top IM residency prograns with easier schedules

[xoggyux]

Something isn't an ad hominem when it proves why your point is less valid. We are talking about why there is value in the top 20 programs delivering rigorous training including 24 hour shifts.

You are someone who hasn't put in anywhere near the rigorous effort needed to get close to one of these programs. You couldn't get into a US medical school and and instead of trying harder, went to the carribean. At the carribean you couldn't even put in the requisite effort to PASS your classes and failed an entire year ... and almost got kicked out if not for an appeal. You barely squeeked by a pass on step 1.

And you're lecturing us in what appropriate effort is for success and knowledge. Honestly I can't think of anyone less qualified than you.

Thank you for making my point. You have not proved my point is less valid at all. You have not even addressed my point, instead, you go to attack me rather than analyze and discuss the topic at hand. Deflections and more deflections.

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[rokshana]

This is a forum, right? A place for debate. In formal debate, an ad-hominem attack is when one side points out characteristics of the other side rather than the position that the other side is debating. For instance
Debater A "Aspirin prevents MI"
Debater B " What do you know? your GPA was only 2.0"
That is an ad-hominem attack.
You ignore everything about my points and go straight to question my credentials rather than discussing the topic. This strategy is meant to fool observers into thinking that you know your stuff and your point is stronger than it actually is, but really it is merely a deflection.

Not to mention the hinting/insinuation of laziness and/or gross incompetence. Don't get me wrong, It really does not bother me. My ego is not so fragile for me to get offended at that, nor do I need external approval from a random stranger on an internet forum.

So again, if this is the limit of what you can debate and you are just going to keep doing attacks to my motives or academic preparation rather than address the actual points perhaps you won't see me replying much of what you write from now on.

No your inexperience is quite relevant...you do not know what the benefits are of working overnight...because you have never done one...I have done both...yes there are pros to NF and shift work, but there IS benefit to the overnight (and actually 30 hours not just 24)...the fact that you can’t recognize that goes back again to your inexperience.

Dunning -Kruger is real.

 

[rokshana]

Second, please learn to be a bit more concise. These walls of text are annoying.

Reminds me of crayola’s early postings...

 

[xoggyux]

No your inexperience is quite relevant...you do not know what the benefits are of working overnight...because you have never done one...I have done both...yes there are pros to NF and shift work, but there IS benefit to the overnight (and actually 30 hours not just 24)...the fact that you can’t recognize that goes back again to your inexperience.

Dunning -Kruger is real.

To the contrary. It is quite irrelevant, especially given the fact that you have absolutely no idea what my experience has been.

Besides. I could be a total non-medical person. A janitor, even a properly mentally ******ed/disabled person. Attacking my motives/credentials/experience has nothing to do with the arguments/points I make. That is by definition an Ad-hominem as I explained earlier.

Even Nobel Laureate say stupid things and make stupid arguments and some dumb/uneducated people can make great points. Address the point, not the person.

The God-Complex is real.

 

[Dwan]

Not really quite sure why you keep posting...you apparently think you know how things should work and aren’t responsive to other, frankly more experienced and better trained opinions ...as pointed out there are posters here who actually HAVE trained at a top 20 program, than yours.
You are inexperienced and will learn soon enough that once you are out of training, how much you will wish that your training was more rigorous.

I thank god everyday that trained at a place that expected more out of me...it was rigorous but with little scut...and even the scut had its role.

And btw...if you think the non clinical BS stops after residency, you are in for a rude awakening...you will be amazed at how much crap your attending shields you from...and you will be expected to be an expert on come the first day as an attending.

Did you interview at T20 programs? Because a good amount of them, including mine, have night float systems. That doesn't make it more cush (I've had up to 100 hr weeks on wards), but this discussion seems to lead into the idea that rigor means lots of 30 hr call.

 

[rokshana]

Did you interview at T20 programs? Because a good amount of them, including mine, have night float systems. That doesn't make it more cush (I've had up to 100 hr weeks on wards), but this discussion seems to lead into the idea that rigor means lots of 30 hr call.

