Top tier programs- is it really true?

[pathology4me]

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Again- struggling with residency decisions. Something I have heard consistently on the interview trail from both faculty and residents is that once you get to a "top tier" program you will come out equally well trained- so my question is, is that true? For example, I have my top 5 AP/CP programs- Penn, BWH, UW, Hopkins, Stanford- they are all pretty different in my opinion considering volume, didactics, fellowships, integrated curriculum vs. not; but training-wise, can I really go to any of them and be just as well trained/have just as many opportunities post residency? Any opinions on deficiencies vs strengths that REALLY make a difference would be helpful......
Thanks!

 

[2121115]

As a grad of one of these "top tier" programs I can tell you this: You will be as good as you make yourself. There is no special magic at any of these places. Don't depend on them to teach you or make you well-trained. It is all about reading, work ethic and looking at slides.

 

[KCShaw]

Agree. And face it, some people will thrive at certain programs and not at others -- there is something to be said for finding the right "fit" for you. It's one thing to separate a small non-academic program with recurring accreditation problems, staff & resident turnover, etc. from a medium to large stable academic program with a good reputation. It's quite another to try to globally separate/rank medium to large stable academic programs with a good reputation. They will be different for sure, but barring things which should mar their reputation (meat factories, etc.), I think you're doing yourself a disservice trying to identify where the "best" place is in general. Instead, focus on trying to figure out what the "best" overall place is for -you-.

So I guess that means yes, I think in general you're going to come out equally well trained as almost anyone else at any other name-brand institution -- and frankly most accredited institutions in the country as far as day-to-day sign-out goes -- if you work yourself equally hard in terms of reading, paying attention, chasing down odd cases your institution does get, exploring other available resources, and are otherwise actively involved in your own education. Some people are more passive than others, and need that extra volume &/or pressure in order to learn. Others get bored at smaller/slower places. Others get easily overwhelmed and need a slower pace/less pressure in order to focus and build themselves up to brilliance. It's just the way it is.

 

[gbwillner]

As a grad of one of these "top tier" programs I can tell you this: You will be as good as you make yourself. There is no special magic at any of these places. Don't depend on them to teach you or make you well-trained. It is all about reading, work ethic and looking at slides.

I would add that at the "top" programs (there is not just five of these BTW), you are more likely to be better trained because the amount of work and didactics will expose you to the cases and volume you need to see. Sure, if you go to another program you could be just as good, but it will be more up to you and how hard you go out of your way to make up for your program's deficiencies. If you see over 4K surgicals per year yourself as part of your training, as I did, you probably saw enough glass. If not, you may have had enough time to see more on your own and make up for it.
I would also say that going to a "top" program makes the rest of your life easier too. You will have a leg up in terms of landing the fellowship you want and, likely, a better job.
I would also stress that there is no "magic" in these specific programs, and that every region of the country has it's elite programs.

 

[KeratinPearls]

As a grad of one of these "top tier" programs I can tell you this: You will be as good as you make yourself. There is no special magic at any of these places. Don't depend on them to teach you or make you well-trained. It is all about reading, work ethic and looking at slides.

TOTALLY AGREE with this statement. You can go to a community hospital program vs. the best program in the country and come out well trained. Depends on the individual and how hard they want to work and if they have the material. The advantage to top programs are connections and name of pathologists who will recommend you when it comes to jobs (BIG plus).

 

[pathology4me]

I would add that at the "top" programs (there is not just five of these BTW),

I definitely know that there are a LOT of great programs out there- these are just the ones that I am considering based on my learning style and where I feel I "fit in". It is a tough decision between a few of them- just wanted to know if there were opinions on any significant differences training-wise that I should consider if I'm aiming for an academic career- or if they are all considered equal in that regard. For instance, I like the residents at one place, volume at the other, faculty at another, etc. Ultimately I know it is my own work ethic that makes the difference, and it is reassuring to hear that sentiment reiterated- I guess I just was looking for any other opinions or advice that might help me focus my decision- and whether there are any glaring positives or negatives- a futile question I know.....

