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WashU radiology residency is extremely malignant. The residents are overworked and bullied daily. The calls are so bad residents literally faint and need medical attention. Instead of addressing this concern, the PD blames the residents for being weak. Multiple attendings call the residents "worthless, useless, pieces of sh!ts, [email protected]" It is terrible. We are scared to speak up because the PD and her goons crush everybody who does. We can only voice the truth on here. Nobody cares about our education. We are constantly kept from going to lecture to do scudwork. We don't even get time to study for the radiology board exam. All the other programs give their residents time off to study but not here. If you fail then you get blamed just like everything else wrong here gets thrown onto the residents. I know there will be a lot of victim blaming for this post but the applicants should know what kind of program this really is.
 

Dave1980

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I interviewed there for residency and I remember all the residents seem tired/unhappy. We had a pre-interview dinner at 6 right across the street from the hospital and like half of the residents showed up late because they were working late.
 
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Getting called a ****** is pretty bad. But not time off for boards is whining.
 
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GadRads

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Getting called a ****** is pretty bad. But not time off for boards is whining.

Your program is doing you a disservice if you do not get time off to study for boards. Some residents have kids, and having some time off is extremely helpful. The core exam is more difficult than USMLE Step 1.
 
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recycledpaper

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Your program is doing you a disservice if you do not get time off to study for boards. Some residents have kids, and having some time off is extremely helpful. The core exam is more difficult than USMLE Step 1.

Yeah yeah yeah.
 
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SeisK

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Yeah yeah yeah.

It’s not a difficult request to execute in terms of scheduling, really. If anyone is saying no to this request it more than likely is a matter of administrative pride than real logistical issues. And seems more reflective of the personality of the leadership of such a program, and how they view their residents, than anything else. You have to ask yourself: would you be okay with attending such a program?
 
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Cognovi

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care to elaborate why your program cannot provide protected study time? Mine can and frankly it should be standard
The ACGME prohibits it. Programs either have to lie to ACGME that they schedule clinical rotations up until Core, or residents have to lie to their program that they're showing up to these rotations.
 
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GadRads

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The ACGME prohibits it. Programs either have to lie to ACGME that they schedule clinical rotations up until Core, or residents have to lie to their program that they're showing up to these rotations.

As long as the core exam continues to place value on unnecessary memorization of minutiae and trivia, most programs will find ways to give their residents time off to study.
 
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Don't most program schedule "easy" rotations and dismiss residents after noon conference (which is focused on board prep) so they can study?
 
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Kaputt

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WashU radiology residency is extremely malignant. The residents are overworked and bullied daily. The calls are so bad residents literally faint and need medical attention. Instead of addressing this concern, the PD blames the residents for being weak. Multiple attendings call the residents "worthless, useless, pieces of sh!ts, [email protected]" It is terrible. We are scared to speak up because the PD and her goons crush everybody who does. We can only voice the truth on here. Nobody cares about our education. We are constantly kept from going to lecture to do scudwork. We don't even get time to study for the radiology board exam. All the other programs give their residents time off to study but not here. If you fail then you get blamed just like everything else wrong here gets thrown onto the residents. I know there will be a lot of victim blaming for this post but the applicants should know what kind of program this really is.

So let's get some more transparency here. Are you a current MIR resident? Recent graduate?
 
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As long as the core exam continues to place value on unnecessary memorization of minutiae and trivia, most programs will find ways to give their residents time off to study.

half the test is written by MIR faculty or friends of MIR faculty. they view their board review as equivalent to free time to study. maybe it's not. MIR is pretty old school in that regard and follows the ACGME directive of "no time off to study" pretty strictly
 

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half the test is written by MIR faculty or friends of MIR faculty. they view their board review as equivalent to free time to study. maybe it's not. MIR is pretty old school in that regard and follows the ACGME directive of "no time off to study" pretty strictly
Maybe because an MIR faculty member is on the ACGME RC for radiology and another (the vice chair for education) is on the ABR board of trustees. It would be more scandalous if the MIR program skirted the rules.
 
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GadRads

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half the test is written by MIR faculty or friends of MIR faculty. they view their board review as equivalent to free time to study. maybe it's not. MIR is pretty old school in that regard and follows the ACGME directive of "no time off to study" pretty strictly

I suspect they probably "share" their test questions with their residents, and so they may not need dedicated time. Maybe MIR attendings are better teachers, but many other residents at other programs have to study even more than they did for Step 1 (despite scoring 240-260+), so that time "off" is helpful. Many of them also studied fairly regularly as radiology residents.

Academicians (like core question writers) tend to be out of touch usually Beyond MOC: Should The ABR Scrap The Core Exam And Find A Way To Assess Competency Objectively? - RadsResident
 

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I don't want to engage in this silly thread but this got forwarded and I read a fair amount of these boards during my application process so I'd like to add a voice of reason. I'm a recent MIR grad and have nothing but excellent things to say about my training, mentors, and overall experience. The original poster doesn't sound like anyone who has worked or trained there, so I'm not sure why anyone would be incentivized to try to trash talk the program aside from someone trying to improve his/her odds of matching. MIR training was an amazing combination of hands-on experience with complex cases, procedures and graduated independent call, as well as engaging teaching from many brilliant researchers and textbook authors. The days we stayed late were for patient care, not scut work, and the whole team would pitch in to help. The PD is incredibly dedicated and there's a huge level of executive function and logistics that goes into keeping one of the best programs in the nation running smoothly. In practice, I'm grateful daily for my training as a fast and accurate reader and physician who knows how to problem solve, and many of my colleagues I've spoken to have shared this sentiment. All medical training is challenging and you'll hear complaints from across the board, but it should challenge you in ways that build the foundation for your career.
 
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808s&heartbreak

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A few of my attendings went there for residency....none of them spoke highly of their times there. 0 out of 3.
 

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I know their culture is not great even for faculty. Almost all breast imaging faculty apparently left and they hired from nearby institutions (SLU) to fill the gap. Even the new breast imaging chief from SLU has reputation for being malignant. I didn't even apply to their program for fellowship. A good education should not come at the price of being crushed or humiliated.
My husband did his fellowship at MIR and was shocked at how much their residents were overworked. He didn't like culture either. I'm not an applicant, so I don't have any motive to talk trash about them. Residents may come out strong but at what price? The institution itself is the problem, not the residents.

