University Hospitals, Cleveland

[cas]

Could anyone give me information on the University Hospitals of Cleveland Residency program? How does it compare to the Cleveland Clinic?

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[Cabbage Head]

They are both good programs. UH has great staff that are easy to get along with, as well as really good resident comraderie. The current 4th year class has really taken a strong ownership in the program, and they have improved the things that residents care about (computers, cubicles, etc.) They have a new department head as of March I think, and I hear he's taking the program in good directions. Another nice thing about UH compared to the Clinic is their university affiliation. Although CCF does a lot of research, I don't think that they do as much basic science research as UH (which is affiliated with Case Western Reserve). Also, the only part of the CDC that isn't in Atlanta is at UH, where they do all this prion research. This isn't to imply that they have an academic leaning over private practice. People can, and do, do both from UH.

 

[yaah]

If UH is the same as Case, they do have a new chair, who was a former professor here (an immunopathologist). New chairmen generally will lead to increased opportunities for residents and support for research.

Cleveland Clinic is an assembly line type of program - heavy case loads, emphasis on diagnostics. Research is not a priority, although no doubt residents do projects.

 

[roach]

I would agree that CCF emphasizes diagostics. They don't push research here, but I think there's plenty of opportunites if one is interested. I'm pretty sure we're usually in the top 5 numbers-wise at USCAP.

If UH is the same as Case, they do have a new chair, who was a former professor here (an immunopathologist). New chairmen generally will lead to increased opportunities for residents and support for research.

Cleveland Clinic is an assembly line type of program - heavy case loads, emphasis on diagnostics. Research is not a priority, although no doubt residents do projects.

 

[Cabbage Head]

I would agree that CCF emphasizes diagostics. They don't push research here, but I think there's plenty of opportunites if one is interested. I'm pretty sure we're usually in the top 5 numbers-wise at USCAP.

Roach, that is the best profile picture and title I've seen in awhile. I couldn't get any picture to upload, so I had to use the ones built in to the site.

UH isn't the same as Case, but they are affiliated. And yeah, Lowe is from Michigan.

I would also agree that they emphasize diagnostics, though most of the staff are involved in a lot of research. Also, how do you define "assembly line", yaah? That's the second time I've heard you say that. I think I know what it implies, but I'm not sure what it really means.

 

[b&ierstiefel]

I don't know exactly what he means but when I hear the phrase "assembly line", I picture residents serving as automatons to simply get the work done. Now, that's quite simplistic and implies that residents don't have any time to think. I haven't heard this phrase actually. However, I have heard the term "factory" used to describe places that have very high volumes. To me, that means that these kind of departments are high throughput type of machines. One can infer that residents don't see all the cases that are signed out and that certain subspecialty services can sometimes be run resident-free.

Our program gets 70K specimens and 20 residents to handle the load. The residents see all the cases but I'll be honest...things are tight here. If the specimen volume continues to go up and the # of residents here cannot increase to meet the demand, we may have to have resident-free services as well in the future.

I can only imagine what it is like at program where over 100K surgical specimens are received and there are only 6-8 residents in a given class. Sheer numbers-wise, that's insane. Some may jump to the conclusion that if residents don't see all the cases that are being signed out, that resident education is compromised. I don't really see it that way though. I think residents can learn a ton just by being in that environment. Plus, as a first year resident, I feel like a sponge. I can imagine that residents at insanely heavy case load institutions like Cleveland Clinic, MGH, Hopkins, Mt. Sinai, etc. are learning a lot of cool stuff.

 

[Cabbage Head]

I don't know exactly what he means but when I hear the phrase "assembly line", I picture residents serving as automatons to simply get the work done. Now, that's quite simplistic and implies that residents don't have any time to think. I haven't heard this phrase actually. However, I have heard the term "factory" used to describe places that have very high volumes. To me, that means that these kind of departments are high throughput type of machines. One can infer that residents don't see all the cases that are signed out and that certain subspecialty services can sometimes be run resident-free.

Our program gets 70K specimens and 20 residents to handle the load. The residents see all the cases but I'll be honest...things are tight here. If the specimen volume continues to go up and the # of residents here cannot increase to meet the demand, we may have to have resident-free services as well in the future.

I can only imagine what it is like at program where over 100K surgical specimens are received and there are only 6-8 residents in a given class. Sheer numbers-wise, that's insane. Some may jump to the conclusion that if residents don't see all the cases that are being signed out, that resident education is compromised. I don't really see it that way though. I think residents can learn a ton just by being in that environment. Plus, as a first year resident, I feel like a sponge. I can imagine that residents at insanely heavy case load institutions like Cleveland Clinic, MGH, Hopkins, Mt. Sinai, etc. are learning a lot of cool stuff.

