Strong supportive Community Programs in major cities

[AllAboutHandsOn]

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hi everyone,

i'm a 3rd yr med student, who loved surgery and starting to plan for 4th yr and possibly a yr off for research.

i'm going through the internal struggle of thinking about academic/university Residencies (therefore probably needing to add a yr's research) and training at a "2nd tier" Residency (and going straight through to 4th yr).
i don't want to close doors (to the top programs, academic route, or possibly competitive fellowships) in case i might really like it, but my gut is leaning towards the idea that i want to start training SOONER, that family and outside activities will be important to me in the future, and wouldn't mind strong clinical training and sticking to the private/non-academic sector.

perhaps i just want to go a great, supportive, 5yr program where clinical training is strong and residents (though tired like everyone else) are perhaps happier and see/do more than those at MGH, UCSF, and JH for example.

the problem is, i don't know where/what these so-called good, 2nd tier programs are. i figure LOCATION is especially important, being close to family and friends etc.

So...of the major cosmopolitan/coastal areas (CA, seattle, ohsu?, boston, NY, east coast) what programs have the reputation of having a supportive, hands-on, camaraderie, perhaps "2nd tier" as in not super-cut-throat to match? I think knowing some of my options, i may feel more reassured just starting 4th yr.

all suggestions would be helpful!! thanks

p.s. i know this is so late in the process...the idea of applying to HHMI, research fellowships all due in January for a year off is sickening right now...in some sort of demented way, i would rather just continue to 4th yr and go to a lower tier residency just b/c i want to start doing surgery sooner...just have no idea what programs have what flavors/feels.

 

[Blade28]

I don't understand...you're considering taking a year off between your MS-III and MS-IV years to do research? Why? This isn't required when applying to academic residencies, you know.

 

[Winged Scapula]

I too am confused.

Is your application somehow otherwise lacking (ie, Step 1 scores) that you think you need to do a year of research to bolster it?

A year of research is not necessary and frankly, I don't know if its worth it...after all, you won't have your name on any publications by the time your apps go in; if you're lucky, you might have something accepted or in press.

I don't see any reason to settle for 2nd tier if you are competitive for the higher ranked programs.

And although it may be true that at fellow heavy programs you aren't getting to do some cases, a top tier program and supportive, good clinical training aren't necessarily at the opposite ends of the spectrum.

If you're not sure that you don't want to pursue an academic track career, then you would be better off training at an academic center, those that don't require research and have good fellowship placement. If you do a search in this forum, you'll come up with multiple lists of "good" residency programs all across the country.

 

[Castro Viejo]

I agree strongly with Kim Cox.

And I don't mean for this to turn into an Academic vs. Community program debate, but...

Academic program all the way. Overall your exposure and training will be well-rounded. Your faculty will be farther reaching. Your fellowship applications won't be tossed out at the major programs. Generally you'll be better off in the surgical world in my opinion. Don't settle for a "2nd tier" program. Go for Gold.

I'm a soon-to-be community program graduate and while I've enjoyed my time here and have every bit of confidence in my training in the operating room, it'll always be a liability outside of private practice. It's just not the way to go if you're unsure of whether you want to be an academician or not. It's hard to change that course once you've started. Even if you do a a fellowship at a university, I think.

And your year off in research as a medical student won't necessarily satisfy your Chairman in the academic surgical program, if that's your purpose for pursuing an HHMI-type research year. As Kim Cox advised, find a program that doesn't require research. It doesn't mean you won't be "asked" to do it, but the chances of it happening won't be 100%.

And this notion that community programs are everyday celebrations of life where the residents are happier, healthier, and not as jaded is just wrong. There are exceptions, but at least the few community programs where I've got friends in the New York metropolitan area aren't happy places. And your chance for a day off is probably not as good as at a larger program. If there's only three of you, who's gonna cover while you're at home celebrating? 🙂

 

[SLUser11]

There are exceptions, but at least the few community programs where I've got friends in the New York metropolitan area aren't happy places. And your chance for a day off is probably not as good as at a larger program. If there's only three of you, who's gonna cover while you're at home celebrating? 🙂

Bolded the important part of that paragraph.