Board study time, we have a similar situation ourselves. Our PD is refusing to give us study time and is proud of following the rules!! Nonsense!
 
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Hard to know if engaging in this thread is productive, but I would like to add a few thoughts as a current resident (PGY4). Regarding calls, the MIR night float system has long been known as one of the harder rotations as well as one of the most educational experiences of the entire program. Few of the large academic programs have been able to continue independent call for radiology residents and I believe it remains a formative experience for MIR trainees. It is certainly tiring but to my knowledge there are residents are not passing out. There are mechanisms in place to get coverage if a resident is out for medical reasons. For perspective, the schedule is two nights on followed by one night off, for two weeks (a total of 9/10 nights in 14 days). For most people who completed internships with 6 nights on and one night off, this is doable. The fact that residents answer phones and talk to clinicians who need to speak to a radiologist seems to me to be included in our job description as radiologists.
Regarding the program director, the idea that she has "goons" is ludicrous. It makes me wonder if this poster is actually familiar with my residency (as does the use of the term WashU Radiology since everyone here calls it MIR). She is known on IR as the attending most likely to tell you to stop what you are doing exactly at noon to attend lecture. IR is probably the only rotation where residents might miss conferences. Every other rotation it's understood the resident has protected didactic time. I won't deign to respond to some of the other claims in that post other than to say I've never seen anyone harassed in the manner described. If you are looking to train in a program where you work 25 hours a week, MIR is not for you. That said, in the interest of becoming a well-rounded radiologist who can handle case volume, make calls confidently, and actually improve patient care I'm happy with my choice of residency.
 

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I am a current applicant debating whether to rank MIR near the top of my list. When I initially saw this thread I wrote it off as a disgruntled resident trying to do damage to their own program. I couldn't believe any faculty was calling their trainees pieces of ****.

Seeing other people follow it up with statements like these has me extremely concerned now.

I remember all the residents seem tired/unhappy. We had a pre-interview dinner at 6 right across the street from the hospital and like half of the residents showed up late because they were working late.
Their residents come out extremely strong but I heard they got crushed.
A few of my attendings went there for residency....none of them spoke highly of their times there. 0 out of 3.
I know their culture is not great...A good education should not come at the price of being crushed or humiliated...My husband did his fellowship at MIR and was shocked at how much their residents were overworked.

This feels like a giant red flag. Can any current residents or recent alumni comment on why MIR is spoken of this way if it's not actually a malignant program? Was it previously true that residents were kept late, missed didactics, shamed in case conferences, overworked, unhappy? Have things changed?
 
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To the MIR fans: if you don't want to engage in the thread then don't engage instead of doing your typical MIR passive aggressive way of engaging while saying you don't want to. It doesn't matter who we are. There are many of us who share the same experience of being abused at MIR. We are publicly humiliated in front of other residents. We get bullied by nurses/techs while the attendings laugh with them. The PD and her goons hold all the power. They do whatever they want to the residents. More calls are added, work days are made longer, residents get their benefits get cut. The only reason there is moonlighting was because residents were driving uber to make ends meet and it looked bad for the program. Now that there is moonlighting, it too is used as leverage by the PD who threatens to take shifts away from any resident who does or says anything she doesn't agree with.
 
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godofsky

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To the MIR fans: if you don't want to engage in the thread then don't engage instead of doing your typical MIR passive aggressive way of engaging while saying you don't want to. It doesn't matter who we are. There are many of us who share the same experience of being abused at MIR. We are publicly humiliated in front of other residents. We get bullied by nurses/techs while the attendings laugh with them. The PD and her goons hold all the power. They do whatever they want to the residents. More calls are added, work days are made longer, residents get their benefits get cut. The only reason there is moonlighting was because residents were driving uber to make ends meet and it looked bad for the program. Now that there is moonlighting, it too is used as leverage by the PD who threatens to take shifts away from any resident who does or says anything she doesn't agree with.
What is your typical study volume/breakdown and shift length on call?
How many nights do you have during residency?
What happens if you skip conference?
How many moonlighting shifts can you typically get in a month?
 
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What is your typical study volume/breakdown and shift length on call?
How many nights do you have during residency?
What happens if you skip conference?
How many moonlighting shifts can you typically get in a month?

Call structure:

R2s and R3s each do 2 weeks of junior night float a total of 4 times. It's a three night rotating system: night 1 you cover 5pm-7am (you cover the children's hospital + adult ER plain films after about 9pm); night 2 you cover adult ED and urgent inpatient body CT 7pm-8am ish; night 3 you're off. So for that 2 week block, which you generally do 4 times during residency, you're on either 10 or 9 nights. These shifts are busy with you reading XR, US, CT independently. Residents don't cover MR on call (neuro fellows cover neuro MR, body fellows and attendings cover body MRs which are infrequent overnight). This is where you learn to be a radiologist. Cover level 1 trauma on both adult and peds sides. Cover hyperacute stroke CTA with neuro fellow on call as your backup. Rarely an R4 has to do a block of junior night float. If they do they get compensated by less shifts in the senior call pool. I think the dedicated IR people get some junior night float in their R4 year as well since they're not in the senior call pool otherwise.

R2s have rotating weeknight ER plain film swing shifts from 5pm-9pm. They also cover some weekend shifts also doing ER plain films (Saturday 12pm-9pm, Sunday 8am-5pm, Sunday 5pm-8pm); there are generally like 17-19 residents per class who those shifts are spread out between. So during R2 you probably have about 14 weeknight shifts about 8-9 total weekend shifts.

R3s as a class cover only 2 shifts per week, an afternoon Saturday (noon-5pm) and Sunday pediatrics shift (8am-5pm). So like a total of 5-6 of those shifts per year. And you're not in the call pool during board prep time. So call as an R3 is very light. While on the topic of R3 and board review time, you basically get 2 months of "study time" in the form of your AIRP block (which you can either do at AIRP or stay in St Louis and do a 'radpath' block which is basically just study time or time off) and another rotation which is basically just study time. Not everybody gets these 2 blocks right before boards so those who don't complain. There is board review from 4pm-6pm like everyday for several weeks. You otherwise don't have protected time to study during the week, but you have weekends and evenings off during study time (no call). No one as far as I know has ever failed the core.

