What is/was the most important factor in considering where to train for you?

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TRED1400

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I know what's important in a program is different and relative to all of us, however, I think there is some consensus over several items. This includes geographic location, fitness, the reputation of the program, hours (aka work-life balance), and several others. I was hoping some of the veterans and those currently in the residency grind could comment on what you thought was important prior to residency and if that has changed, or what you would consider being important now if you could go back.

For me specifically, geography is important to me since my wife and I are currently expecting and want to be close to family, however, another important aspect for me is doing a fellowship. Therefore, I am wondering if certain programs with little to no fellowships should be lower on my list since I would have to be away for an entire year from my family. I know things change, but I am wondering if this has been a real challenge for others out there and am curious about your thoughts.

So, what is/was important to you? Appreciate any advice.

Thanks.
 
My top 6 since I wasn’t married or geographically restricted at the time:

1. Did the program graduate competent clinicians who could walk into any case and not blink
2. Did the previous graduating class all get desired jobs or match into desired fellowships
3. Board pass rate
4. Work-life balance
5. Gut feeling about whether I would fit in personality-wise based on my interactions wth residents and attendings
6. Training sites all in one city cause I didn’t feel like driving 3 hrs a day or staying in shtty dorm rooms for months at a time
 
As a resident currently, location was most important. I am also married. Next important was reputation and work life balance.

Looking back, I would have tried to consider my long term goals a little more closely. You say youre interested in a fellowship, what type of fellowship? Some programs are better than others if your planning on going into a specific sub specialty. For this same reason, I think location should still be most important, you should train close to where you want to practice.
 
Focus on education vs service. There's a big difference in happiness when you're working 50 hours a week doing educational cases vs 70-80 hours doing cystos and lap appys at 3 in the morning and relieving CRNAs in the afternoon.

Some people here will say to do as many cases as you possibly can during residency. I agree but only when those cases are big or difficult or on sick patients. Doing basic cases on ASA 1-2s can only teach you so much...
 
Before residency
1) what is the reputation
2) is it in a big city
3) do the people seem happy

During residency
1) are the residents cool (are they going to **** you over when you need them or will they have your back when you're having an emergency)
2) how are the cases (are good cases taken by fellows or even srnas?)
3) does the department seem to care about residents (attending teaching in the or) and listen to feedback
4) are you stuck at 7 pm doing cataracts

Like dipri said, you want to train where you want to practice or where they have a large, well known alumni base who can get you connected.

I totally agree with the people above, especially vector.
 
I would say 3 most important aspects are

1). Case mix- By far the most important.
2). Location- Easier to stay in a particular area if you did residency there.
3). Fellowship opportunities.

As mentioned above, CRNAs and Fellows shouldn’t soak up all the juicy cases (should have plenty of regional, cardiac, peds, trauma, etc).
 
My first cutoff was determining a baseline of quality of residency in terms of academic reputation and case experience. Beyond that I sorted that group based on how much I'd enjoy living/working in the area and that department, or at least my best guess.
 
1. Case mix
2. Resident happiness
3. Vibe

That said, I wish I would have asked and thought more about average hours/wk. I am convinced you can be a very good anesthesiologist working ~50-55 hours per week.

While I am happy at my current program as a CA1, I wish I were working a bit less.
 
I thought location was important - I still feel that way

I thought fellowships at the hospital were important to get good training - they are, sort of (see below)

I didn’t appreciate the importance of trusting that gut feeling. Now I do.

I thought having CRNAsin the hospital was a bad thing. I mostly disagree with this now.

Here are my thoughts:

Go where your gut tells you. If you feel comfortable on interview day and you seem to like everyone and get along with them (while actually being yourself) then go there. If you have a hard time deciding between two places and one has an academic advantage and the other feels more like home, go to the one that feels like home. 4 years is a long time to be around people you don’t get along with (or in a place you don’t like) but it can be so much easier if you’re around people you naturally get along with.

My personal thought on fellowships: remember that if you have cardiac fellows they’ll be taking lots of hearts. Same for peds and regional. If you want to do a fellowship (which you might change your mind about) then this probably doesn’t matter because you’ll have your fellowship to train up on that stuff. If you don’t plan on doing a fellowship, however, think long and hard before going somewhere with fellowships as they might erode your training.

