Unhappy with my residency program

[dndplz]

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Seeking some advice if anyone else has experienced similar feelings. I am a first year in a major city at a smaller, lower resourced, underfunded hospital. I chose this program mostly because of location and I really wanted to experience a big city, but the culture is slowly killing me. Everyone talks about how broke the hospital is, ultrasounds are hard to find, attendings don’t really teach, the hospital is gritty, and it’s pretty hard to get research opportunities. Other programs in the area have much better didactics, fancy state of the art equipment, VR training headsets, fancy SIMS labs etc. One positive is the residents say they do come out competent and able to handle anything- our program does livers and hearts and is a level 1 trauma. We get a lot of early autonomy and there’s not much hand-holding compared to other programs. We also have a ton of sick, complex patients. Not a lot of fellows either to compete with.

I am shooting myself in the foot for not applying to the more prestigious programs in the area/ ranking some of the more prestigious programs on my list above this one. I just always imagined being somewhere where people are proud of their training and I’m not getting that vibe.

Has anyone felt similar to this? I guess I’m wondering whether or not it’s worth looking at swapping programs/ transferring, although I don’t want to have that affect my reputation given how small of a community anesthesia is.

 

[cittykat]

My take:

VR headsets and SIMs are nonsense. Lots of stool time with sick patients is what matters. Sounds like you’re in a good program. Although it is annoying not to have enough ultrasounds. Transferring will not affect your reputation.

 

[Arch Guillotti]

stick it out

 

[UscGhost]

Seeking some advice if anyone else has experienced similar feelings. I am a first year in a major city at a smaller, lower resourced, underfunded hospital. I chose this program mostly because of location and I really wanted to experience a big city, but the culture is slowly killing me. Everyone talks about how broke the hospital is, ultrasounds are hard to find, attendings don’t really teach towards the boards, the hospital is gritty, and it’s pretty hard to get research opportunities. Other programs in the area have much better didactics, fancy state of the art equipment, VR training headsets, fancy SIMS labs etc. One positive is the residents say they do come out competent and able to handle anything- our program does livers and hearts and is a level 1 trauma.

I am shooting myself in the foot for not applying to the more prestigious programs in the area/ ranking some of the more prestigious programs on my list above this one. I just always imagined being somewhere where people are proud of their training and I’m not getting that vibe.

Has anyone felt similar to this? I guess I’m wondering whether or not it’s worth looking at swapping programs/ transferring, although I don’t want to have that affect my reputation given how small of a community anesthesia is.

VR training and sim labs are worthless compared to sick patients and challenging cases

Clinical autonomy is huge

Ultrasounds are important unfortunately.

Research is a waste of time unless you plan on being a faculty researcher after

 

[FiO2@21]

If you can get good at blocks with a crappy ultrasound you'll be excellent with an adequate ultrasound.

 

[Gern Blansten]

Sounds like a good program that will help achieve your goal…which is to be a competent board certified anesthesiologist. The teaching to the boards is not that big of a loss because 90% of how you do on the boards is completely dependent on how much YOU study. VR headsets and sim labs are overrated and won’t significantly impact your ability to be a great anesthesiologist. Everybody thinks they need more ultrasounds, no matter how many you have. And they are very expensive. A lot of places struggle to find the resources such as ultrasound, videolaryngoscopes, etc. you learn to share limited resources and you manage.
Your hospital is certainly not alone in that struggle. Finish the program and be proud of your training, even if others don’t share your pride. You will likely look back on this period of time with fondness and pride of how well you did managing sick patients with graduated autonomy and austere resources. I’ve never used a VR helmet and hope I never do. I have to battle to find an ultrasound when I need one (frequently because one of our surgeons “borrowed” one), but somehow always make it work out. Learn as much as possible from your attendings, but DO NOT rely on them alone to get you ready for boards. That is your responsibility They can point you in the proper direction and give you some assists. But the board exams are up to you.
Don’t let bad attitudes of others creep into your mind. You are there to get as much out of your training period as possible. Take care of your own priorities and be a positive influence in the residency program. Just like one bad apple can ruin a bunch, one positive attitude can really make a difference in a group full of bad attitudes. The key is to focus on what is good about your program and not dwell on what you don’t have (VR headsets etc).

 

[Burned_Out]

If you can get good at blocks with a crappy ultrasound you'll be excellent with an adequate ultrasound.

But how many bad blocks & complications will he/she have to endure before they get good with crappy equipment? I had a couple adductor canal and IPak blocks this past week on fat legs that I swear could not be done on the older 20 yr. old GE Vernova systems with small linear probe. Think adductor canal depth > 7-8 cm depth. Needed the HD Sonosite with nice curvilinear probe for greater imaging depth.