R4s have a rotating weeknight ER shifts which parallel the R2 shifts. Probably like 14-16 weeknight shifts and 8-10 weekend shifts. This call shift goes from 5pm-midnight, then you go to sleep and are backup, and you get the next day off.

All of this call is independent and you read out your cases face to face with the attendings the next morning.

R1s and sometimes upper levels do random Saturday morning shifts with attendings (not independent) which usually is like an 8am-noon shift on something like nucs, chest, GI, ultrasound, whatever. Body CT and neuro have some slightly longer shifts. IR call is completely separate and mostly covered by fellows but per month on IR you probably work about 1 weekend.

What happens if you skip conference?
There are morning conferences on most rotations. Those are small groups with attendings generally curating great teaching cases for you and a couple other residents. If you miss those or are late, that's a bad look, and attendings take it personally because they put in work to curate content for you and it sends them the message that you don't care about their time or your own education. And you really shouldn't want to miss those. They're amazing conferences.

You're not supposed to skip the general noon conference (but I never got in trouble for skipping)


Moonlighting?
I remember getting a shift per month or so. It was scanner baby sitting overnight where you slept at the hospital and accumulated dollars by being physically present in the hospital (or sat there during the day on a Saturday or Sunday). I never even had a contrast reaction in 2 years of covering that stuff. Since I graduated they added more and more sites for coverage. Being assigned to some sites which were like 20 minutes away from main campus meant they even let you out of service early on those days. Disgruntled posters talk about moonlighting as a hammer the PD uses to beat the freedom out of you. That's crazy. The PD does use the threat of taking away your moonlighting shifts if you fail to complete things you're supposed to be doing (turning in evaluations, doing quizzes and checkboxes for ACGME crap, stuff like that). The PD's job is often herding cats. Having such wonderful, lucrative moonlighting far outweighs the annoyance of being told to do something you were supposed to do anyway.


If you couldn't tell, I'm an MIR grad and I'd be happy to answer any questions via PM by anybody who has them.

I don't know who OP is but they've been on a mission to air their grievances and they've been doing it the past calendar year via numerous sockpuppet accounts here. It's getting kinda ridiculous. If I were a prospective resident I'd take all this with a huge grain of salt.
 
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Kaputt

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To the MIR fans: if you don't want to engage in the thread then don't engage instead of doing your typical MIR passive aggressive way of engaging while saying you don't want to. It doesn't matter who we are. There are many of us who share the same experience of being abused at MIR. We are publicly humiliated in front of other residents. We get bullied by nurses/techs while the attendings laugh with them. The PD and her goons hold all the power. They do whatever they want to the residents. More calls are added, work days are made longer, residents get their benefits get cut. The only reason there is moonlighting was because residents were driving uber to make ends meet and it looked bad for the program. Now that there is moonlighting, it too is used as leverage by the PD who threatens to take shifts away from any resident who does or says anything she doesn't agree with.

1. Barnes Jewish Hospital controls your benefits, not the radiology program.
2. What calls are being added? The call schedule has been unchanged for like a decade
3. I was never bullied by a nurse or tech there. Not sure how that happened to you. But on day 1 I made it a point to treat everyone around me with respect, so I never had a negative interaction with any nurse or tech.
4. The uber story is pretty classic (and no, onlookers--I won't elaborate on that one)
 
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Call structure:

R2s and R3s each do 2 weeks of junior night float a total of 4 times. It's a three night rotating system: night 1 you cover 5pm-7am (you cover the children's hospital + adult ER plain films after about 9pm); night 2 you cover adult ED and urgent inpatient body CT 7pm-8am ish; night 3 you're off. So for that 2 week block, which you generally do 4 times during residency, you're on either 10 or 9 nights. These shifts are busy with you reading XR, US, CT independently. Residents don't cover MR on call (neuro fellows cover neuro MR, body fellows and attendings cover body MRs which are infrequent overnight). This is where you learn to be a radiologist. Cover level 1 trauma on both adult and peds sides. Cover hyperacute stroke CTA with neuro fellow on call as your backup. Rarely an R4 has to do a block of junior night float. If they do they get compensated by less shifts in the senior call pool. I think the dedicated IR people get some junior night float in their R4 year as well since they're not in the senior call pool otherwise.

R2s have rotating weeknight ER plain film swing shifts from 5pm-9pm. They also cover some weekend shifts also doing ER plain films (Saturday 12pm-9pm, Sunday 8am-5pm, Sunday 5pm-8pm); there are generally like 17-19 residents per class who those shifts are spread out between. So during R2 you probably have about 14 weeknight shifts about 8-9 total weekend shifts.

R3s as a class cover only 2 shifts per week, an afternoon Saturday (noon-5pm) and Sunday pediatrics shift (8am-5pm). So like a total of 5-6 of those shifts per year. And you're not in the call pool during board prep time. So call as an R3 is very light. While on the topic of R3 and board review time, you basically get 2 months of "study time" in the form of your AIRP block (which you can either do at AIRP or stay in St Louis and do a 'radpath' block which is basically just study time or time off) and another rotation which is basically just study time. Not everybody gets these 2 blocks right before boards so those who don't complain. There is board review from 4pm-6pm like everyday for several weeks. You otherwise don't have protected time to study during the week, but you have weekends and evenings off during study time (no call). No one as far as I know has ever failed the core.

R4s have a rotating weeknight ER shifts which parallel the R2 shifts. Probably like 14-16 weeknight shifts and 8-10 weekend shifts. This call shift goes from 5pm-midnight, then you go to sleep and are backup, and you get the next day off.

All of this call is independent and you read out your cases face to face with the attendings the next morning.

R1s and sometimes upper levels do random Saturday morning shifts with attendings (not independent) which usually is like an 8am-noon shift on something like nucs, chest, GI, ultrasound, whatever. Body CT and neuro have some slightly longer shifts. IR call is completely separate and mostly covered by fellows but per month on IR you probably work about 1 weekend.