 

[gbwillner]

I definitely know that there are a LOT of great programs out there- these are just the ones that I am considering based on my learning style and where I feel I "fit in". It is a tough decision between a few of them- just wanted to know if there were opinions on any significant differences training-wise that I should consider if I'm aiming for an academic career- or if they are all considered equal in that regard. For instance, I like the residents at one place, volume at the other, faculty at another, etc. Ultimately I know it is my own work ethic that makes the difference, and it is reassuring to hear that sentiment reiterated- I guess I just was looking for any other opinions or advice that might help me focus my decision- and whether there are any glaring positives or negatives- a futile question I know.....

All programs have their strengths and weaknesses... including these. I would find out what those are, and see which program among these has weaknesses least relevant to your interests. I would also say that these are all in very different parts of the country, with different weather and costs of living. That should also carry some weight. If you want a research-type academic career vs. clinical track, these programs will also have different priorities and training styles.

 

[cjw0918]

Agree with everyone above. Would also say it is worth considering where you would like to settle once you are through with training. If there is an elite program in that city, go there. Getting a job in the real world is all about connections and if you are already a local, this can only help you. You are more likely to know the groups in town and be part of local path organizations.

 

[GoodNewsEvery1]

I think among those listed, you couldn't go wrong with any of them and I think location would play a major factor in choosing. As long as you put in the time and effort, you'll be well off from any of them.

I have a question along the same lines. Is there really much difference between one that is considered a top program (like Penn) vs one that I think is really good but not often listed as a top one (like Pittsburgh or Cleveland Clinic)? Is there really even much difference in reputation?

 

[malchik]

I have no idea where people get their notions of what the top programs are. It is so incredibly arbitrary. You could find plenty of people who think CC and Pittsburgh are better than Penn, and the reverse is also true. When I was a med student I was skeptical of people like me who largely dismiss the hierarchy, but trust me, you will see as I have that it is a lot of BS.

I would look closely at fellowships, which can vary considerably among good institutions, both in terms of what they offer and quality. If there is a fellowship you are considering, definitely don't go somewhere that doesn't have it because internal candidates have an advantage getting fellowships. If you're not sure, go somewhere that has lots of good fellowships.

 

[GoodNewsEvery1]

I have no idea where people get their notions of what the top programs are. It is so incredibly arbitrary. You could find plenty of people who think CC and Pittsburgh are better than Penn, and the reverse is also true. When I was a med student I was skeptical of people like me who largely dismiss the hierarchy, but trust me, you will see as I have that it is a lot of BS.

I would look closely at fellowships, which can vary considerably among good institutions, both in terms of what they offer and quality. If there is a fellowship you are considering, definitely don't go somewhere that doesn't have it because internal candidates have an advantage getting fellowships. If you're not sure, go somewhere that has lots of good fellowships.

That is kind of what I was thinking. I don't think the training is really any better at those programs compared to the others, or many of the of the other programs I saw for that matter. Some places may train in a way that is more your style but that is just personal preference. In fact, I loved all 3 places and would be very happy with any of them.

My only question comes from the fact that there is a completely arbitrary idea that people have of a "top program" and if going to one will ever really affect something down the road. As in, will someone think, "hmm, this guy went to program A while this guy went to program B, so lets go with the first one." In my mind, that probably won't happen and as long as you put in the time to learn and get the connections you need, it won't make much of a difference. And as pointed out earlier, having connections in the area you'd like to eventually practice should be noted.

 

[gbwillner]

My only question comes from the fact that there is a completely arbitrary idea that people have of a "top program" and if going to one will ever really affect something down the road. As in, will someone think, "hmm, this guy went to program A while this guy went to program B, so lets go with the first one." In my mind, that probably won't happen and as long as you put in the time to learn and get the connections you need, it won't make much of a difference. And as pointed out earlier, having connections in the area you'd like to eventually practice should be noted.

