What GI PDs look for in a resident: research vs clinical rigor

[Elixir6]

I'm an MS4 making my rank order list for residency. I have a big research background and want to go into GI and stay in an academic center 100%. I took my rank order list to the GI PD at my program for some input about my ROL and I think I am going to pretty much keep my ROL as is based on his comments, but I left the meeting a little confused as to what GI PDs are looking for in an applicant.

#1 Resident research vs clinical rigor of a residency
My #1 choice on ROL is place that is a little on cush end of residency, but has amazing research opportunities and a fantastic GI fellowship program. They have great GI placement for residents. But my #2 choice is a place that is notorious for being tough and having lots of critical care months, so barely any time for research, but it also has excellent GI placement (maybe even better placement than my #1).

In the end I am interested in getting into a good academic GI fellowship and doing some research, but I am willing to work damn hard in residency and I'm not afraid of some tough love along the way. I guess posters here are going to tell me to go where I will be happier because that's where I will do "better" but I was wondering if there are any opinions out there since my #1 and #2 picks are pretty much on opposite extremes of residency style. So is the appetite of GI PDs more set towards seeing people with excellent research or rock solid clinical training (maybe they won't even look at your research track record if they feel your residency was not rigorous?).

#2 Fellow-run programs
I interviewed for IM at a program with the stigma of being fellow run (also has a great GI fellowship). I asked the PD about what they do to make sure fellows don't overshadow residents and the residents have enough autonomy. She said, oh, good question, we get this every year, but that no program can be fellow run because there are only a few fellows at each institution, they are busy doing procedures and not interested in managing patients at the level of a resident, plus there are so many more patients than fellows that no program can possibly be fellow run. I felt satisfied with her answer. So, I put together my ROL and took it to the GI doc at my home institution: What did he tell me. Oh, that program is very fellow driven and we don't like taking residents from there for our GI fellowship because they aren't up to snuff clinically. Now I'm left scratching my head wondering where the truth lies. Any opinions on this?

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[BeardedRunner]

From what I've heard from classmates and friends applying, research is very important. The appetite of the PDs is for the reputation/national rank of your residency program, research experience, and connections. They will not be put off by a "non-rigorous" residency training program.
I have some co-residents that do a special 3 month research elective during 2nd year to make themselves more competitive. Residency is a time to learn, but it's also an important time to mold yourself into a good candidate, because you really only have 2 years to apply. Applications open July after 2nd year. So in that time period you need to make solid connections with your home GI dept attendings and carry out a research project. However, since you are MD/PhD, your previous research might carry over, I have met people who only did research in med school and then matched into an academic GI fellowship straight out of medical school.
I feel that all good academic residency programs will provide you with the training that you need and that residency gets rough anywhere you go. The program doesn't need to be especially rigorous.
2. Fellow-run vs non-fellow run, I feel that wherever there are fellows, they will be doing a lot of the work, but as a resident you get a lot of experience as well. I don't really believe that some fellows completely eclipse residents in some programs. The reason being that, for example, during a GI elective, you'll be working with the consult fellow, you'll be asigned to see and evaluate a few patients, then you will present directly to the attending. The fellow will then present any other patients. The attendings are there to evaluate YOU as the resident and to train the fellow, they don't just ignore you because you're a resident.

 

[loeffy]

If you're an MD/PhD, you already have an advantage when it comes time to apply. How's the name recognition of each program? Are they equivalent? Are they both at large academic hospitals? I wouldn't give much weight to what that GI doc said, every program chooses their fellows differently, and you mentioned that both programs have solid match lists. Though I don't care to put too much emphasis on match lists, I think it's a rough indicator of the how the IM program is viewed by fellowship programs. Also, calling programs cush, fellow-run, etc. can be subjective so be careful in putting too much emphasis on those classifications. What programs are we comparing here, if you don't mind sharing?

 

[Elixir6]

Thanks so much for your input. I have been on SDN too much if people already know me as MD/PhD, though it was probably a giveaway that I typed the word "research" out like 12 times in my post. I guess it doesn't hurt to just say the names, I liked Mayo and UTSW the best, but other favorites include Cornell, OSU, Colorado, UCSD and Case. You can see how my top choices are really different so that's the only reason I have been grappling with the order. The other programs are all great, totally solid training and setup for GI. Moreover, I would be happy training at any of these places, but I guess since residency is going to be my whole life for 3 years and since GI is so damn competitive I'd take words of wisdom from anyone in the know.

Really, I'm not sure how fellows can overshadow residents, but it's just something you hear a lot. The only difference I have gleaned on the interview trail is whether the ICU fellow is up with you overnight, or sleeping in the call room, or whether the residents independently mess with the vent settings or whether that's fellow only turf. Probably a minor difference in training, but what do I know?

 

[HoldTheCoffee]

This is just IMO, but if you are MD/PhD and did GI related research already, I don't see how 3 months of a chart review or some other small project would really enhance your research CV that much, unless you had 0 publications during your PhD time or manage to actively engage in your project while not on the research elective (doable but tough).