What happens if you skip conference?
There are morning conferences on most rotations. Those are small groups with attendings generally curating great teaching cases for you and a couple other residents. If you miss those or are late, that's a bad look, and attendings take it personally because they put in work to curate content for you and it sends them the message that you don't care about their time or your own education. And you really shouldn't want to miss those. They're amazing conferences.

You're not supposed to skip the general noon conference (but I never got in trouble for skipping)


Moonlighting?
I remember getting a shift per month or so. It was scanner baby sitting overnight where you slept at the hospital and accumulated dollars by being physically present in the hospital (or sat there during the day on a Saturday or Sunday). I never even had a contrast reaction in 2 years of covering that stuff. Since I graduated they added more and more sites for coverage. Being assigned to some sites which were like 20 minutes away from main campus meant they even let you out of service early on those days. Disgruntled posters talk about moonlighting as a hammer the PD uses to beat the freedom out of you. That's crazy. The PD does use the threat of taking away your moonlighting shifts if you fail to complete things you're supposed to be doing (turning in evaluations, doing quizzes and checkboxes for ACGME crap, stuff like that). The PD's job is often herding cats. Having such wonderful, lucrative moonlighting far outweighs the annoyance of being told to do something you were supposed to do anyway.


If you couldn't tell, I'm an MIR grad and I'd be happy to answer any questions via PM by anybody who has them.

I don't know who OP is but they've been on a mission to air their grievances and they've been doing it the past calendar year via numerous sockpuppet accounts here. It's getting kinda ridiculous. If I were a prospective resident I'd take all this with a huge grain of salt.

wait, 14-16 weeks of night float as an R4!? Am I reading that right?
 

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wait, 14-16 weeks of night float as an R4!? Am I reading that right?
14-16 weeknight shifts, aka individual nights for the academic year. Not 14-16 weeks. They are swing shifts after a day of normal work, followed by a day off
 

GadRads

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The call schedule at MIR is similar to my program's schedule with very busy call shifts. My program may have had slightly more call shifts. Some might consider that as getting crushed, but I view it as good training. Note that I am assuming whoever posted the MIR schedule is truthful, and that the schedule has not changed significantly since he/she left the program.

After reading all the comments, I think the truth is probably somewhere in the middle. I suspect the program tends to have favorites who get better treatment than other non-favored residents. This model creates graduates who will swear by MIR and others who will always despise their time there. Overall, this raises the question as to whether MIR treats its employees equitably.
 
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As a current resident, I would like to add some additional perspective. Generally, I think I am in between the various positive and negative posts above. I will try to be as objective as possible and reconcile the various differing opinions here.

First off, I just want to defend our new head of breast. I think she is a welcome addition to our faculty and highly emphasizes patient education and wellbeing. She has brought a breath of fresh air and stability to the breast department, which did see a big exodus recently. If she had a reputation for being difficult to work with in the past, she is certainly not the case now. We have hired a lot of new faculty members to replace those that have left for private practice and other academic institutions, so I think we are still feeling everyone out and these attendings are getting their bearings.

I do think the facts of what radresident7 are true. Our shifts have been a moving target over the course of the past year or two (mainly because of COVID and to keep up with volume). Some things have gotten better (attending coverage to 9 and 11 for body and neuro, which greatly improves AM readout on night float) but other things have gotten worse (increased volumes because we are acquiring new hospitals throughout the area). As an aside, I think having attendings on overnight slows things down greatly but we pay the benefits in the morning. An increase in volume across all departments does not seem to be unique but our issue seems to be hiring more attendings to match the increased volume. Recruiting someone to the Midwest, who may not have any real ties, is tough to swallow, especially if the pay is not great. Prestige can only do so much. The lack of manpower spills over to the residents because we have to dictate more, stay later, have less time to think during the day, etc. Additionally, attendings, who historically did not need to dictate much, now dictate more on their own because of volume or privileges at these new hospitals. What this means is that everyone gets busy and attendings forget to explicitly tell you to leave for conference (probably unintentionally). Of course, leaving without telling anyone is frowned upon, so we are left in limbo if we don't speak up. If I was told to pick up a new study right before noon conference, I think the vast majority of attendings would be ok if I said I couldn't because of noon conference. Holding onto a dictation over the noon hour is not preferred, so wanting to read out and delaying going to noon conference probably happens more than it should.

Our benefits are not that great to begin with (I blame BJH for spending money on the hospital fountains and the clash between employed by the hospital and not technically being an employee of the university) but we did get a billion (?) dollar new pacs, recently upgrade our EMR, and revamped our reading rooms (so maybe that's where our money is going). Shout out to Dr. Narra, who honestly has done so much for us and deserves praise from every single person in the institution. However, I do wonder where all the money we saved on not interviewing applicants live went and how much money we get as the largest radiology program in the country but it's probably tied up in administrative budgeting that is not worth getting into and is honestly something I can overlook for the time being.

Regarding our training, specifically night float, and the stresses that come with it, I may be in the minority but I get the feeling that we are actually middle of the road. We have recently changed our night float system to acidometer covid guidelines and streamlined live readout, so these numbers are based on the night float system described by Kaputt and mmityul. To put our numbers in perspective, one night float resident will read approximately 50 body and neuro CTs overnight, a handful of ultrasounds (max 10), and the rare nuclear medicine study. A "busy" night may mean up to 70 and is especially painful if the number of body CTs reaches more than 30. No MRs, which are read by the neuro fellow or body fellow. The other night float resident covered the peds hospital (plain film, CT, non-neuro MRs, fluoro, ultrasound) and was responsible for adult plain films (mainly ED and inpatient questions). In total, an average night means 130 or so plain films with 10 or so CTs/US/etc. After talking to a few fellows and residents elsewhere, frankly, I think these numbers are comparable if not slightly lower than other places. We do issue full reports and have to undergo live readout in the AM, which did increase the fatigue aspect of night float. On top of that, we have a system of overreads often requiring us to call in our errors and make sure everything is well documented. Great for patient care and accountability but not the most fun thing to do at the end of your shift. All in all, I think our night float experience is tough but doable. Worse still, we've gone through a lot of changes (with night float, daily rotations, faculty hiring, new PACS, increasing volume), in the setting of covid, in a city that may not be for everyone, so I can see why the original poster is not happy. In summary, night float is tough and I was very tired after my round of night float but it was doable and I do feel faster/smarter having done it.

