Rank List Help: Duke & Wake Forest

[A20]

As the title says, I am having trouble deciding between Duke and Wake Forest to put at my #1 spot. I was really impressed by both programs, and I am having a really difficult time deciding which may be best for obtaining both my personal and professional goals. As far as career goals, I am strongly considering pursuing a fellowship in cardiac, critical care, or pain. Also, I think there is a good possibility I will choose to stay in academic medicine. In the immediate future my wife and I plan to try to have children starting when I am late PGY1 or PGY2.

Wake Forest: I have that “gut feeling” that Wake is a better fit. I feel like I got along better with the residents and faculty at Wake during my interview, and the culture seemed to be more welcoming and laid back. They seem to offer a pretty great work-life balance and were really family-friendly giving my wife and I more ability to try to start a family. Wake appears to offer great clinical training (I think their airway training is top of the field) and a variety of complicated cases with the exception of liver transplant. Both cardiac and pain fellowships are offered, and they have a decent record of matching to other strong programs if so desired. The biggest drawback for me is their critical care experience which is an admitted weakness. They only rotate through MICU as an intern and CT-ICU in the CA years.

Duke: Duke seems to offer superior clinical training, and during my interview I really couldn’t identify a glaring weakness in the program. Duke also has the brand name, but I’m not sure how much stock to place in that. They offer great cardiac, critical care, and pain training with fellowship programs offered in all of these specialties. Unfortunately they don’t offer a chronic pain rotation until CA3 year, so there is less early exposure and opportunity to decide if that is something I would like to pursue. During my interview day, I don’t think I clicked as well the residents. My limited grasp of the culture was that it was a little more high strung and in some people I got this sense of superiority which left a poor impression.

Winston-Salem vs RTP: The RTP area seems to offer more amenities, but WS was more than adequate and seemed really family friendly. The housing market seems to be blowing up in Durham giving WS a little cheaper COL. My wife plans to go back to school when we move for residency, and it appears that there are more options for schooling in the Triangle. Overall, I think my wife and I could really be happy in either place.

Ultimately, training at Duke seems like it may help me to better achieve my professional goals and is currently sitting at #1, but I really don’t know. I assume that both would be fantastic places to train. I’m curious for your collective thoughts on these programs, any additional aspects that I should be considering, and general advice. Thanks in advance!

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[NICMAN]

I had a similar dilemma. Strongly considered Cardiac and academics.

I went to Wake Forest and felt like the cardiac experience was very good. I grew to love Winston and my family had a chance to really grow. In the end I would personally choose Wake Forest again if I had to do it all over again. The culture at Wake Forest is very collegial. I felt like I could easily talk with surgical attendings and residents. The anesthesia department is very well-regarded within the hospital. Most of all I really liked most everybody I worked with and frequently hung out with people outside the hospital—even (*gasp*) some of the attendings. I had two children in residency and felt like it was celebrated (rather than tolerated), my mother-in-law passed away unexpectedly and I was able to take family leave to fly overseas for her funeral with little notice and they facilitated it with almost zero hassle.

I would say that the clinical training at both places is superb. You will have more research and “high academics” at Duke but I felt like the direct contact, informal teaching, and mentor ship at Wake Forest was superior due to the closeness with which you work with attendings. We his isn’t just my impression—this was confirmed to me by all of my Duke-trained attendings at Wake Forest. In theend it was those intangibles that I feel gave Wake Forest a better-tailored training experience for me.

 

[Gern Blansten]

Both are outstanding. Go to the one you felt like was a better fit in the city you enjoyed the most. Both programs have excellent reputations and would be in my top 15 list.

 

[A20]

Thank you for your insight. Could you speak to the critical care training you received at Wake? If you were inclined, did you feel you received adequate preparation to pursue a fellowship in critical care?

More generally, I'm curious on people's perception on the value of "brand name" training. Would the Duke name on a CV open any additional doors in the future? I know this an incredibly subjective question that doesn't exist in a vacuum, but I'm curious if anyone feels there are opportunities that may be missed by choosing one vs the other.

 

[deleted697127]

As the title says, I am having trouble deciding between Duke and Wake Forest to put at my #1 spot. I was really impressed by both programs, and I am having a really difficult time deciding which may be best for obtaining both my personal and professional goals. As far as career goals, I am strongly considering pursuing a fellowship in cardiac, critical care, or pain. Also, I think there is a good possibility I will choose to stay in academic medicine. In the immediate future my wife and I plan to try to have children starting when I am late PGY1 or PGY2.

