What is a "good" residency program?

[unsung]

I understand that even for noncompetitive specialties, the "good" programs will still be highly competitive.

What I have never fully understood is what constitutes a "good" program. What makes the program so highly competitive and desirable? Obviously, going to a "good" program is important if one wants to proceed in academia. But what about the rest of us?

I have been doused too long in the dreariness that is MSI, that I'm starting to wonder why I'm working so hard. Why do I care about scoring well relative to the mean, or getting a high Step 1 score, etc.?

It's not necessarily true that a more competitive residency program would provide superior training or that I would learn "more" from such a program. I know that already fr my med school experience. Quality of teaching has nothing to do with school ranking based on research.

Part of it is that I would like to feel "competent", and it's hard for me to feel that way unless I'm doing well, of course. So for my own edification and peace of mind that I actually "learned" something in the first two years, I do still care a lot about the Step 1. Plus, it's sort of a baseline ticket to doing well in 3rd year, in terms of actually knowing answers to all those pimping Qs.

But beyond those reasons, what's the incentive to haul ***** and get high scores? "Good" residency programs don't pay more or offer better perks, right?

I'm just trying to figure this out for myself, as the specialties I'm interested in aren't competitive.

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[deleted77919]

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[WholeLottaGame7]

I understand that even for noncompetitive specialties, the "good" programs will still be highly competitive.

What I have never fully understood is what constitutes a "good" program. What makes the program so highly competitive and desirable? Obviously, going to a "good" program is important if one wants to proceed in academia. But what about the rest of us?

I have been doused too long in the dreariness that is MSI, that I'm starting to wonder why I'm working so hard. Why do I care about scoring well relative to the mean, or getting a high Step 1 score, etc.?

It's not necessarily true that a more competitive residency program would provide superior training or that I would learn "more" from such a program. I know that already fr my med school experience. Quality of teaching has nothing to do with school ranking based on research.

Part of it is that I would like to feel "competent", and it's hard for me to feel that way unless I'm doing well, of course. So for my own edification and peace of mind that I actually "learned" something in the first two years, I do still care a lot about the Step 1. Plus, it's sort of a baseline ticket to doing well in 3rd year, in terms of actually knowing answers to all those pimping Qs.

But beyond those reasons, what's the incentive to haul ***** and get high scores? "Good" residency programs don't pay more or offer better perks, right?

I'm just trying to figure this out for myself, as the specialties I'm interested in aren't competitive.

As you hinted at, the best incentive to do well is for your own personal benefit (and your future patients).

Beyond that, you never know what specialty or what program you may want to end up at, so you might as well aim high on Step 1. Much easier to have a 250 and decide to go into family medicine than to get a 210 and suddenly realize you oh-so-badly want to do radiology.

Otherwise, Dakota's comments are right-on. I would add that a "good" residency program is the one that fits what you want. Community-based vs academic, location, case load/diversity, size of the program, fit with current residents, particular specialists in a subspecialty you're interested in, etc.

 

[WellWornLad]

But beyond those reasons, what's the incentive to haul ***** and get high scores? "Good" residency programs don't pay more or offer better perks, right?

Medical students have been competing academically their entire lives. By this stage it's more conditioned response than a reaction to perceived rewards.

 

[airplanes]

Dakota's post just reminds me that playing the game and padding the 'ol CV never ends...

 

[sunset823]

unsung, I'm identifying more with your question now, as for my summer internship I'm living with an anesthesia resident. She's smart, and though she came from a somewhat unknown public school in the southwest, she interviewed and did visiting rotations at some BIG names - however, she told me that at a certain big name, her rotation experience was terrible - the program was malignant, and the quality of teaching was actually really poor.

it definitely turned topsy turvy my notion that I should just go to the biggest name that will take me. Choosing a residency is way more complicated than choosing a med school. And this aside from spousal/family issues other people have to think about.

I think to a certain extent the really big names will always be competitive just cuz of the name, no matter how they treat their residents. However, other high level but not 'top tier' programs (like where I'm currently interning) who treat their residents really well are certainly getting more competitive, though I'm finding it's more regional. If I hadn't come here for an internship (in the south), I would have no idea how good or bad the quality of training is here, because so few people match in the south from my midwestern school.

