top programs

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what the hey, I am a fourth year. Not much else to do . . . . . .


This is a previous poster's take on "top programs":
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Academic anesthesiologists I have spoken to generally seem to stratify the outstanding programs into 3 tiers...

1) Best of the best: JHU, MGH, UCSF

2) Considered to be Elite programs: Alabama, Brigham, Columbia, Duke, Mayo, Michigan, Penn, Stanford, Wake Forest, U. Washington

3) Other excellent academic programs: Beth Israel, Cornell, Dartmouth, MC Wisconsin, Mt. Sinai, Northwestern, Penn State, UC Irvine, UCLA, UCSD, U. Chicago, U. Colorado, U. Florida, U. Iowa, UNC Chapel Hill, U. Pittsburgh, U. Rochester, U. Texas Galveston, Utah, UVA, Vanderbilt, Wash U, Yale
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Most people I know who matched into these programs had a Step 1 above 215 and a mixture of A's and B's (Honors and High Passes) on their core third year rotations.
 
This is another one. This brought about quite a bit of controversy amongst the residents on this site, but I felt like it helped see how some other schools were kind of thought of. LOTs of residents disagreed with this posting, but nonetheless it gave me a better grasp of how certain programs are viewed by at least one guy.

FROM OLD POST:

Want Rankings of Gas Programs? Look Here.
Below is a list of rankings of Anesthesiology programs from a leader in the field. He has been on the RRC and is at my home institution. He told us that "the list should never leave the room attached to my name as I dont want to hurt my friends feelings". Ok, well, here it is, not attached to his name, but for your reference, and for future reference of gas applicants. Many people have been told this list at my home program, so I don't know why it has not been leaked before, so here you go.

He based it on prestige, research, resident happiness, overall education, applicant competitiveness, and job opportunities. Basically, it's the official list you should apply from for 2008, and he told us to apply only to this list. He told us that any of these programs will prepare us for a future in Anesthesiology.

Separated by tiers, within the tiers there are no individual ranks. 4 tiers, covering the top 40 or so programs.

Oh. I wont respond to any pms. I wont sign into this account again. I am posting from a internet hotspot where I am vacationing. So, contest it amongst yourselves, but it is exactly as he put it. I apologize if your program is missing.

Enjoy.

1st Tier:

Cornell
Columbia
Brigham and Womens
Mass General
Johns Hopkins
UVA
Duke
Wake Forest
UAB
Mayo Rochester
University of Washington
UCSF
Stanford
UCLA

2nd Tier:

UPenn
UF
Emory
Vanderbilt
Northwestern
University of Chicago
University of Michigan
University of Texas, Galveston
Washington University
Medical College of Wisconsin
Loma Linda
UC-San Diego
Oregon Health Science Center

3rd Tier:

Dartmouth
University of Pittsburgh
University of Rochester
Yale
Iowa
Indiana U
University of Wisconsin- Madison
Rush Presbyterian
University of Tennessee- Knoxville
Medical University of South Carolina
Medical College of Georgia
Oschner Clinic
University of Texas, San Antonio
University of Texas, Houston
University of Kansas @ Kansas City
University of Nebraska
University of Colorado
University of Arizona - Tuscon
Virginia Mason

4th Tier:

University of Kentucky
University of Louisville
University of Mississippi
University of Miami
Mayo Clinic- Jacksonville
Scott & White - Texas A&M
 
UTSouthwestern said:
Guess UT Southwestern is 5th tier. 🙄
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Yeah, I know this second one gets a lot of hate. Let the games begin! :clap: I just thought it was good to see two different opinions even if the second one . . . well, shall we say is a little less than impressive? 😉
 
I prefer to rank the programs based on proximity to an In-N-Out Burger, and as such UCLA is the clear #1 program in the country.
 
Just a reminder, these 'top programs' are always a list of programs sharing a name with famous colleges and programs with lots of research that doesn't really improve your clinical training. There is no meaningful way to compare programs' clinical training and therefore no meaningful list for those of us who don't want a research career. But if you need to stroke your ego...
 