I interviewed in 2007-2008, most places still had overnight call, generally a Q4 though many had started to have some portion of NF incorporated in the schedule...it wasn’t until 2011 that 24 hour call wasn’t allowed for interns ...but it was only in 2003 that the 80 hour work week was required of all ACGME programs so there are people here that did easily over 100/week on a regular basis.
I had a couple of interviews that were probably top 25? So no, not top 20.

Rigor doesn’t necessarily mean lots of 30 hour calls, but there is value in the overnight call. Value that apparently has been recognized since programs are again allowed to have interns go back to having 24 hour call. As a resident, you want to have expose to significant pathology, to learn how to manage patients as well as manage a team and by the end of your 3yrs, feels that you can practice independent of the safety net of having an attending and in fact be that attending.
I remember being at a place where the residents had an 8 pt cap and could only admit 3 pts a day...sure it may have made the day to day life for the resident easier but not sure that in the long run, it truly was beneficial to their training to not learn how to handle a higher census...because for many of those residents who were destined to become hospitalists, they had to learn how to deal with a census of 20 pts and 17 admissions in a 12 hour shift as an attending...attending life shouldn’t be harder than resident life!

It’s important to make sure that the hours you are spending at the hospital are contributing to your education, but there will always be some scut.

My dad used to tell me that where you trained gave people a sense of what kind of doctor you are ...now, he was a urologist so that hierarchy ran much deeper for surgeons, down to who you trained with...it may not exist as much in IM but I’m fellowship, did see that same importance placed on who with and where you trained.

 

[wjs010]

I interviewed in 2007-2008, most places still had overnight call, generally a Q4 though many had started to have some portion of NF incorporated in the schedule...it wasn’t until 2011 that 24 hour call wasn’t allowed for interns ...but it was only in 2003 that the 80 hour work week was required of all ACGME programs so there are people here that did easily over 100/week on a regular basis.
I had a couple of interviews that were probably top 25? So no, not top 20.

Rigor doesn’t necessarily mean lots of 30 hour calls, but there is value in the overnight call. Value that apparently has been recognized since programs are again allowed to have interns go back to having 24 hour call. As a resident, you want to have expose to significant pathology, to learn how to manage patients as well as manage a team and by the end of your 3yrs, feels that you can practice independent of the safety net of having an attending and in fact be that attending.
I remember being at a place where the residents had an 8 pt cap and could only admit 3 pts a day...sure it may have made the day to day life for the resident easier but not sure that in the long run, it truly was beneficial to their training to not learn how to handle a higher census...because for many of those residents who were destined to become hospitalists, they had to learn how to deal with a census of 20 pts and 17 admissions in a 12 hour shift as an attending...attending life shouldn’t be harder than resident life!

It’s important to make sure that the hours you are spending at the hospital are contributing to your education, but there will always be some scut.

My dad used to tell me that where you trained gave people a sense of what kind of doctor you are ...now, he was a urologist so that hierarchy ran much deeper for surgeons, down to who you trained with...it may not exist as much in IM but I’m fellowship, did see that same importance placed on who with and where you trained.

You mean interns capped at 8? Would be weird for a resident to be capped at 8. And what do you mean admit 3/day? Who is on call every day?

 

[jdh71]

Best day/night of residency was working the December 24th 24hr call. I was the senior holding the admitting pager. I had two competent interns on under me. The resident in the ICU was a third year on her way to an Endo fellowships and was counting down the days of that month so she could be done with the ICU for good.

