What to look for in a program

[peter2013]

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Good afternoon everyone. I'm looking for advice on what factors are important to consider when looking at residency programs. In particular, are there any factors that you weighed heavily that you wish you hadn't? Or any factors that you wish you had looked into more?

 

[esodeviation]

- Busy surgical volume - at least 180-200 cataracts as primary surgeon and diverse experience in other procedures
- Presence of a county hospital or VA medical center or both (this helps a lot with surgical volume)
- Representation of all subspecialties on faculty
- Happy residents - look not just at what they say when you interact with them on interview but read between the lines and look at how they say it - are they excited to be at their program?
- Good balance of supervision and autonomy - you want to graduate feeling confident making decisions on your own, but with appropriate supervision and backup especially early on
- A city/town that you will enjoy living in for 3 years - especially if you have family - make sure they will be happy

 

[DrZeke]

Seems like about half the programs fall short of that number of cataracts... Not sure if you can comment on that

 

[rocketbooster]

Seems like about half the programs fall short of that number of cataracts... Not sure if you can comment on that

More like 90%. It says he's an attending but he's def off about cataract numbers. I have heard 100+ is a must, 150 is awesome and 200 is unbelievable.

 

[DrZeke]

More like 90%. It says he's an attending but he's def off about cataract numbers. I have heard 100+ is a must, 150 is awesome and 200 is unbelievable.

That's what I thought... pretty sure I can achieve "awesome" status at my future program 😉

 

[dantt]

I second esodeviation.

Don't let programs fool you. You asked what to look for in a program. 100 cataracts is a bare minimum and there's no such thing as a "high quality" cataract. The second hump for learning good cataract surgery is at 160 and there are a fair number of programs that meet that.

PGY4s at my program regularly do 5-10 cataracts/week and many break 250. The cataract schedule is booked out 6 months in advance. Procedures are so plentiful first years regularly do PI's, PRP's on the spot. Second years have surgical slots they can fill with whatever procedure they want and there's no lack of patients. Realize though when you have that kind of surgical volume, you have to see that volume of patients.

 

[LightBox]

Yes, the more cataracts, the merrier. That being said, looking back, I think I would have replaced 50 phacos with 50 of "something else".

When you hit private practice, you won't even blink for another 50 cataracts. But another 50 transplants or filters -- now that's a different story.

 

[esodeviation]

More like 90%. It says he's an attending but he's def off about cataract numbers. I have heard 100+ is a must, 150 is awesome and 200 is unbelievable.

To reply to the concerns about cataract numbers... I finished residency in 2012 and now am in private practice doing comprehensive ophthalmology including a pretty good volume of cataract surgery. 100 is probably the bare minimum to feel comfortable doing cataract surgery. There have been good studies published showing a significant decrease in complication rate at around 80 surgeries and then again at around 160. More cases with more autonomy as your progress is definitely better. I finished with around 230 cataracts and feel very comfortable in private practice with small pupil cases, pseudo-ex, traumatic cataracts, vitrectomized eyes, etc. Would I have felt as comfortable if I had only done 100 in residency - almost certainly not as I just would not have seen as much at that point. Every cataract you do is a little different in terms of density, pupil size, corneal clarity, zonular issues, chamber depth, etc. and the more experience that you can get in different techniques and approaches during residency, the better, especially if you plan to do comprehensive or significant cataract surgery when you're done.

 

[esodeviation]

Here's a link to the article about the phaco learning curve which is most often cited regarding the decrease in complication rate and increase in efficiency as the number of cases increases:

http://www.v2020la.org/pub/PUBLICATIONS_BY_TOPICS/Residency training/The Resident Surgeon....pdf

 

[peter2013]

Thank you for the feedback! I really appreciate it. Does anyone have thoughts on the size of a program? I know some programs have 2 residents per class, and that worries me a little bit. Other programs have quite a bit more.

 

[esodeviation]

My program had 9 residents per year which was great. As long as there is enough surgery and clinical experience to go around (our program probably could have had 10-11 per year without the clinical and surgical experience suffering) I think more residents can be better. If someone gets sick or is on vacation, its a lot easier to cover call and clinic with more residents. I thought the collegiality in our program was great because of the size. With just 2 or 3 residents, a difficult personality in the group could hurt your experience a lot more than in a larger class. In our case, this wasn't an issue anyways, but could imagine that it happens occasionally even in a specialty like ophtho that tends to attract more laidback personalities.