CRNAs (if managed properly and if the department has its priorities straight) can actually enhance your training by taking the less educational cases. At my place they do the eyeballs while we do the AAA, heart, sick peds whatever. If they weren’t around we’d be doing eyeballs and 18 yo appys. In other words, they do the grunt work while we get an education. Something to think about.
 
nimbus said:
For me in the end, it came down to the vibe I got from the residency director. Probably not the best way to make a decision but it worked out well.
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I totally get this! But buyer beware, the average PD in Anesthesia only lasts something like 4 years. Of course there are places where a PD is there for decades but those are the exception.

During my training we had 3 different PDs which was overall positive as it helped change some culture with new faces being brought in from the outside, but they were rocky transitions.
 
If you want to be a badass, go somewhere with no to limited fellows, a huge case mix and attendings who don't give a ****. Your residency life will suck, but nobody will be better than you.

If you just want to get through residency and get a good job/fellowship, go to the biggest name place where you get out at 3 and the attendings actually care about teaching and there's decent cases so you can pretend you know what you're doing after residency.

Never go anywhere where there are SRNA trainees or CRNAs that are involved in running the board in any capacity.
 
1) location
2) culture/vibe
3) facilities , is everything broken.
4) flexibility - ease of take vacation, moonlighting, conference days, etc
5) case mix
 
The facilities/equipment is one I didn’t think too much about til I started training. Your life as a resident is a lot easier and more educational if your program has money to pay good techs, has all the latest meds, pumps, scopes, blades, lines, ultrasounds, monitors, machines, and has good callrooms, resident library, and decent dining options.
 
I fell in love with my (critical care) fellowship program on the interview day. The PD, the secretary, most of the faculty I met (about 5-6 people I chatted with), the ICU, the hospital, the location, the way the fellowship was structured. They even put me in a 4-star hotel. I just went with my gut (loooved the PD), and then I had the best year of my GME. Truly tap danced to work.

A good training experience starts with nice people to work with. If you're treated like meat on the day of your interview, you know you'll be just a number. Same if the current trainees warn you about anything major. Did I train at a big name power house that produces awe when mentioned? Nope (but the brand is known nationally). Did I get great training in modern up-to-date critical care, including MICU? Yep (and I thank my gods every day I am in the ICU that I was trained by anesthesiologists and internists, not surgeons). Did I work less than 60 hours a week in a meaningful fashion? Yep . Was it fun? You bet. I was sorry it was over.

Years earlier I had interviewed at a huge name, and what I saw made me decide not to do a critical care fellowship. Choose your program wisely! Don't just be an inmate, regardless of how big the name etc.
 
FFP said:
I fell in love with my (critical care) fellowship program on the interview day. The PD, the secretary, most of the faculty I met (about 5-6 people I chatted with), the ICU, the hospital, the location. They even put me in a 4-star hotel. I just went with my gut (loooved the PD), and then I had the best year of my GME. Truly tap danced to work.

A good training experience starts with nice people to work with. If you're treated like meat on the day of your interview, you know you'll be just a number. Same if the current trainees warn you about anything major. Did I train at a big name power house that produces awe when mentioned? Nope (but the brand is known nationally). Did I get great training in modern up-to-date critical care, including MICU? Yep (and I thank my gods every day I am in the ICU that I was trained by anesthesiologists and internists, not surgeons). Did I work less than 60 hours a week in a meaningful fashion? Yep . Was it fun? You bet. I was sorry it was over.

Years earlier I had interviewed at a huge name, and what I saw made me decide not to do a critical care fellowship. Choose your program wisely! Don't just be an inmate, regardless of how big the name etc.
Click to expand...

Gonna need some names
 
Obviously a lot of characteristics factored into my decision, but the main thing that helped me decide between my two favorites was work life balance. The other was presence of an in-house fellowship in the subspecialty I think I want. Both were high quality programs, but the one I ended up putting #2 had a much bigger name than the other and was in a much more desirable location. The residents there just seemed to spend a LOT more time in the hospital without any obvious difference in training quality or fellowship/job outcomes.
 
be sure to rank the programs in a realistic order given one's unique level of competitiveness. If you are moderately competitive, and you get an interview at Mass General, you should be realistic about the overall picture and not get lulled into "big name" syndrome.