The snow started with drifting snow in the morning with a winter storm warning announced, and it wasn't a matter of if but when and then HOW MUCH. The snow showers started around 10am. The wind picked up by early afternoon and by sundown it was a blizzard. Attendings and fellows and "back-up/jeopardy" were unable to make it in. Cell service was sketchy, but the phones basically worked. The electricity stayed on. Snow plows and bulldozers out. The national guard called in to assist EMS with Humvees. The way the streets were laid it it only made sense to clear the way to my hospital and directed all EMS there. It was kind of a slow admitting during the day. But after the sun went down the crap hit the fan and we admitted 15 to the floor and 5 into the ICU. For those in residency familiar with "caps" - I had your same caps. But the concept of "cap" really didn't matter at that point did it? The floor patients as I remember were your per usual mixture of IM types of admits. We just hammered them out. But the ICU players were sick sick sick. Since the on her way to endo fellowship colleague was like a deer in the headlights and without the confidence or skill set for procedures, I spend a lot of my time in the ICU helping her out. As I recall, five central lines, five arterial lines, a thoracentesis, and an intubation when a guy failed BiPAP (three were already on a vent before hitting the unit)(thank God none were a GI bleed needing a scope). And as a group the four of us followed up on images and labs and kept in contact with attendings and fellows as was appropriate but otherwise I ran than service and that hospital that night.

Roads weren't open in the morning and the calvary was unable to arrive until after about 2pm the next day. I personally admitted three more to the floor between 7am and 2pm and did a cardioversion in the ICU for an unstable vtach that never did require CPR.

At the end of all of that I was exhausted yes. I went home, ate really good, and then slept until the next day when I showed up for work on time. BUT there was literally NOTHING in residency that gave me the confidence of that ONE night. There is something to be said for the value of doing things that are HARD so you know you can. Nothing in life and I mean - NOTHING - of value comes about in life EXCEPT for sweat, blood, and tears that you get going through the valuable experience.

I started fellowship as a guy who knew he had been taken to the abyss (at least once), looked over, and had the abyss look back, and then came back to tell the story. I was much more confident than most of my first year classmates, some of who came from some really well regarded university IM programs.

I guess at the end of the day, you simply can't argue into someone the experience they need, and they just need to have their turn at it.

 

[rokshana]

You mean interns capped at 8? Would be weird for a resident to be capped at 8. And what do you mean admit 3/day? Who is on call every day?

Yes, interns capped at 8 and intern admits of 3 on the days that they were on call.
However there are places that do a drip system and do admit every day.

 

[jdh71]

Did you interview at T20 programs? Because a good amount of them, including mine, have night float systems. That doesn't make it more cush (I've had up to 100 hr weeks on wards), but this discussion seems to lead into the idea that rigor means lots of 30 hr call.

You actually probably work fewer hours in a week when you take 24hr calls. The 12 and 16 hours shifts grind and smolder.

And I don't know if you need "LOTS" of 30hr call, but you need some.

 

[MD46]

Residency isn't just about mimicking what attendinghood is like. It is about training you to be a good attending. There are a lot of things in residency that are "unheard of" as an attending, which have tremendous value in molding you into a competent attending.

You keep railing against the fact that there aren't any trials about clinical competency with a call system... there also aren't trials trialing if walking on a sidewalk is safter than crossing a highway.



Your ignorance about the system against which you are arguing as well as your attitude is amusing. What do you think actually happens during 24 hour calls? You admit and you cross cover the patients of your colleagues. The difference is you get to see the most important 24 hours of the patient's hospital stay that you wouldnt during a night float system. This also allows weaker residents (say those who failed a year in the Carribbean and barely matched) to skate by without maturing.

Your attitude is common in people we jokingly call TWKs- third world killers. Those who trained outside the US and are a dangerous combination of lazy and stupid...



good luck in the rest of your career. I hope you change your attitude.

Excuse me? what do you mean by that. Are you implying people who trained out side the US are a combination of Lazy and stupid??

Explain your point please.

I trained here in residency and fellowship at reputable University Programs and yet to see a so called american medical student do a proper physical exam. lol. Thye dont know any thing about text books, reading off lectures (ppts) and brief handouts, not preparing for medicine it seems like only for exams.

I can go on, need to hear your side first.

 

[jdh71]

Why do people always go around looking to start a fight?

For most of the physical exam, if it was a lab test you’d never order it as it lacks sensitivity and specificity. Neuro exam can be really really helpful due to the binary nature of the system as they manifest peripherally (it’s either on or its off) but heart, lung, abdominal exam? Good grief. It’s all LDH and ACE levels.

 

[MD46]

Why do people always go around looking to start a fight?

