top tier programs intrinsically more difficult than mid tier?

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neurotrancer

neurotrancer

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Do top tier, prestigious programs necessarily make for a more difficult resident experience than mid tier residency programs? For example, in comparison between University of Pennsylvania and Thomas Jefferson?
 
Like everything else,the answer is "it depends." It depends on what you mean by "difficult," for starters. Time commitment? expectations? Many lower tier programs are tough because they make you gross a ton and you don't get much education out of the program. Many better programs are tough because they expect you to learn throughout residency, perhaps do research of some kind, etc.
 
i think this is similar to the differences between top med schools and those of the mid-tier. the material to be learned is the same - knowing the diagnostic features of entity X will be required at any program. the difference may be in your competition. say you go to Pitt hoping to do H&N with Barnes... well, you may have 2 other people in your year wanting the same thing, so the competition could be stiff. while at a smaller program with fewer uber-competitive fellowships, you may be able to "shine" more, whatever that's worth. i think yaah's comments about time are probably quite valid - if you're expected to gross or do significant research, that takes time away from reading texts/journal articles or reviewing study sets, or whatever.

but in the end i think pathology resident is tough no matter where you go; such is the nature of the vast amount of material we're expected to learn in 4 years.
 
Difficulty is in the eye of the beholder. I would encourage people to look for programs where they place an emphasis on you taking a lead role in seeing cases and developing a thought process on how to work up them up, in essence, actually taking responsibility for your cases. Of course, there are also other ways to get solid training (didactics, unknown sessions, etc) which are important as well. I really felt that at a place where I rotated (mid-tier smallish academic hospital), the residents could really skate by during signout and in essence not even really understand why something was being diagnosed the way that it was. Of course, I'm not going to generalize across the board with my n=1 mid-size program experience, but it would be something I would inquire about (are residents observers or are they responsible for the cases after the grossing is done?) You can skate at most programs (even the big ones), but I think some places tend to place an emphasis on residents taking ownership of their cases, which forces your brain to actually work and learn, which ultimately helps you be a better pathologist. Most of this is probably individual dependent, but it helps when the faculty push you as well and aren't there just trying to move glass.
 
DarksideAllstar said:
Difficulty is in the eye of the beholder. I would encourage people to look for programs where they place an emphasis on you taking a lead role in seeing cases and developing a thought process on how to work up them up, in essence, actually taking responsibility for your cases. Of course, there are also other ways to get solid training (didactics, unknown sessions, etc) which are important as well. I really felt that at a place where I rotated (mid-tier smallish academic hospital), the residents could really skate by during signout and in essence not even really understand why something was being diagnosed the way that it was. Of course, I'm not going to generalize across the board with my n=1 mid-size program experience, but it would be something I would inquire about (are residents observers or are they responsible for the cases after the grossing is done?) You can skate at most programs (even the big ones), but I think some places tend to place an emphasis on resident's taking ownership of their cases, which forces your brain to actually work and learn, whcih ultimately helps you be a better pathologist. Most of this is probably individual dependent, but it helps when the faculty push you as well and aren't there ust trying to move glass.
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👍👍👍
 
I will put it a different way: There is a HUGE spectrum between the hours residents work at different programs, even on the order of 50% less at the low end vs. the highest teir.

Does that make programs more difficult? No, any monkey can pull 16 hour days but it does mean you are there at your scope or grossing for much much longer than someone elsewhere and in the end getting the same certificate.

IMO, until proven otherwise there is no correlation between hours worked and % pass rate on the boards, job success or future income.

take from my statement what you will.
 
If I was hiring someone right out of residency two years ago and had the choice of a person on the 5-year plan vs. a person on the 4-year plan (all other things created equal), I would take the person with more experience. That is the name of the game after all. So now if someone is coming out of a less time intensive residency vs. a "top-tier" program, I am also going to err on the side of the person who has seen more and done more.

Of course someone is going to play devil's advocate and say that they would hire on personality, communication skills, etc. And that of course is true. Also the program one goes to doesn't determine their fate. In other words, good trainees can come out of smaller programs.

But all of these scenarios are placing the "underdog" resident against the odds in a smaller program, having them work their butt off, and come out triumphant in a Hollywood style ending. What is stopping a resident at a "top-tier" program from doing the same and competing for the same job? Then who would come out on top?
 
