How do you guys go about deciding which programs are better than others? I have been fortunate enough to get more interview invites than I can possibly go to. So now I have to decide which programs I'd rather interview for. Aside from the location factor, I'm having trouble deciding. I've tried looking at US News ranking, but since that's mostly based on how much research money they get, I think that's too limited. I also looked at pass rates. But for the smaller programs, pass rates can be real skewed year to year.
So what other data are you guys looking at to decide how strong (academically) a program is?
The really difficult part to your question is that you're asking about choosing where to interview, so it's all sight-unseen...
I think it's always important to start with the people at your home program and ask for opinions. This can certainly be open to bias, but hopefully the more people you poll, the better picture you'll get.
Of course "strong" is very subjective. Some places are outstanding clinically, but don't have a strong research focus. Others have exceptional research opportunities but because of the structure of the program are not as strong at producing clinicians. However, how much of an impact this is for you is certainly dependent on your own personality, learning style, and career goals. And I think that's really the kicker. If you're someone who needs to time to read on your patients in order to learn the condition and the correct treatment plan, then you're going to suffer a lot at a program where things are busy, you need to work fast, and learn by doing. Likewise, if you're a "do-er", going to that program that expects a significant amount of reading time and focuses on textbook knowledge, you'll likely be frustrated that your education is more self-directed rather than patient directed.
It's probably obvious, but if you're thinking fellowship in the future, you do need to examine how many fellows the program produces, particularly in the fields you're interested in. My feeling is that if you see a residency is producing a ton of fellows in a few particular fields, you can be confident that the experience there in that field is very strong. I think this is especially true in the larger fields like NICU, PICU, ER, Heme/Onc and Cards, in part because the other fields (GI, Pulm, Rheum, Endo, Development, Ado) are so much smaller and you're getting a self-selecting group in those fields rather than people being turned on to the field by their experiences. The one exception to that would be if a program has turned out an extraordinary number of fellows in that field, like 8 allergy/immunology fellows in the last 5 years or something like that, because that would be an outlier and
something is definitely going on there and the program is known within the field. I would be less inclined to say that you should take into account where the fellows actually end up, unless you are really confident that you know the subspecialty reputations in that field.
As far as the fellow v resident run argument, it's a limited set of places you're going to be run into this conflict anyway. I do think it's important that if you're interviewing at a place that has a number of fellowships that you find out how the residents like it AND you ask for specific numbers of procedures the residents have done. No place is going to tell you that the fellows steal procedures, but in talking to my friends as they gone on fellowship interviews, there can be surprising "cultures" set up at places with fellows - things that have developed over time. One of my Neo friends was shocked to hear at several places that residents rarely even asked to place umbilical lines and that job typically was left to the fellow, even when the fellow was extremely busy. If the expectation is that you're only going to place lines a couple of times as a resident (because that's what everyone else is doing), then it's not going to feel like procedures are being stolen from you when the fellow does it instead of you. But there are residencies out there (with neo fellows) where the assumption is the residents are going to place lines and they leave having done it 30+ times.
Now, I think what I've said above is great if you're going on to fellowship. I think it's much harder if you're going to be a general pediatrician. How do you measure the success of a program in that regard? I think you are left with fewer metrics. Board pass rates are obviously important, but after that? Most people find jobs out of residency, most people are going to end up employed close to their residency program, so how do you tell?
It's just my opinion, but I think one thing you can look at is the structure of the program. For me, I was never worried about figuring out well child checks/immunization schedules/anticipatory guidance/ADHD or things like ear infections and viral illnesses - I don't think it's possible for a pediatrics residency to NOT give you enough exposure to have a firm grasp on these things. I was worried about learning that sick vs. not sick dilemma, how do I identify the things that need more than fluids, rest, and the occasional antibiotic, and more importantly what to do when those kids walked through the door. I think most applicants can agree with that. I'm biased as a future intensivist, but that's certainly what I want my general peds friends capable of doing so that they can get my help. With that in mind, I'll posit that a residency program in which you get a substantial amount of ER time (more than just 1 or 2 months total) will make you a significantly stronger clinician. So much of peds EM really is bread and butter gen peds, it's going to help you anyways, but it's that constant exposure to kids who are really sick with any number of conditions that adds so much to your training. Again, just my opinion, but something to consider.