"Tier" may make a difference in how many interviews you get for competitive fellowships- pain being the most competitive. Having said that, if you're thinking pain, try to match at an anesthesia program with a great pain fellowship that takes a lot of their own. Cleveland Clinic would be a perfect example. I think 9 of their spots went to internal candidates this year.
 
Go to a place where you'll be happy liiving and working, and where you'll get good training and pass your boards. My program didn't make Mack Bronson's list, but half my class passed their written boards after their CA1 year. We get great training, and it's an amazing place to live. It may not have the name Hopkins does, but our grads have no trouble getting great jobs, and I don't have to live in Baltimore.
 
If you are looking for experience in regional anesthesia, Mayo's program has much to offer.
Our grads leave with over 120 blocks of the Fem/sciatic/psoas/fascia iliaca/popliteal/interscalene type alone, during a single two month rotation. It doesn't include the rest of their three years here. Not bragging, just pointing out a good program.
 
Dejavu said:
If you are looking for experience in regional anesthesia, Mayo's program beats every program we know of (and our division chair has visited many).
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While the WFMC has a good program, I imagine there are several other programs that would take issue with the "beats every program" comment, possibly even to the point that they say they beat every program.
 
bubalus said:
While the WFMC has a good program, I imagine there are several other programs that would take issue with the "beats every program" comment, possibly even to the point that they say they beat every program.
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I would be interested to hear from people working at programs where their residents get these numbers of blocks, just to see how their programs are organized.

What I said wasn't meant to "dis" other programs, and I apologize if anyone thought so. I am just darned proud to work in a program where the residents graduate with so much regional experience since regional is an area of interest for me.👍
 
Dejavu said:
If you are looking for experience in regional anesthesia, Mayo's program beats every program we know of (and our division chair has visited many).

Our grads leave with over 120 blocks of the Fem/sciatic/psoas/fascia iliaca/popliteal/interscalene type alone. They also get well over the spinal/epidural/axillary quotas as well.

Not to mention vast general anesth, pain clinic, OB, and ICU experience all the while having a fairly decent lifestyle.

Nuff said...👍
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3 months into my CA2 year, I've done 17 sciatics, 10 lumpar plexus, 12 femoral, 5 interscalene, 4 supraclav, and 7 various other blocks (ax, infraclav, etc) to go along with 114 lumbar epidurals, 23 thoracic epidurals, and 71 spinals. (No, I don't remember this off the top of my head. I had to pull up my case log summary)

Considering I've got 21 months left and haven't even hit the high volume regional rotations as a CA3 I expect to have somewhere around 200-300 regional blocks (combination of single shot and catheter) along with plenty of epidurals and spinals. I think that there are several residency programs out there that provide high volume and quality training in regional, though some are better than others. I doubt your division chair has visited all.
 
Idiopathic said:
I would have thought that my presence here would have pushed this up to a 'Top Tier' program in your eyes 😉
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I didn't come up with that list but thought it was reasonably accurate. If you want to put Vandy in the top tier be my guest. 😀
 
Mman said:
3 months into my CA2 year, I've done 17 sciatics, 10 lumpar plexus, 12 femoral, 5 interscalene, 4 supraclav, and 7 various other blocks (ax, infraclav, etc) to go along with 114 lumbar epidurals, 23 thoracic epidurals, and 71 spinals. (No, I don't remember this off the top of my head. I had to pull up my case log summary)

Considering I've got 21 months left and haven't even hit the high volume regional rotations as a CA3 I expect to have somewhere around 200-300 regional blocks (combination of single shot and catheter) along with plenty of epidurals and spinals. I think that there are several residency programs out there that provide high volume and quality training in regional, though some are better than others. I doubt your division chair has visited all.
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Apparently I didn't proof-read my post for bragging. Let me edit it.
 
whether you do 10 or 20 infra-clavicular blocks isn't what is going to make the difference - as more and more regional programs are gearing towards ultrasound, i think the question should become... 1) is there a lot of exposure to regional and 2) will the graduate feel comfortable doing most of their blocks with ultrasound guidance... and even more so 3) will the graduate feel comfortable performing catheterized blocks (as more and more ortho centers like interscalene catheters, etc..)

and i would also like to point out that numbers are not everything - understanding the clinical implications, when to, when not to, complications,etc is very important to distinguish anesthesiologists from technicians...
 
