Resident and attending collegiality

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I was wondering how important resident and attending collegiality is. That is, do resident and faculty staff need to really get along (both within the group and between the groups)? What if the program is really good but kinda toxic. What is it like at your respective institutions? Is there a way of figuring this out during the interview process?

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Your questions are very good ones but are often difficult to answer within the confines of a one day, structured visit to a given department. Ultimately, a rotation is the best way to answer these types of questions. Anyway, that's not what you asked, so here goes:

That is, do resident and faculty staff need to really get along (both within the group and between the groups)?

1. Resident-Resident interactions: IMO, this is of critical importance. Especially in the beginning of your residency you will need to lean on the senior residents for support. You will need to ask them how to resolve various patient care issues, dosimetry issues, on-call issues, etc. Later you will rely on them for their job interview experience. Residents who hang out together and/or get along extremely well is a mark of a healthy program.

2. Faculty-Resident interactions: During interview day, the residents are more likely to give you the truth than faculty on this matter. In my experience, this boils down more to how individual faculty interact with residents. Younger faculty tend work better with residents and ususally teach more. Given a large enough department there are always a few bad apples but as long as most faculty and residents get along then that's optimal.

3. Faculty-Faculty interactions: Very difficult subject to broach in an interview setting. Even if you rotate at a program for one month, this is hard to ascertain. As a (not so new) PGY-2, I am slowly learning more and more about the subtle political relationships within my department. As long as there are no obviously negative issues apparent, you should not have to worry about this much.

What if the program is really good but kinda toxic?

Avoid at all costs.

Seriously.

If you don't feel comfortable not ranking a program, then move it to the bottom of your list. Rad Onc is a long residency and you will be spending a lot of face time with faculty. This medical speciality is like an apprenticeship and if you don't have a good relationship with the "master" then you will be absolutely miserable. Also, Rad Onc is a field that by its very nature attracts easy going personalities. If you can tell a program is toxic from a single interview day then it must be very bad indeed.

Each year, as reported by applicants, Rad Onc residencies can often change in subtle and not-so-subtle ways.

Take the following examples:

1. Duke: Had a history of being highly malignant; from recent reports, this seems to have turned around completely

2. Jefferson: History of disgruntled residents; this has appeared stable over the last couple of years; though since Curran is leaving for Emory who knows what it was like this year?

This is why it is very important for applicants to review programs candidly after interview season is over.
 
well its the difference between wanting to wake up and go to work or not, and how much you feel comfortable learning.
 
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Thanks to both of you for your excellent advice. Much appreciated. What is the culture like in your institutions (both at the resident and faculty level)? Do you feel that your initial impressions were on-target (as far as collegiality and being happy to wake up for work)? I think places can probably put on a good show (both from a resident and faculty recrutment standpoint)... is it fair to ask abotu this in the interview?
 
The relationship and collegiality is as crucial as mentioned above.

I really like waking up for work and I think that of the people I interviewed with at this program, I was pretty much right about them.

As far as assessing that, it's difficult. I do think programs put on a show on resident interview day. Not that they are being deceitful, but just that they want to show the invites good time (they may cater lunch or take you out the night before or have everyone on site or give the residents time off to spend with you - these are things that may rarely happen during the year), plus I kind of think people are in good mood around that time.

I think 'red flags' are when any resident says anything very negative on interview day. Don't take that with a grain of salt, don't try to read between lines. Give that resident a call or an email about those coments, and see what they have to say.

There were 2-3 places on the trail where these things would happen - overly defensive residents, saying certain things are hell but you get through it, saying things 'are getting better', etc. I just knew that I'd rank them lower, regardless of what faculty said. As far as 'staying away', honestly, I'd rather be at a malignant rad-onc program than a benign medicine program ....

S
 
What is the culture like in your institutions (both at the resident and faculty level)?

Resident-Resident: Extremely strong. Definitely the strength of our program as far as I'm concerned.

Faculty-Resident: Variable, but mostly good. Relationships w/ younger faculty tend to be informal (using first names) and fruitful (in terms of didactics). Older faculty are more formal and set in their ways but, obviously, have a wealth of clinical knowledge to impart. Quirks abound among more senior faculty which can range from slightly annoying to borderline malignant.

Faculty-Faculty: The senior faculty run the show. Juniors are dumped on frequently in terms of call, new patients, etc. If you survive long enough you can be in the former group. Other than this political environment though, relationships among faculty are very cordial.

Do you feel that your initial impressions were on-target (as far as collegiality and being happy to wake up for work)?

I rotated in the department and feel that my impressions were accurate. Would I feel the same way after a one day interivew? I dunno. Overall I am very happy to wake up for work.

I think places can probably put on a good show (both from a resident and faculty recrutment standpoint)... is it fair to ask abotu this in the interview?

Yes, but you will likely get a canned answer from faculty. Perhaps the best people to ask are outgoing PGY-5's who, perhaps, have the least to lose by being honest about the program. Also, they have the added perspective of 3+ years in the same program.
 
Stephew, any other suggestions or comments from Boston/Harvard? Reportedly the residents there are reasonably normal. I think you're the only attending on on here with experience on both sides of the aisle.
 
Thanks to both of you for your excellent advice. Much appreciated. What is the culture like in your institutions (both at the resident and faculty level)? Do you feel that your initial impressions were on-target (as far as collegiality and being happy to wake up for work)? I think places can probably put on a good show (both from a resident and faculty recrutment standpoint)... is it fair to ask abotu this in the interview?

yes its fair to ask but use good judgement. Ask appropriate people in appropriate ways.
 
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