Wake Forest: I have that “gut feeling” that Wake is a better fit. I feel like I got along better with the residents and faculty at Wake during my interview, and the culture seemed to be more welcoming and laid back. They seem to offer a pretty great work-life balance and were really family-friendly giving my wife and I more ability to try to start a family. Wake appears to offer great clinical training (I think their airway training is top of the field) and a variety of complicated cases with the exception of liver transplant. Both cardiac and pain fellowships are offered, and they have a decent record of matching to other strong programs if so desired. The biggest drawback for me is their critical care experience which is an admitted weakness. They only rotate through MICU as an intern and CT-ICU in the CA years.

Duke: Duke seems to offer superior clinical training, and during my interview I really couldn’t identify a glaring weakness in the program. Duke also has the brand name, but I’m not sure how much stock to place in that. They offer great cardiac, critical care, and pain training with fellowship programs offered in all of these specialties. Unfortunately they don’t offer a chronic pain rotation until CA3 year, so there is less early exposure and opportunity to decide if that is something I would like to pursue. During my interview day, I don’t think I clicked as well the residents. My limited grasp of the culture was that it was a little more high strung and in some people I got this sense of superiority which left a poor impression.

Winston-Salem vs RTP: The RTP area seems to offer more amenities, but WS was more than adequate and seemed really family friendly. The housing market seems to be blowing up in Durham giving WS a little cheaper COL. My wife plans to go back to school when we move for residency, and it appears that there are more options for schooling in the Triangle. Overall, I think my wife and I could really be happy in either place.

Ultimately, training at Duke seems like it may help me to better achieve my professional goals and is currently sitting at #1, but I really don’t know. I assume that both would be fantastic places to train. I’m curious for your collective thoughts on these programs, any additional aspects that I should be considering, and general advice. Thanks in advance!

Why Are So Many Surgeons Assholes?

And how can we make them nicer?

psmag.com

“As an example, the surgeon mentions Duke University's infamous doctor divorce rate. A story persists of a (now-former) head of Duke Medical School claiming that their residents have an over "100 percent divorce rate." That is, students showed up married, got divorced, got re-married, and then divorced a second time. The reason being that they were over-worked and lived a life where work came first, everything else a distant second. And that claim was made as a boast to prospective students.”

I realize these are both elite institutions in the south, however, there is a stark contrast in the national reputations of their cultures. WF seems to be regarded as a great program for residents with families. Dukes reputation seems to be that of short white coats for physicians and a weird pride in a dysfunctional dedication to career over family. I didnt train at either and don’t know anyone currently at either, however, i still think it is something to consider.

 

[A20]

That was an interesting read. I'm curious how that culture among the surgeons permeates the rest of the OR. From my interview I was told roughly half of the residents at Duke are married, some with children. While at WF there was definitely more married couples with children. The culture at WF also seemed more supportive and family friendly. That's definitely a strong consideration of mine.

 

[CubsDynasty]

"(I think their airway training is top of the field)"

Can you explain what that means and what ranking system exists for airway training?

 

[A20]

"(I think their airway training is top of the field)"

Can you explain what that means and what ranking system exists for airway training?

Totally subjective, but that's the impression I got while interviewing there in comparison to some of the other big name programs I visited. They place a lot of emphasis on training in awake intubation and get experience in many different emergency airway techniques. The CA3s that I spoke with felt really confident in all of these techniques. Check out their website if you'd like to see more about what I'm referring to. It's definitely a unique experience.

 

[abolt18]

As the title says, I am having trouble deciding between Duke and Wake Forest to put at my #1 spot. I was really impressed by both programs, and I am having a really difficult time deciding which may be best for obtaining both my personal and professional goals. As far as career goals, I am strongly considering pursuing a fellowship in cardiac, critical care, or pain. Also, I think there is a good possibility I will choose to stay in academic medicine. In the immediate future my wife and I plan to try to have children starting when I am late PGY1 or PGY2.

Wake Forest: I have that “gut feeling” that Wake is a better fit. I feel like I got along better with the residents and faculty at Wake during my interview, and the culture seemed to be more welcoming and laid back. They seem to offer a pretty great work-life balance and were really family-friendly giving my wife and I more ability to try to start a family. Wake appears to offer great clinical training (I think their airway training is top of the field) and a variety of complicated cases with the exception of liver transplant. Both cardiac and pain fellowships are offered, and they have a decent record of matching to other strong programs if so desired. The biggest drawback for me is their critical care experience which is an admitted weakness. They only rotate through MICU as an intern and CT-ICU in the CA years.

