Tiers in EM Residencies?

[migm]

Having interviewed at Resurrection and seen the numbers and data provided by the PD about procedure counts, happiness of residents, ability to go into competitive markets, comfort of residents with very sick patients, 100% board pass rate for oral and written for the last several years, 100% desire to come back to this residency if given a chance to start over as seen on an anonymous survey.. I would have to disagree with the rationale that ranks that program in the 3rd tier.

It makes me wonder what it is you're basing your ordering on - is it competitiveness? highest step 1 score? I'm not sure anything above is valid beyond (maybe?) the well known names that continue to come up as "1st tier" because a lot of people apply there. So.. what is this based on?

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[namethatsmell]

I was trying to resist...but the little popcorn man two posts up...well, turns out I couldn't resist...

First, putting "brand-nameness" aside, explain how NYP is of a "higher tier" than Mt. Sinai and SLR.

Chicago
Tier 1
Cook County, University of Chicago (cook rules this town)

Christ (some think of Christ as Tier 1)

Tier 2
Northwestern, I would place Christ here

Tier 3
Resurrection, UIC

Cook does not "rule" Chicago. Yeah, Cook is a great program. You also have Christ and Northwestern which are phenomenal programs. I'm going to assume that you haven't interviewed at U Chicago and/or know little about their recent meltdown. It's a solid program, but one that is very much still picking up the pieces.

I have no idea how you are ranking these, but I'm not sure you can really rank the Chicago programs in a general way since they all offer different things that are of huge appeal depending on the residency experience you're looking for.

 

[FSU2013]

I dunno about all this. There has only been one program that I can say I pray I don't match there and it's one of the aforementioned "top tier" programs. There are also a couple "bottom tier" programs I liked a lot and thought would graduate excellent, well-rounded EPs - and that is fit and all-around happiness aside.

 

[migm]

isn't the point of accreditation to certify the last sentence in your post is true?

 

[br0wnmamba]

Having interviewed at Resurrection and seen the numbers and data provided by the PD about procedure counts, happiness of residents, ability to go into competitive markets, comfort of residents with very sick patients, 100% board pass rate for oral and written for the last several years, 100% desire to come back to this residency if given a chance to start over as seen on an anonymous survey.. I would have to disagree with the rationale that ranks that program in the 3rd tier.

It makes me wonder what it is you're basing your ordering on - is it competitiveness? highest step 1 score? I'm not sure anything above is valid beyond (maybe?) the well known names that continue to come up as "1st tier" because a lot of people apply there. So.. what is this based on?

Tiering programs implicitly involves a great deal of subjectivity and as such I'm sure that there will always be controversy about where a program belongs or how it stands relative to others. The goal wasn't to put down something that was concrete. I wanted to make something where programs that offer something exceptional--be it research oppurtunities, procedural experience, etc.--could be highlighted. The verbage that gets passed along is that there are a lot of programs that have good things going on and while that's certainly true, I've noticed from my interviews that while every programs might have certain unique attributes, there are programs out there that have more areas of strength than others.

Depending on what everyone else thinks, the working definition of how I've tiered the programs are as follows:

Tier 1: The "brand names" of EM; the programs that have been around long enough and have demonstrated such strength in academics, clinical training and numerous other criteria that they frequently are referred to when discussing the strongest programs in the country. Tend to be very competitive for reasons beyond location or name recognition of the academic affiliation.

Tier 2: Programs that compared to Tier 3 programs demonstrate numerous areas of strength but are not typically recognized as being among the "brand names" of EM. Tend to be more compeititve due to strength of academic affiliation or several other reasons beyond location.

Tier 3: "Everyone else." Programs that offer adequate oppurtunities and may have one or two distinguishing qualities but are not generally regarded as being amongst the "stronger/strongest" programs in the country. Range from compeititve by virture of location to not very competitive.

I think your example of Resurrection is precisely why a list such as the one I constructed may be helpful. Clearly it offers numerous distinguishing qualities but someone outside of the region would not be made aware of this by just looking at the program's website. Further, I think if you compared Resurrection to your average Tier 3 program, I'm sure there would be people that prefer the Tier 3 program for a particular reason, but the idea of the list is that most people would opt to probably consider Resurrection to be a stronger program.

I've moved Resurrection to Tier 2, thanks for the contribution.

 

[KeyzerSoze]

Those sound like some pretty subjective and therefore less than useful criteria. The discussion about Resurrection could probably apply to many of your lower tier programs. Out of curiosity, why did you put Detroit Receiving in the first tier and Henry Ford in the third tier? They both seem like great programs to me and I certainly didn't see that kind of disparity between them.