Fellowship/no fellowship I can see both ways. No fellows= more experience especially with something like TEE.

But, if you want to do the fellowship, it helps to have a home program where they already know you.....
 
GA8314 said:
be sure to rank the programs in a realistic order given one's unique level of competitiveness. If you are moderately competitive, and you get an interview at Mass General, you should be realistic about the overall picture and not get lulled into "big name" syndrome.

Fellowship/no fellowship I can see both ways. No fellows= more experience especially with something like TEE.

But, if you want to do the fellowship, it helps to have a home program where they already know you.....
Click to expand...

Not sure you understand how the match works. You should rank the programs in the order in which you would choose to attend them. Ranking according to how competitive you think you are makes no sense given the mechanism of the match.
 
vector2 said:
1. Did the program graduate competent clinicians who could walk into any case and not blink
Click to expand...

Is this a thing? I'm preparing to finish residency and go into private practice next year, and while I think my training has been pretty good overall, I am nervous! The thought of a newly minted attending walking into "any case" and not blinking reeks of overconfidence and naivete to me. Maybe I'm must reading too much into your particular choice of words, but I think that because I have received good training, I will be blinking early and often next year.
 
GA8314 said:
be sure to rank the programs in a realistic order given one's unique level of competitiveness. If you are moderately competitive, and you get an interview at Mass General, you should be realistic about the overall picture and not get lulled into "big name" syndrome.

Fellowship/no fellowship I can see both ways. No fellows= more experience especially with something like TEE.

But, if you want to do the fellowship, it helps to have a home program where they already know you.....
Click to expand...

THIS MAKES ZERO SENSE. RANK IN ORDER OF PREFERENCE. THERE IS NO GAMING THE MATCH
 
gaughinglas said:
Is this a thing? I'm preparing to finish residency and go into private practice next year, and while I think my training has been pretty good overall, I am nervous! The thought of a newly minted attending walking into "any case" and not blinking reeks of overconfidence and naivete to me. Maybe I'm must reading too much into your particular choice of words, but I think that because I have received good training, I will be blinking early and often next year.
Click to expand...

Yes, you are reading too literally into the choice of words. I (along with many others) have said before that I learned as much my first year out as I did in my last year of fellowship and residency. Anyone who joins any sort of busy practice taking care of sick pts is going to encounter situations which require looking some things up or consulting with a more senior colleague for their thoughts or procedural help.

That being said, the more challenging your residency was (case complexity and attendings giving you autonomy during ca-3), the fewer of these situations you will encounter. I was fortunate enough to train somewhere where by the end of CA-3 I would do an esophagectomy entirely by myself. Attending would be outside the room while I went to sleep, placed a double lumen, Aline, 2nd IV, bronched to confirm placement, positioned, and then I would manage the case and any blood loss or ventilation problems on my own, occasionally texting with updates or calling if things got really squirrelly. On the other hand, there are some academic institutions such as where I did CC fellowship where the surgeons are such primadonnas that the attending can barely leave the room for 5 min at a time.
 
Psai said:
Gonna need some names
Click to expand...
Good luck with that. I've been trying to get him to mention his program's name since before he actually started. It might have been nice to know when applying if there was some awesome hidden gem out there (aside from the program I attended, of course).

Sent from my SM-G930V using SDN mobile
 
gaughinglas said:
Is this a thing? I'm preparing to finish residency and go into private practice next year, and while I think my training has been pretty good overall, I am nervous! The thought of a newly minted attending walking into "any case" and not blinking reeks of overconfidence and naivete to me. Maybe I'm must reading too much into your particular choice of words, but I think that because I have received good training, I will be blinking early and often next year.
Click to expand...
Maybe not quite, but the converse is definitely a thing. I have some colleagues that are graduates of a program that didn't seem to prepare them for encountering moderately sick patients undergoing routine procedures. They've delayed pts for cardiology "clearance" that most of us wouldn't even think twice about taking to the OR. Coming on here and reading some of you guys post about your residency experiences makes me think that my training was terribly deficient...but it was far better than some of my actual peers' training, apparently.

