What makes a residency program good?

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RussianJoo

RussianJoo

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So I am doing an anesthesia elective at my home program, and I absolutely love it over here, but some people have told me that the residency program isn't that good. without giving too much info, here are some facts about the program and hospital. to me it sounds like a pretty solid program what do you guys think?

It's at a community hospital, it's a very small program (under 5 residents per year), there are no CRNAs, attendings do their own cases. There are morning lectures a few times a week by the attendings and daily afternoon resident run lectures starting at 3pm. and of course a weekly grand rounds. There are no fellowships in the program. The board pass rate if very close to 100%. They have CT trained anesthesiologists doing hearts, and peds trained anesthesiologists doing peds cases.. the hospital has a Neurosurg residency so there is a decent neuro anesthesia exposure as well and I am not sure on the number of transplants but they do occur at this hospital as well. The only thing I was told that's missing is Trauma.

Here are some facts about the hospital:

~600 bed hospital
~7,000 annual births, with a fairly high C/S rate.
~15,000 annual inpatient surgeries.
~5,000 annual outpatient surgeries.
~ 600 annual open heart surgeries. also the CT anesthesiologists cover another hospital located 15min away and they said that residents are more than welcome to go there as well, that hospital does ~800 annual open heart surgeries, so there's potential to do a lot of hearts( at least it seems to me like a lot of hearts), which i am definitely considering as a fellowship option.
So is ~1,400 annual open heart surgeries a good number? or do most university programs have considerably more?

~14 CT-ICU beds run by CT trained anesthesiologists.
~12 CCU beds (not 100% sure who runs the CCU)
~ 18 Mixed Neuro/Surgery/Medicine ICU beds run by IM/CCM intensivisits, who love to teach.

Call is pretty brutal for CA-1's but there's almost no call for CA-3's. Definitely no weekend call for CA-3s.

Don't know how much this is true but I was told by attendings that everyone that was interested in a fellowship pretty much got the fellwoship that they wanted, but not too many seemed to be interested.

The residents seem very happy, and not too over worked. the attendings are very friendly for the most part, and most are very eager to teach.

What do you guys think? Do large university hospitals really have that many more annual cases? I understand that this hospital probably doesn't get all the zebras and really complicated cases, but there's plenty of peds, ob-gyn, ortho, hearts, ENT, and neuro cases, at least that's what I think. the Pain service is pretty busy too, I did a day of acute pain and we did 1 axillary block, 1 interscaline, 1 femoral, and about 8 epidurals, and there's a chronic pain clinic as well.

There's almost no research being done here, but I was told if a resident is interested the attendings will be very supportive.

I guess the only 2 downsides that I see is that it's not a university program and there are no fellwoships in the program, but how important are these two things anyway?

I am really happy here, and wouldn't mind matching here, however, there's always that little voice in your head that contradicts you into thinking if there's something better out there. So I am here to ask the veterans. does this sound like a solid program on paper? are the number of annual cases pretty average compared to other facilities? or are they bellow or above average?

I personally feel that a good residency program will have a ton of different cases so that you can get all the training you need to be confident and competent once you graduate and also will have a fellowship in the field that you're interested in. I feel that this program fulfills one of the requirements.


I know there are some threads on this forum with the same exact title but I was wondering if you guys could comment about this particular program.

as always thank you in advance for your replies.
 
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RussianJoo said:
So I am doing an anesthesia elective at my home program, and I absolutely love it over here, but some people have told me that the residency program isn't that good. without giving too much info, here are some facts about the program and hospital. to me it sounds like a pretty solid program what do you guys think?

It's at a community hospital, it's a very small program (under 5 residents per year), there are no CRNAs, attendings do their own cases. There are morning lectures a few times a week by the attendings and daily afternoon resident run lectures starting at 3pm. and of course a weekly grand rounds. There are no fellowships in the program. The board pass rate if very close to 100%. They have CT trained anesthesiologists doing hearts, and peds trained anesthesiologists doing peds cases.. the hospital has a Neurosurg residency so there is a decent neuro anesthesia exposure as well and I am not sure on the number of transplants but they do occur at this hospital as well. The only thing I was told that's missing is Trauma.