I would say it is not COMPLETELY arbitrary. What you say above is probably true for for those going into private practice who want to stay at a particular location, but for academics (and PP on a national level) it does matter. Programs with good reputations have broad alumni networks across the country. Look at the institutions you are looking into- where did the faculty train? A program like BWH has a large number of alumni as faculty across the country (same for Penn, MGH, WashU, UCSF, etc etc etc...), meaning when you want a job there they will put you above others, all else being the same. Similarly, others who did not train there know of the reputation of those places and know you are likely well trained. From what I've seen, fellowship interviews don't do slide reviews (or job interviews at academia), meaning they have no real way of assessing your skills and will base their decision on your charm and recommendations (and research talk for academic jobs). If recommendations are coming from famous people or your interviewer's old buddies from institution X that will have more meaning than random professor Y.

That being said, there is history on this board of talking about the "top 5" programs, and anything outside of that is crap. This is BS. There are programs out there people will say have great reputations, without much debate, those with great reputations and some debate, and those most would not consider the top. I personally would think the number of "elite" programs is like 10-20. All those programs the OP listed are probably in that category, and likely Pitt and CC too.

 

[lurksalot]

I would say it is not COMPLETELY arbitrary. What you say above is probably true for for those going into private practice who want to stay at a particular location, but for academics (and PP on a national level) it does matter. Programs with good reputations have broad alumni networks across the country. Look at the institutions you are looking into- where did the faculty train? A program like BWH has a large number of alumni as faculty across the country (same for Penn, MGH, WashU, UCSF, etc etc etc...), meaning when you want a job there they will put you above others, all else being the same. Similarly, others who did not train there know of the reputation of those places and know you are likely well trained. From what I've seen, fellowship interviews don't do slide reviews (or job interviews at academia), meaning they have no real way of assessing your skills and will base their decision on your charm and recommendations (and research talk for academic jobs). If recommendations are coming from famous people or your interviewer's old buddies from institution X that will have more meaning than random professor Y.

That being said, there is history on this board of talking about the "top 5" programs, and anything outside of that is crap. This is BS. There are programs out there people will say have great reputations, without much debate, those with great reputations and some debate, and those most would not consider the top. I personally would think the number of "elite" programs is like 10-20. All those programs the OP listed are probably in that category, and likely Pitt and CC too.

This. I would add that private practice groups do care where you've trained, and some programs just open more doors for you in both private and academic sectors.

 

[2121115]

I would add that private practice groups do care where you've trained

^^^ This ^^^


Big time.


Don't buy the "I don't want to go into academics so I don't need to go to a name brand program" line of thinking. It helps to have the name brand, even if it doesn't necessarily mean you are better trained (which it doesn't).

 

[KCShaw]

Worth pointing out the difference again -- name brand program benefit is largely politics, networking, and recognition, not necessarily better training than any other decent sized reputable-if-less-well-known program.

Department chairs and private practice owners generally recognize quite a few brand name programs, though are more likely to know a few individual pathologist names associated with certain institutions. You may be better off being able to say you did GU with Epstein, or cyto with DeMay, or soft tissue with Weiss, or whatever, than carrying merely an institution name. I've also had far more than one elder pathologist ask me what the big name programs are "these days," so not everyone bothers to keep up with such "trivialities."

Anyway.. IMO one should go to the most reputable program that feels "right" to them from all the personal, location, etc. points of view, and not have a seizure about going to THE BEST PLACE EVARRR, whatever that is. Especially for residency. I would personally push a little harder to go to the best available fellowship in your desired subspecialty at the expense of other things, as that final year ultimately may define your future much more significantly than residency.

And for what it's worth I've seen numerous residents from solid but not-necessarily-name-brand programs get offers from and land fellowships at name-brand places, including AFIP in the day, Hopkins, Sloan-Kettering, etc., and evidently do well enough in those fellowships.

 

[HbyHA]

Anyway.. IMO one should go to the most reputable program that feels "right" to them from all the personal, location, etc. points of view, and not have a seizure about going to THE BEST PLACE EVARRR, whatever that is. Especially for residency. I would personally push a little harder to go to the best available fellowship in your desired subspecialty at the expense of other things, as that final year ultimately may define your future much more significantly than residency.

Absolutely agree. hard to learn anything if you are absolutely miserable with your life because you don't like your program and/or life. though there is always the individual who is the exception...