Sent from my SM-G930V using SDN mobile
 
psychbender said:
Good luck with that. I've been trying to get him to mention his program's name since before he actually started. It might have been nice to know when applying if there was some awesome hidden gem out there (aside from the program I attended, of course).

Sent from my SM-G930V using SDN mobile
Click to expand...
Yeah, good luck with that! What did you expect? The man is an arse (sorry mods, that's the truth); I know him well.

He's keeping it secret, so he won't have to admit it's some third rate no-name program. It's not like he knows stuff they don't teach at UPMC or Stanford. He's never ever posted anything I haven't heard about before.

Just ignore him.
 
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FFP said:
Yeah, good luck with that! What did you expect? The man is an arse (sorry mods, that's the truth); I know him well.

He's keeping it secret, so he won't have to admit it's some third rate no-name program. It's not like he knows stuff they don't teach at UPMC or Stanford. He's never ever posted anything I haven't heard about before.

Just ignore him.
Click to expand...
kylr3Fb_d.jpeg


Sent from my SM-G930V using SDN mobile
 
jonnythan said:
Not sure you understand how the match works. You should rank the programs in the order in which you would choose to attend them. Ranking according to how competitive you think you are makes no sense given the mechanism of the match.
Click to expand...

Yes. You should choose where you think you have the best chance of matching. Especially if you are not that competitive. But, if you want to be an anesthesiologist, it will be a lot easier for the mild to moderate grad to be of interest to a mid-tier program than he/she would be to a top tier program. So, be realistic about things, even if you get an interview or two from such a place.
 
TRED1400 said:
I know what's important in a program is different and relative to all of us, however, I think there is some consensus over several items. This includes geographic location, fitness, the reputation of the program, hours (aka work-life balance), and several others. I was hoping some of the veterans and those currently in the residency grind could comment on what you thought was important prior to residency and if that has changed, or what you would consider being important now if you could go back.

For me specifically, geography is important to me since my wife and I are currently expecting and want to be close to family, however, another important aspect for me is doing a fellowship. Therefore, I am wondering if certain programs with little to no fellowships should be lower on my list since I would have to be away for an entire year from my family. I know things change, but I am wondering if this has been a real challenge for others out there and am curious about your thoughts.

So, what is/was important to you? Appreciate any advice.

Thanks.
Click to expand...


Looking back now about 5 years, I would want the following in a program:


A major university program that has everything you need under one roof
A hospital that sees a lot of poor patients with uncontrolled illnesses
Not to be moving all around on outside rotations
Exposure to serious things like thoracic, transplants and GSW level traumas - going outside for those things fox x months, red flag
Not to be forced to do research if I dont want to
Not to be mandated to do home beeper call for nominal extra pay
A schedule that is sometimes brutal, and sometimes fine (tough calls, but not more than 5 a month)
Heavy exposure to OB

As far as fellowship, I know you have probably heard this before, but I would NOT worry about that. Your mind may change, and even if you pick a program (or even city/area) that has fellowship programs locally or in house, there is no guarantee of you getting one of those 2 spots with 6 co residents applying. And if it means moving away from my family for a year? I think you need to reevaluate that decision
 
GA8314 said:
Yes. You should choose where you think you have the best chance of matching. Especially if you are not that competitive. But, if you want to be an anesthesiologist, it will be a lot easier for the mild to moderate grad to be of interest to a mid-tier program than he/she would be to a top tier program. So, be realistic about things, even if you get an interview or two from such a place.
Click to expand...

You definitely don't understand how the match works then. There is nothing to lose by ranking, say, Duke #1 and UMass #2 if you'd rather go to Duke, even if you're a marginal candidate at Duke and the PD at UMass is your father.

Please quit giving misleading advice on rank lists.
 
FFP said:
Yeah, good luck with that! What did you expect? The man is an arse (sorry mods, that's the truth); I know him well.

He's keeping it secret, so he won't have to admit it's some third rate no-name program. It's not like he knows stuff they don't teach at UPMC or Stanford. He's never ever posted anything I haven't heard about before.