 

[br0wnmamba]

Those sound like some pretty subjective and therefore less than useful criteria. The discussion about Resurrection could probably apply to many of your lower tier programs. Out of curiosity, why did you put Detroit Receiving in the first tier and Henry Ford in the third tier? They both seem like great programs to me and I certainly didn't see that kind of disparity between them.

What would you argue would be more useful criteria? I could certainly come up with a means of assigning relative value for each program for things like volume, acuity, # of publications, etc but for me, having more definitive criteria goes against trying to subjectively identify which programs are the "strongest, stronger, strong."

 

[DreamingTheLive]

Tiering programs implicitly involves a great deal of subjectivity and as such I'm sure that there will always be controversy about where a program belongs or how it stands relative to others. The goal wasn't to put down something that was concrete. I wanted to make something where programs that offer something exceptional--be it research oppurtunities, procedural experience, etc.--could be highlighted. The verbage that gets passed along is that there are a lot of programs that have good things going on and while that's certainly true, I've noticed from my interviews that while every programs might have certain unique attributes, there are programs out there that have more areas of strength than others.

Depending on what everyone else thinks, the working definition of how I've tiered the programs are as follows:

Tier 1: The "brand names" of EM; the programs that have been around long enough and have demonstrated such strength in academics, clinical training and numerous other criteria that they frequently are referred to when discussing the strongest programs in the country. Tend to be very competitive for reasons beyond location or name recognition of the academic affiliation.

Tier 2: Programs that compared to Tier 3 programs demonstrate numerous areas of strength but are not typically recognized as being among the "brand names" of EM. Tend to be more compeititve due to strength of academic affiliation or several other reasons beyond location.

Tier 3: "Everyone else." Programs that offer adequate oppurtunities and may have one or two distinguishing qualities but are not generally regarded as being amongst the "stronger/strongest" programs in the country. Range from compeititve by virture of location to not very competitive.

I think your example of Resurrection is precisely why a list such as the one I constructed may be helpful. Clearly it offers numerous distinguishing qualities but someone outside of the region would not be made aware of this by just looking at the program's website. Further, I think if you compared Resurrection to your average Tier 3 program, I'm sure there would be people that prefer the Tier 3 program for a particular reason, but the idea of the list is that most people would opt to probably consider Resurrection to be a stronger program.

I've moved Resurrection to Tier 2, thanks for the contribution.

I think this exercise is pretty futile, as I've alluded to plenty of times. I'm not going to nitpick which programs from tier 3 should be in tier 1, etc. although I'd argue that approx. half your list is upside down.

My problem is with your tiers. Tier 1, your so-called brand name programs, should be much, much smaller. 5-8 programs at max. that are truly "name brand" programs (to med students, b/c nobody else gives a ****). You've got Tier 2 a**-backwards as well. Tier 2 shouldn't be the smallest cohort, but should actually be the largest grouping within your hierarchy as there are SO many great programs, each with their own unique draws/attributes, of which makes them so difficult to distinguish and equally appealing to different folks. Tier 3, like tier 1, should be tiny, and should be programs that you could legitimately state are "not good" programs comparatively (I've really only heard there might be a handful at most).

 

[DreamingTheLive]

Those sound like some pretty subjective and therefore less than useful criteria. The discussion about Resurrection could probably apply to many of your lower tier programs. Out of curiosity, why did you put Detroit Receiving in the first tier and Henry Ford in the third tier? They both seem like great programs to me and I certainly didn't see that kind of disparity between them.

Exactly. I'm not from the Detroit area, but anyone I've ever heard describe Henry Ford and Detroit Receiving would say Henry Ford >>>>>>>>>>>>>>>>>>>> Detroit Receiving, and from what I've heard, it's not even close.

 

[br0wnmamba]

I think this exercise is pretty futile, as I've alluded to plenty of times. I'm not going to nitpick which programs from tier 3 should be in tier 1, etc. although I'd argue that approx. half your list is upside down.

My problem is with your tiers. Tier 1, your so-called brand name programs, should be much, much smaller. 5-8 programs at max. that are truly "name brand" programs (to med students, b/c nobody else gives a ****). You've got Tier 2 a**-backwards as well. Tier 2 shouldn't be the smallest cohort, but should actually be the largest grouping within your hierarchy as there are SO many great programs, each with their own unique draws/attributes, of which makes them so difficult to distinguish and equally appealing to different folks. Tier 3, like tier 1, should be tiny, and should be programs that you could legitimately state are "not good" programs comparatively (I've really only heard there might be a handful at most).

I welcome you to demonstrate your own list. Honestly, maybe we just see things differently or you're just exceptionally drawn to being politically correct (which doesn't seem to be the case with your wording) but I really don't believe you can put 130 programs in one single category. Your post alone demonstates my point:

Exactly. I'm not from the Detroit area, but anyone I've ever heard describe Henry Ford and Detroit Receiving would say Henry Ford >>>>>>>>>>>>>>>>>>>> Detroit Receiving, and from what I've heard, it's not even close.

