Wake v. Duke v. UNC: Any and all thoughts to help me make a decision, please

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NJNCdoc2be

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I'd love to hear opinions and experiences on these programs from residents and interviewees. I had a great experience at Duke and UNC and a so-so interview at Wake.

Is UNC's reputation really weak? If so, why? I can't seem to find any weaknesses.

Is Duke's reputation really malignant? Again, as above, why? They have an anesthesia night float system for God's sake!

Help, the list countdown is to less than 1 month! 😱
 
Three great choices. Traditionally, Duke has a strong reputation followed by Wake, with UNC as the relative newcomer. Reputations are funny things.

I didn't get Wake; supposed to be strong, but showed a pretty weak caseload the day I was there. Didn't get a good vibe from the residents, had one pretty wierd interviewer. They didn't fill last year.

UNC's a master at marketing, as we've all learned. Boysen, the Chair, was incredible; I don't think I've ever seen a Chair stand up for his residents like he has. Even a letter to the newsletter a while back in defense of one of his resident's letters. I'd jump at the chance to work for him as an attending. Happiest residents of anywhere in NC, and the surrounding area is beautiful. Alas, their hearts seemed a bit weak while they're sorting out the surgery Chair's position (shuffle there not too long ago, I hear), and so going to Carolinas Medical Center for cardiac. That said, their caseload was the most acute I've seen on the interview trail, and Chief's are going to great fellowships. This will soon be the place to be, but for now is still growing.

Duke, well, it's Duke. PD seemed good, Chair seemed good, but not exactly warm and fuzzy like UNC. I wasn't clicking well with the residents. Very strong in cardiac and regional, while I think UNC is the place for Peds in NC. Good test scores, but not many didactics.

I guess it's all in what you're looking for. Name? Duke. Happy residents? UNC. Middle of the road? Wake.
 
Being a UNC student I may be a bit biased but I agree with the above review. I did not interview at Duke so I can only give second-hand info, but it has a very good reputation. I have heard a couple of people warn me that the surgery program can be a bit overpowering there, but that is the only thing I heard as far as malignancy.

UNC, I like very much. The residents and faculty are great to work with. I have enjoyed working with the department as a student and I think the residents do as well. Hearts is still a little slow--I think--for the number of residents and I believe you can do outside rotations for more, which is a negative if you want a lot of heart experience.

I did not have a good experience at Wake either, which was very diasppointing. They have a great reputation, but the interview day left me very turned off. The residents seemed kind of 'blah' about the program, but I do not know any info that would suggest there is anything wrong with the program, I just did not fit.

All three would be great for training, I think. Reputation? I never really thought about it like this and hurts to say it but Duke (our basketball nemesis) probably has the best, then Wake (not my opinion but nationally), then UNC. Even still, I think UNC has a great program so I don't think you can go wrong.
 
It's too bad that you didn't enjoy your time at Wake. I can tell you that the residents are happy and that there are no big weaknesses in the program (except perhaps the interview day it seems 🙂 Wake is just as strong as Duke in clinical training (not as sure about research but there are a lot of nationally known researchers). When you are looking at programs make sure that you can design your CA3 year to your interests - you should at least be able to pick a certain number of heart, regional, and peds months etc.
 
I'll agree with the comments about Wake Forest. I really do think that this is a strong program in desperate need of a new way to present itself.

I'll also mention that second looks at these places were VERY valuable to me. I would suggest them to anyone grappling with these same programs. The "regular" day does a lot to tease out the strengths and the weaknesses.

Also, I think that UVa should be on the list with the above 3 programs. Another historically strong program in the same part of the country, with wonderful people.

👍
 
It's too bad that Wake Forest doesn't have a better structured interview day. I think a lot of people (myself included) are sort of turned off by the whole interview in the OR/scramble around deal. However I have spent some time there and I can tell you without a doubt Wake Forest is an excellent program, and IMHO, is the best program in NC. I say this from asking around some of the gas docs I know in NC (including ones who went to UNC). This is not to say anything bad about UNC or Duke, they are both fine programs. In fact I would say that Wake is on par w/ANY top program in the country. I think they are the best in the Southeast.