Here are some facts about the hospital:

~600 bed hospital in the suburbs of NYC.
~7,000 annual births, with a fairly high C/S rate.
~15,000 annual inpatient surgeries.
~5,000 annual outpatient surgeries.
~ 600 annual open heart surgeries. also the CT anesthesiologists cover another hospital located 15min away and they said that residents are more than welcome to go there as well, that hospital does ~800 annual open heart surgeries, so there's potential to do a lot of hearts( at least it seems to me like a lot of hearts), which i am definitely considering as a fellowship option.
So is ~1,400 annual open heart surgeries a good number? or do most university programs have considerably more?

~14 CT-ICU beds run by CT trained anesthesiologists.
~12 CCU beds (not 100% sure who runs the CCU)
~ 18 Mixed Neuro/Surgery/Medicine ICU beds run by IM/CCM intensivisits, who love to teach.

Call is pretty brutal for CA-1's but there's almost no call for CA-3's. Definitely no weekend call for CA-3s.

Don't know how much this is true but I was told by attendings that everyone that was interested in a fellowship pretty much got the fellwoship that they wanted, but not too many seemed to be interested.

The residents seem very happy, and not too over worked. the attendings are very friendly for the most part, and most are very eager to teach.

What do you guys think? Do large university hospitals really have that many more annual cases? I understand that this hospital probably doesn't get all the zebras and really complicated cases, but there's plenty of peds, ob-gyn, ortho, hearts, ENT, and neuro cases, at least that's what I think. the Pain service is pretty busy too, I did a day of acute pain and we did 1 axillary block, 1 interscaline, 1 femoral, and about 8 epidurals, and there's a chronic pain clinic as well.

There's almost no research being done here, but I was told if a resident is interested the attendings will be very supportive.

I guess the only 2 downsides that I see is that it's not a university program and there are no fellwoships in the program, but how important are these two things anyway?

I am really happy here, and wouldn't mind matching here, however, there's always that little voice in your head that contradicts you into thinking if there's something better out there. So I am here to ask the veterans. does this sound like a solid program on paper? are the number of annual cases pretty average compared to other facilities? or are they bellow or above average?

I personally feel that a good residency program will have a ton of different cases so that you can get all the training you need to be confident and competent once you graduate and also will have a fellowship in the field that you're interested in. I feel that this program fulfills one of the requirements.


I know there are some threads on this forum with the same exact title but I was wondering if you guys could comment about this particular program.

as always thank you in advance for your replies.
Click to expand...

The way you describe it, it sounds better than a university program. Med students are obsessed for some reason about the number of cases a hospital does...as long as your exposed to all the various types of cases (cv, peds, etc, etc) not a big issue. Your attendings are doing their own cases which means they almost certainly have more relevant things to teach you than university attendings who work on crossword puzzles while the residents pound through the cases. Since its a community program, the issues will be not getting really sick patients (which are transferred to tertiary centers cause no private guy wants to touch it -surgeon or anesthesiologist), advnaced specialty case (peds hearts, peds livers, and other cases I hate and will never ever do again after residency)- but again, your never gunna do these cases after residency so who cares so much. I think the bigger the name the easier it is to get a fellowship period. Also, coming from a community program may make it more difficult finding a job in an area of the country where no one knows anything about it. No call CA-3 year? Im sold.
 
DreamMachine said:
I feel that having CRNAs in the ORs can be a good thing. We had CRNAs around during residency. This was ideal, because the residents got the pick of the challenging cases, and the CRNAs did all the fluff. I would not want to be at a residency program in which the residents are the work force for the hospital, unless there is a ton of residents. For example, you will learn nothing doing an ORIF of an ankle at 7 pm as a CA2.