Obviously there are tiers. Most people are just too PC to say as much. My OP revised appropriately. I'm hoping to modify it extensively pending further input. Thanks for contributing.

 

[migm]

Perhaps subcategorization within tiers?

Research vs procedural vs strengths of certain fellowships? Or too complicated?

I do agree with the sentiment that most programs are "2nd tier"

 

[Croooz]

You can lead a horse to water...

 

[Cerberus]

Things that no one cares about aside from medical students...

 

[FSU2013]

Things that no one cares about aside from medical students...

Question: What is assigning tiers to EM residencies?

Next, I'd like to take potent potables for 600, Alex.

 

[KeyzerSoze]

Question: What is assigning tiers to EM residencies?

Next, I'd like to take potent potables for 600, Alex.

I'm sorry, the correct response was "where EM gets trauma procedures."

 

[DreamingTheLive]

I welcome you to demonstrate your own list. Honestly, maybe we just see things differently or you're just exceptionally drawn to being politically correct (which doesn't seem to be the case with your wording) but I really don't believe you can put 130 programs in one single category. Your post alone demonstates my point:



Obviously there are tiers. Most people are just too PC to say as much. My OP revised appropriately. I'm hoping to modify it extensively pending further input. Thanks for contributing.

OK, I'll bite. What about this list....(my apologies to Osteopathic programs):

Tier 1

University of Alabama
Maricopa Medical Center
University of Arizona/Tucson
University of Arizona
University of Arkansas
Kern Medical Center
University of California (San Francisco)/Fresno
Loma Linda University
UCLA Medical Center/Olive View
University of Southern California/LAC+USC
Alameda County Medical Center
University of California (Irvine)
University of California (Davis)
Naval Medical Center (San Diego)
University of California (San Diego)
University of California (San Francisco)
Stanford University Hospital/Kaiser Permanente
Los Angeles County-Harbor-UCLA Medical Center
Kaweah Delta Health Care District (KDHCD)
Denver Health Medical Center
University of Connecticut
Yale-New Haven Medical Center
George Washington University
Christiana
Georgetown University Hospital/Washington
University of Florida
University of Florida College of Medicine Jacksonville
Florida Hospital Medical Center
Orlando Health
University of South Florida Morsani
Emory University
Medical College of Georgia
University of Chicago
McGaw Medical Center of Northwestern University
University of Illinois College of Medicine at Chicago
John H Stroger Hospital of Cook County
Resurrection Medical Center
Advocate Christ
University of Illinois College of Medicine at Peoria
Southern Illinois University
Indiana University
University of Iowa
University of Kansas
University of Kentucky
University of Louisville
Earl K Long Medical Center/Louisiana State University (Baton Rouge)
Louisiana State University
Louisiana State University (Shreveport)
Maine Medical Center
Johns Hopkins University
University of Maryland
Boston Medical Center
Brigham and Women's Hospital/Massachusetts General Hospital
Beth Israel Deaconess Medical Center/Harvard
Baystate Medical Center/Tufts University
University of Massachusetts
University of Michigan
Detroit Medical Center/Wayne State University (Detroit Receiving Hospital)
Henry Ford Hospital/Wayne State University
Detroit Medical Center/Wayne State University (Sinai-Grace Hospital)
St John Hospital
Genesys Regional Medical Center
Grand Rapids Medical Education Partners/Michigan State University
Western Michigan University
Sparrow Hospital/Michigan State University
William Beaumont
Central Michigan University
Hennepin
College of Medicine Mayo Clinic
HealthPartners
University of Mississippi
University of Missouri at Kansas City
Washington University/B-JH/SLCH Consortium Program
St Louis University
University of Nebraska
University of Nevada
Dartmouth-Hitchcock Medical Center
Cooper Medical School of Rowan University/Cooper University Hospital Atlantic Health (Morristown)
UMDNJ-Robert Wood Johnson
Newark Beth Israel Medical Center
UMDNJ-New Jersey
University of New Mexico
Albany Medical Center
Albert Einstein College of Medicine (Jacobi/Montefiore) Program
Lincoln Medical
Brooklyn Hospital Center
New York Methodist
Maimonides Medical Center
SUNY Health Science Center at Brooklyn
University at Buffalo
New York Hospital Medical Center of Queens/Cornell University Medical College
NSLIJHS/Hofstra North Shore-LIJ School of Medicine at North Shore University
NSLIJHS/Hofstra North Shore-LIJ School of Medicine at Long Island
Albert Einstein College of Medicine at Beth Israel Medical Center
New York Medical College (Metropolitan) Program
New York Presbyterian
Mount Sinai School of Medicine
New York University
St Luke's-Roosevelt
University of Rochester
SUNY at Stony Brook
SUNY Upstate
University of North Carolina
Carolinas Medical Center
Duke
Vidant Medical Center/East Carolina University
Wake Forest University
Summa Health System
Akron General
University Hospital/University of Cincinnati
Case Western Reserve University/University Hospitals
Case Western Reserve University (MetroHealth) Program
Ohio State University
Wright State University
Mercy St Vincent Medical Center
University of Toledo
University of Oklahoma
Oregon Health & Science University
St Luke's Hospital
Lehigh Valley
Geisinger
Penn State University
Drexel University
Thomas Jefferson
Albert Einstein
University of Pennsylvania
Temple University
Allegheny General Hospital
UPMC
York Hospital
Hospital Episcopal San Lucas/Ponce School of Medicine
University of Puerto Rico
Brown University
Medical University of South Carolina
Palmetto Health/University of South Carolina
University of Tennessee College of Medicine at Chattanooga
Vanderbilt University
University of Texas Southwestern Medical School (Austin)
Christus Spohn Memorial Hospital
University of Texas Southwestern
Texas Tech University Health Sciences Center
Darnall Army Medical Center Program
San Antonio Uniformed Services
John Peter Smith Hospital (
University of Texas at Houston
Baylor College of Medicine
Texas A&M College of Medicine-Scott and White
University of Utah
University of Virginia Program
Eastern Virginia Medical School Naval Medical Center (Portsmouth) Program
Virginia Commonwealth University
Carilion Clinic-Virginia Tech Carilion
University of Washington Program
Madigan Healthcare System Progra
West Virginia University
University of Wisconsin
Medical College of Wisconsin