For most of the physical exam, if it was a lab test you’d never order it as it lacks sensitivity and specificity. Neuro exam can be really really helpful due to the binary nature of the system as they manifest peripherally (it’s either on or its off) but heart, lung, abdominal exam? Good grief. It’s all LDH and ACE levels.

I do get your point, it was just " one example".
Care to comment on the part that says "
Your attitude is common in people we jokingly call TWKs- third world killers. Those who trained outside the US and are a dangerous combination of lazy and stupid..."

I am not looking to start a fight, but seems like discrimination exists every where.

 

[jdh71]

I do get your point, it was just " one example".
Care to comment on the part that says "
Your attitude is common in people we jokingly call TWKs- third world killers. Those who trained outside the US and are a dangerous combination of lazy and stupid..."

I am not looking to start a fight, but seems like discrimination exists every where.

Well. Looks like he said those who trained outside the United States AND are lazy and stupid.

There was an important qualifier there.

He didn’t say anyone trained outside the US is lazy and stupid.

I’ve personally ran into both fantastic and horrible physicians from third world countries. It seems like third world medical students are the same slice of life you see everywhere yeah?

It’s only discrimination on a racist or xenophobic sense if you are trying to misunderstand what was said and are going to simply assume the worst about anyone.

 

[xoggyux]

Well. Looks like he said those who trained outside the United States AND are lazy and stupid.

There was an important qualifier there.

He didn’t say anyone trained outside the US is lazy and stupid.

I’ve personally ran into both fantastic and horrible physicians from third world countries. It seems like third world medical students are the same slice of life you see everywhere yeah?

It’s only discrimination on a racist or xenophobic sense if you are trying to misunderstand what was said and are going to simply assume the worst about anyone.

Interesting. Usually, when I am talking about lazy people I just say, "lazy people". I don't need to clarify "Lazy AND Black people", "Lazy AND Hispanic people" and "Lazy and Jew people".

At the end of the day, all we are doing is having the old "old generation vs new generation" endless fight.
the "Kids grow better when parent spank them"

Everyone has a nice anecdote of when they were in a hard situation and they made the best out of that situation and end up coming on top. The classic "undertaker" situation. Many Jews did amazing and flourish ( after immigrating to the US escaping the holocaust, does that mean we should aim to have a holocaust once every few generations? Look at the list of Billionaire Jews, the list of Philanthropist jews, The list of Nobel laureate, over 20% are jews despite a global population of less than 3% Jews. I am sure that as heartless as it seems, you could make the same argument that those did great because they learned the hard way how to be resilient, that however, would not be a justification to argue in favor of genocide.

I have no doubt that you are the doctor that you are today due to the training that you got (dah!) but that does not mean that there is only one path to success, it definitely does not mean that everyone will have to have the same path and finally, it does not mean that it is the optimal.

 

[jdh71]

Interesting. Usually, when I am talking about lazy people I just say, "lazy people". I don't need to clarify "Lazy AND Black people", "Lazy AND Hispanic people" and "Lazy and Jew people".

The context of the comment being discussed was the concept of “third world killers”. Who are the ones that kill? It was specified. It wasn’t just a random comment about all lazy and stupid folks nor just about people from the third world.

 

[Instatewaiter]

It is inelectually lazy to claim racism or xenophobia especially out of context. When you don't have an argument- RACISM!

What was said was, "Your attitude is common in people we jokingly call TWKs- third world killers. Those who trained outside the US and are a dangerous combination of lazy and stupid"

Let's examine why this would be. As a whole, third world country medical education is not the same standard as the Western Europe, North America, Israel, parts of Asia etc. When you start with less than ideal medical education and add laziness to the mix, you get really dangeous physicians. As JDH has said, those who come from the third world and are hard working frequently become wonderful physicians. Many of the leaders in US medicine were trained outside the US including both of the major programs where I trained. Where I did fellowship, the current head of the Heart and Vascular institute and the fellowship program director were trained in third world countries and their skills are second to none. The difference is that they are exceptionally hard working. This is what separates them from the assassins out there. It doesn't hurt that they also went to very strong medical schools in ther respective country.