There are plenty of university affiliated community programs that don't exclude you from future choices to do fellowships or enter academia. Graduates from my program went on to do fellowships at Hopkins, Emory, Baylor, Mayo, Wash U, etc. Others have accepted academic appointments at university programs in the midwest.

We also are a bigger program at 6 spots/year......I do agree that some "country club programs" that only have 2-3 residents/year end up with unexpectedly difficult call schedules.

I think that the OP should explore different options, perhaps interviewing at both academic and community programs, and then decide what fits best.

I've also winced every time I've read "second tier" in this thread, so my opinion is biased and somewhat defensive. I don't feel that anything about my current training is second rate.....

 

[AllAboutHandsOn]

sorry if i offended any of you by calling them "second tier". i was referring to the slightly less competitive to get into residencies.

basically i've gotten quite a bit of advice from attendings saying that top programs are super difficult to get into, "with 100 to 1 ratio of applicants to spots", either with a billion honors or stellar step 1 scores. my board scores are decent, above the national average; leadership and surgery-related activities are somewhat lacking b/c i didn't think envision myself as a surgeon early on.

i guess my self-doubts and the above advice are making me feel obligated to "add something to my resume", knowing that a year in the lab may be a great learning experience and helpful training for future academic work. part of me also just wants to go ahead and start residency, doing what i know i'll love, but i wonder if my sub-par credentials may be closing doors for me a good residency programs.

 

[Castro Viejo]

i guess my self-doubts and the above advice are making me feel obligated to "add something to my resume", knowing that a year in the lab may be a great learning experience and helpful training for future academic work. part of me also just wants to go ahead and start residency, doing what i know i'll love, but i wonder if my sub-par credentials may be closing doors for me a good residency programs.

Your "subpar" credentials may close a few doors.

But so what? Academic surgery neither begins nor ends with these guys, but they are good. Damn good.

I think the point is that your year off in lab land as a medical student isn't going to really help much at all. By the time you get your feet wet in the lab, it'll be time to apply again, and you won't have ANYTHING to show for your year off. Just having "HHMI Cloisters" or whatever the heck it is on your CV isn't going to automatically open doors. They'll want to see hard evidence of research (i.e., papers, posters, presentations, etc.).

Go with what you've got. If you're feeling the pinch, take Step 2 and kill it. Get into the best academic residency possible (or whatever personally fits you best) and do your thing. If you go to a "second tier" program and do well, you'll probably do just as well as someone from one of those surgery meccas.

 

[burz80]

i agree with all the advice above. i'm a 4th year, and i'm going through interviews right now. before applying, i worried about not having any significant research activity during med school, but the general advice given to me was that this wasn't necessarily a big deficiency in my overall application. based on that, i applied to a wide variety of programs, including some highly competitive, academic ones that were "dream programs" for me. i received rejections from some of them, but i also received interview offers from others. my advice to you at this point would be to concentrate on your 3rd year clerkships, honoring as many of them as you can. if you have some free time and you WANT to do research, try to find a faculty member to work with on a small project over the next year to year and a half. when it comes time to apply next year, don't eliminate programs because you think you're not competitive enough. you never know who will find you to be a great candidate for their program. i hope this info helps, and i wish you the best of luck.

 

[quagmire]

have faith. there are a ton of great programs out there. we all don't have to train at man's greatest hospital or hopkins. i applied to all these places without an ounce of research in my ERAS app. I got a lot of interviews and there were some places that showed more interest than others. rather than taking a year off spend a couple months at a couple of different big academic places and kick a** as a 4th year rotator. that way they get to know you, you can get a good letter which travels farther than some crap poster presentation, and you get to know whether that place is the place you want to be at. you can always take time off in residency like most of us who are interested in an academic life. kick butt on step II, do some away rotations, and finish off 4th year with your friends that you have made along the way. I have friends (my wife even) who took time off in medical school and their fourth year wasn't quite as meaningful when all their friends were off somewhere being doctors....

of course if you don't have friends and you want to sit in a lab for a year, knock your self out at the NIH (which is supposed to be a great experience by the way).😉