PICU Recommendations

[FrkyBgStok]

Congrats to those who have matched. I was going to wait until closer to the application season to ask, but with everyone having interviews fresh in their mind, I figured I would ask now and bump it later.

I am a DO from a midwest community program planning to apply to peds critical care this coming application season. My med school grades are crap, but I have been doing very well in residency. My USMLE step 1 is slightly below average, and my COMLEX scores have all been a little above average. I have one publication, one poster presentation (from residency, non PICU), multiple QI projects (non PICU), and am involved in a couple small PICU related research items now. I will likely have good letters.

I plan to apply broadly so my main question is which programs should I save my money on, maybe because they are very academic focused or because they don't take DOs? Also, which programs are heavily research focused as I want to have enough research experience to get involved in the future, but I don't need 1000 publications. I will likely do private practice. Finally, are there any programs that I should keep on my list as reasonable reaches or fitting what I may be looking for?

I am asking online mainly because the PICU group is relatively small here and a couple pretty removed from the process. Thanks for the input and again, congrats on matching.

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[Stitch]

I think it's good that you have some idea about what you want to do and what you are looking for. Do you have any geographical preferences? There's a wide range of programs that might be good fits. Something else to consider would be good cardiac exposure. A few private practice models do hearts and you might need that experience. Also don't rule out research. You may find something that really interests you, and there are a LOT of options from basic science to clinical to quality related.

 

[FrkyBgStok]

Very good points thank you. and i don't have a geographical preference as I have never really lived outside of the midwest. part of me would like to stay there, but another part of me wants to try something new.

 

[michigangirl]

Congrats to those who have matched. I was going to wait until closer to the application season to ask, but with everyone having interviews fresh in their mind, I figured I would ask now and bump it later.

I am a DO from a midwest community program planning to apply to peds critical care this coming application season. My med school grades are crap, but I have been doing very well in residency. My USMLE step 1 is slightly below average, and my COMLEX scores have all been a little above average. I have one publication, one poster presentation (from residency, non PICU), multiple QI projects (non PICU), and am involved in a couple small PICU related research items now. I will likely have good letters.

I plan to apply broadly so my main question is which programs should I save my money on, maybe because they are very academic focused or because they don't take DOs? Also, which programs are heavily research focused as I want to have enough research experience to get involved in the future, but I don't need 1000 publications. I will likely do private practice. Finally, are there any programs that I should keep on my list as reasonable reaches or fitting what I may be looking for?

I am asking online mainly because the PICU group is relatively small here and a couple pretty removed from the process. Thanks for the input and again, congrats on matching.

Hi there,

First of all, congrats on choosing the best specialty ever ;-)

Second, your question is VERY challenging to answer. The reason is that unlike the residency process, the fellowship process is much less cut and dry, i.e. less reliant on scores/grades for you to "make the cut". I don't have a sense for the volume/acuity of the PICU that you have worked in, but having at least 1 VERY STRONG letter from that rotation is essential. If it's not a high acuity PICU and you would like to pursue a larger academic program, it would be a great idea to do a rotation in a larger PICU within a children's hospital (i.e. if you're in Illinois, there are 3 good options in Chicago) to get a PICU-specific letter from your rotation there if that's an option with your program. That may be challenging to arrange, however.

Although many residency programs may have a "no DO" trend, you'll find that the fellowship programs at those same institutions have matched many DOs. I'm curious about your med school grades-- why were they "crap"? What was the general gist of your Dean's Letter? That may have a significant impact depending on how it's framed.

If you can take the lead (with mentorship of course) on of the PICU research projects and submit an abstract at a PICU-based conference like SCCM or the peds critical care colloquium (in Baltimore this year!) that would help significantly as well. Shameless plug, but check out PCCC 2018 – October 5-7th, 2018, Baltimore, Maryland

The timing of the conference is such that it's right at the beginning of interview season and you'll have the chance to meet a lot of fellowship directors/other fellows. All those abstracts are also published in Pediatric Critical Care Medicine which will be good for the CV.

Bottom line-- without knowing the details of med school, no program is really off the table-- if you get your foot in the door for an interview, that's your chance to shine, as interviews carry a LOT of weight. The paper stats will be a part of getting that foot in the door, but glowing letters and some PICU research of substance (clinical, QI, translational, etc) where you had a significant role will be very helpful.

Good luck!

 

[BigRedBeta]

Agree with most of @michigangirl's post.

Don't worry about medical school grades. Rarely a consideration, unless there is something egregious.

Expect to answer questions about why you chose your residency program. Totally okay to say that your goals changed after X and Y events as plenty of people enter residency without knowing their ultimate destination.

I wouldn't worry about DO status - people care far more about if you can do the work, not the letters behind your name.

To that end, your letters matter immensely. Ideally a strong PICU letter, but a good letter matters more than who wrote it. Letters from NICU or PEM or Cards attendings will carry more weight than other fields if you're looking to expand your circle of potential writers.

I am very hesitant to recommend away rotations to residents. The math on the benefits/risks doesn't work out well in my opinion.

Projects are good. And I agree with PCCC as a good specialty specific conference with a lower barrier to entry than many other options.

Lastly, it's best to avoid saying you'd likely do private practice in the future. You're going to be talking with people who have dedicated their careers to academic medicine and that's where 90%+ of the jobs are.