They get good case numbers, are big on regional, and have CRNA's/SRNA's to help out w/the case load and easy cases. The chairman, Dr. Roy, is very helpful and friendly and is a true resident advocate as well as being a nationally prominent leader in anesthesia circles. He still spends one day a week in the OR. At Wake, you are not shipped off to other places to get your case numbers (aka UNC sending residents to CMC). You do all your training at Baptist except OB, which is done at Forsyth which is very close. No extra driving around from hospital to hospital. You have the option to spend a month at CHOP if you so desire, but this is not required.

In general, I think that the comments about resident "happiness" in general are kind of laughable. On a single interview day, you are really seeing only a very small slice of residency life. There are always going to be people who are unhappy, whatever they are doing in life. There are also people who you just aren't going to click with, for whatever reason. At Wake, all the residents I met were "happy".

I think the only thing that should dissuade someone from this program is the location. If you are single or need a huge nightlife, it definitely isn't the place for you.

I wouldn't put any stock in the fact that they had an unfilled spot last year. This was a single advanced spot, and was the first unfilled spot in quite some time.

Hope this helps.
 
blotto geltaco said:
This is not to say anything bad about UNC or Duke, they are both fine programs. In fact I would say that Wake is on par w/ANY top program in the country. I think they are the best in the Southeast.

They get good case numbers, are big on regional, and have CRNA's/SRNA's to help out w/the case load and easy cases. The chairman, Dr. Roy, is very helpful and friendly and is a true resident advocate as well as being a nationally prominent leader in anesthesia circles. He still spends one day a week in the OR. At Wake, you are not shipped off to other places to get your case numbers (aka UNC sending residents to CMC). You do all your training at Baptist except OB, which is done at Forsyth which is very close. No extra driving around from hospital to hospital. You have the option to spend a month at CHOP if you so desire, but this is not required.

QUOTE]

I find this post funny, specifically because of the reasons given that Wake is better than Duke (or UNC). We also have good case numbers, are in fact the biggest in regional (it's published, we're 95%) and also have CRNAs to help out with caseload and breaks. Our chairman is also an amazing man who is well known in anesthesia circles and does spend regular time in the OR. Our chair and PD are very strong resident advocates. We also are not driving around from hospital to hospital. Our VA, where we rotate, is right across the street and is one of the gems of our program.
We have a fabulous mix of attendings from a variety of backrounds who are all excellent and approachable. We have our share of surgeons with egos like any institution, but frankly I have been surprised at how nice many of them are. Most of the "so called" malignant surgeons really warm up to you after you have worked with them a little bit and they get to see that you are good. I had a surgeon change his surgical technique yesterday when I told him my concerns for doing general anesthesia on a particular patient before he even spoke to my attending. Duke doesn't spoon feed you. We don't have didactics everyday like UNC does, however there are many educational opportunities available. You can pick a mentor who will never give you any kind of assignments or didactics or you can pick a mentor who will meet with you a few times a month and give you study questions and quizzes. You can attend specialty conferences that occur every week. The environment does stimulate you to want to read because the attendings ask inquisitive questions and our cases are complex.
About peds.. Duke doesn't have the high volume of routine peds cases like an institution with a children's hospital would. Our peds cases are extremely complex because the patients are so sick. If you can anesthetize these kids you can certainly anesthetize healthy ones. If you are interested in peds it will prepare you well enough to do a fellowship at a place with a children's hospital.
I could go on and on, but I have other things to do. PM me any specific questions.
 
Gaslady, thanks for your reply about Duke. It is a program that has earned itself a great deal of respect. Your Chair and PD seemed extremely solid. There is no need for you to defend the overall "ranking" of your program.

That said, Wake seemed a fantastic place to train as well. Programs in the northeast (ranking 1-5 on most lists) frequently commented on how exceptionally competent the visiting Wake residents performed. It may not have the core labs and research network of Duke, but for training purposes Wake has earned itself a top-notch listing.

One of my beefs with Duke were the fellows. They didn't even seem to act in a supervisory role, but rather at the level of the residents.