You should choose a place where you leave the hospital at a decent time. At the end of the day, you will need time to unwind. Anesthesiology is a stressful field. If you are not getting out at a decent hour, you will end up sacrificing your reading or your sanity.
Click to expand...

unless you're on call you leave the hospital at 5pm. and everyone gets out of the OR at 3 for daily resident run lectures. from what I have seen the attendings are the work horse of the hospital in this OR. There are about 20 or so attendings and not all of them have residents fallow them, I think some just prefer to work on their own. The attendings that want to have residents do, and from what I have seen once the attending trusts you and knows you can handle the case you pretty much do the case by yourself.

you're right it would seem that a small program with no CRNA coverage would work their residents to the death, but surprisingly this is not the case with this place.. i'll double check with more residents, but from what I see this place is not malignant and residents are happy.
 
sounds like you're at XXXX. it's not the greatest residency, but if it gives you a shot at getting into that group i would stay - that practice is sweet.
 
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I've been told the same.

Overall the difference is not necessarily in the numbers but in the types of cases. You do hearts but what kind, how sick are the patients, are they multiple valves, etc. Especially around NYC the sick complicated patients tend to go to the major academic centers.

From what I get from talking to people, after 1-1/5 years you can handle the bread and butter pretty well but what the major centers give you is those totally wild cases that make even the attendings think. Those are the things you want to see in residency so that you are better prepared for practice with it is your license. Also, you get more cutting edge things (like more exposure to regional with and w/o US) which you may not see in a smaller place.

Lastly, I don't know the details at your program but if you are 1:1 with attendings most of the time, how much do they leave the room and let you run the case. In many PP heavy practices you don't have too much autonomy (even if they do leave the room they give you little freedom to experiment with the anesthetic choice) and that will hurt your training. I know that is the case with one program in LA. The more "academic" the center the more autonomy the residents usually get.

Overall what makes a program great:
1) Happy residents - treated with respect by the program and who can manage to have a life outside the hospital
2) Wide diversity of cases and attendings hopefully showing you the cutting edge in as many areas as possible (regional, cardiac, etc) in terms of anesthesia and surgical practice
3) Good didactics (or other structured learning) to help you understand your reading and what you do in the OR
4) If you are interested then exposure to research​


Jeff05 said:
sounds like you're at XXXX. it's not the greatest residency, but if it gives you a shot at getting into that group i would stay - that practice is sweet.
Click to expand...
 
95% of the programs out there will train you well IF YOU put the time and hard work in... just my opinion.
 
mstudent12345 said:
I've been told the same.

Overall the difference is not necessarily in the numbers but in the types of cases. You do hearts but what kind, how sick are the patients, are they multiple valves, etc. Especially around NYC the sick complicated patients tend to go to the major academic centers.

From what I get from talking to people, after 1-1/5 years you can handle the bread and butter pretty well but what the major centers give you is those totally wild cases that make even the attendings think. Those are the things you want to see in residency so that you are better prepared for practice with it is your license. Also, you get more cutting edge things (like more exposure to regional with and w/o US) which you may not see in a smaller place.

Lastly, I don't know the details at your program but if you are 1:1 with attendings most of the time, how much do they leave the room and let you run the case. In many PP heavy practices you don't have too much autonomy (even if they do leave the room they give you little freedom to experiment with the anesthetic choice) and that will hurt your training. I know that is the case with one program in LA. The more "academic" the center the more autonomy the residents usually get.

Overall what makes a program great:
1) Happy residents - treated with respect by the program and who can manage to have a life outside the hospital
2) Wide diversity of cases and attendings hopefully showing you the cutting edge in as many areas as possible (regional, cardiac, etc) in terms of anesthesia and surgical practice
3) Good didactics (or other structured learning) to help you understand your reading and what you do in the OR
4) If you are interested then exposure to research​
Click to expand...

thanks you pointed out some great points.. the attendings here do leave the room pretty regularly and let you run the case, however, i don't think they'll be too happy if you try something different.. each attending likes things his/her way and that's how the residents do it...

so you're right a university center would give me more freedom to experiment and try different drugs. plus give me the oppertunity to do difficult unstable cases.
 
