressed with the rigor of the first year and the heavy focus on medical training and competence, I was concerned that the faculty of my program counseled training at Columbia, Yale, or MGH over Hopkins or other programs (although they all were trained at one of these three sites), and, although I agreed strongly with the focus on assessment, I was not certain if that meant necessarily that therapeutic training was more broad than deep.
In the end, I walked away feeling an excellent education was to be had at either program (or others), but I preferred JHH and, for what it’s worth, ranked them 1st.
GOOD LUCK!!
 

nortomaso

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Tomato, I appreciate your input. I never doubted that Columbia's psychoanalytic orientation would come at the expense of psychopharm training. But I am worried that its coming at the expense of other therapeutic modalities. I'm also put off that so much time is spend on theories that have never been empirically validated and which seem difficult to discuss with their proponents unless you adopt their own unique vocabulary and thus tacitly accept the concepts behind the words.

I would like to stress that I am not here to put down any place or line of thought. I studied Freud extensively as a philosophy of science student and I am sincerely baffled that psychoanalytic thought continues to pervade American psychiatry whereas academic psychology has become increasingly evidence-driven.

I would welcome any thoughts on the matter; I'm currently a third year student trying to get a feel for the various programs so that I can choose my away electives as well as know what to aim for. I also want to make sure that I am comfortable with the field and those practicing it. Thanks in advance for any replies.
 
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worriedwell

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For what its worth, I chose Penn first over Columbia and I'm thrilled with my decision (now the waiting begins). Also, to plug Penn, Beck Institute is there (read CBT training at its best) and residents there seem to get a stronger CBT environment than at any other program (this is from word of mouth knowledge of people who trained at Penn and then went on to do fellowship elsewhere (Yale, MGH) and then reported that they felt much more thoroughly trained in CBT than their colleagues). At the same time, residents are also being exposed to psychodynamic training and even the possibility of full blown psychoanalytic training. Not to mention the strong psychopharm and research there.

Also, regarding the cliqueyness of the 2nd year residents...they actually have a reputation of being an extremely tight nit and fun group that the residency is very happy with, but that may have come at the expense of them neglecting the applicants and not trying to sell the program to them. I think thats a shame because I have a friend who did an away rotation there who really enjoyed working with the second years. Maybe by the end of interview season they just got tired of sitting with applicants and bs-ing with them. Especially on Friday afternoon. Maybe I'm rationalizing, I know but just a thought. Also, you can't predict what your particular class is going to be like and it often is different than previous ones. That being said, the Thursday night dinner was a good way to chat up some residents and have some undivided attention.
 

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Hi, I would also like to mention that last semester I called UPenn and asked about psychotherapy training there. The person I spoke with said that psychiatry residents can opt to take a "psychotherapy track" there, that as far as she knew, was the only school to offer such an option. According to her, this track is a new option.

I dunno how good this info is, I'm just typing here what she told me.



worriedwell said:
For what its worth, I chose Penn first over Columbia and I'm thrilled with my decision (now the waiting begins). Also, to plug Penn, Beck Institute is there (read CBT training at its best) and residents there seem to get a stronger CBT environment than at any other program (this is from word of mouth knowledge of people who trained at Penn and then went on to do fellowship elsewhere (Yale, MGH) and then reported that they felt much more thoroughly trained in CBT than their colleagues). At the same time, residents are also being exposed to psychodynamic training and even the possibility of full blown psychoanalytic training. Not to mention the strong psychopharm and research there.

Also, regarding the cliqueyness of the 2nd year residents...they actually have a reputation of being an extremely tight nit and fun group that the residency is very happy with, but that may have come at the expense of them neglecting the applicants and not trying to sell the program to them. I think thats a shame because I have a friend who did an away rotation there who really enjoyed working with the second years. Maybe by the end of interview season they just got tired of sitting with applicants and bs-ing with them. Especially on Friday afternoon. Maybe I'm rationalizing, I know but just a thought. Also, you can't predict what your particular class is going to be like and it often is different than previous ones. That being said, the Thursday night dinner was a good way to chat up some residents and have some undivided attention.
 