Laziness causes a dangerous physician irrespective of where they were trained. It is just more noticible and dangerous when the medical education wasnt as rigorous to start with.

I stand by my statement.

 

[KnuxNole]

It boils down to just getting your damn job done and learning about medicine and being the best doctor you can be. As everyone knows there is a LOT to learn in any residency, and I mean a LOT. If your residency isn't "cush", you make the best of it and do what you have to do. Don't be one of "those" residents who spends more time complaining and fighting.

 

[obiwan]

Why do people always go around looking to start a fight?

LOL, I'm off SDN for a few weeks and I come back to this steaming pile of horses**t

 

[jdh71]

LOL, I'm off SDN for a few weeks and I come back to this steaming pile of horses**t

I guess so . . .

I mean this steaming pile of horse**** has also been vacant for almost a week and probably would have remained so if not for this comment and bump

 

[Eyeronic]

Re: Top 20-25 IM residencies. I do think cultures and schedules fluctuate over time, but back when I was applying and interviewing, these were some of the "Cush" programs, relative to others in that group:

Mayo Clinic MN
Brigham & Women's
Northwestern (did not interview there)
Pittsburgh

That said, any program in that Top 20-25 group will work you quite hard; it will be beyond the call schedules and patient load/complexity. As others have alluded to here, you'll feel compelled to work crazy hard just to keep up with your co-residents who are also "that good", if not better. That's why the pedigree is worth something when you leave; you've earned your stripes.

If you're looking for true "Cush" in that cluster, you'll need to adjust your expectations.

 

[CanIMakeIt]

good to see @jdh71 and @Instatewaiter are still active LOL

that said, there is no substitute to patient care without doing actual patient care. If you are really interested in taking care of patients then put in the time and learn - books will only take you so far.

 

[CanIMakeIt]

Solid contribution. Glad that the previous generation was willing to get taken advantage of with no evidence of improved patient outcomes. Work smarter, not harder is the mantra of this generation. If you don't like that, you can hold fast to your opinion as dogma and drift away into obscurity, because whether or not you agree, that IS the way of the future. It's already happening in the business world, and as per the norm, medicine is well behind the curve.

I have to agree with @jdh71 about this. The only smart way of learning medicine is actually doing it rather than watch grey's anatomy or House. I have seen ICU care deteriorate to an the level where they can't even start treatment for AFib RVR, NSTEMI before calling cardiology or I was surprised to see that Vanc dosing is done by pharmacy at most places. People pulling out calculators for CHA2DS2-VAsc score even when all the components are in the name - or to calculate creatinine clearance. There is no substitute to following your patients as the disease progresses - handouts from overnight interns/residents don't make you learn medicine - disease process will not wait for your shift to teach you. You can learn in book who will need pressors but until you yourself have to start one or have to do a para, thora, central line then what's the point. Learning when to call consults, what workup needs to be done before calling consults is also part of medicine. If all you are going to do is call consults at the drop of a hat as a trainee then at least don't burden yourself with that MGH handbook or whatever interns are carrying these days . All I am saying is take pride in your work and pride comes from doing it right - not just smart.

If you are treating as just another job - like one of the other poster @Anicetus suggested and turf any case where you have to do is more than shake a patient's hand then how are you doing your job. Even bankers/Investment etc DO their job by advising the clients - how are you doing your job by turfing your patients. Well I guess they are better off in someone else's hand who knows what they are doing than dying at your hands.

ok I will dismount my high horse now

 

[jdh71]

You clearly have a huge ego problem. Case in point, you have posted almost 70 thousand posts on here. Assuming you averaged just one minute on each post, you have spent almost 50 days of your life just posting here. That doesnt include the amount of time you've spent reading these threads to come up with some half-witted insult and quoting your, "experience," as your justification for being a pathetic troll. Only an egomaniac would spend 50 days of their life typing to annoy medical students. I suggest getting a life sir.

did you really bump this dead thread to pick a fight and then actually have the temerity to tell *me* to get a life?!

That’s pretty funny. I bet people like having you around at parties. Because of the funny.