I would advise this resident to invest in a high quality POCUS device if they are stuck with a laptop size 1st gen Sonosite or older GE system.

 

[Burned_Out]

I had a thought based on this resident’s experience. What if you are a stuck in a HCA or Envision sponsored anesthesia residency program where they teach you jack and use you as cheap labor. Knowing that you are nothing more than a stool sitter and will be unqualified to lay hands on people after residency, what would you do?

Me…if I can’t transfer to another residency program, I would look toward applying to a fellowship program to get the remedial skills you lack from residency. It’ll give you an extra year to pass the boards as well.

 

[Gator7]

Faced similar issues in residency. Here’s my take:

Academics: Non-issue. Watch UK lectures on YouTube. Study same books as everyone else.

Written boards/ITEs: do as many qbanks as you have time for. Ended up >95% on all ITEs.

Oral boards: I went with Dr. Ho due to weak oral prep in residency. Passed first try.

Clinical skills: Autonomy is huge and you have that. Likely too much as I did. Example: handled all hospital airways solo overnight as a CA1 with attending on home call.

Seek out the quality Attendings and learn as much as possible. Continue to jump at every opportunity (big cases, lines, blocks, etc). Block skills are super important in PP do as much as you can. If attendings are weak then watch NYSORA or other YouTube videos.

Head down, stick it out. You got this.

 

[DrN2O]

Everyone talks about how broke the hospital is, ultrasounds are hard to find, attendings don’t really teach towards the boards, the hospital is gritty, and it’s pretty hard to get research opportunities. Other programs in the area have much better didactics, fancy state of the art equipment, VR training headsets, fancy SIMS labs etc. One positive is the residents say they do come out competent and able to handle anything- our program does livers and hearts and is a level 1 trauma. We get a lot of early autonomy and there’s not much hand-holding compared to other programs. We also have a ton of sick, complex patients. Not a lot of fellows either to compete with.

I am shooting myself in the foot for not applying to the more prestigious programs in the area/ ranking some of the more prestigious programs on my list above this one. I just always imagined being somewhere where people are proud of their training and I’m not getting that vibe.

Complex cases, sick patients, level 1, autonomy: all sounds like positives to me.
"How broke the hospital is.": everyone bitch about money.
"Attendings don't really teach towards the boards.": No one has ever asked me what my USMLE or board scores were when I meet them in preop. I do a TEVAR solo while the residents are in a classroom on their educational day, and wonder how that's better. It sounds like other graduates liked their training.

My question is why did you not apply to the other "more prestigious" program in the area? Nothing you've said sounded toxic: stool sitter, CRNA encroachment, abusive faculty etc. You got good training, big city living, but not "big name." Two out of three ain't bad. There is no guarantee you will like your next program, and you will have the stigma of having to leave a "lesser" program. Sure if you become the "superstar" resident, it won't matter, but what stops you from being one at the current program?

 

[Lecithin5]

I hear you. I feel you. Stick it out. Eye on the prize. It’ll be worth it.

 

[dannyboy1]

Residency should teach you how to be an anesthesiologist. Question banks and ultimate board prep should be fine for the boards.

 

[unkemptmiso]

Stick it out. Do more cases.

If it makes you feel better, I want to a fancy program with all of those things + pedigree. I had the same complaints as you have right now. Not enough teaching, being used as staff to keep the ORs running cheaply, being gaslighted that it was our fault the attending didn't want to teach us (lol), didactics but they were all lectures on professionalism and diversity etc etc. It doesn't get better at a fancy programs, it's all the same. Do more cases, get really good, and then gtfo and dont look back.

 

[FiO2@21]

I had a thought based on this resident’s experience. What if you are a stuck in a HCA or Envision sponsored anesthesia residency program where they teach you jack and use you as cheap labor. Knowing that you are nothing more than a stool sitter and will be unqualified to lay hands on people after residency, what would you do?

Me…if I can’t transfer to another residency program, I would look toward applying to a fellowship program to get the remedial skills you lack from residency. It’ll give you an extra year to pass the boards as well.

For better or worse I was a product of one of those programs. My understanding is that the experience is pretty variable. We had someone transfer in from a failed program and our experiences were quite stark. I felt like I had excellent exposure with adequate faculty (some excellent, some mediocre, most average). We lacked tertiary/quaternary level cases that I had to read about for oral boards.