I agree, it would be nasty if the residents on service saw 100% of the specimens. But we don't. In fact, before subspecialty was implemented 3 years ago, residents only saw 40%. It's higher now, but I'd know we don't see them all. I don't feel shortchanged though, it just gives you some flexibility on how you spend your time. As a first year, I don't really pick and choose what I see, because it's all new to me. But I know the 3rd years aren't reviewing every hernia and Hartmann's revision with attendings during signout.

 

[b&ierstiefel]

I agree, it would be nasty if the residents on service saw 100% of the specimens. But we don't. In fact, before subspecialty was implemented 3 years ago, residents only saw 40%. It's higher now, but I'd know we don't see them all. I don't feel shortchanged though, it just gives you some flexibility on how you spend your time. As a first year, I don't really pick and choose what I see, because it's all new to me. But I know the 3rd years aren't reviewing every hernia and Hartmann's revision with attendings during signout.

So I'm just curious here since I'm not at your program (obviously). The remainder of the cases that are not seen by residents...how does that work? Are the remainder of the resident-free services fellow driven or do the PAs gross in the stuff and the cases go straight to the attendings? Or do some of the cases go straight to fellows for signout?

I agree that after 1st year, you can cut out the bullsh*t cases from you queue (damn gallbags, appendices, hernia sacs, stupid joint revisions, etc.) and you can focus your efforts on the cancer and special inflammatory cases.

 

[Cabbage Head]

So I'm just curious here since I'm not at your program (obviously). The remainder of the cases that are not seen by residents...how does that work? Are the remainder of the resident-free services fellow driven or do the PAs gross in the stuff and the cases go straight to the attendings? Or do some of the cases go straight to fellows for signout?

I agree that after 1st year, you can cut out the bullsh*t cases from you queue (damn gallbags, appendices, hernia sacs, stupid joint revisions, etc.) and you can focus your efforts on the cancer and special inflammatory cases.

editing because that is probably confusing:

I sit down with an attending with a big stack of GI Large stuff. Most of it I've seen, some I might not have gotten to preview. The attending and I will usually go through said stack and put them in some sort of order (i.e. maybe we'll put the ones I previewed on top, maybe we'll put the 'good' ones on top, whatever) Then we sign out. There is an hour and a half to GI Large signout, and when it's over, hepatobiliary begins. So the attending leaves. If we have finished all the cases (and that is often the case) then that's great. If we haven't finished all the cases, the attending finishes those and then gives me back ones they think I need to see because I'm a ***** and called something cancer when it's not, or because it's a good case, or just because I previewed it or whatever the case may be.

 

[sinaility]

I don't know exactly what he means but when I hear the phrase "assembly line", I picture residents serving as automatons to simply get the work done. Now, that's quite simplistic and implies that residents don't have any time to think. I haven't heard this phrase actually. However, I have heard the term "factory" used to describe places that have very high volumes. To me, that means that these kind of departments are high throughput type of machines. One can infer that residents don't see all the cases that are signed out and that certain subspecialty services can sometimes be run resident-free.

Our program gets 70K specimens and 20 residents to handle the load. The residents see all the cases but I'll be honest...things are tight here. If the specimen volume continues to go up and the # of residents here cannot increase to meet the demand, we may have to have resident-free services as well in the future.

I can only imagine what it is like at program where over 100K surgical specimens are received and there are only 6-8 residents in a given class. Sheer numbers-wise, that's insane. Some may jump to the conclusion that if residents don't see all the cases that are being signed out, that resident education is compromised. I don't really see it that way though. I think residents can learn a ton just by being in that environment. Plus, as a first year resident, I feel like a sponge. I can imagine that residents at insanely heavy case load institutions like Cleveland Clinic, MGH, Hopkins, Mt. Sinai, etc. are learning a lot of cool stuff.

I don't like the phrases, "factory" or "assembly line". I feel that they have a negative connotation. We are highly respected and appreciated as residents. The thing with Mount Sinai's program is that we have 9 fellows. So in our institution, every case is signed out with either the residents or fellows. Usually we have a resident on every service, and sometimes with a fellow. Neuropath is really the only service that doesn't always have a resident, but they have a fellow. All of the cases, including the routine hernia sacs, gallbladders, etc are expected to be written up in advance (with codes for routine specimens). The attendings typically respect the resident's ability to sign out hernia sacs, gallbladders, etc so they quickly look at these cases and add their initials if nothing is atypical. If the resident writes everything up in advance, sign out is usually pretty quick, allowing for more "at the scope teaching". Our senior residents are usually done signing out after an hour or two because most of their diagnoses are correct and don't need any modification. The attendings usually aren't picky with wording if the diagnosis is correct. PAs typically gross the routine "junk" specimens too. Big volume, diagnostically driven programs are more than factories. Also, not all diagnostically driven programs have big volume. Actually Case UH doesn't have that big of a surgical volume (I think a little over 30,000 cases/year). By the way, didn't a neuropathologist at Case win the Nobel Prize last year?

 

[yaah]

I defer to those who train at these places. I certainly have no expertise there! I'm glad you both are posting your experiences.