Master Chief said:
If I was hiring someone right out of residency two years ago and had the choice of a person on the 5-year plan vs. a person on the 4-year plan (all other things created equal), I would take the person with more experience. That is the name of the game after all. So now if someone is coming out of a less time intensive residency vs. a "top-tier" program, I am also going to err on the side of the person who has seen more and done more.

Of course someone is going to play devil's advocate and say that they would hire on personality, communication skills, etc. And that of course is true. Also the program one goes to doesn't determine their fate. In other words, good trainees can come out of smaller programs.

But all of these scenarios are placing the "underdog" resident against the odds in a smaller program, having them work their butt off, and come out triumphant in a Hollywood style ending. What is stopping a resident at a "top-tier" program from doing the same and competing for the same job? Then who would come out on top?
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Man by starting with the whole 5 year vs 4 year thing you totally lost me..

You know there are no more 5 year programs...right?


I think the whole discussion is invalid as there are programs at all levels that overwork (in a scut like manner) their residents...

Some big name places overwork people because they can and they have the big name. Some small places like to make sure their people don't gross too much to try and make sure they can brag about that and attract good residents...
 
djmd said:
Man by starting with the who 5 year vs 4 year thing you totally lost me..

You know there are no more 5 year programs...right?
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I said in the scenario "two years ago" (i.e. 2006) when both classes finished at the same time, who would you have chosen, the person with 4 years of experience or the one with 5 years?

And I totally agree with everyone that this discussion is a little too vague to say anything meaningful. My point was just that many people seem to trash the big name places, and think that they can get the same type of training at their local community program, which may be true for any one person. However, in my experience at both big name and not-so-big name places: while the individual might be equally good regardless of the program, the average of all the residents was better at the big name place.
 
Master Chief said:
If I was hiring someone right out of residency two years ago and had the choice of a person on the 5-year plan vs. a person on the 4-year plan (all other things created equal), I would take the person with more experience. That is the name of the game after all. So now if someone is coming out of a less time intensive residency vs. a "top-tier" program, I am also going to err on the side of the person who has seen more and done more.

Of course someone is going to play devil's advocate and say that they would hire on personality, communication skills, etc. And that of course is true. Also the program one goes to doesn't determine their fate. In other words, good trainees can come out of smaller programs.

But all of these scenarios are placing the "underdog" resident against the odds in a smaller program, having them work their butt off, and come out triumphant in a Hollywood style ending. What is stopping a resident at a "top-tier" program from doing the same and competing for the same job? Then who would come out on top?
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For me it rarely a question of comparing apples and apples in terms of training because one or more applicants will present themselves as a douche bag/someone with no personality, making the choice easy.

For most it plays like this: you have an opening, you imediately are flooded with TONS of applicants so you take the pile and sort them by who has the skills you want (criteria no1), then if you have say 5 dermpath trained people you take those and sort them by quality of training. Offer interviews to say 3-4 of those and see which person is a best fit for the group. Rarely would you have to sink down deep into your applicant pile to grab at those with no special skills from lower tier programs, if ever. There are just way the hell too many people looking for jobs.

Conclusion: if you go to a lower tier program and dont do some sought after fellowship you better have MAD phone interpersonal skills to even get an interview. Better have some connections too.
 
LaDoc, I think we are on the same page though I may not be making my point very clear. I originally posted because you made it sound like it didn't matter where you train. However, your most recent post puts the importance of training in perspective, and that is that it gets your foot in the door. If you don't have any other skills, then the door will be shut pretty quickly. And even MAD phone skills doesn't guarantee an interview. Therefore, for all the people contemplating a "top-tier" program vs. a close-to-home warmer, friendlier option, my advice would be to go to the best place you can. Now somebody will probably make the rebuttal that the best place for one person might not be the best place for another, it is an individual thing, etc. The best programs are top-tier for a reason. Though the top program might not be same for everyone (i.e. one might pick MGH and another BWH), any top-tier will for the most part be better than any second-tier.
 
I'd swear that the PDs from various top-tier programs are paying you guys to have this discussion right before rank lists are due...
 