I had some other issues with the residents (involving arrogance) and one interviewer as well.

Since when did daily didactics become a bad idea?!?!?? I get this only from programs with "big" names, and can't help but think it's a cop-out.
 
GasPundit,
I don't have a problem with daily didactics, but I wouldn't want the length of my day increased because I had to attend a daily didactic. An ideal situation would be getting relieved earlier to attend didactics, but at many large institutions, that is just not a reality or possible because of the volume of cases that need to be done and the financial ramifications of such a policy.

What do you mean about the fellows functioning as residents? We have very little interaction with fellows. We don't even have fellows in every area. The fellows that are there are functioning independently and aren't really supervising residents. They don't take our cases, procedures or interactions. Our supervision comes directly from our attendings. I think that's a big plus. I like the fact that I'm taught from someone with a lot of experience who may have written the chapter on the topic rather than someone who is a learner like me or from someone from another country who has practiced anesthesia for 20 years and can tell me multiple different safe ways to do a case that someone from the US wouldn't even be familiar with.
 
Gaslady,

Are major cardiac cases assigned to the fellow or resident preferentially? I was told that major cardiac cases went to the fellows, and then to the residents. While your residents mentioned this wasn't too big a deal, I thought it was. As a resident, I'm looking for a resident training program that will let me, not the fellow, do the biggest cases available.
 
GasPundit said:
Gaslady,

Are major cardiac cases assigned to the fellow or resident preferentially? I was told that major cardiac cases went to the fellows, and then to the residents. While your residents mentioned this wasn't too big a deal, I thought it was. As a resident, I'm looking for a resident training program that will let me, not the fellow, do the biggest cases available.

I haven't been on cardiac recently, but my colleagues have told me the residents are doing the majority of the cases, sometimes more than fellows because the fellows have other responsibilities such as echo or research. I really don't think it's an issue. It seems like some residents would actually like the fellows to do more cases than they currently do, but I only know what I hear in the lounge. We also have a cardiac rotation at the VA that most of the CA3's do and I have never heard of a fellow going over there. The only cases I know of that the fellows do that residents don't is peds hearts. That's appropriate though. The heart babies that we have are really sick with hypoplastic left heart syndrome and tend to have long runs on ECMO.
 
GasPundit said:
Gaslady,

Are major cardiac cases assigned to the fellow or resident preferentially? I was told that major cardiac cases went to the fellows, and then to the residents. While your residents mentioned this wasn't too big a deal, I thought it was. As a resident, I'm looking for a resident training program that will let me, not the fellow, do the biggest cases available.

Gaspundit,
I think that you will likely receive excellent training at Duke and at Wake Forest - you should probably just go with your gut when ranking them. Since you were asking about cardiac cases I can tell you that at Wake the residents do not compete with the fellows (usually just one cardiac fellow) for cases, and do peds cases as well (including hypoplasts, BT, Norwood, Fontan, etc.) ECMO is often employed. Obviously these cases are handled in very close supervision with the peds heart attending (almost always 1:1). These can be very valuable learning experiences, particularly if you are interested in further training in peds or hearts. In fact one of the attendings was a pediatric cardiologist prior to doing an anesthesia residency and is very good at explaining the anatomic and physiologic changes involved with the various congenital heart lesions. Wake residents also have the opportunity to do a dedicated month of TEE during the CA-3 year, and several residents take the certification exam each year .
Good luck with the match.
 
Thanks guys. I realize that pediatric hearts, along with complex liver tx, are some of the biggest cases out there. Some programs (in the southeast), such as Wake, UVa, and UF aren't bashful about letting their residents do these cases. How? Strong attending supervision. Residents at these programs unanimously agree these cases strengthen their clinical skills.

This also says a lot about a training program. Attendings are obviously strong enough teachers to get residents and patients through these cases. When dealing with a kid (or adult) who needs surgery after one of these procedures, you can't help but understand the physiology a bit more. Residents mention these cases make others look fairly routine. I'll venture to say that with proper attending supervision and teaching, it's hard to argue that cases as complex as pediatric hearts aren't good for training.