 

[VA Hopeful Dr]

did you really bump this dead thread to pick a fight and then actually have the temerity to tell *me* to get a life?!

That’s pretty funny. I bet people like having you around at parties. Because of the funny.

With an account registered yesterday.

Seems legit.

 

[jdh71]

With an account registered yesterday.

Seems legit.

yeah when you create an account just to tell me to get a life, you really have lost any and all moral high ground to make the recommendation

 

[shwillrogue]

did you really bump this dead thread to pick a fight and then actually have the temerity to tell *me* to get a life?!

That’s pretty funny. I bet people like having you around at parties. Because of the funny.

Clearly I hit a nerve there. Ironic how you think I am the one picking a fight. Go home pathetic, sad, old, troll. Or, as per usual, you can continue wasting your life, boasting about your "experience" online where literally nobody cares.

 

[rokshana]

You clearly have a huge ego problem. Case in point, you have posted almost 70 thousand posts on here. Assuming you averaged just one minute on each post, you have spent almost 50 days of your life just posting here. That doesnt include the amount of time you've spent reading these threads to come up with some half-witted insult and quoting your, "experience," as your justification for being a pathetic troll. Only an egomaniac would spend 50 days of their life typing to annoy medical students. I suggest getting a life sir.

you woke up this decrepit thread to post this??? apparently its you that has nothing to do but search though old, old, old threads and then post a stupid response.

 

[shwillrogue]

With an account registered yesterday.

Seems legit.

Very good reasoning. The first thread I see has some jaded dingus being a prick for no reason, and me criticizing that behavior makes me illegitimate. You should have been a detective with those smarts.

 

[rokshana]

Clearly I hit a nerve there. Ironic how you think I am the one picking a fight. Go home pathetic, sad, old, troll. Or, as per usual, you can continue wasting your life, boasting about your "experience" online where literally nobody cares.

you do realize, many of us actually know each other irl...and dude, if you really are looking at old threads...jdh's creds are only something you would dream of having.

 

[jdh71]

Clearly I hit a nerve there. Ironic how you think I am the one picking a fight. Go home pathetic, sad, old, troll. Or, as per usual, you can continue wasting your life, boasting about your "experience" online where literally nobody cares.

Clearly you find yourself misunderstanding any “nerves” here. I’ve basically been making fun of you.

This kind of post like yours happens from time to time. I’ve never seen any crime in my post count nor have I ever felt bad about it. I’d guess about half of it is werewolf games in the lounge. SDN has been a hangout spot for me in downtime for years.

Ive also spent a reasonable amount of time and posts trying my best to help out those coming behind me. My experience isn’t a boast it just is. It also informs and backs up my opinions. I’m sorry this bothers you so much. I’d suggest not letting all that live rent free in your head. I mean if I’m really nothing but a troll why are you even wasting my time. You like playing yourself?

At the end of the day it’s a free country, free web forum, and you are free to make yourself look like as much of an ignorant ass as you like.

 

[jdh71]

This is a hangout place for you?!?! jesus. This keeps getting more and more pathetic. And bothered isn't the right word. But jaded old pricks hammering on about the good old days, and how much they work and deserve respect need to be challenged. And the funny thing is, the people who go on about how much experience they have, and how hard they've worked, usually haven't worked all that hard. If they did, they wouldn't have to impose that idea onto people on the internet for 50 days of their pathetic life .You clearly have some freud-ian issues going on. So once again, I suggest getting a life.

Yeah. There are a lot of cool people here on SDN. Friends with them through medical school. We all went through residency and fellowship together. Still communicate now that we are all attendings. Lots of fun people in the lounge and there was a time when there was a regular werewolf game. That's not pathetic its social.

I don't think I hammered anywhere about the "good ole days" nor did I say I "deserved" respect. - we were talking about the best way to train. To learn the medicine of acutely ill people. You're the one projecting some weird personal stuff into the conversation here. The irony is you accusing me of the weird freudian stuff. You created the account to just pick a fight and think the "problem" is me. Our hero? It would be funny if it wasn't so very sad.