Doc Samson

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nortomaso said:
I'm currently a third year student trying to get a feel for the various programs so that I can choose my away electives as well as know what to aim for. I also want to make sure that I am comfortable with the field and those practicing it. Thanks in advance for any replies.
Ummmm... if you're only a 3rd year student, how have you been posting reviews of your interviews of residency programs?
 

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Doc Samson said:
Ummmm... if you're only a 3rd year student, how have you been posting reviews of your interviews of residency programs?

Did you notice the date on his post?... a year ago. Or was that a joke of some sort?
 

nortomaso

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Doc Samson said:
Ummmm... if you're only a 3rd year student, how have you been posting reviews of your interviews of residency programs?

Ummmmmm....Perhaps if you look at the date you'll have your answer. Then again, we tend to only notice details that confirm our pre-existing beliefs, be they religion, a negative opinion of a particular person, or that the source of a patient's problems lie with his attraction towards his mother. That's why a pan-scientific approach to psychiatry is so important. ;)
 

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sga430 said:
i am an IMG with an interview at Harlem. how strongly is it affiliated with columbia??
There isn't any affiliation at the level of psychiatry training. Good luck with your interview- the psychiatrist I know there is a great guy- he would be a lot of fun in an interview.
 

Doc Samson

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JMD said:
Did you notice the date on his post?... a year ago. Or was that a joke of some sort?
The moral here, as always, is that I am an idiot... and that Norto just can't stop grinding that psychoanalytic axe of his.
 

Doc Samson

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nortomaso said:
Ummmmmm....Perhaps if you look at the date you'll have your answer. Then again, we tend to only notice details that confirm our pre-existing beliefs, be they religion, a negative opinion of a particular person, or that the source of a patient's problems lie with his attraction towards his mother. That's why a pan-scientific approach to psychiatry is so important. ;)

Though seriously Norto, I'm curious... what does your rank list look like? You're obviously very smart, well read, and interested in multiple aspects of neuropsychiatry, but if training with a psychodynamic emphasis is such an anathema to you then it essentially rules out Columbia, Cornell, Sinai, NYU, MGH/McLean, Longwood, Cambridge, UCLA, and UCSF. So what's left? Hopkins, Pitt, Penn, Duke, and WUSTL where you'll get little exposure to psychodynamics and no chance to compare the scientific basis of your opinion with clinical experience?
 

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Doc Samson said:
Though seriously Norto, I'm curious... what does your rank list look like? You're obviously very smart, well read, and interested in multiple aspects of neuropsychiatry, but if training with a psychodynamic emphasis is such an anathema to you then it essentially rules out Columbia, Cornell, Sinai, NYU, MGH/McLean, Longwood, Cambridge, UCLA, and UCSF. So what's left? Hopkins, Pitt, Penn, Duke, and WUSTL where you'll get little exposure to psychodynamics and no chance to compare the scientific basis of your opinion with clinical experience?
Over the past few weeks, I've been speaking with a very senior academic psychiatrist about this, and his impression of some of the programs nortomaso listed -- specifically Columbia, UCLA, and UCSF -- is that they are too large to be dogmatic. (At Columbia specifically, I don't think it's possible for Eric Kandel not to cast a very long shadow over the department.) Now, it's possible that he's too senior to know what's currently going on and that his information is outdated, but I don't think that's the case.

Besides, I do think that a psychoanalytic emphasis should give you excellent skills for psychiatric practice no matter what modalities you end up using.

-AT.
 

nortomaso

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Doc Samson said:
Though seriously Norto, I'm curious... what does your rank list look like? You're obviously very smart, well read, and interested in multiple aspects of neuropsychiatry, but if training with a psychodynamic emphasis is such an anathema to you then it essentially rules out Columbia, Cornell, Sinai, NYU, MGH/McLean, Longwood, Cambridge, UCLA, and UCSF. So what's left? Hopkins, Pitt, Penn, Duke, and WUSTL where you'll get little exposure to psychodynamics and no chance to compare the scientific basis of your opinion with clinical experience?