Regarding the original poster's comments on being made fun of, by techs, nurses, and MDs, I do think that happens but not way beyond what is pervasive through medicine. Maybe it's a little bad for a radiology program but compared to medical school, I at least explain my thoughts without fear of getting yelled at. I sympathize with the original poster because they have grievances which I can totally see and feel like I have experienced but to a much smaller degree. However, if you are a bad apple in the program (for being lazy, rubbing people the wrong way, etc.), you may not get favorable treatment from people. Also, you just might not get along with someone, which is not good if that person happens to work with you very frequently. I think this is not specific to MIR but human nature, especially in a high stress environment. LadyRads, our culture can be a little stale/old-fashioned and does have a lot of sticks without much carrots so to speak. Naturally, this does tend to bring the worse out of people (especially attendings who have been here a while and walked up hills both ways). The culture can be a little hard to get used to, especially when residents and medical students are less and less tolerant of "malignant" behavior of any sense. Therefore, when we are corrected on errors, it is easy to take it very poorly depending on how the feedback is delivered. I have gotten very bad feedback and glowing reviews the next rotation. Par for the course for anyone who struggled with subjective reviews on limited interactions over the course of a month (sounds like 3rd year of med school to me). On top of that, the department is huge and everyone does things differently so it's hard to be 100% right about every situation.

That being said, I think the overall day to day anxiety level is going down because we are slowly hiring more attendings (especially in neuro where business is booming). On top of that, I personally think the vast majority of our new hires have been very nice, efficient, like teaching. There were times on neuro where the list would be in the 50s around noon and residents would have to read out 10 studies at 5PM because things were so backed up. Now, we have many more attendings on service for readout, so the list is way, way more manageable. Our CT service regularly scans 100+ patients a day, so residents will read 20+ CTs each, but fortunately, our body/chest attendings are very efficient, fast, and help each other out, so there are times where people leave an hour or so early. When there is reduced staffing, especially of the attendings, then we run into trouble.

Addressing our board reviews, yes, we do not get dedicated time off. Residents are let of service at 4 and have two hours of review over the course of three months or so. There were times where you worked a full day, then stayed for two hours afterwards for boards review. Obviously, other residents have it better than us in that regards but given how busy we are at times, I can see why attendings are loathe to lose manpower at the end of the day (especially in the past where lists stayed big towards the end of the day). While many attendings do write for the boards, not all the attendings who give boards review do write for the boards. Furthermore, we are not told the questions ahead of time (as much as we would like) but I do think the board reviews are more focused on what could appear on the boards. The reason we do not get dedicated time off is probably exactly for the reason Cognovi stated. On top of that, our PD is very by the books, probably because wrangling 70+ residents, each with their own unique issues, is no easy task. Having spoken to the R4s who took the test, I'm not sure our board reviews or studying made a big difference (crazy I know). It seemed like the vast majority of the test was focused on nucs, physics, and non-interpretive skills, which makes sense given the structure of the test, and is a known weakness for all residents. That being said, I can see that studying for boards is very stressful and having time off at the end of the day to decompress is very welcome. As far as needing board reviews for studying, it is very helpful but my sense is that the residents could not study the other sections (maybe with passable overall scores) because of the good day to day training, although I doubt any resident would trust this advice. Perhaps the alumni here will disagree.

All in all, is MIR a perfect program? Clearly not. We are a little old-fashioned in a lot of ways and it shows in certain ways as described by the original poster. It is busy and there are daily stresses that make it feel even busier than it probably is. We do have many exceptional teachers and great education but the fellows that come here seem pretty good too. I do think people can be difficult to work with if personalities clash but I attribute that to human nature. Overall, I am slightly positive regarding my time here so far. The training has been very good and I think I will be in a good position once I graduate but I can't say that I didn't leave here with some scars (not to surprising since residency isn't supposed to be a walk in the park). I agree with GadRads above, there are favorites/golden children and other residents who fly under the radar. I think there are faculty who are very well regarded and well connected so if you are liked by them, you can benefit greatly. No one is purposefully treated poorly I don't think but I do think a bad working relationship with even one attending can make your time here not fun.
 
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As a current resident, I would like to add some additional perspective. Generally, I think I am in between the various positive and negative posts above. I will try to be as objective as possible and reconcile the various differing opinions here.

First off, I just want to defend our new head of breast. I think she is a welcome addition to our faculty and highly emphasizes patient education and wellbeing. She has brought a breath of fresh air and stability to the breast department, which did see a big exodus recently. If she had a reputation for being difficult to work with in the past, she is certainly not the case now. We have hired a lot of new faculty members to replace those that have left for private practice and other academic institutions, so I think we are still feeling everyone out and these attendings are getting their bearings.

I do think the facts of what radresident7 are true. Our shifts have been a moving target over the course of the past year or two (mainly because of COVID and to keep up with volume). Some things have gotten better (attending coverage to 9 and 11 for body and neuro, which greatly improves AM readout on night float) but other things have gotten worse (increased volumes because we are acquiring new hospitals throughout the area). As an aside, I think having attendings on overnight slows things down greatly but we pay the benefits in the morning. An increase in volume across all departments does not seem to be unique but our issue seems to be hiring more attendings to match the increased volume. Recruiting someone to the Midwest, who may not have any real ties, is tough to swallow, especially if the pay is not great. Prestige can only do so much. The lack of manpower spills over to the residents because we have to dictate more, stay later, have less time to think during the day, etc. Additionally, attendings, who historically did not need to dictate much, now dictate more on their own because of volume or privileges at these new hospitals. What this means is that everyone gets busy and attendings forget to explicitly tell you to leave for conference (probably unintentionally). Of course, leaving without telling anyone is frowned upon, so we are left in limbo if we don't speak up. If I was told to pick up a new study right before noon conference, I think the vast majority of attendings would be ok if I said I couldn't because of noon conference. Holding onto a dictation over the noon hour is not preferred, so wanting to read out and delaying going to noon conference probably happens more than it should.