Many of the "lower tier" / "mid tier" programs have people placing into fellowships at top programs. If you are interested in being a private practice specialist, I think what potential employers would be looking at more closely would be where the job applicant did their fellowship. I would not consider university of Buffalo, NY to be a top tier program, however if one of their residents went to MD Anderson for fellowship (which will happen this upcoming academic year), I think that their job prospects are negligibly differnt from someone who went to a program that had a bigger name for their residency but still still went to MD Anderson for fellowship. The way I see it, the MD Anderson fellow / former Buffalo resident may get 6 job offers for their first job, however the MD Anderson fellow / former Johns Hopkins resident would get 10 job offers. The question then becomes, is the theoretical relative benefit that much more worthwhile? How important are bragging rights to the individual? Their endpoint of a common fellowship would be the same, and for job placement I think fellowship is much more relevant.
 
Master Chief said:
LaDoc, I think we are on the same page though I may not be making my point very clear. I originally posted because you made it sound like it didn't matter where you train. However, your most recent post puts the importance of training in perspective, and that is that it gets your foot in the door. If you don't have any other skills, then the door will be shut pretty quickly. And even MAD phone skills doesn't guarantee an interview. Therefore, for all the people contemplating a "top-tier" program vs. a close-to-home warmer, friendlier option, my advice would be to go to the best place you can. Now somebody will probably make the rebuttal that the best place for one person might not be the best place for another, it is an individual thing, etc. The best programs are top-tier for a reason. Though the top program might not be same for everyone (i.e. one might pick MGH and another BWH), any top-tier will for the most part be better than any second-tier.
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I wholeheartedly agree. You can't go wrong by going to a top-tier place...with regards to fellowships, sure you can go to a top-tier place for a fellowship but it's gonna be hard and you're at the mercy of the fellowship not filling with in-house people.
 
sweetymd said:
is cc a top-tier program?
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Ask your advisers. These discussions of top-tier programs often go in the wrong directions with feeling being hurt and all. Some people on this message board are fragile.

Seriously, get this info in person from someone you trust.
 
neurotrancer said:
Many of the "lower tier" / "mid tier" programs have people placing into fellowships at top programs.
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I agree with Bierstiefel's post-- you are completely at the mercy of "top programs" not filling their fellowships with in-house candidates in order to have a shot at any fellowship there. This is one of the perks of going to a "top program" with many fellowship opportunities.

And FYI, not all surg path fellowships are built the same. I think the best examples of this that I can think of are the oncologic fellowships at the cancer centers (MDA, MSKCC, Roswell Park). I can only speak for my experience of 1 month at MSKCC, but I saw very little medical disease-- 95% of it was neoplastic (the other 5% we ruled out neoplastc). Some good medical consults came in on a couple of the services I rotated on, but by and large everything was tumor. Obviously this is because these are institutions specializing in tumors-- diagnosing, surgerizing, chemo'ing, and radiating them. I would argue that you would see more non-neoplastic (read: medical) pathology by doing a surg path fellowship at an institution that sees a whole spectrum of patients (including peds). And generally speaking, many of the fellows that I met there were interested in staying in academics (AP-only, etc).

Maybe some people who did oncologic path fellowships would care to comment on the variety of material that they have seen.
 
Master Chief said:
LaDoc, I think we are on the same page though I may not be making my point very clear. I originally posted because you made it sound like it didn't matter where you train. However, your most recent post puts the importance of training in perspective, and that is that it gets your foot in the door. If you don't have any other skills, then the door will be shut pretty quickly. And even MAD phone skills doesn't guarantee an interview. Therefore, for all the people contemplating a "top-tier" program vs. a close-to-home warmer, friendlier option, my advice would be to go to the best place you can. Now somebody will probably make the rebuttal that the best place for one person might not be the best place for another, it is an individual thing, etc. The best programs are top-tier for a reason. Though the top program might not be same for everyone (i.e. one might pick MGH and another BWH), any top-tier will for the most part be better than any second-tier.
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Yeah my statements superficially seem contradictory BUT what I am getting at is this: many people from top tier programs have crap communication skills and although from outward analysis top programs should give you a big monetary advantage career wise, Im not seeing a good correlation meaning likely many of the top Harvard types are squandering their training rep edge by simply being douche bags or introverts.

Hmm I hope that makes sense.

The core of this is if you are a douche bag, no training program will save you. Conversely if you are as smooth as Ben Affleck in 'Boiler Room' or Damon in "Rounders" no lower tier program will deep six you....
 