I now work with colleagues from more "reputable" programs. I did ask them how they did certain cases out of curiosity but besides that don't feel that our clinical acumen was much different. I did do a fellowship at a quaternary center but it was not in the OR (and I didn't moonlight). I didn't start behind in fellowship and think I was considered above average (or they were just nice).

However I think the most important part of my training was my own self-sufficiency. I read almost every day. I frequently reflected on my anesthetics and sometimes looked up how I could do it better. Studied hard for my exams, etc. I think that's true no matter where you go.

 

[circleK]

Your program sounds great for producing highly competent, independent, ready to work anesthesiologists. You’ll be ready to join any group when you’re done with training.

 

[AdmiralChz]

Man I get this and I felt it in training. I trained at a large state university program that was underfunded, no SIM lab, minimal ultrasounds, no X payment if you stay past Y time, etc. Total workhorse program, on the fellowship trail I was definitely working harder than most but not all.

When I started in fellowship and then private practice I was able to hit the ground running fast. I was ahead of many colleagues and it showed. I had the skills the reps to do just about everything and needed minimal orientation to big cases. Only issue I had was how to supervise which is pretty common.

This isn't a "wow look at me post", it's basically to agree with everyone else saying you are in training to become a competent, independent anesthesiologist. SIM labs and VR head sets are cool, but it is no substitute for real life experience. Residency is short, 3 clinical anesthesia years. It's not worth it to transfer and it'd likely throw up red flags ("You left because you didn't like your program? Why should I accept you into my practice or fellowship then, are you going to bail?").

Seek out the biggest, most complicated cases you can. Get TEE experience, even if it's just on your cardiac rotation - I am shocked at how few new graduates know how to use this modality even in a basic sense despite the ABA making it a requirement. Do blocks, get on the big blood bath and specialty cases if that's available to you. Yes this gets old after a while, I was really sick of peds cardiac with attendings breathing down my back for sure.

It's easy to look across the street and be jealous at shiny carrots and cool technology, but just focus on you. If that stuff is really that important to you search out a job that has a high level of technology and learn from someone there.

 

[dndplz]

Thank you everyone for your responses! Another question I had was that I have my eye on getting an attending job at an academic program in the same area as my training program but it’s definitely higher tier than my program. I know that completeting a fellowship there would be helpful, but is there anything else I can do to network with them? Is it taboo to ask to do research through their department (super well funded research programs) since I am at a different training program?

I’m just trying to stay positive and look towards the future to set a goal and work towards a job that has better facilities than my program. I think what really brings me down now is the poor facilities of my hospital and it’s not the most academic.

 

[Twiggidy]

Grind it out. Residency is terrible no matter where you go. Every practice who hires after residency wants someone who can handle a variety of cases and is just reliable. The ability to do things virtually will means less to a group hiring than some who can do things ACTUALLY. A good city hospital will give you experience taking care of medical and socially difficult to deal with patients and that’ll help you in the future. It’ll make the boutique practice in the fancy part of town that much easier.

 

[Gator7]

Thank you everyone for your responses! Another question I had was that I have my eye on getting an attending job at an academic program in the same area as my training program but it’s definitely higher tier than my program. I know that completeting a fellowship there would be helpful, but is there anything else I can do to network with them? Is it taboo to ask to do research through their department (super well funded research programs) since I am at a different training program?

I’m just trying to stay positive and look towards the future to set a goal and work towards a job that has better facilities than my program. I think what really brings me down now is the poor facilities of my hospital and it’s not the most academic.

I interviewed at a “pseudo Ivy League” place for an academic position before going the PP route.

How to get the interview? Connections. Especially if the place you’re interested in is local. There are definitely attendings at your program that know people there just ask around.

I interviewed without doing a fellowship and the person I interviewed with was genuinely confused about what a general anesthesiologist was. They have fake-fellowship trained people at every position. Needless to say it was not the right fit.

 

[Ashers]

One positive is the residents say they do come out competent and able to handle anything- our program does livers and hearts and is a level 1 trauma. We get a lot of early autonomy and there’s not much hand-holding compared to other programs. We also have a ton of sick, complex patients. Not a lot of fellows either to compete with.

This is the most important bit.

I would have hated any more Sim, wellness, out of or sessions than we already had (actually, i hated what we already had). The OR is where you learn what you need to function. The board stuff can be learned through practice questions or oral board prep.

Edited for clarity

 

[cchoukal]

This is the most important bit.

I would have hated any more Sim, wellness, out of or sessions than we already had (actually, i hated what we already had). The OR is where you learn what you need to function. The board stuff can be learned through practice questions or oral board prep.

Edited for clarity

This, all day.