 

[VA Hopeful Dr]

Yeah. There are a lot of cool people here on SDN. Friends with them through medical school. We all went through residency and fellowship together. Still communicate now that we are all attendings. Lots of fun people in the lounge and there was a time when there was a regular werewolf game. That's not pathetic its social.

I don't think I hammered anywhere about the "good ole days" nor did I say I "deserved" respect. - we were talking about the best way to train. To learn the medicine of acutely ill people. You're the one projecting some weird personal stuff into the conversation here. The irony is you accusing me of the weird freudian stuff. You created the account to just pick a fight and think the "problem" is me. Our hero? It would be funny if it wasn't so very sad.

I feel like we need a train wreck emoji for SDN

 

[MickyMyki]

Um, that wasn’t the issue...the issue discussed was that training for residents NEEDS to be rigorous...you need to see lots of patients while you have the safety net of an attending to make sure you know how to handle situations when you are an attending...and that it is EXTREMELY obvious which doctors out there had a through training experience and those that were just kinda there, biding there time. No where was there ANY mention of patient safety or outcome as an issue... the point was more that many of this upcoming generation are looking to have others do their work and that their needs are more important than the needs of the patients that they are supposed to be serving.

One develops a reputation fairly quickly in residency... everyone figures out who the slackers are... and if that microscope gets put on you, well...don’t expect any sympathy from those here when you post here that you were put on probation or dismissed...remember your attendings as PD as well as admin come from the same generation as the attendings here... and have the same work ethics.

Curious, as an M4, how long does it take to build a reputation as a hard worker/strong intern?

 

[jdh71]

Curious, as an M4, how long does it take to build a reputation as a hard worker/strong intern?

we know who you are by September

 

[makethemostofit]

Curious. I hope to attend a rigorous program (not cush). Which should I rank higher- a cush, reputable program (i.e. Mayo/UVA) or a rigorous program that is not as reputable (i.e UIC)? obvious, i am ranking highest the rigorous reputable programs. But I wasn't sure how to sort program out if they only have 1 or the other

 

[xoggyux]

I think you are splitting hairs (or worse, trolling). Those are all great programs. Assuming that you got good chances on all of them, I'd say choose whichever you like the most when you attend your interview. This shouldn't be such a hard decision really. Don't get caught like a deer in the middle of the road amused at the bright light of the semi-truck coming your way.

 

[SandP]

Not trolling...I'm serious. This thread seems to indicate that a high volume/rigorous training is essential to becoming a great clinician. In fact, one poster said the choice comes down to cush vs. good training, as if they're mutually exclusive. If that is true--would I really get good training at a cush program like Mayo where I'm carrying 6 pts max?

 

[ace_inhibitor111]

Cush and reputable is better. I’m betting there is a degree of overshooting when it comes to how much workload you need to become competent. You’ll be prepared to handle most IM gigs with the Mayo residency + the added benefit of the added prestige.

 

[Jesus1]

Not trolling...I'm serious. This thread seems to indicate that a high volume/rigorous training is essential to becoming a great clinician. In fact, one poster said the choice comes down to cush vs. good training, as if they're mutually exclusive. If that is true--would I really get good training at a cush program like Mayo where I'm carrying 6 pts max?

You don't always have to choose between cush and good training. This is a common misconception amongst people. Assuming you're intrinsically motivated to study and do your best while you're at work, you'll learn a ton and be an excellent physician. There's also people at the workhorse programs that are not well trained and see a very limited range of pathology, albeit seeing the same pathology a ton. You only need to see so many cases endocarditis to know how to manage it.

 

[sallyhasanidea]

You don't always have to choose between cush and good training. This is a common misconception amongst people. Assuming you're intrinsically motivated to study and do your best while you're at work, you'll learn a ton and be an excellent physician. There's also people at the workhorse programs that are not well trained and see a very limited range of pathology, albeit seeing the same pathology a ton. You only need to see so many cases endocarditis to know how to manage it.