Of the places you list as those I would rule out, I have only applied to MGH/Mclean, UCSF, Columbia and Longwood. I didn't care much for longwood,, but I really liked MGH/Mclean and didn't find it had a psychoanalytical bent at all. The clinical curriculum actually reminded me quite a bit of Hopkins, but more academics thrown in, more of an emphasis on C-L, and more time/opportunity for research. UCSF did seem quite psychoanalytic in some ways, but they also took other types of psychotherapy very seriously as well and it, more than any other program, struck me as a big tent with a lot of divergant, raucous inhabitants.

On the other list, I didn't get the impression that one wouldn't get any psychodynamic training at Penn or Duke. The asssistnt PD at Penn is writing a book on practical psychodynamics and psychodynamic training figures largely into the curriulum. But he is also well versed in the psychotherapy literature. As at Duke, psychotherapy is skeptically embraced and empirically validated. I was very impressed with both programs. Interestingly, even at WUSTL, one-third of the PGY3 didactic time is spent on psychodynamics, and the lectures are given by members of the St louis analytic institute. They are also available to supervise residents' outpatient clinic.

My concern is more one of time-investment. I do not want to spend hours discussing erotic transference (and this is done at Columbia). I also do not want to be in a an environment where the human spirit is seen as immune from experimental validation. I do believe there is much that is interesting, and even correct, in psychoanalytic thought. I find Drew Westen's writings about experimental validation of unconscious processes particularly fascinating. But it also seems to me that much of the emphasis on psychoanalytically inspired thought in American psychiatry residency is a relic of a philosophy that had a lockhold on the field until a few years ago. And that lockhold was on the whole harmful and wrong. Destructive concepts such as the schizophrenogenic mother dominated because more weight was given to personal clinical experience than to objective data. When someone tells me that I have to participate in something for a few years before I can see the truth in it, it makes me nervous.
 

Doc Samson

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atsai3 said:
Over the past few weeks, I've been speaking with a very senior academic psychiatrist about this, and his impression of some of the programs nortomaso listed -- specifically Columbia, UCLA, and UCSF -- is that they are too large to be dogmatic. (At Columbia specifically, I don't think it's possible for Eric Kandel not to cast a very long shadow over the department.) Now, it's possible that he's too senior to know what's currently going on and that his information is outdated, but I don't think that's the case.

Besides, I do think that a psychoanalytic emphasis should give you excellent skills for psychiatric practice no matter what modalities you end up using.

-AT.
None of the programs I listed are dogmatic, but they all have an unavoidable psychodynamic base (remember we're talking training programs here, not whole departments).
My question is not about having your training limited to dynamic theory, but being able to tolerate a program that takes it seriously when you've dismissed it due to "lack of evidence." If I had that reaction to any treatment modality (be it dynamic, behavioral, or pharmacologic) I would have been miserable in training because, in a well rounded program, you should be able to avoid any of them.
 

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Doc Samson said:
The moral here, as always, is that I am an idiot... and that Norto just can't stop grinding that psychoanalytic axe of his.
[stroking beard]
Axe...Axe....
Now why would Doc Samson be visualizing Dr. Norto grinding an axe?
Perhaps he feels that Dr. Norto is preparing to punish him for being an "idiot" by severing his ________?

:smuggrin:
 

Doc Samson

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OldPsychDoc said:
[stroking beard]
Axe...Axe....
Now why would Doc Samson be visualizing Dr. Norto grinding an axe?
Perhaps he feels that Dr. Norto is preparing to punish him for being an "idiot" by severing his ________?

:smuggrin:
Oh goodie... free association. Hmmm... I think he wants to sever my fingers so I can't type. ;)