Our benefits are not that great to begin with (I blame BJH for spending money on the hospital fountains and the clash between employed by the hospital and not technically being an employee of the university) but we did get a billion (?) dollar new pacs, recently upgrade our EMR, and revamped our reading rooms (so maybe that's where our money is going). Shout out to Dr. Narra, who honestly has done so much for us and deserves praise from every single person in the institution. However, I do wonder where all the money we saved on not interviewing applicants live went and how much money we get as the largest radiology program in the country but it's probably tied up in administrative budgeting that is not worth getting into and is honestly something I can overlook for the time being.

Regarding our training, specifically night float, and the stresses that come with it, I may be in the minority but I get the feeling that we are actually middle of the road. We have recently changed our night float system to acidometer covid guidelines and streamlined live readout, so these numbers are based on the night float system described by Kaputt and mmityul. To put our numbers in perspective, one night float resident will read approximately 50 body and neuro CTs overnight, a handful of ultrasounds (max 10), and the rare nuclear medicine study. A "busy" night may mean up to 70 and is especially painful if the number of body CTs reaches more than 30. No MRs, which are read by the neuro fellow or body fellow. The other night float resident covered the peds hospital (plain film, CT, non-neuro MRs, fluoro, ultrasound) and was responsible for adult plain films (mainly ED and inpatient questions). In total, an average night means 130 or so plain films with 10 or so CTs/US/etc. After talking to a few fellows and residents elsewhere, frankly, I think these numbers are comparable if not slightly lower than other places. We do issue full reports and have to undergo live readout in the AM, which did increase the fatigue aspect of night float. On top of that, we have a system of overreads often requiring us to call in our errors and make sure everything is well documented. Great for patient care and accountability but not the most fun thing to do at the end of your shift. All in all, I think our night float experience is tough but doable. Worse still, we've gone through a lot of changes (with night float, daily rotations, faculty hiring, new PACS, increasing volume), in the setting of covid, in a city that may not be for everyone, so I can see why the original poster is not happy. In summary, night float is tough and I was very tired after my round of night float but it was doable and I do feel faster/smarter having done it.

Regarding the original poster's comments on being made fun of, by techs, nurses, and MDs, I do think that happens but not way beyond what is pervasive through medicine. Maybe it's a little bad for a radiology program but compared to medical school, I at least explain my thoughts without fear of getting yelled at. I sympathize with the original poster because they have grievances which I can totally see and feel like I have experienced but to a much smaller degree. However, if you are a bad apple in the program (for being lazy, rubbing people the wrong way, etc.), you may not get favorable treatment from people. Also, you just might not get along with someone, which is not good if that person happens to work with you very frequently. I think this is not specific to MIR but human nature, especially in a high stress environment. LadyRads, our culture can be a little stale/old-fashioned and does have a lot of sticks without much carrots so to speak. Naturally, this does tend to bring the worse out of people (especially attendings who have been here a while and walked up hills both ways). The culture can be a little hard to get used to, especially when residents and medical students are less and less tolerant of "malignant" behavior of any sense. Therefore, when we are corrected on errors, it is easy to take it very poorly depending on how the feedback is delivered. I have gotten very bad feedback and glowing reviews the next rotation. Par for the course for anyone who struggled with subjective reviews on limited interactions over the course of a month (sounds like 3rd year of med school to me). On top of that, the department is huge and everyone does things differently so it's hard to be 100% right about every situation.

That being said, I think the overall day to day anxiety level is going down because we are slowly hiring more attendings (especially in neuro where business is booming). On top of that, I personally think the vast majority of our new hires have been very nice, efficient, like teaching. There were times on neuro where the list would be in the 50s around noon and residents would have to read out 10 studies at 5PM because things were so backed up. Now, we have many more attendings on service for readout, so the list is way, way more manageable. Our CT service regularly scans 100+ patients a day, so residents will read 20+ CTs each, but fortunately, our body/chest attendings are very efficient, fast, and help each other out, so there are times where people leave an hour or so early. When there is reduced staffing, especially of the attendings, then we run into trouble.

Addressing our board reviews, yes, we do not get dedicated time off. Residents are let of service at 4 and have two hours of review over the course of three months or so. There were times where you worked a full day, then stayed for two hours afterwards for boards review. Obviously, other residents have it better than us in that regards but given how busy we are at times, I can see why attendings are loathe to lose manpower at the end of the day (especially in the past where lists stayed big towards the end of the day). While many attendings do write for the boards, not all the attendings who give boards review do write for the boards. Furthermore, we are not told the questions ahead of time (as much as we would like) but I do think the board reviews are more focused on what could appear on the boards. The reason we do not get dedicated time off is probably exactly for the reason Cognovi stated. On top of that, our PD is very by the books, probably because wrangling 70+ residents, each with their own unique issues, is no easy task. Having spoken to the R4s who took the test, I'm not sure our board reviews or studying made a big difference (crazy I know). It seemed like the vast majority of the test was focused on nucs, physics, and non-interpretive skills, which makes sense given the structure of the test, and is a known weakness for all residents. That being said, I can see that studying for boards is very stressful and having time off at the end of the day to decompress is very welcome. As far as needing board reviews for studying, it is very helpful but my sense is that the residents could not study the other sections (maybe with passable overall scores) because of the good day to day training, although I doubt any resident would trust this advice. Perhaps the alumni here will disagree.

All in all, is MIR a perfect program? Clearly not. We are a little old-fashioned in a lot of ways and it shows in certain ways as described by the original poster. It is busy and there are daily stresses that make it feel even busier than it probably is. We do have many exceptional teachers and great education but the fellows that come here seem pretty good too. I do think people can be difficult to work with if personalities clash but I attribute that to human nature. Overall, I am slightly positive regarding my time here so far. The training has been very good and I think I will be in a good position once I graduate but I can't say that I didn't leave here with some scars (not to surprising since residency isn't supposed to be a walk in the park). I agree with GadRads above, there are favorites/golden children and other residents who fly under the radar. I think there are faculty who are very well regarded and well connected so if you are liked by them, you can benefit greatly. No one is purposefully treated poorly I don't think but I do think a bad working relationship with even one attending can make your time here not fun.

about your recruitment woes, I think the rate your institutions were offering when I was looking was supposedly in the low 2s? Comparable to NYC rates.