 

[justin8818]

Haha, I see what you did there. Nice.

 

[br0wnmamba]

Exactly. I'm not from the Detroit area, but anyone I've ever heard describe Henry Ford and Detroit Receiving would say Henry Ford >>>>>>>>>>>>>>>>>>>> Detroit Receiving, and from what I've heard, it's not even close.

OK, I'll bite. What about this list....(my apologies to Osteopathic programs):

Tier 1

*All EM programs*

I mean, if you can't see how hypocritical your two posts are, I don't know what to say and have no interest addressing anything you may have to say in the future. Listen, I know admitting that there are differences between programs and their reputation is controversial and leaves people feeling uneasy; noone wants their program to be the lowest tier. I'm not advocating that everyone rank tier 1 programs higher than tier 2 programs. You should rank your programs according to how well you feel like you fit in and how happy you can see yourself at that particular institution. My only interest in tiering the programs is to understand which programs are generally well thought of and generally have more to offer than what most programs traditionally put on the table. I don't think anyone would fault you for ranking Saginaw #1 if you genuinely had that "gut felling" on interview day and the location worked for you and your potential SO, but to think that the program is generally regarded to be on the same level as say, Cook County, is just delusional. You and I both know it doesn't work that way, so why not just cut the ****?

 

[RustedFox]

I mean, if you can't see how hypocritical your two posts are, I don't know what to say and have no interest addressing anything you may have to say in the future. Listen, I know admitting that there are differences between programs and their reputation is controversial and leaves people feeling uneasy; noone wants their program to be the lowest tier. I'm not advocating that everyone rank tier 1 programs higher than tier 2 programs. You should rank your programs according to how well you feel like you fit in and how happy you can see yourself at that particular institution. My only interest in tiering the programs is to understand which programs are generally well thought of and generally have more to offer than what most programs traditionally put on the table. I don't think anyone would fault you for ranking Saginaw #1 if you genuinely had that "gut felling" on interview day and the location worked for you and your potential SO, but to think that the program is generally regarded to be on the same level as say, Cook County, is just delusional. You and I both know it doesn't work that way, so why not just cut the ****?

Compare oranges to Cadillacs much ?

Sure, there are pros and cons to every program, and some are "by and large" better than others, but the point is:

ALL EM PROGRAMS WILL TRAIN YOU ADEQUATELY. There's no need for "tiers", that's what dreamingthelive is trying to say.