XXX is a decent program..

they are crooks business wise.

the hospital is insanely good hospital. one of the best in the area next to hackensack.

training in a private practice is a good good thing because i think it makes you more efficient. its up to you what you are lookign for. you wont be inferior if thats what you are asking. you will probably put in more labor epidurals than any other program
 
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What makes the program "good"?

You do.

you decide how much or how little training you get out of your residency. I think what people forget is just because we finish a residency, by no means is our training over. You continue to make yourself better, how hard you work at it is up to you.
 
With so many strong programs in the NY/NJ/PA area, its hard for XXX to stand out as anything more than a community program. It's not a big program (i believe only 4 residents per year) but it is FMG and DO friendly so that's a plus for some. In addition, I think there are 3 university programs in that state which may or may not have a more academic emphasis. I don't quite know how much a daily resident run lecture could teach me - i think i'd rather learn from people who have been doing it for a while longer than those 1-2 years ahead of me. While you will definitely learn how to do things the "private" way, I wonder how often they get new blood to bring new things to the table. As for landing a job there, something to find out would be how often they hire their own graduates.
 
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Dude, it sounds like you've found your own personal utopia. So keep it in your back pocket.

Try to do another rotation at one of the big-time university programs you keep hearing about.

Go on many interviews and try to keep an open mind about each one. Write down what you like and dislike about each.

Then, when it comes time to create your rank order list, sit down with a nice bottle of whatever-your-preferred-spirit is, do some soul searching and pick out which program is best for YOU!

Everyone (including me) will have their $0.02 to add about everything, but at the end of the day, you are the only one who knows what makes you happy.
 
maceo said:
XXX is a decent program..

they are crooks business wise.

the hospital is insanely good hospital. one of the best in the area next to hackensack.

training in a private practice is a good good thing because i think it makes you more efficient. its up to you what you are lookign for. you wont be inferior if thats what you are asking. you will probably put in more labor epidurals than any other program
Click to expand...


Ding, Ding, Ding... I was just thinking it was XXX. I interviewed there and thought the program was ok. The PD and facilty was nice, but the way the interview was set up turned me off completely. I was a bit TOO small for my liking. Go with your heart man! Good luck in this very stressful process!
 
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Thank you everyone for your thoughts and comments a lot of you brought up excellent points and questions that I should ask the programs where I rotate/interview.


However, I ask that you please not speculate which program I am talking about. trying to guess the program wasn't my intention. If I wanted people to know the program name I would have mentioned it. The intention of this thread was simply to see what other criteria a student should look for in an anesthesioloy residency besides just the name of the program, and the association an individual would make with that name. So I wanted to know purely on the numbers is the program I mentioned a solid program?


The comments many of you have made about the fact that the resident him/herself makes the program good or bad is excellent. I truely hope that if you can excel at any program you'll graduate a compitent anesthesiologist and have the oppertunity to persue the fellowship of your choice, it might not be in the location of your choice, but I fell that's not as important.

Once again thank you everyone for your comments. You've raised some excellent points that I need to address.
 
RussianJoo said:
Thank you everyone for your thoughts and comments a lot of you brought up excellent points and questions that I should ask the programs where I rotate/interview.


However, I ask that you please not speculate which program I am talking about. trying to guess the program wasn't my intention. If I wanted people to know the program name I would have mentioned it. The intention of this thread was simply to see what other criteria a student should look for in an anesthesioloy residency besides just the name of the program, and the association an individual would make with that name. So I wanted to know purely on the numbers is the program I mentioned a solid program?


The comments many of you have made about the fact that the resident him/herself makes the program good or bad is excellent. I truely hope that if you can excel at any program you'll graduate a compitent anesthesiologist and have the oppertunity to persue the fellowship of your choice, it might not be in the location of your choice, but I fell that's not as important.

Once again thank you everyone for your comments. You've raised some excellent points that I need to address.
Click to expand...

If that's the case, you probably shouldn't have mentioned the location. 🙄
 
More US-trained attendings than foreign attendings that have never taken the boards and never will.
 
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