Tenesma said:
whether you do 10 or 20 infra-clavicular blocks isn't what is going to make the difference - as more and more regional programs are gearing towards ultrasound, i think the question should become... 1) is there a lot of exposure to regional and 2) will the graduate feel comfortable doing most of their blocks with ultrasound guidance... and even more so 3) will the graduate feel comfortable performing catheterized blocks (as more and more ortho centers like interscalene catheters, etc..)

and i would also like to point out that numbers are not everything - understanding the clinical implications, when to, when not to, complications,etc is very important to distinguish anesthesiologists from technicians...
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I would completely agree.

On a related topic, how about ultrasound for line placement? It's nearly universal in academic hospitals, but from what I gather it's not common in private practice settings. I understand there is a major cost issue, but there is pretty good evidence that it is safer. Will there be a shift towards more ultrasound being used outside university settings?
 
Idiopathic said:
certainly not universal...im at a big academic center and have never used US for a line
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Really? I guess my N of about 14 for friends from med school had it at 100%.
 
Where I did intern year, US guidance was almost required as a safety precaution when placing central lines in both the MICU and SICU. Almost required meaning that if it was emergent and no US machine was around/working or in one case that i saw it not used, we had no sterile sheath to cover the probe (but we did use it to locate the IJ before prepping).
 
There is definitely data showing better outcomes from US guidance line placement, but that is not the end of the arguement. It seems short sighted to teach inexperienced operators primarily with ultrasound technique. It is definitely easier to learn when an experienced operator is helping, but without a foundation in anatomical technique a dangerous knowledge gap exists.

Not every location, and for sure not every situation that an anesthesiologist will find himself in will US be available. It is one thing for the fleas to primarily learn US, but it is shortsighted for a group who claim to be experts in lines to not be excellent in all techniques.

It may be appropriate for an anesthesiologist to learn percutaneous trach without ever doing a standard open trach, but it would seem ridiculous for a general or especially an ENT surgeon to limit their expertise to only perc.

Jet and UT would better answer this, but is definitely seems to be limited in PP. Experienced guys like those two are so deft at dropping lines, the data seems far fetched from representing their actual practice.
 
thats why you go for your landmarks first. Put a mark there. Then use the U/S to see if you were right.

There isn't a reason I can think of not to use U/S for a line placement in a non emergency situation in the OR.

In the SICU I'll use a "finder needle" first then go for the catheter and transduce before dilating. If the patient is on the large side I'll grab the U/S but its a pain to nab it OR's.
 
there is a decent amount of data as it relates to ultrasound central lines -

less number of sticks
quicker procedure

interestingly, the incidence of accidental arterial puncture was not necessarily decreased... will have to dig up the papers, but you can definitely pubmed.com it...

i believe that an anesthesiologist should feel comfortable enough to throw in a line in a blink without an ultrasound, but also be adept enough to use ultrasound for elective lines....
 
Idiopathic said:
Really? where is this 'outcome data' of which you speak
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I'm too lazy to dig up the articles but have seen numerous ones with decreased complication rates. I guess it would depend on how you define outcomes. Fewer line infections? Yep. Fewer arterial punctures? Yep. Lower 30 day mortality? Unlikely.

Using U/S is just better than not using it. The only downsides are cost and potentially time, however if you know how to use the U/S it takes less than 30-60 seconds of extra set up if the equipment is available. And that 30 seconds quickly gets made up when you get the line on the first needle pass every time.

I agree that you need to know how to do it both ways, but I believe that every location doing enough lines should be investing in ultrasound for the betterment of patient care.
 
i actually remember dissing ultrasounds for central lines until one day i was struggling getting an IJ cordis on a bleeding liver case gone wrong... one of my colleagues took the US from the regional guys and brought into the OR. He handed me the probe, put the screen in front of my face.

had the probe in the left hand, the 18gauge angiocath in the right hand - and literally with a bit of goop, i had the cath in like flynn... [i prefer the angio cath over the thin-wall needle cause as soon as I am in, i thread the cath into the IJ, and then i can thread the wire at my leisure without having to hold the thin-wall like it may pop out of the vein any minute...]
 
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