 

[classdodger]

just my .02
what exactly is the op trying to get out of these lists. "competitiveness" can be tiered by pure data, if a program gets 1000 apps for 10 spots and interviews 100 people, it is inherently more competitive than than a program getting 600 apps to fill the same. good luck finding the data, but it will carry a lot more weight than a few peoples opinions, if thats what your looking for.
now if we are trying to rank programs based on quality of training or reputation this is just silly, and absolutely impossible even by the most informed EM guys/gals among us.
Ask yourself, does stanford or harvard make people what they become or do they just get the best and the brightest and ride their coat tails for life. Its absolutely a little of both but if i can use bill gates and mark zuckerburg as examples i think their truncated educations show that where they went likely wouldnt have mattered. Now i know you can talk about being somewhere great and networking and without that yada-yada-yada.
I think the same applies to EM. I think there are programs that take top medical students and turn the in to top residents and they would have become top docs because thats who they are and the program gets a bump from that, give them weaker medical students and they produce weaker residents. I think there are very few programs that actually coach you up beyond your potential. So go where you wanna go and apply where you wanna apply and when you interview you will get to make you own opinions

 

[fahimaz7]

Well established programs have put out quality (and some not quality) residents for several decades. Chances are someone has been to where you want to end up practicing and that said person will be able to help you land a job there a whole lot easier than the graduate that has never stepped foot in that state before. Take for example...

The attendings on here keep harping on the fact that it's who you know and not where you graduate from. While that may very well be the case, it's a lot easier to know the right people if you graduate from a program that has 100's on EM graduates all around the country.

There's something to be said about legacy and history. There's no denying that you will have an easier time getting into certain markets from Cinci, Denver, UCLA, USC, Cook, Emory, Vandy, CMC, etc than the newer programs on the street. It's not that their training is poor, it's just that they haven't been around long enough to really establish themselves in all the right places.

 

[DreamingTheLive]

I mean, if you can't see how hypocritical your two posts are, I don't know what to say and have no interest addressing anything you may have to say in the future. Listen, I know admitting that there are differences between programs and their reputation is controversial and leaves people feeling uneasy; noone wants their program to be the lowest tier. I'm not advocating that everyone rank tier 1 programs higher than tier 2 programs. You should rank your programs according to how well you feel like you fit in and how happy you can see yourself at that particular institution. My only interest in tiering the programs is to understand which programs are generally well thought of and generally have more to offer than what most programs traditionally put on the table. I don't think anyone would fault you for ranking Saginaw #1 if you genuinely had that "gut felling" on interview day and the location worked for you and your potential SO, but to think that the program is generally regarded to be on the same level as say, Cook County, is just delusional. You and I both know it doesn't work that way, so why not just cut the ****?

Lol, don't get your panties all in a bunch. I was just having a little fun with you. Plus, there was nothing hypocritical at all in my post as the first statement was hearsay, and not reflective at all of my opinion. Are you an FMG?

(note: I'm not responsible for any of my own comments at this point as I'm well over the legal limit of "punch")

 

[DreamingTheLive]

Compare oranges to Cadillacs much ?

Sure, there are pros and cons to every program, and some are "by and large" better than others, but the point is:

ALL EM PROGRAMS WILL TRAIN YOU ADEQUATELY. There's no need for "tiers", that's what dreamingthelive is trying to say.

Thank you RF.

 

[Olliver]

I want to really put in a plug for picking a program where you'll be happy. I'm at a well-regarded program that is a horrible fit, and I regret having ranked this program first. I chose it mainly because I thought it would be good for getting me ready for fellowship, and I ignored my gut feeling to choose my second ranked program first based on fit. Now I'm just trying to get through my training as quickly as possible and not planning to do fellowship any more. I was miserable enough for a while that I contemplated dropping out of EM altogether.

To those of you currently applying, don't make the mistake I made. You can't begin to imagine how demoralizing it is to hate going to work every day until you experience it for yourself. I hope none of you do. Also, please don't PM me asking where I go. It doesn't matter. All programs are the sucks if they're the wrong program for you.

 

[bad virus]

I want to really put in a plug for picking a program where you'll be happy. I'm at a well-regarded program that is a horrible fit, and I regret having ranked this program first. I chose it mainly because I thought it would be good for getting me ready for fellowship, and I ignored my gut feeling to choose my second ranked program first based on fit. Now I'm just trying to get through my training as quickly as possible and not planning to do fellowship any more. I was miserable enough for a while that I contemplated dropping out of EM altogether.

To those of you currently applying, don't make the mistake I made. You can't begin to imagine how demoralizing it is to hate going to work every day until you experience it for yourself. I hope none of you do. Also, please don't PM me asking where I go. It doesn't matter. All programs are the sucks if they're the wrong program for you.

+1 for funnies if you're at Yale

Since some crazy pump up techno music is being played by my neighbor and im feeling particularly bold: CAN I GET AN "F"

 

[catmandoo]

Per Oliver's previous post they are at "an intense county program". I don't understand why you would think they were at Yale or why being at Yale and being unhappy at Yale is funny.

 

[bad virus]

Per Oliver's previous post they are at "an intense county program". I don't understand why you would think they were at Yale or why being at Yale and being unhappy at Yale is funny.

I am pretty sure he's not at Yale, and it was nothing more than a silly semi-inside joke. You'll probably figure out the joke if you do a search or hang around for another 9 months.