Just ignore him.
Click to expand...
It's funny because if I had to bet, my money would have been on UPMC. Back to the drawing board.
 
GA8314 said:
Yes. You should choose where you think you have the best chance of matching. Especially if you are not that competitive. But, if you want to be an anesthesiologist, it will be a lot easier for the mild to moderate grad to be of interest to a mid-tier program than he/she would be to a top tier program. So, be realistic about things, even if you get an interview or two from such a place.
Click to expand...

No because if you put the programs in order of your preference you may still end of at the place you had the best chance at matching but you also keep the chance that one of the other programs you ranked above them will take you. There is literally zero upside to how you say people should rank. If you don't understand the match at all, don't try to give advice about it.
 
GA8314 said:
Yes. You should choose where you think you have the best chance of matching. Especially if you are not that competitive. But, if you want to be an anesthesiologist, it will be a lot easier for the mild to moderate grad to be of interest to a mid-tier program than he/she would be to a top tier program. So, be realistic about things, even if you get an interview or two from such a place.
Click to expand...

Again, that’s not how the match works. If you got an interview at a program, you have a chance at matching there. Doesn’t much matter if it’s an early interview offer or late in the season.
 
GA8314 said:
Yes. You should choose where you think you have the best chance of matching. Especially if you are not that competitive. But, if you want to be an anesthesiologist, it will be a lot easier for the mild to moderate grad to be of interest to a mid-tier program than he/she would be to a top tier program. So, be realistic about things, even if you get an interview or two from such a place.
Click to expand...

your post should have a big bright disclaimer that it is bad advice from someone that doesn't understand the match algorithm and should not be followed by anyone participating in the match.


Just to recap how it actually works. When you come up in the match, it looks at your rank list and attempts to put you at your #1 choice. If your #1 choice has an open spot, it puts you there. If your #1 choice is full, it compares how the program ranked you vs everyone else already there and if you rank ahead of at least 1 person it kicks them out and puts you there. If your #1 program is already full of people they ranked above you, the algorithm drops down to your #2 program and runs the same logic. After it puts you at a program successfully, it moves on to the next person and does the same thing.

What that means is that you are guaranteed to match at the highest program on your list that would have a spot for you. It doesn't not hurt you in any way to rank programs that are a "reach" compared to more realistic options. Why? Because if those programs are already full and can't/won't take you then it'll put you somewhere lower on your list. There is no penalty against you for having not matched at places higher up your list when it puts you are somewhere lower down your list. The entire algorithm is biased for the applicants rank list over the program rank list.
 
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Psai said:
THIS MAKES ZERO SENSE. RANK IN ORDER OF PREFERENCE. THERE IS NO GAMING THE MATCH
Click to expand...

Your preference should be those that you got the best vibes from which you are most competitive for, especially if you
jonnythan said:
You definitely don't understand how the match works then. There is nothing to lose by ranking, say, Duke #1 and UMass #2 if you'd rather go to Duke, even if you're a marginal candidate at Duke and the PD at UMass is your father.

Please quit giving misleading advice on rank lists.
Click to expand...

They will be less likely to rank you at all.
 
jonnythan said:
You definitely don't understand how the match works then. There is nothing to lose by ranking, say, Duke #1 and UMass #2 if you'd rather go to Duke, even if you're a marginal candidate at Duke and the PD at UMass is your father.

Please quit giving misleading advice on rank lists.
Click to expand...

you may be right. 🙂

But, doesn't this process video assume they must also rank you? Not high, but simply to rank you, no? In other words, is it possible to rank at a place that did not rank you at all? I didn't think so but maybe I am wrong.

the-match-process-video
 
GA8314 said:
you may be right. 🙂

But, doesn't this process video assume they must also rank you? Not high, but simply to rank you, no? In other words, is it possible to rank at a place that did not rank you at all? I didn't think so but maybe I am wrong.

the-match-process-video
Click to expand...

you do have to be ranked by a program to end up there, but it does not hurt you in any way to rank a program that doesn't rank you. You just move down the list to your next spot.
 