Do you have a list of programs with early sign out? Actual work volume doesn't matter to me, but just sitting around and doing nothing until sign out does on days where I'm not on call

 

[disorder]

Do you have a list of programs with early sign out? Actual work volume doesn't matter to me, but just sitting around and doing nothing until sign out does on days where I'm not on call

I heard UCSF, MGH, BW, JHU, Penn, Columbia don't have early sign out.
It's not uncommon to hear residents and interns lament in the work rooms, "If only had I known about early sign out, I would've ranked Stanford higher!"

Also, fantastic graveyard bump for a fantastic question. This thread has made me laugh.

 

[MD46]

Some mid west programs and where I did my residency, we would sign out at 4 pm, be done by mostly 430p unless there were med students etc presenting.

2nd Signout for the on call team to the night person was at 7pm. Call was 1:4 , so would go home early on non call days. If you wanted to leave early, tell you 3rd yr resident, sign out your patients to them and they will signout for you. Every one for the most part was supportive and always willing to help.

 

[HatTricks01]

I heard UCSF, MGH, BW, JHU, Penn, Columbia don't have early sign out.
It's not uncommon to hear residents and interns lament in the work rooms, "If only had I known about early sign out, I would've ranked Stanford higher!"

Also, fantastic graveyard bump for a fantastic question. This thread has made me laugh.

We do have early sign out. If you’re not on call/admitting, get your work done ASAP, pray none of your patients become active, and GTFO of the hospital. It’s been a while since I interviewed but IIRC, most programs had early sign out provided the call schedule was call/non call. Can’t speak to drip system admitting as I avoided those places.

 

[mudderMD]

Have to admit I despise these threads.

Kids are lazy af these days.

I was thinking the same... what the hell kind of question is this? Weird top tier privilege.

 

[shouldigomd]

Early vs late sign out is not what drains you or makes a program cush vs non cush.

I would have much rather worked like a dog on a rotation with a good year long schedule than a 4pm sign out with 8 months of IM wards.

 

[neoexile]

I was thinking the same... what the hell kind of question is this? Weird top tier privilege.

Given now I'm a 3rd year who has had interns in the past who want to home when THEIR patient is crashing in front of me, I'm NOW more suspicious of people asking for "cush" schedules.

Medicine is a responsibility, not a 9-5 job. Lives are the line here. People like those who go the extra mile to make sure care is safe and complete regardless of how much time you spend.

 

[tantacles]

Given now I'm a 3rd year who has had interns in the past who want to home when THEIR patient is crashing in front of me, I'm NOW more suspicious of people asking for "cush" schedules.

Medicine is a responsibility, not a 9-5 job. Lives are the line here. People like those who go the extra mile to make sure care is safe and complete regardless of how much time you spend.

That's cool. I think this is kind of a reductive attitude, though. I don't think anyone is suggesting that you're getting out of there at 4 no matter what. I think, though, that there are some programs that waste their interns' time, and there are some programs that get people out early because they've created a system that allows for that. There are also myriad programs that are in between these two extremes.

 

[chessknt]

Given now I'm a 3rd year who has had interns in the past who want to home when THEIR patient is crashing in front of me, I'm NOW more suspicious of people asking for "cush" schedules.

Medicine is a responsibility, not a 9-5 job. Lives are the line here. People like those who go the extra mile to make sure care is safe and complete regardless of how much time you spend.

You're right every doctor should stay in the hospital at all times to ensure nothing bad happens to their patients. A single doctor couldn't cover multiple patients on a rotating schedule to let all the others get out early to improve overall quality of life, that's just crazy town.

 

[neoexile]

You're right every doctor should stay in the hospital at all times to ensure nothing bad happens to their patients. A single doctor couldn't cover multiple patients on a rotating schedule to let all the others get out early to improve overall quality of life, that's just crazy town.

Not what I said at all. You are putting words in my mouth and creating a strawman.

What I'm saying that you should at least make sure your patients are stable/managed before you head home. Make sure your patients are signed out appropriately so that whatever team can know what is going on. This should be done ideally before you clock out, but if you have to stay a little longer then you stay a little longer.

Going home at 5 when a patient is critical, but not being managed or signed out appropriately is not acceptable.