Except wash U is in the midwest....

Pretty hard for me to pass up NYC or Boston for the same amount of salary to go to St Louis, no offense.

maybe washU finally increased their salary a bit and that’s why you are seeing improved recruitment.
 

GadRads

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So there is c
I sympathize with the original poster because they have grievances which I can totally see and feel like I have experienced but to a much smaller degree. However, if you are a bad apple in the program (for being lazy, rubbing people the wrong way, etc.), you may not get favorable treatment from people.
....

I agree with GadRads above, there are favorites/golden children and other residents who fly under the radar. I think there are faculty who are very well regarded and well connected so if you are liked by them, you can benefit greatly. No one is purposefully treated poorly I don't think but I do think a bad working relationship with even one attending can make your time here not fun.

It is easy to assume that the ill-favored residents are lazy or not hard working. Many times that isn't true. I believe the residents who match at MIR have a baseline decent work ethic.

Think about some of your medical school classmates with problematic personalities and biases. These people become attendings too, and with a little bit of power, imagine how they may treat "underlings".

I interviewed at a program like this and ranked it at the bottom. The vibe was awful and trusted residents who I knew personally at this program expressly told me not to come there. I am not opposed to working a little harder than usual, but this becomes painful when the working environment can get toxic.

There's usually no smoke without some fire.
 
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So there is c




It is easy to assume that the ill-favored residents are lazy or not hard working. Many times that isn't true. I believe the residents who match at MIR have a baseline decent work ethic.

Think about some of your medical school classmates with problematic personalities and biases. These people become attendings too, and with a little bit of power, imagine how they may treat "underlings".

I interviewed at a program like this and ranked it at the bottom. The vibe was awful and trusted residents who I knew personally at this program expressly told me not to come there. I am not opposed to working a little harder than usual, but this becomes painful when the working environment can get toxic.

There's usually no smoke without some fire.
Quickly defending our attendings, there is not a single attending who I think does not work incredibly hard. Do some of them have eccentricities that irk me and other residents? Yes. Have I not wanted to work with an attending because they are way too particular about how things are done? Yes. However, they no doubt handle a lot of things in the background that we just don't appreciate in the reading room. As an intern, I hardly ever went to those social work/dispo meetings but that is probably one of the most important determinants of how big my census would be. This past year with COVID has shed light on the fact that everyone is going through some rough times but despite that I think we are in a much better place because it was our chance to reassess things.

To the point about vibe and personalities, I think the vibe is hard to judge fairly unless you've been at a place for a while. Despite my long post above, I am baffled that any resident has been called worthless, useless, etc to their face. Perhaps they have gotten less teaching or not felt as appreciated as other residents. The small handful of "mean" attendings may bust you for something innocuous but that is by far and away the exception. Of course, that shouldn't be accepted but we know how difficult it is to fight the authority gradient. In a program this large, it is impossible to be on good terms with 100+ attendings and not leave some bad impression somewhere along the line.

I am much happier now as a resident than I was as a medical student because I've been treated much better and with more respect. Do I wish that every day someone would buy me lunch and I could take 30 minute coffee breaks at a time? Yes but I think that may be too much to ask for when you have 70 residents,100 attendings, and hundreds of ancillary staff, who work pretty damn hard too, to keep happy without a little drama popping up here and there. When was the last time any one of us praised the techs for doing a good job but we are very quick to trash them when images come over slowly or they call too often to clarify orders? Overall, I'd like to think that I gave a fair picture of MIR but my guess is that we are probably just like any other program with its big personalities and beefs.
 
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about your recruitment woes, I think the rate your institutions were offering when I was looking was supposedly in the low 2s? Comparable to NYC rates.

Except wash U is in the midwest....

Pretty hard for me to pass up NYC or Boston for the same amount of salary to go to St Louis, no offense.

maybe washU finally increased their salary a bit and that’s why you are seeing improved recruitment.
Exactly. This makes everything worse. The only reason we moved to St. Louis is because we were hoping for a good educational experience with a program that will value us. We don't mind working hard but to work 14 hours in the ED overnight which is so busy we don't get any break only to be called stupid or worthless by the AM readout attending should not be acceptable. We know the attendings are stressed and overworked by underlining issues brought on by poor leadership at the department and hospital level that existed long before COVID but they are supposed to be our role models instead they abuse residents to release their frustration. The culture at MIR is that to make residents stronger they need to be crashed and beaten down so the attendings don't even think twice before yelling at or belittling residents as they think they are helping residents get better. Of course not every attending is like that and different subsections can differ greatly. Some are very nice but it seems that the malignant ones got all the power and leadership roles at MIR.
 
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Gadofosveset

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It's interesting to me to read through this thread. It has the sort of rhythm that these threads typically do... there's a "whistleblower," then a bunch of people jump on the bandwagon, then the program's residents come on in defense, then there's back and forth between the offense and the defense.

I find this interesting because I trained at what I think is/was a malignant program -- pretty sure it was -- and there are different perspectives you can take on this. Nearly all of the residents who ended up in my program just "powered it out" and, usually justifiably, feel that they are better prepared because they had meaner, tougher training. I think there's actually a kernel of truth in this. They *are* meaner, faster, and eventually smarter than residents who selected programs primarily because they thought a program was an easy four years. The people who graduated with me read circles around those folk - I've seen the comparison and there's no comparison.

But there's also a sort of identity in being part of the malignant program and fear of making it public. That somehow if the program is actually dinged for offenses then that will look bad on the residents when they try to get jobs. Or it will dilute the quality of applicant and then then the name brand of the program will suffer when they try to get jobs, or - worst case scenario - the program will get put on probation, very clearly endangering the residents' futures. It's enough of a fear to keep current residents pretending things are great, or maybe even deluding themselves... I mean, what choice would you make: (1) a reputation for being capable because you come from a tough program; (2) being known as coming from a program on probation?

We almost had some whistleblowers. They were underperformers (and always a bad culture fit) in the tougher meaner culture. They were on the way out and therefore willing to threaten the program and (the way it was usually interpreted) threaten the other residents' futures. But often they were just threatening to tell the truth.

