Strong Programs? Definition?

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docscience

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I had a long conversation with a resident in IM (2nd year) and was asking him for advise on applying to IM programs, etc.

For the first time I think I understand what a "strong program" is.....he told me to ask on interviews if I would be the only in house physician at times.

For instance, his med school (UAB) has a very strong IM program (according to him) because they train the residents how to put in lines, intubate, paracentesis, etc. He said that at this current program, surgery is consulted to put in a line/chest tube if the medicine people are struggling with it. She said it would suck to be a 3rd year resident and have to struggle with lines. And worse, if you are an attending, you won't be able to charge for a chest tube if you don't know how to put one in.

Also, a surgery resident once said...ask if the other departments are strong. If you have a strong surgery program for example, you won't get consulted to manage someone's diabetes....they will put them on insulin/whatever they need by the surgery staff. If going to a weak program, IM may be consulted to do bitch work. He did state that at times, there are lazy surgery residents who don't want to do anything...

So is this a good way to look at how strong programs are? By how their supporting departments interact with them, and how many lines/intubations/etc. that they do? (obviously if you want to do hospital medicine)

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I had a long conversation with a resident in IM (2nd year) and was asking him for advise on applying to IM programs, etc.

For the first time I think I understand what a "strong program" is.....he told me to ask on interviews if I would be the only in house physician at times.

For instance, his med school (UAB) has a very strong IM program (according to him) because they train the residents how to put in lines, intubate, paracentesis, etc. He said that at this current program, surgery is consulted to put in a line/chest tube if the medicine people are struggling with it. She said it would suck to be a 3rd year resident and have to struggle with lines. And worse, if you are an attending, you won't be able to charge for a chest tube if you don't know how to put one in.

Also, a surgery resident once said...ask if the other departments are strong. If you have a strong surgery program for example, you won't get consulted to manage someone's diabetes....they will put them on insulin/whatever they need by the surgery staff. If going to a weak program, IM may be consulted to do bitch work. He did state that at times, there are lazy surgery residents who don't want to do anything...

So is this a good way to look at how strong programs are? By how their supporting departments interact with them, and how many lines/intubations/etc. that they do? (obviously if you want to do hospital medicine)

Though I believe it was recently taken out of ABIM requirements, I think lines/thora/para/LP/intubation are standard skills taught and used at any IM program. Judging program strength by procedure numbers (in MEDICINE!) is pretty stupid. You want to look at fellowship match, faculty support, research connections, prestige, etc. If you want to do any/all of those procedures, you will have plenty of opportunity at any residency program you to go, with the exception of maybe the Mayo Clinic (which seems to have dedicated teams to do lines and procedures - can anyone clarify?).
 
A "strong program" is a nebulous term. It all depends on what you want out of it. As the other poster commented, this could range from clinical training, to academic reputation, to research opportunities, to resident autonomy, to fellowship placement, to job market placement after graduation...etc.

As to looking at the "strength" of other specialties, I think that's hit or miss. If surgery is the dominant dept, you might see more surgical dumps onto the IM service and less collegial interactions between the two. I don't think the inverse is true though for a dominant IM dept. It all depends on the Chairs and who is willing to go to the mattresses for their respective dept. My own academic institution has a very large transplant surgery dept (so much so that they recently made a TV show about it), and yet they routinely admit their pts to Medicine...even if they're only 3 months post-transplant. The explanation was literally "We're too busy to take care of our pts, so your dept agreed to start caring for them." The same was not true at the institution at which I did my residency, where IM was at least as strong (if not stronger) than the surgery dept. The lesson being, a stronger surgery dept may walk all over a weaker IM dept but not vice-versa.

I think you'll develop a better grasp of what you'll want in a program during your 3rd yr clerkships by seeing what you like and dislike in your own home program. If you're truly pre-med still, I wouldn't worry about all of this just yet. For now, just relax :p
 
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Strong is kind of a poorly defined term in this context . . . people may define this differently, person to person

You will need to attempt to define some goals prior to interviews and then find a program that will best match what you are wanting to do with you career. For instance, you may get all the lines and tubes and other procedures you want at a program, but perhaps that program is not so great for fellowship placement. Or the converse, perhaps you go to a place that offers fewer procedures as a resident, but places people into top programs or perhaps has a research mentor you'd like to work with.

The only context of "strong" you really should be concerned with is what is going to be the best for you, realizing there may be very few places that may fit all your criteria - give and take. Although, I think you should feel comfortable doing lines, paracentesis, and intubating if you have to coming out of residency . . . LPs we just don't do that often anymore, so you're lucky if you can find a few, but it's kind of neurology's territory these days, and thoracentesis has kind of become the domain of the pulmonary sub-specialists, mostly because of the possible complications. And chest tubes, while pretty cool to place, are a pain in the ass to manage, and just really aren't all the indicated very often these days anymore, and if surgery wants them, they can have them - ironically enough though, the surgeons seem to be getting too busy in the OR to do them, and, at least in the MICU, they are starting to do more and more, and may someday be the realm of pulmonary as well.

I've been lucky to be at medical school and in a residency program where medicine and surgery get a long pretty well. We do get dumped on by ortho more than we should, but you can make the case that allowing these guys to do anything but bones might be malpractice (I kid, I kid [no, seriously!])

EDIT: Just for clarification, the large bore, surgical kind of chest tubes are not often needed these days, when other modalities work just as well or better.
 
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