Duke: Duke seems to offer superior clinical training, and during my interview I really couldn’t identify a glaring weakness in the program. Duke also has the brand name, but I’m not sure how much stock to place in that. They offer great cardiac, critical care, and pain training with fellowship programs offered in all of these specialties. Unfortunately they don’t offer a chronic pain rotation until CA3 year, so there is less early exposure and opportunity to decide if that is something I would like to pursue. During my interview day, I don’t think I clicked as well the residents. My limited grasp of the culture was that it was a little more high strung and in some people I got this sense of superiority which left a poor impression.

Winston-Salem vs RTP: The RTP area seems to offer more amenities, but WS was more than adequate and seemed really family friendly. The housing market seems to be blowing up in Durham giving WS a little cheaper COL. My wife plans to go back to school when we move for residency, and it appears that there are more options for schooling in the Triangle. Overall, I think my wife and I could really be happy in either place.

Ultimately, training at Duke seems like it may help me to better achieve my professional goals and is currently sitting at #1, but I really don’t know. I assume that both would be fantastic places to train. I’m curious for your collective thoughts on these programs, any additional aspects that I should be considering, and general advice. Thanks in advance!

I have a wife and kids. Being at an institution that loves and values my family as much as myself was essential to me. My family has always been #1 with work being 2nd place when things get real and my program has allowed me to care for my family members when they were sick and gotten me out of clinical duties when my family needed me. This is only to say that having a program that values and supports ALL of me has been fantastic. It has taken so much stress out of otherwise stressful life circumstances, like a kid being in the hospital.

 

[CUBR]

Take your gut feeling over what you see on paper any day. It's your body's more holistic way of telling you it's the right decision over simply your head saying Duke is a great program.

I always tell applicants to give more weight to the stuff outside of the hospital including family, the city, social network. The training you ultimately receive is going to be relatively similar regardless of which ACGME program you go to. Unless you already have a research grant going and will need the institutional support to accomplish it, then Duke is probably the way to go.

 

[A20]

Thanks everyone who has posted. I appreciate the input. It has definitely given me a lot to think about.

 

[Nivens]

Totally subjective, but that's the impression I got while interviewing there in comparison to some of the other big name programs I visited. They place a lot of emphasis on training in awake intubation and get experience in many different emergency airway techniques. The CA3s that I spoke with felt really confident in all of these techniques. Check out their website if you'd like to see more about what I'm referring to. It's definitely a unique experience.

I remember being really impressed by the awake fiber presentation as well. It’s a gimmick- you will emerge from any recognizable anesthesia program an expert in the airway.

Sounds like you have plenty of good reasons to choose Wake over Duke, but this should not be one of them.

 

[caligas]

If it helps: Durham has more big city amenities and is closer to the coast, Winston better access to mountains.

 

[LunchMD]

Curious to hear exactly how they are training their residents in the advanced techniques if they truly feel so confident. Simulation? Elective awake fibers? Spending time in ENT clinics or scrubbed with them on trachs? If they do what everyone else does and just rely on clinical experience, you'll likely only do about 15 awake fibers in all of residency, no crics, and no other emergency techniques. Asleep fibers, sure, do as many as you want whereever you go.

 

[Justice4all]

I had one attending that did at least one asleep FOB once a day. Says to maintain skills

 

[NICMAN]

Curious to hear exactly how they are training their residents in the advanced techniques if they truly feel so confident. Simulation? Elective awake fibers? Spending time in ENT clinics or scrubbed with them on trachs? If they do what everyone else does and just rely on clinical experience, you'll likely only do about 15 awake fibers in all of residency, no crics, and no other emergency techniques. Asleep fibers, sure, do as many as you want whereever you go.

All c-spine surgeries with myelopathy get an awake fiber optic as well as many surgeries with oropharyngeal pathology and anterior mediastinal masses, etc. I did about 60+ of them in residency. It was helpful. This was emphasized because it is unique to Wake Forest. No other program in the country comes close to that level of training on awake fiber optic intubations. And yes, I still do one every two months or so (the ENT residents where I practice do most of them).