What are the factors I should consider when checking out residency programs?

[drg123]

Interview season is upon us and soon many will be going all over to see what residency programs are like. I'm excited for the opportunity.

I wanted to open up this question to get the wisdom of the crowd here on this PM&R forum. There are certain baseline things I think we all will be looking at, but I especially want to hear from people further along in their training (residents/fellows/attendings) about the things we should look for that aren't obvious to a interview rookie. Or put another way, what are things you wish you had known or cared about when going through this process?

Obvious stuff:

- Curriculum and Program Structure
- Clinical emphasis (e.g. outpatient vs. inpatient heavy, MSK vs TBI/SCI, etc.)
- Geography and Cost of Living
- Salary/Benefits
- Program 'feel' and culture
- Resident happiness and well-being
- Fellowship placement
- Research opportunities
- Call schedule
- Average Work hours
- Potential faculty mentors
- Facilities (single site vs multi-site)
- Parking (probably the most important

What else should be on this list? And in what order would you prioritize these and other things that aren't here? @RangerBob @j4pac

Thanks for your help.

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[j4pac]

I think that you hit all of the high points.

Other things to consider include:
- what does a typical day on an inpatient service look like? What does the typical day on call look like? Shoot...know everything possible about call. Most of your stress from residency will likely come on call...so I'd understand the details. How many calls per night? What type of calls per night? How often do residents come in (if home call)? What resources do you have if you need help on call? Is there a rapid response or code team? Is it your job to field calls overnight from random patients while on call?
- how receptive is the program to process improvement? Any examples?
- what processes are in place to make residency efficient or less stressful?
- what are the relative weaknesses of the program (I think I go to the best program in the country, and yes, even my program has relative weaknesses)?
- how reliant is the hospital on residents in both the inpatient and outpatient setting? Any difficulty getting vacation? When can you take vacation?
- what is the program's process to secure didactic time? Do consultants pull pagers? How often do you get paged out of didactics and how often do you have to leave during didactics?
- what do residents typically do after residency...general practice or fellowship...and why? what type of fellowship do residencies typically go into? are the resources in place to allow residents to enter any fellowship of their choosing?
- how much administrative work does the average resident do? are there any processes in place to make it easier/more efficient.
- I'd try to ask specifics about procedures. No only how many EMG's...but do you have a dedicated block for EMG? Does the resident do both the NCS and EMG? What is the complexity of cases seen within EMG? Is ultrasound being a tool used for diagnostic purposes in EMG? Is there time for education in the course? Are injections palpation guided or ultrasound guided. How many of each? What type of injections? Any education on ultrasound and how to perform the injections? Any experience with diagnostic ultrasound? What are residents allowed to do on their pain rotation? Do they perform or observe procedures? Do they get experience with cervical and thoracic procedures, pumps/stims? Any experience with ultrasound or palpation guided nerve blocks? Any experience with regenerative practices such as PRP or BMAC? Any experience or do you have the capability to learn how to perform a bone marrow aspirate. Is Botox and/or phenol being performed? E-stim/EMG/ultrasound guided? I'd encourage to have as many tools in your tool bag as possible.
- if you have had resident's struggle in the past, what are the typically reasons? who is a POOR fit for the program?
- what is the research presentation policy? are there any services in place to make doing research easier (librarians, research directors, media support, etc).

 

[drg123]

Thanks @j4pac! That's useful stuff that I wouldn't have thought about.

How does one tactfully and appropriately go about finding out this info? Especially about work hours and call. This is critical stuff, but if one seems too inquisitive, you give off the impression of 'not wanting to work.' I may be misperceiving but that would be my hesitation.

I think that you hit all of the high points.

Other things to consider include:
- what does a typical day on an inpatient service look like? What does the typical day on call look like? Shoot...know everything possible about call. Most of your stress from residency will likely come on call...so I'd understand the details. How many calls per night? What type of calls per night? How often do residents come in (if home call)? What resources do you have if you need help on call? Is there a rapid response or code team? Is it your job to field calls overnight from random patients while on call?
- how receptive is the program to process improvement? Any examples?
- what processes are in place to make residency efficient or less stressful?
- what are the relative weaknesses of the program (I think I go to the best program in the country, and yes, even my program has relative weaknesses)?
- how reliant is the hospital on residents in both the inpatient and outpatient setting? Any difficulty getting vacation? When can you take vacation?
- what is the program's process to secure didactic time? Do consultants pull pagers? How often do you get paged out of didactics and how often do you have to leave during didactics?
- what do residents typically do after residency...general practice or fellowship...and why? what type of fellowship do residencies typically go into? are the resources in place to allow residents to enter any fellowship of their choosing?
- how much administrative work does the average resident do? are there any processes in place to make it easier/more efficient.
- I'd try to ask specifics about procedures. No only how many EMG's...but do you have a dedicated block for EMG? Does the resident do both the NCS and EMG? What is the complexity of cases seen within EMG? Is ultrasound being a tool used for diagnostic purposes in EMG? Is there time for education in the course? Are injections palpation guided or ultrasound guided. How many of each? What type of injections? Any education on ultrasound and how to perform the injections? Any experience with diagnostic ultrasound? What are residents allowed to do on their pain rotation? Do they perform or observe procedures? Do they get experience with cervical and thoracic procedures, pumps/stims? Any experience with ultrasound or palpation guided nerve blocks? Any experience with regenerative practices such as PRP or BMAC? Any experience or do you have the capability to learn how to perform a bone marrow aspirate. Is Botox and/or phenol being performed? E-stim/EMG/ultrasound guided? I'd encourage to have as many tools in your tool bag as possible.
- if you have had resident's struggle in the past, what are the typically reasons? who is a POOR fit for the program?
- what is the research presentation policy? are there any services in place to make doing research easier (librarians, research directors, media support, etc).

 

[j4pac]

Thanks @j4pac! That's useful stuff that I wouldn't have thought about.

How does one tactfully and appropriately go about finding out this info? Especially about work hours and call. This is critical stuff, but if one seems too inquisitive, you give off the impression of 'not wanting to work.' I may be misperceiving but that would be my hesitation.

Definitely reserve the questions that require more tact for residents. Obviously, you don’t want to ask only questions about work hours...that could come off wrong. But you could ask all of the above questions in the right context, and it could come off like an interested consumer.

I’d be careful going to a program with unhappy residents. PM&R residents are typically pretty happy people. If you encounter residents that are disgruntled, I say that’s a red flag. You can get a great education in PM&R without burnout or malignancy. You may feel you have sacrifice quality for a decent work-life balance...absolutely untrue regarding PM&R.

 

[RangerBob]

Definitely reserve the questions that require more tact for residents. Obviously, you don’t want to ask only questions about work hours...that could come off wrong. But you could ask all of the above questions in the right context, and it could come off like an interested consumer.

I’d be careful going to a program with unhappy residents. PM&R residents are typically pretty happy people. If you encounter residents that are disgruntled, I say that’s a red flag. You can get a great education in PM&R without burnout or malignancy. You may feel you have sacrifice quality for a decent work-life balance...absolutely untrue regarding PM&R.

I agree with JPacs assessment-if the residents aren’t happy in PM&R, it’s a red flag. We’re a pretty happy group.