training at small programs

[YOOOUK09]

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I am interested in some very small programs (4-6 per year) because of their locations. I know that one should be concerned about small programs because of a "lack of exposure" and, I can imagine, less frequent didactics.

So that I don't overlook other facets of training at smaller programs, I was wondering if we could have some discussion about the pros/cons of training at a smaller program.

Specifically, what effect does "lack of exposure" during training have on practice after residency? To this MS4, most of psych seems to be strong interpersonal skills and good judgment (we don't treat Zebra diseases, do we?). How does "exposure" really matter? Developing better judgment?

Also, can anyone think of other advantages or drawbacks to training at small programs I might not be thinking of?

 

[Doc Samson]

From a CL perspective at least, we do treat (or at least identify) zebra diseases. Transplant psychiatry, HIV psychiatry, and psychooncology are all budding areas of specialization that tend to be focused on large tertiary care centers. From an addictions standpoint, large cities/programs also offer exposure to different drugs of abuse (which epidemioogically vary widely by geography).

 

[OldPsychDoc]

I don't think that a small program in terms of # of residents necessarily means less exposure. I trained at a fairly large program with relatively fewer inpt psych beds and a more homogeneous outpt population than the smaller program I now work with.

Our residents here (in a small-medium program, 5-7 residents/yr) rotate through 2 very large urban hospitals, both with very diverse patient bases on their inpatient and consult services. They choose from a very wide variety of outpatient training options. What I think they lose sometimes is the sense of working together with their peers as they are often quite spread out. Call schedules are often a big deal at smaller programs, though we tend to not rely exclusively on residents for that service.

 

[swanny]

I trained in a small program in general psychiatry, and a large program for child psychiatry, and am now directing a small program in general psychiatry. Here are some of my thoughts:

I don't think that exposure to a variety of patients is a problem in most small programs. I think most small programs have general psych floors and outpatient clinics, as opposed to large programs that have specialty floors and clinics. In the end, you see and treat all the usual problems that patients have. When a "zebra" comes in the door, I think the residents are quick to share that information and then take time to discuss the case and see the patient (even if they aren't involved).

Small program usually have a "family" atmosphere-you know everyone and everyone knows you. There is more interdependence and connection. I think many residents like this, and find small programs very supportive. However, if there is a disruption (e.g. a resident drops out or has problems), you are more vulnerable in a small program. Hopefully, the "family" is "healthy" and not "dysfunctional."

I don't think workload (e.g. number of patients or amount of call) is appreciably different in small vs. large programs-everyone works hard. Some small programs may be spread out, but many are not. I think, more often, large programs are spread out, and this leads to less contact between residents and faculty.

Hope that helps!

 

[wolfvgang22]

I was wondering the same thing. Thanks for the good replies. 🙂