As for specific programs, look at the fellow lists and see what projects are being done by the fellows to give you a sense of what they seem to support. Most programs are going to be broad based in their research projects, but if all the fellows are doing bench research, you can bet that's where they tend to push their trainees. Certain places are also known for researching particular topics - Pittsburgh and TBI, Colorado and hypoxia research, sepsis at Cinci and Seattle. Going through faculty lists and plugging the names into PubMed will also give you that insight if their publication lists aren't readily available. It doesn't mean that you can't go there and do something else, but if you're interested in those things, then that can be something to talk about on your interview day. You will often get an itinerary before your interview so you can look up who you are interviewing with, but often times things change on the actual day so don't get too caught up in knowing your interviewers entire CV.

 

[FrkyBgStok]

very good advice and i appreciate your two's input. sincerely.

 

[MrBigLips]

Just recently matched into a PICU fellowship position on the West Coast, but trained in Chicagoland. My application is very different from most in that I am an IMG, but I also completed a 3 year post doc research fellowship prior to starting residency.

That said, I think BigRedBeta and MichiganGirl have given you some solid advice. There may be a selected handful of programs that may not interview due to being a DO, but I suspect that I can name them on a single hand. Work hard, show interest, and garner some strong PICU/NICU/ER LORs. I highly recommend doing an away elective at an institution you can see yourself at. It sounds like you have already positioned yourself well in terms of research and QI projects so keep up the good work.

For what it's worth, for the past 3 years or so the number of PICU fellowship positions and number of applicants has been nearly equal. Therefore, as long as you apply broadly and attend as many interviews as possible, you should be okay. For reference, I applied to 28 programs all across the nation (but all large academic hospitals). I received 6 interviews, and 2 waitlists. Again, I am an IMG so I suspect that I may have received more interviews if I was not screened for that reason. Good luck and feel free to reach out if you have any further questions.

 

[SurfingDoctor]

I would strongly recommended against doing an away rotation in a PICU as a resident. It will only be disadvantageous.

 

[MrBigLips]

I would strongly recommended against doing an away rotation in a PICU as a resident. It will only be disadvantageous.

how so?

 

[SurfingDoctor]

how so?

You will never learn the system of the hospital in one month, compared to the residents in their home program. Thus you will always be relatively inefficient compared to the other residents. I mean, if one has no intention of applying to that program, I guess it would be okay, but I can’t imagine why someone would want to go do that.

 

[Stitch]

You will never learn the system of the hospital in one month, compared to the residents in their home program. Thus you will always be relatively inefficient compared to the other residents. I mean, if one has no intention of applying to that program, I guess it would be okay, but I can’t imagine why someone would want to go do that.

This. It's pretty difficult to shine in this sort of circumstance, and in general your own picu will give you plenty of experience. Better to get good letters from your home program and ask them to call people they know at fellowship programs that you are interested in.

 

[BigRedBeta]

You will never learn the system of the hospital in one month, compared to the residents in their home program. Thus you will always be relatively inefficient compared to the other residents. I mean, if one has no intention of applying to that program, I guess it would be okay, but I can’t imagine why someone would want to go do that.

Triple stamp.

Med students doing aways get a pass, because they don't know anything. Fellows and attendings are not going to cut a resident the same slack. You might get some pity, but your evals aren't going to take in to account the true depth of disadvantage you're at being out of your home system.

When you're a resident there are system quirks that you just learn because that's how you "grew up" and you know how to navigate those almost without thinking. Obviously, there are a lot of differences between institutions and you're not going to pick those up in 4 weeks. I honestly spent the first 4-5 months of fellowship at a new hospital being extraordinarily frustrated at systems issues - things that were "just the way they were" but were illogical (the PICU was only to interface with the neurocritical care service, never the floor neuro team) or inefficient (only 3 out of the 20+ hospitalists wanted attending to attending sign out, but don't you dare as a fellow try to tell those three about a patient coming to their team...everyone else was fine talking to a resident or fellow) or even just flat out dumb (like residents on heme/onc started dopamine on the floor at 1mcg/kg/min), but that I had to get used to. Nevermind the classic "you'll be searching for the bathroom" or navigating a different build of EPIC (they do vary substantially from place to place) that people usually throw out. It's just not a recipe for success.

 

[PTPoeny]

I did an away rotation as a resident and wouldn't recommend it to improve your applicant. I did an away rotation in a cardiac icu because I thought I wanted to do cardiac and it was going to change how I ranked programs. I went back to my med school so some of the issues mentioned advice were lessened but not gone. I would never have asked for a letter based on that experience and was not applying to that program. It did really help me get a better sense of what I was looking for in terms of cardiac experience in a program but it did not help my application. Not a single program asked about it while I was interviewing. Also since away rotations really aren't a thing the clinical team had no idea what to do with me when I first got there

 

[MrBigLips]

Thanks for explaining. I can certainly understand some of the points being made, specifically those pertaining to systems based issues. However, I still feel that doing an away rotation as a resident can be beneficial. Though I suppose for a selected set of individuals.
1) Residents who are not completely sure if the selected subspecialty is their life long goal or not. I feel that sometimes residents pick certain fellowship because that really have a great experience at their home program because of the attendings and staff, and not because they necessarily enjoy the medicine. It's not until you rotate somewhere else that you realize you only liked the field because of the people you were surrounded by. Similarly, the same can be said for residents who don't have a good experience at their home institution but still have a desire to pursue a fellowship in that field.
2) Residents who are not at top ranked programs. Sometimes the faculty aren't as resourceful and although they want the best for their residents, they just don't have the contacts.