I was hi on redbull and nestle crunch when i decided to post that troll comment and no offense was meant by it. Also the F thing is just another stupid inside joke that you'll catch if anyone on here decides to indulge me.

 

[fahimaz7]

I hear Yale is the top of the top.

 

[FSU2013]

Per Oliver's previous post they are at "an intense county program". I don't understand why you would think they were at Yale or why being at Yale and being unhappy at Yale is funny.

On a semi-regular basis people post some nebulous comment about Yale being malignant, but there is never anything to back it up. Sometimes it comes from ms4s, occasionally anonymous posters claiming to be Yale residents. There are also several regulars here who work with a lot of Yale grads who say they loved their training and it was a very collegial environment. It just seems to keep coming up every couple months but there's never any definitive proof, much like the yeti or Nessy.

He wasn't saying anything negative about Yale, just making a joke because there have been "I heard Yale is kinda malignant, can anyone verify?" posts ad nauseum.

 

[Arcan57]

Tier I
The program I or any blood relative have attended
Tier II
Programs that attendings you like and/or respect have attended
Tier III
Programs you've never heard of
Tier IV
Programs in place you've never heard of
Tier V
Programs that have had negative things said about them by at least one SDN member
Tier VI
Programs that have had negative things said about them by at least one SDN member who can actually be verified as having any first hand experience with the program
Tier VII
FM fellowship programs
Tier VIII
NP/PA "residencies"
Tier IX
Watching the complete series of House,Scrubs and ER
Tier X
Watching General Hospital once while visiting elderly relatives without cable


I think that's pretty comprehensive and objective. Mods, please close the thread

 

[FSU2013]

Tier I
The program I or any blood relative have attended
Tier II
Programs that attendings you like and/or respect have attended
Tier III
Programs you've never heard of
Tier IV
Programs in place you've never heard of
Tier V
Programs that have had negative things said about them by at least one SDN member
Tier VI
Programs that have had negative things said about them by at least one SDN member who can actually be verified as having any first hand experience with the program
Tier VII
FM fellowship programs
Tier VIII
NP/PA "residencies"
Tier IX
Watching the complete series of House,Scrubs and ER
Tier X
Watching General Hospital once while visiting elderly relatives without cable


I think that's pretty comprehensive and objective. Mods, please close the thread

Whoa, whoa, whoa. Let's not get ahead of ourselves. I'd rather watch every episode of scrubs (for the third-fourth time) than do some sort of NP residency.

 

[gman33]

I would put watching Scrubs as Tier I.
Much better time than going to work at any program.

As for the whole ranking thing, it really doesn't make any sense.
There are different things that every individual is looking for in a program.
You probably won't have any idea what these things actually are until you start your training.

A month here or there of some rotation probably doesn't make any difference.

I'll throw out a few things that I think are important.
Location. Different things for each person.
Your boss. Having a good PD and other leadership. Doesn't have to be your best buddy, but someone who stands up for the residents and your education.
Variety. Some will argue this point, but spending a significant amount of time at a variety of practice environments can only help your education. Spending all your time at the level 1 tertiary center is only good if that's the only place you want to practice.

Fit - Do you like the culture of the program. Do not underestimate this one.

All those things aside, I think you really learn from seeing patients and trying to figure out what the hell is going on. Hopefully you have some attendings/fellow residents who will help you in this regard. You can do this anywhere as long as you see enough patients.

 

[DreamingTheLive]

I would put watching Scrubs as Tier I.
Much better time than going to work at any program.

As for the whole ranking thing, it really doesn't make any sense.
There are different things that every individual is looking for in a program.
You probably won't have any idea what these things actually are until you start your training.

A month here or there of some rotation probably doesn't make any difference.

I'll throw out a few things that I think are important.
Location. Different things for each person.
Your boss. Having a good PD and other leadership. Doesn't have to be your best buddy, but someone who stands up for the residents and your education.
Variety. Some will argue this point, but spending a significant amount of time at a variety of practice environments can only help your education. Spending all your time at the level 1 tertiary center is only good if that's the only place you want to practice.

Fit - Do you like the culture of the program. Do not underestimate this one.

All those things aside, I think you really learn from seeing patients and trying to figure out what the hell is going on. Hopefully you have some attendings/fellow residents who will help you in this regard. You can do this anywhere as long as you see enough patients.

Yes!!!!!!! Why the whole EM rankings is largely a moot point!

 

[EM2013]

There are rankings for IM and Peds, etc...why aren't there rankings for EM? It seems absurd to say that every program will train you the same as any other program. There's nothing inherently different about the practice of EM that would make this statement true. Would you rather take your kid to CHOP or Podunk Childrens'? Your mother to Brigham or Mount St. Elsewhere? Following this logic through, there must be certain EDs which provide better care because the residents and attendings there are of higher quality than the rest and it would make sense that these places produce a higher quality product that is more sought after than others.