I get a little annoyed when residents from big-name programs tell me they don't do pediatric hearts because they're "too complicated for just a resident", or are "fellow-level" cases. It tells me those programs will be fantastic for fellowship; it warns me those programs could be partially coasting on their parent universities big name for resident training. A true top-tier resident training program should offer everything to its residents, and teach everything well too.
 
GasPundit -

I've enjoyed reading your comments and am thrilled with the response that my initial question has generated.

As we near our deadline... what's your final #1?

🙄
 
Go for whoever is ranked higher in the basketball. Seriously, I'd go for Duke because of the prestige.
 
I was thinking that but I was holding back. So far Duke/UNC/Wake are all ranked pretty high in NCAA hoops so I don't think you can go wrong if you like basketball.
 
There are degrees of difficulty in peds hearts. The majority of heart babies at Duke are ridiculously sick and frankly I am glad we don't have to do them. I don't want to go anywhere near them. It might be a different story when you have kids who are coming in from home for surgery, but these babies have hypoplastic left heart syndrome and many of them don't make it. We don't see many of what might be considered routine peds hearts, like ASD repair or Tets. We see enough train wreck peds on our pediatrics rotation, as many of our patients have syndromes.
By the way, the residents do the liver transplant cases and CA1s will do liver resections.
If you come to Duke I wouldn't count on being able to see many games, because the tickets are nearly impossible to get. You have to wait on line for a chance at the lottery.
 
GasPundit said:
Three great choices. Traditionally, Duke has a strong reputation followed by Wake, with UNC as the relative newcomer. Reputations are funny things.

I didn't get Wake; supposed to be strong, but showed a pretty weak caseload the day I was there. Didn't get a good vibe from the residents, had one pretty wierd interviewer. They didn't fill last year.

UNC's a master at marketing, as we've all learned. Boysen, the Chair, was incredible; I don't think I've ever seen a Chair stand up for his residents like he has. Even a letter to the newsletter a while back in defense of one of his resident's letters. I'd jump at the chance to work for him as an attending. Happiest residents of anywhere in NC, and the surrounding area is beautiful. Alas, their hearts seemed a bit weak while they're sorting out the surgery Chair's position (shuffle there not too long ago, I hear), and so going to Carolinas Medical Center for cardiac. That said, their caseload was the most acute I've seen on the interview trail, and Chief's are going to great fellowships. This will soon be the place to be, but for now is still growing.

Duke, well, it's Duke. PD seemed good, Chair seemed good, but not exactly warm and fuzzy like UNC. I wasn't clicking well with the residents. Very strong in cardiac and regional, while I think UNC is the place for Peds in NC. Good test scores, but not many didactics.

I guess it's all in what you're looking for. Name? Duke. Happy residents? UNC. Middle of the road? Wake.

Wake and Duke are top-level, well-known, well-respected programs. You'll have the world in your hands when you leave.
 
gaslady said:
There are degrees of difficulty in peds hearts. The majority of heart babies at Duke are ridiculously sick and frankly I am glad we don't have to do them. I don't want to go anywhere near them. It might be a different story when you have kids who are coming in from home for surgery, but these babies have hypoplastic left heart syndrome and many of them don't make it. We don't see many of what might be considered routine peds hearts, like ASD repair or Tets. We see enough train wreck peds on our pediatrics rotation, as many of our patients have syndromes...

I'll bite; I'm intrigued by Duke, but am enjoying the role of devil's advocate. I've never met a kid with HLHS who wasn't critically ill, and I've already lost kids in the heart room. I'll agree that ASD/Tet repairs are relatively simple ped-heart cases. Do you do many non-cardiac procedures on Fontants/Glenn's/etc, or would these be fellow-cases as well? Glad to hear residents are involved in liver tx's. Any comments about OB?

Again, I'll reiterate my conclusion thus far: Duke seems to be a fantastic place for fellowship. While a superb residency training program, I'm not sure it is far and away the best in the southeast. Please keep the rebuttals coming, you may win me over yet.
 
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