GA8314 said:
Your preference should be those that you got the best vibes from which you are most competitive for, especially if you


They will be less likely to rank you at all.
Click to expand...

Jesus christ man. I don't know how to help you. You are just plain wrong. Where they put you on their list is 100% irrelevant to where you put them on your list.

Even if they don't like you much and ranked you 100 out if 100, if you rank them 1 and the 99 other people didn't rank them then you will match there even though you weren't their first choice. If you rank BI one because you thought that you wouldn't match at the brigham then you just screwed yourself out of your desired program for no reason. If you ranked brigham 1 and BI 2 and you don't make it into brigham then you end up at BI anyway. Your preference should be your preference. There is literally zero downside to ranking brigham number one if you want to match there the most, no matter where they rank you. It is a very simple concept, I am unsure why you are having so much trouble with it.
 
nimbus said:
For me in the end, it came down to the vibe I got from the residency director. Probably not the best way to make a decision but it worked out well.
Click to expand...

My PD was a robot, I think, corporate climber type. And crna advocate, except I found that out before finishing residency
 
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vector2 said:
The facilities/equipment is one I didn’t think too much about til I started training. Your life as a resident is a lot easier and more educational if your program has money to pay good techs, has all the latest meds, pumps, scopes, blades, lines, ultrasounds, monitors, machines, and has good callrooms, resident library, and decent dining options.
Click to expand...

Completely agree, now that I work in PP with limited resources compared to residency, what an academic place has and all the resources and technology available, I feel kind of helpless sometimes. Can't just throw down a tee when s*it hits the fan, MTP, ABG? Lol. ERAS? No time for that. Lidco, spv\ppv? Que? All about the units!
 
For me, it was all about location. Interviewed at all the programs in that region and ranked in order of post-residency opportunities: best PP job placement, best fellowship placement. Done. I think it took me 30 minutes total to make my rank list after interviews. But I had done a lot of preparation, talked to lots of people in the classes ahead of me as well as the attendings at my med school. I applied strategically and my list didn't change much from what I would have written down before the whole application process started.

It seemed to me that hard work up front made that final list an easy task.
 
rakotomazoto said:
For me, it was all about location. Interviewed at all the programs in that region and ranked in order of post-residency opportunities: best PP job placement, best fellowship placement. Done. I think it took me 30 minutes total to make my rank list after interviews. But I had done a lot of preparation, talked to lots of people in the classes ahead of me as well as the attendings at my med school. I applied strategically and my list didn't change much from what I would have written down before the whole application process started.

It seemed to me that hard work up front made that final list an easy task.
Click to expand...

Word people are like I'm doing fellowship at man's greatest hospital I'm like that's nice but where da benjamins at
 
No one has really even mentioned the two most important factors.

I think almost ALL residencies have the power and ability to train you competently. If you want to be a great anesthesiologist, that will be up to you...how much you read, how teachable you are, how much you pay attention and get the useful tidbits out of each scenario, etc. That can happen ANYWHERE.

So what are the two most important. By the way...I agree with many, weather is important..but this is way more important.

1. How much free food is provided?
2. How is the parking?
 
epidural man said:
No one has really even mentioned the two most important factors.

I think almost ALL residencies have the power and ability to train you competently. If you want to be a great anesthesiologist, that will be up to you...how much you read, how teachable you are, how much you pay attention and get the useful tidbits out of each scenario, etc. That can happen ANYWHERE.
Click to expand...

This is true to a certain extent, but it doesn’t take away from the fact that one should go to a mothership, tertiary center wth crazy case complexity compared to a more community oriented institution. I trained at the former and now I’m staff at what’s closer to the latter. We do level I trauma, some sick icu cases, and some lowish volume cardiac and crani, but my residents still have to rotate offsite (at non-academic shops wth staff who don’t necessarily care about their education) for pedi, neuro, and cardiac. When we’re at home and say I have a neuro case with a resident, I try to do my best by them by bringing some journal article or going over some neuro clinical pearls, but it’s not necessarily the same experience I had as a resident doing an open aneurysm clipping with some neuro fellowship trained nerd who knows all the literature and lives and breathes neuroanesthesia.
 
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