 

[fahimaz7]

There are rankings for IM and Peds, etc...why aren't there rankings for EM? It seems absurd to say that every program will train you the same as any other program. There's nothing inherently different about the practice of EM that would make this statement true. Would you rather take your kid to CHOP or Podunk Childrens'? Your mother to Brigham or Mount St. Elsewhere? Following this logic through, there must be certain EDs which provide better care because the residents and attendings there are of higher quality than the rest and it would make sense that these places produce a higher quality product that is more sought after than others.

The shame in this thread is that they are acknowledging a difference in training, exposure, and opportunities, but with doing so are saying that your best program is the one "that aligns with your personal interest, goals, and location preference" and that it's different for each applicant.

It's a mature way of looking at the argument, but it does acknowledge an inherent difference within the programs.

 

[Apollyon]

Every attending and resident in this thread was once a student. Every single one of us. And, every attending has completed residency. We DO know about which we are talking. Bar none, the only ones protesting are self-designated students. Have any of you expended ANY brain power as to why we, who HAVE been in your shoes, do not support this student led and pushed agenda? And, also, becoming indignant about it strikes me as being ignorant as to the details.

But, go ahead and MF me. I'm just a dumb ER doc.

 

[glorfindel]

every attending and resident in this thread was once a student. Every single one of us. And, every attending has completed residency. We do know about which we are talking. Bar none, the only ones protesting are self-designated students. Have any of you expended any brain power as to why we, who have been in your shoes, do not support this student led and pushed agenda? And, also, becoming indignant about it strikes me as being ignorant as to the details.

But, go ahead and mf me. I'm just a dumb er doc.

+1

 

[RustedFox]

+1

Hahahaha.


+2.

 

[RustedFox]

+1 for funnies if you're at Yale

Since some crazy pump up techno music is being played by my neighbor and im feeling particularly bold: CAN I GET AN "F"

I've had a particularly good day...


*Wheel of Fortune music plays* .... * ding-ding-DING-diiinnnnng*

... and badvirus says... "F"....


F _ _ _ _ _ _ F _ _ _ _

_ _ _ _ _

 

[Cerberus]

hahahaha.


+2.

+3

 

[Glitterbox]

I think this issue will probably be a little more relevant going forward based on how this years application cycle went. I think the EM world could be a little more helpful about giving out this sort of info to applicants so everyone isn't applying to 30-40 programs because they have know clue what their chances are because no one will tell them what programs are competitive and which ones aren't. How the hell are you supposed to know "fit"based on ERAS? Everyone says they're looking for smart residents who work hard.

Gauging your competitiveness and the competitiveness of various programs is just a part of good application planning. Which is necessary to ensure a successful Match, especially as the field becomes more competitive. I just think that this is a myth that needs to be done away with. There are programs that are more competitive than others, their are programs that will carry more name recognition than others, on my aways and at my home rotation, and even during interviews, heard attendings and residents evaluating their own programs against others frequently.

 

[Cerberus]

I think this issue will probably be a little more relevant going forward based on how this years application cycle went. I think the EM world could be a little more helpful about giving out this sort of info to applicants so everyone isn't applying to 30-40 programs because they have know clue what their chances are because no one will tell them what programs are competitive and which ones aren't. How the hell are you supposed to know "fit"based on ERAS? Everyone says they're looking for smart residents who work hard.

Gauging your competitiveness and the competitiveness of various programs is just a part of good application planning. Which is necessary to ensure a successful Match, especially as the field becomes more competitive. I just think that this is a myth that needs to be done away with. There are programs that are more competitive than others, their are programs that will carry more name recognition than others, on my aways and at my home rotation, and even during interviews, heard attendings and residents evaluating their own programs against others frequently.

Look, you guys already know which programs are going to be more competitive and it's more likely to be based on location than anything else. Do you really think every program in CA aside from Kern Count/UCDavis are going to provide better training that some program in the midwest? If you are looking at programs in a city that people want to live in, it will be more competitive, period. It's also pointless trying to tier programs based on "competitiveness" because you guys really don't know what a particular program will be looking for. I've done a lot of interviews this year where we had stellar applicants who me and the other interviewers just felt wouldn't fit in well at our program but who we all agreed would make a good resident somewhere. I've given a lot of people with average board scores and decent applications high scores after interviewing them because they were someone I felt I would enjoy working with and felt they'd be a stronger resident than the guy with 260s on STEPI/II, international experience, and 50 publications. .