It's a tough situation. I think I came out of residency much faster and sharper than other residents. In fact, I know I did. And I can honestly attribute a lot of this to the aggressive training. But I do not remember it fondly -- there was probably more stress than was necessary and some of the faculty were just straight up abusive.

It's also a tough situation because everyone just assumes that you can just *boom* make a training program that is forward thinking, with rigorous training and caring faculty and just the right amount of work, etc. As far as I can tell, keeping these all in balance takes a great deal of money and only some of the larger Ivy-ish programs can manage it, if even they can. The rest of us have to choose programs that veer toward one extreme or the other - too much or too little. Just know yourself and what culture you'll thrive in and then, as mentioned, pick up on the hints that the current residents are dropping in the interview dinners, etc. Some of us tried to drop hints, but applicants weren't listening. Almost no one is going to straight out hate on their program and that is the reddest of red flags if they do... it means there's no benefit at all there that they want to preserve by faking. And some current residents straight up mislead applicants about the culture, which doesn't help either, because applicants usually hear what they want to hear.
 
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Gadofosveset

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Also, have a grain of salt about an anonymous whistleblower on a forum like this. I'm not trying to legitimize any particular take on MIR - I know only a little about them. Pay more attention to the residents at the interview dinner and interview day. The residents at every program are going to have a spectrum of opinions about the program - that's normal - some depressed or sour/pessimistic residents may not be rosy about what is actually an ok program. But if there is true malignancy you can sense it if you're putting the feelers out. Malignant programs have a certain vibe -- like the resident have to justify everything.
 
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throk

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Also, have a grain of salt about an anonymous whistleblower on a forum like this. I'm not trying to legitimize any particular take on MIR - I know only a little about them. Pay more attention to the residents at the interview dinner and interview day. The residents at every program are going to have a spectrum of opinions about the program - that's normal - some depressed or sour/pessimistic residents may not be rosy about what is actually an ok program. But if there is true malignancy you can sense it if you're putting the feelers out. Malignant programs have a certain vibe -- like the resident have to justify everything.
I was 0% able to suss out culture/malignancy over Zoom socials. MIR seems perfect on paper but all I have to judge resident happiness are threads like this, where I see multiple anonymous strangers commenting on residents being overworked, tired, unhappy, kept late.

Very frustrating situation, do I treat this as a red flag or ignore it?
 
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I was 0% able to suss out culture/malignancy over Zoom socials. MIR seems perfect on paper but all I have to judge resident happiness are threads like this, where I see multiple anonymous strangers commenting on residents being overworked, tired, unhappy, kept late.

Very frustrating situation, do I treat this as a red flag or ignore it?

imagine you are a PD. You had a zoom interview with some med student who seems to be great. But some resident says this person is lazy and don’t show up on time while some other residents say that she/he is the greatest person ever. No other med student is so controversial. The resident who say that this student is great may or may not be related to the student.

how would you rank this student?
 
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throk

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imagine you are a PD. You had a zoom interview with some med student who seems to be great. But some resident says this person is lazy and don’t show up on time while some other residents say that she/he is the greatest person ever. No other med student is so controversial. The resident who say that this student is great may or may not be related to the student.

how would you rank this student?
I take your point, and will probably sleep better at night by ranking my home program #1 where I know firsthand the residents are happy. It feels foolish to change my ranklist because of an SDN post but you're right, I have heard mixed things about MIR but not its peers, and that's all I have to go on this year.
 
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I take your point, and will probably sleep better at night by ranking my home program #1 where I know firsthand the residents are happy. It feels foolish to change my ranklist because of an SDN post but you're right, I have heard mixed things about MIR but not its peers, and that's all I have to go on this year.
If you are comfortable with the situation that’s all that matters. I made it a point to talk to ~5-6 residents at my top choice offline ranging from senior to junior so I can get a clear picture of the environment. These complaints do seem valid though tbh but if you’re comfy with that and that potential environment then go for it I guess.
 
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I take your point, and will probably sleep better at night by ranking my home program #1 where I know firsthand the residents are happy. It feels foolish to change my ranklist because of an SDN post but you're right, I have heard mixed things about MIR but not its peers, and that's all I have to go on this year.

I absolutely believe MIR provides excellent training, and if that is the most important thing to you, then for sure rank it accordingly. But you also have to be honest with yourself about what you can tolerate, assuming you don't fall on the favored side of the curve.
 
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I think overall my experience is more in line with aggrocrag3’s. It is a busy program and as residents we do get to do a lot. Attendings are humans too. We all make mistakes. A former chief gave me a valuable piece of advice. He said “radiology is about opinions and can be quite subjective”. There are things that a majority of people would agree on, but there are other things that only certain people can see or hallucinate. There are definitely attendings that I personally enjoy working with who are nice, smart, chill and understanding. On the contrary, there are also attendings - whom I pray not to have to work with - who are eccentric, nitpick every word in your report and disagree with everything you say. There are days I feel confident about myself and accomplished after reading out with the chill attendings and other days when I feel completely defeated or question my capability of ever becoming a mediocre radiologist . Either way, I do believe the attendings want us to learn and be competent. I am by no means the poster child of this program, but someone who tries to survive. I personally think radiology is akin to many sports. Many can play it decently, but only a few can be exceptional.

I also want to address a separate post about the new section Chief on breast. She is amazing. She is the best teacher I have encountered in the breast section. There is nothing about her that is malignant. Our program is very lucky to have her. It’s SLU’s loss.

Lastly, I wanna throw in my two cents to the applicants. Do not expect MIR to be CUSH. It is not. Some attending may believe you have to be crushed to be good. However it is also not neurosurgery. You work 10 hour days at most with the exception of IR and night float. In fact, being slow and lazy are extremely frowned upon not only by the attendings but also by your fellow residents. It is expected by everyone that you pick up as many studies as possible and read them as fast as possible. Since we are the biggest program in the country, we probably have fewer night floats/ calls compared to other smaller programs. Radiologists are also not psychiatrists or medicine docs. They may not have the best interpersonal skills. I can see how people may feel offended by certain attendings, but we are all adults mostly in our late 20s/ early 30s and need to cope with our emotions.
 
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