But though this program is both great academically and treats its residents great (yes, there are perks, a laptop at the beginning of intern year, for starters), the 'culture' of the program and location isn't really for me, something I find very important if I'm going to be in a place for 4-5 years (including fellowship).

So basically a good residency is 1) a recognizable name, not necessarily top tier 2) non-malignant, helpful to residents, good teaching and 3) a good fit for you. (e.g., Don't want to be the single resident and expect to have a social life in a program where everyone else is married.)

 

[typhoonegator]

As stated, a "good' residency suits your needs and desires. However, particularly on SDN, "good" residencies are the big name tertiary care places that people have come to think of as the Emerald Cities of each specialty. MGH, BWH, Mayo, Columbia, UCSF and the like. All of these have earned their reputation due to a combination of high-profile research, US News garbage, myth, and legend. People read the CPC cases from the MGH in the NEJM and think, "Oooh, I want to go to there." Some "good" residencies are warm and cuddly, but many of these big names are steeped in tradition and remain fairly malignant. Because the "good" reputation stems significantly from their academic stature, research and leadership at the departmental and professional level tend to be priorities.

Only you can decide if this interpretation of "goodness" fits with your own. If you want to do private practice cardiology with no research component in the midwest, going to internal medicine residency and cards fellowship at the Brigham might be overkill. Or it might not be, if you simply have to go to a Harvard program.

 

[deleted77919]

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[SouthernSurgeon]

That is entirely specialty dependent. For example, some of the best known/most respected EM programs are Cincinnati, Denver, Indy, Carolinas, etc. Does that carry cachet with the public? No. But within the field they are hugely respected. Those places you mentioned (except for Mayo) haven't even offered EM residencies for very long. In the case of EM you are reading Annals articles from Cincinnati, etc.

But the rest of your post holds true.

And again...sometimes the "Emerald cities" really are extremely strong training programs. It is very very field dependent and can be tough to figure out. You need a reliable advisor in that field to help you sort through it.

 

[Law2Doc]

And again...sometimes the "Emerald cities" really are extremely strong training programs. It is very very field dependent and can be tough to figure out. You need a reliable advisor in that field to help you sort through it.

Agreed. Don't kid yourself by thinking that the big name places you have heard of are good at everything. They aren't. Every academic center is known for some things and severely lacking at others. Every one. The premeds are allowed to ignorantly think that just because a program is affiliated with Harvard it must be the best in everything, but once you are in med school and actually thinking about residency, it is your obligation to find out, through a mentor and graduates in the field, what places are good, not so good, benign and malignant in your desired specialty. It's most often not what you think. (Which again is one reason why match lists are pretty useless to premeds.).

As for why one should work hard in med school the reasons are several. (1) you will need that knowledge to be a competent physician. You can't coast through with minimal passing grades and think that you are going to pick things up later when you need them. Life (esp residency life) comes at you fast and the more you have jammed into the recesses of your mind, the better off you are. To a greater extent you need the early med school stuff on the Step exams and in rotations as well. Work hard, you will benefit from it. (2) Most people change their minds at least once in terms of desired specialty. Best to keep your doors open. doing well does this for you.

 

[shreypete]

Agreed. Don't kid yourself by thinking that the big name places you have heard of are good at everything. They aren't. Every academic center is known for some things and severely lacking at others. Every one. The premeds are allowed to ignorantly think that just because a program is affiliated with Harvard it must be the best in everything, but once you are in med school and actually thinking about residency, it is your obligation to find out, through a mentor and graduates in the field, what places are good, not so good, benign and malignant in your desired specialty. It's most often not what you think. (Which again is one reason why match lists are pretty useless to premeds.).

As for why one should work hard in med school the reasons are several. (1) you will need that knowledge to be a competent physician. You can't coast through with minimal passing grades and think that you are going to pick things up later when you need them. Life (esp residency life) comes at you fast and the more you have jammed into the recesses of your mind, the better off you are. To a greater extent you need the early med school stuff on the Step exams and in rotations as well. Work hard, you will benefit from it. (2) Most people change their minds at least once in terms of desired specialty. Best to keep your doors open. doing well does this for you.