 

[DB2013EM]

I think this issue will probably be a little more relevant going forward based on how this years application cycle went. I think the EM world could be a little more helpful about giving out this sort of info to applicants so everyone isn't applying to 30-40 programs because they have know clue what their chances are because no one will tell them what programs are competitive and which ones aren't. How the hell are you supposed to know "fit"based on ERAS? Everyone says they're looking for smart residents who work hard.

Gauging your competitiveness and the competitiveness of various programs is just a part of good application planning. Which is necessary to ensure a successful Match, especially as the field becomes more competitive. I just think that this is a myth that needs to be done away with. There are programs that are more competitive than others, their are programs that will carry more name recognition than others, on my aways and at my home rotation, and even during interviews, heard attendings and residents evaluating their own programs against others frequently.

Outside of the obvious ten big name programs (Carolinas, Highland, Denver, etc.) , there really is no rhyme or reason to anything in this process. Each program values different things and it is hard to make a ranking of competitiveness. Using a previous tier system posted in this thread, I've received invites from "Tier 1" programs while haven't heard from many "Tier 3" programs. At the end of the day, I think a lot of students, myself included, are attracted to the sexy names of big universities and brand names, while we neglect great programs that have boring names and are lesser known. I've done rotations at a Tier 1 and a Tier 3 program, and they do get brought up, but they never say "HOW CAN WE BE MORE LIKE TIER 1" they always discuss both. If you rotate at Highland, it is a different story, but outside of the top 10 obviously brand name programs, it is pretty much a level playing field all around. I would say the fit and how much the program will the bring the best out of YOU matter a lot more than some arbitrary tit for tat tier system.

I am a 4th Year Student BTW, just to give it perspective.

 

[fahimaz7]

Look, you guys already know which programs are going to be more competitive and it's more likely to be based on location than anything else. Do you really think every program in CA aside from Kern Count/UCDavis are going to provide better training that some program in the midwest? If you are looking at programs in a city that people want to live in, it will be more competitive, period. It's also pointless trying to tier programs based on "competitiveness" because you guys really don't know what a particular program will be looking for. I've done a lot of interviews this year where we had stellar applicants who me and the other interviewers just felt wouldn't fit in well at our program but who we all agreed would make a good resident somewhere. I've given a lot of people with average board scores and decent applications high scores after interviewing them because they were someone I felt I would enjoy working with and felt they'd be a stronger resident than the guy with 260s on STEPI/II, international experience, and 50 publications. .

So what you're saying ist hat UC Davis is tier 1?

 

[woeiru]

Outside of the obvious ten big name programs (Carolinas, Highland, Denver, etc.) ...

Curious to know which the obvious ten big names you mentioned are...

Sorry, couldn't help myself.

 

[fahimaz7]

Curious to know which the obvious ten big names you mentioned are...

Sorry, couldn't help myself.

I think he meant to say Denver, Highlands, Carolinas, Emory, Vandy, Cinci, Christiana, Pitt, Cook, and Harbor. After having interviewed at 4 of them it's interesting to realize how different my experience would be at each one, and how each program is quite a bit different and would be a good fit for different applicants. A program that might be #1 for one applicant may go unranked by another applicant.

What other "big hitters" did I miss?

 

[Arcan57]

I was a pretty competitive applicant back in the day. I got interviews everywhere I applied except for 2 places on the Western side of the country (one a big name, the other not so much). I matched at my first choice at a "name" program the midwest after doing an away rotation there and absolutely loving it. In my class was a very smart guy who didn't fit the culture and had an incredibly rough time during residency (I would have considered eating a gun if I had to go through what he went through). If you asked him about the quality of my program you'd get a very different response then if you asked any of my other classmates.

As Apollyon mentioned, there's a reason the attendings talk about fit. And it's not to try and increase our competitiveness in the job market if we came from unheralded programs. At this moment in time, fellowships and jobs tend not to be dependent on where you trained. There are markets that are tough to break into (good luck getting a job in Denver without being related to someone), but those tend to be because of location and require connections which can be difficult for any program to guarantee.

 

[migm]

Ok so, how does one assess the culture of a program?

 

[Akail]

I think he meant to say Denver, Highlands, Carolinas, Emory, Vandy, Cinci, Christiana, Pitt, Cook, and Harbor. After having interviewed at 4 of them it's interesting to realize how different my experience would be at each one, and how each program is quite a bit different and would be a good fit for different applicants. A program that might be #1 for one applicant may go unranked by another applicant.

What other "big hitters" did I miss?

Didn't really know Christiana belonged in that list...I know it's regardly highly but wasn't aware it had that sort of esteem.

 

[fahimaz7]

Didn't really know Christiana belonged in that list...I know it's regardly highly but wasn't aware it had that sort of esteem.

Put it in there to see what people would say. It's a great program, but for some reason doesn't have the same reputation as the others in that list. Who would you add?