Bierstiefel said:
Dude, just hang out in a bar for the next month. Time til match day will go fast.
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Yeah... everything I need to know, I learned from Animal House.

I'm not worried about matching, just having lingering doubts about not putting one of those top 5 programs at the very top of my rank list... I feel like I overall have made the best decision for my career and my family, but still... lingering doubts.

BH
 
LADoc00 said:
The core of this is if you are a douche bag, no training program will save you. Conversely if you are as smooth as Ben Affleck in 'Boiler Room' or Damon in "Rounders" no lower tier program will deep six you....
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Agreed. But do you also think that Affleck and Damon used their skills to get into a competitive fellowship?

And neurotrancer, you are correct in your assessment that fellowships are WAY more important than residency. I would say your fellowship training basically makes your residency irrelevant. After all, you are being hired for your subspecialty training, not your 50+ autopsies.
 
Hi guys. Does anyone know much abt this program. Visited for an interview and it seemed good. Final ROL due soon and not quite sure were to place it. Where in the 'tier' stratosphere would it be placed? Thanks.
 
How do you define top tier?

The program that produces the most department chairs? Produces the most faculty? The program that writes the most books or journal articles? The program whose grads get the most grants? The program that has the most people rank it #1?

But do chrondrosarcomas get signed out better at BWH than they do at Mayo or MDA or at a VA or county hopspital?

Is someone really going to teach you more about diagnosing GBMs at JHU than at Oklahoma? It is all in the textbooks anyway. Now if you want to do microarrays on GBMs and then develop a target for therapy there might be better places to be, but in terms of learning diagnostic pathology, there are many equivalent programs.

It is all about volume and being at an institution with broad surgical and medical subspecialty. Lots of places have that.
 
pathstudent said:
How do you define top tier?
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Personal bias, hubris, hearsay, arbitrary criteria that may or may not apply, and wishful thinking. "Quality of training" usually doesn't apply in these rankings because most people only have experience with one program, with perhaps limited exposure to a few others. Their biases generally lead them to overlook weaknesses at programs they are interested in propping up (for whatever reason, because they train there or they want to, for example), or to accentuate weaknesses at programs they are not interested in propping up.

You will hear lots of people mention different programs being good at one thing or another, etc etc. Good programs will keep being brought up. Unfortunately you have to see for yourself. There are a handful of programs (DON'T ASK WHICH ONES) which have more cache in academia, but that doesn't mean a high performing resident/attending at a "lesser" program can't gain high respect and advance.

http://forums.studentdoctor.net/showthread.php?t=260318
 
I would say Hopkins sort of seems to be at the forefront of pathology and that a far disproportionate number of dept chairs, heads of surg path, program directors and faculty in general seem to have trained at Brigham.

Those two programs seem unique in those regards.

When it comes to sorting out MGH, Penn, Michigan, Washington U, U Washington, University of Chicago, UCSF, Stanford, and numerous other tertiary med centers associated with a univeristy, it all comes down to homerism, like rooting for your favorite sports team.

It is as ridiculous as the US news rankings, except they at least use some quantifiable data.

But to answer the OP's question...the answer is "NO". Pathology is incredibly difficult no matter where you go.
 
pathstudent said:
I would say Hopkins sort of seems to be at the forefront of pathology and that a far disproportionate number of dept chairs, heads of surg path, program directors and faculty in general seem to have trained at Brigham.
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I think WashU has the most department chairs. I would include them in the "five"- at least mine anyway.
 
gbwillner said:
I think WashU has the most department chairs. I would include them in the "five"- at least mine anyway.
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Another issue is that, for example, some people do med school +/- PhD at one place, then residency at another, fellowship at one or more others, then get a junior faculty position at another before moving on again. So who claims them? All of the above?

Don't even bother trying to decide on "top 5" or top any number. It's a pointless argument. And don't forget, programs change. A program that may have been a superstar many years ago may now be less of a great place, etc etc.
 
pathstudent said:
It is all about volume and being at an institution with broad surgical and medical subspecialty. Lots of places have that.
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And that really only counts if you're wanting to be a hardcore surgical pathologist... if you're interested more in research or CP, might be a different list entirely.

BH
 
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