 

[loeffy]

Not sure if your app has any "weak" spots (IMG, low board scores, etc.), but if not, you'll probably have no problem matching into GI from most of those programs, though that's assuming you're not only gunning for big time academic places. I would probably put UTSW first, I think it has a stronger academic name and will give you more rigorous training. I interviewed at Mayo and it did seem cush and I didn't care for the Mayo-isms or the location. If you think you might want to end up in Cali for fellowship and beyond, I would put UCSD higher on your list, same for Cornell and NYC. The Cali and NYC markets seem a little easier to crack coming from within those areas.

 

[Elixir6]

Thanks everyone for your input. Yeah, they're all solid places so I'm real lucky. I did get pubs from my research though none of it was related to GI. I am planning on doing research during clinical blocks - just got to do what you got to do on nights and weekends I guess. Ain't no one doing a mouse project and running Western blots, but I think there's interesting work to be done more than just a case report.

 

[BeardedRunner]

I think that at most academic places, the fellows and respiratory therapists are entrusted to modify vent settings. At community hospitals with no fellows, the residents actually get to put in central lines on their own (once they are certified) and interns can put in orders to change vent settings.
As for the ICU fellow being up with you all night - that can vary from fellow to fellow, but for the most part, they are busy seeing consults throughout the hospital all night, so you are often left alone.
All the programs you listed are good, it really comes down to where you want to live. That's the advice most residents told me on the interview trail, just choose the place where you think you'll be happy for the next 3 years, the training will be excellent at each institution. Also, I agree with loeffy that many places, especially NYC and California are very regional, so once people start there, they tend to stay in the area for fellowship and even junior faculty.

 

[Hepat0l0gy]

Thanks everyone for your input. Yeah, they're all solid places so I'm real lucky. I did get pubs from my research though none of it was related to GI. I am planning on doing research during clinical blocks - just got to do what you got to do on nights and weekends I guess. Ain't no one doing a mouse project and running Western blots, but I think there's interesting work to be done more than just a case report.

I was in your shoes last year and ended up selecting an academic program with more research focus then the typical top 10 academic programs (i.e >2 pubs per residents). I chose the program because I was told that it will help me get the fellowship and establish a career that I want.

So far it's been working pretty well. I am finishing up two manuscripts and one of them is a prospective multi-center clinical study. I have two more research projects down the pipeline waiting for me.

I would recommend ranking a program that will invest in your academic and professional success rather than seeing you as a free labor.

Good luck with the match.

 

[Hepat0l0gy]

(Deleted user)

Are there particular programs within the "top 10" that come to mind for seeing their residents as "free labor"? Faculty at different programs tend to say the same things, making it hard to differentiate them. Thanks!

I suggest asking the interviewer(s) about "extra curricular" activities that residents pursue outside of their clinical responsibilities. Some programs i interviewed have said something along the line of "our residents have rigorous clinical responsibilities that they have limited amount of time for other activities as a first year". In my mind this translates to 80+ hr work week for at least 9 out of 12 months with little time to READ, learn, AND pursue your personal academic interests.

Other programs I interviewed said something along the line, "we have dedicated research mentor starting intern year that will support you through your residency". One program even introduced me to a junior faculty and we talked about his experience going through residency/fellowship/junior faculty and how the program can help me achieve xyz. In my mind this translates to they are willing to invest in me as a resident and beyond.

Talk to the current residents about their experience as a resident and the "culture" of the program. Have a frank conversation with them about the pro/con of the program. There is always a con to a program. You will be surprised to learn the number of residents who are less than ecstatic with their program.

Ultimately trust your gut instinct. Choose a program that best fit your learning style, career goals, and personality.

 

[Lovemph]

I am an IMG PGY2 at a small program. Will be applying for a GI fellowship come July. Was wondering if non GI related manuscripts count? So far have a couple of abstracts and manuscripts but only one manuscript and 2 abstracts are GI related.

 

[HelpPleaseMD]

I am an IMG PGY2 at a small program. Will be applying for a GI fellowship come July. Was wondering if non GI related manuscripts count? So far have a couple of abstracts and manuscripts but only one manuscript and 2 abstracts are GI related.

why not? honestly don't understand these questions. obviously better if topic is in GI

 

[Lovemph]

I know right?. But someone said non GI research especially if in another specialty may seem like one is not committed enough to GI. And may count against one. That's why I put up the question

 

[gutonc]

I know right?. But someone said non GI research especially if in another specialty may seem like one is not committed enough to GI. And may count against one. That's why I put up the question

But you also have GI research. So what does it matter? Are you not going to apply just because you have some non-GI stuff on your CV? Because that's just dumb.

 

[Lovemph]

Thanks for the reply. I know the question sounds dumb.. Just freaking out making sure my bases are covered. And trying to make sure I'm not missing out on any helpful tips for July.

 

[HelpPleaseMD]

Thanks for the reply. I know the question sounds dumb.. Just freaking out making sure my bases are covered. And trying to make sure I'm not missing out on any helpful tips for July.

its cool. all quality research helps ... but thats self explanatory

gl