several questions about comparing FM residency programs

[sophiejane]

For those in it or beyond it...some questions from a jittery 4th year...

1. Does medical school or university affiliation matter? What does that get you in terms of your education? Is no affiliation better or worse?

2. How small is too small for an unopposed program? For example...330 beds and 60 residents versus 170 beds and 20 residents...(I guess you also have to take into account how many of those beds are filled with private patients...)

3. How many ER visits a year is a good number? How about deliveries? Is 3,000 deliveries/year a decent number for a small (7/class) program?

4. Faculty: resident ratio--does this matter? Most say about 4:1 that I've seen.

5. NICU/CCU? Some have both, some have neither. How important?

I know everyone says when you find "The One" you will know it...but it's impossible (for me) not to think and wonder about this stuff anyway. I know there is no perfect program, but I want to maximize my learning as best I can, and you have to start with the raw materials of the hospital...

Thanks,

SJ

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[deleted87716]

Does medical school or university affiliation matter? What does that get you in terms of your education? Is no affiliation better or worse?

University affiliation often gets you better lecturers and faculty more dedicated to academics. You don't need to be in a big, academic medical center for this, either. Many unopposed (or relatively so) family medicine residencies at smaller hospitals have university affiliation (mine did).

How small is too small for an unopposed program? For example...330 beds and 60 residents versus 170 beds and 20 residents...(I guess you also have to take into account how many of those beds are filled with private patients...)

That, and lots of other variables, like the size of the hospital's cachement area, size and location of competing facilities, availability of ICU services, advanced surgical or treatment facilities (e.g., open-heart, oncology, inpatient psych., etc.), admitting patterns of local primary care physicians, availability of a hospitalist service, etc. The number of beds in the hospital or the number of residents in the program doesn't necessarily tell you much about the learning experience.

How many ER visits a year is a good number? How about deliveries? Is 3,000 deliveries/year a decent number for a small (7/class) program?

Again, I don't think this necessarily means much, as many of the deliveries could be private. The number of ER visits is unreliable as well, as you'd have to know how many of those visits resulted in admissions to the resident service.

Faculty: resident ratio--does this matter? Most say about 4:1 that I've seen.

IMO, quality > quantity, and it's better to have lots of good, board-certified family physicians on faculty than lots of midlevels.

NICU/CCU? Some have both, some have neither. How important?

You'll need some experience in these either way, even if it's at another facility (an "away" rotation). Having them in-house is more convenient, and you'll get more exposure that way.

Hope this helps!
Kent

 

[sophiejane]

Thanks, Kent.

What's a cachement area, though? I haven't run into that term yet.

Also, what do people feel is a reasonable load of patients while on inpatient service, one where you can maximize learning but not feel overwhelmed? Seems like 2-3 is too few and 12-13 is too many...

How many patients should you expect to see in clinic? I saw programs this past year where residents only saw 2 or 3 patients in a half day at clinic. This doesn't seem like enough.

 

[lowbudget]

For those in it or beyond it...some questions from a jittery 4th year...

1. Does medical school or university affiliation matter? What does that get you in terms of your education? Is no affiliation better or worse?

Some univeristies provide oversight from a management (fiscal/curricular) point of view, but may not be involved in the day-to-day academic teaching of the residents.

The best lectures come from academics, and the best preceptors are faculty with practical experience. The other way just doesn't seem effective/efficient. Setting may play some role, but it depends on the individual faculty, really.

4. Faculty: resident ratio--does this matter? Most say about 4:1 that I've seen.

Regarding faculty size, the more faculty you have overall, the more diversity you get in teaching (which is good I think, especially in a broad field like FM). Unfortunately, it also tends to be more political and sometimes slower moving. I think the key thing is finding a faculty body known by residents to be good doctors and good teachers. The bonus is to find faculty who have the same medical interests as you do (i.e. procedures, OB, pedi, international/wilderness medicine, HIV, research, stuff like that.)

5. NICU/CCU? Some have both, some have neither. How important?

There are pros and cons. The pro to having these facilities is that you have back up specialists to curbside/teach and a place for your patients to go. And having these facilities draw patients to the hospital. The other thing is if you really want to do more work in intensive care setting, you don't have to do an away rotation. The con is that the FM resident's role or responsibility may be limited by the presence of specialists. But that'll depend on what your interests are with regard to intensive care medicine.

 

[lowbudget]

Also, what do people feel is a reasonable load of patients while on inpatient service, one where you can maximize learning but not feel overwhelmed? Seems like 2-3 is too few and 12-13 is too many...

"Overwhelming" depends on how often you get new patients (either from call or hand-offs) and how fast they get discharged. It also depends on how much scut or paper work you're expected to do. Of course, their unstable medical problems will dictate, and if you have specialists on board, you can expect to be sabotaged.

RRC's new requirement is that you carry 5 patients at a time.

Over the course of your intern year, you'll start to see similar cases again and again, and so they stop being overwhelming and to some extent become less educational. The fact that RRC wants us to carry at least 5 patients at a time is ridiculous because it doesn't say anything about how educational these patients are. And educational value varies individual to individual.

How many patients should you expect to see in clinic? I saw programs this past year where residents only saw 2 or 3 patients in a half day at clinic. This doesn't seem like enough.

Hard to say. Part of it is scheduling (1 hr per patient? Or double booked into a 15 minute time slot?), part of it is the need for check out. Early on, you won't have a patient panel, but will see more patients later on. It also depends on your patient population and the no-show rate and the reasons why they're seeing a doctor (urgent care needs? Or chronic medical management?). Of course, it also depends on your level, interns have fewer patients booked while seniors will have more.

 

[deleted87716]

What's a cachement area, though? I haven't run into that term yet.

Sorry. It just describes the geographic area that the hospital draws patients from.

Also, what do people feel is a reasonable load of patients while on inpatient service, one where you can maximize learning but not feel overwhelmed? Seems like 2-3 is too few and 12-13 is too many...

When I was in residency, the average inpatient load per team was probably around 15 patients. A team consisted of an intern and a second-year resident. That's really not as bad as you think, because some of the patients are going to be quick in-out admissions, and some are "rocks" (awaiting placement) who require little time or attention.

How many patients should you expect to see in clinic? I saw programs this past year where residents only saw 2 or 3 patients in a half day at clinic. This doesn't seem like enough.

As interns, we usually saw 6-7 patients in a half day. Third-years saw 10-12.

 

[sophiejane]

Thanks to both of you--this will help build my list of questions to ask on interviews.