Questions I should ask...

[Worf]

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Hello everyone:

I've been offered the Navy HPSP but haven't yet signed...I set up a meeting next week with the director of the EM residency program in San Diego...being that I will not be a medical student until the Fall, I have little ability to judge a high quality residency program from a crappy one...What should I be looking for in a good training program? What sort of questions should I be asking?

Right now, I'm riding the fence on whether I should take the scholarship...I want to serve....but I want to make sure that the residency training program that I am interested is good...and I'm tired of talking to the recruiter who really seems to know less about the HPSP program than I do...

Worf

 

[idq1i]

Have you looked through the Navy-related posts in this forum yet? I'd strongly recommend it. It will allow you to get a better picture of the state of military medicine.

One of the biggest drawbacks to the Navy scholarship is the almost-obligatory GMO tour, where you are deployed to play doctor with only one year of GME. Make sure you can tolerate this (misuse of physicians, IMO) before signing on the dotted line.

Here's one question that you should ask: What is the case load like?

 

[DoctorInSpace]

Just so you know, with any of the military scholarships, you may not get your #1 choice of residency. Each branch has certain needs in certain specialties and you might not be able to take the most direct route to your goal. If you are dead set on a certain specialty or a specific residency program, you might want to re-think the scholarship. There are a lot of uncertainties you need to be comfortable with. You might have to do a civilian residency if you are trying to go into an ultracompetitive field.

My point---if you are OK with plans changing on you, then you will do much better than if you are deadset on one specific path. Being a military doc means you will subject to the needs of the military.

For me, i'm totally fine w/the unknown and couldn't be happier about my decision to take the scholarship.

 

[militarymd]

For EM, these are the things that I would ask/evaluate.

First, set a gold standard. I'm not EM, so I don't know what the good programs around the nation are, but find out, and then look at the following numbers.

Patient encounters per year
Types of patients seen - trauma, type of trauma, peds, CHF, etc.
Number of procedures: intubations, central lines, closed reductions, sedation experience, chest tubes, involvement in trauma care, number of codes run, etc.
Research/Publications/Didactic conferences
RRC approval...type of approval, unconditional vs other.

Now compare San Diegos program with the your gold standard, and you will see for yourself what kind of experience you'll get.

I would not use board-certification rate as a rule.

 

[mitchconnie]

Worf,

Congratulations on really looking into the training programs before signing. Wish I'd been so smart. I have the following thoughts.

It is EXTREMELY difficult to get an accurate read on a program based on a discussion with the program director--they will be relentless boosters of their program because they want the best people. Everything they say will have a positive spin. If you want the real scoop, talk to some recent graduates, or better yet people in the same medical center who work with the ER but aren't in the program--Gen surg, IM, FP etc.

Ask the program director POINT BLANK "How has your program been affected by the massive drop in patient volume and case variety at military medical centers nationwide." If he says it hasn't affected them and they haven't changed, then run away as fast as you can, because he is lying to your face. If he says that they have fully integrated their program with a quality civilian program nearby, then the training is more likely to be OK.

If the program is not fully integrated with a civilian program, look at how many rotations are done outside the home instituiton. As I have said on other posts, away rotations are likely of poor quality, because the attendings won't know you or trust you enough to let you manage tough cases. If critical portions of your training are done outside of the military hospital, it is a big problem.

Do not be fooled by boards pass rate. If the residents have tons of time to study because there are no patients to see, they will pass the poards.

Unfortunately, you are four years from beginning training, so everything may have changed by the time you are a house officer. This is a time of change, and perhaps collapse of military GME at many medical centers.

Sorry for a somewhat long, and rather negative post, but quality of military GME and maintaining skills while in military practice are big issues of mine.

 

[Worf]

Thanks for all the advice, I think I'm ready for my meeting. I will definitley decide if I am signing the HPSP contract based upon this visit. I'll let you all know....

-Josh