In general, I think 2 residents per year would be a program to avoid in general. Even 3 is a bit small, although there are so many programs with 3 residents that you may not be able to avoid this. As long as the clinical volume supports it, I would generally take the program with the bigger class size IF all other things were equal, but once you get at least 4 or 5 residents, its probably all about the same in terms of the experience.

 

[ophtho898]

Factors I was told to consider when visiting each program are:
- resident happiness
- resident comfort (clinically/surgically) after finishing residency
- fellowship match
- surgical #'s
- whether the program is hand-holding, throw-you-to-the-wolves, or somewhere-in-between
- call schedule
- whether or not all fellowships are represented at the program
- presence of VA/county hospital

What I'd like to know is: what are some really important factors to consider that MS4s may not yet realize are important? for instance, I never realized how important it was to have a VA until this year.

 

[Modder]

Factors I was told to consider when visiting each program are:
- resident happiness
- resident comfort (clinically/surgically) after finishing residency
- fellowship match
- surgical #'s
- whether the program is hand-holding, throw-you-to-the-wolves, or somewhere-in-between
- call schedule
- whether or not all fellowships are represented at the program
- presence of VA/county hospital

What I'd like to know is: what are some really important factors to consider that MS4s may not yet realize are important? for instance, I never realized how important it was to have a VA until this year.

How does one assess this:
"- resident comfort (clinically/surgically) after finishing residency"

Do u just ask current residents about how graduates of the program felt about their training once they entered practice?

 

[ophthope]

My program had 9 residents per year which was great. As long as there is enough surgery and clinical experience to go around (our program probably could have had 10-11 per year without the clinical and surgical experience suffering) I think more residents can be better. If someone gets sick or is on vacation, its a lot easier to cover call and clinic with more residents. I thought the collegiality in our program was great because of the size. With just 2 or 3 residents, a difficult personality in the group could hurt your experience a lot more than in a larger class. In our case, this wasn't an issue anyways, but could imagine that it happens occasionally even in a specialty like ophtho that tends to attract more laidback personalities.

In general, I think 2 residents per year would be a program to avoid in general. Even 3 is a bit small, although there are so many programs with 3 residents that you may not be able to avoid this. As long as the clinical volume supports it, I would generally take the program with the bigger class size IF all other things were equal, but once you get at least 4 or 5 residents, its probably all about the same in terms of the experience.

You UT Southwestern folks love the big class size. I've got the opposite opinion though - I think 3 or 4 residents is a good number - I like the cohesiveness of the tight-knit group. While one bad apple could make it rough I haven't seen that happen very much, and the literally one time I saw a personality issue it ended up okay. I'm at a less trauma-heavy program so splitting the call up or getting someone to cover isn't a really big issue. Only having 2 residents would probably be rough for call. But then again I can imagine that if UTSW lost one ophtho resident everybody else would feel it, you guys seemed to be working pretty hard. So maybe my opinion is based more on how strenuous call is going to be than it is based on class size.


Here was my thought process on residency programs. It's more of a process than a list and read it knowing that I (like most applicants) have no interest in academic medicine or research as a career:

1. Clinical Stuff:
--- surgical volume and diversity, representation of all subspecialties on faculty, good fellowship match rate (notably research did not matter at all to me as long as there was enough around to help me match a fellowship)

2. Real Life
--- do the residents look happy?, cost of living, city size / safety, commute distance (especially to distant VAs), location, etc

Basically as long as #1 was 'good enough' then #2 mattered much more. After that a lot of places tied on #2 criteria so I ranked the places that were equal on #2 criteria amongst themselves based on #1 attributes. In pretty much any field I've found that people who let #1 far supercede #2 have a greater chance of being unhappy. The super-type A people who will focus on #1 at the expense of everything else aren't listening to this advice anyway. In ophthalmology almost any program can turn you into a good ophthalmologist. You can either be miserable for 3 years while you're being molded into an eye surgeon or you can be around faculty and co-residents whose company you enjoy and whose personalities mesh with your own. Generally this stuff works out, and most people like where they end up.

 

[helpfulstranger]

As usual, ophthope's advice is solid.

This is also a nice resource: http://www.medrounds.org/ophthalmology-pearls/articles/Sanchez-Match-Pearls.pdf

 

[ophtho898]

bumping this since interview season will be in full swing soon. Any advice from current/former residents? Particularly concerning things we should look for in programs that we may not know to look for at this stage in our training

Question: Some people say having all fellowships represented is good for a program, others say having few fellows is good because your surgical #s will be better. So, anyone have perspective on this?

 

[LightBox]

bumping this since interview season will be in full swing soon. Any advice from current/former residents? Particularly concerning things we should look for in programs that we may not know to look for at this stage in our training

Question: Some people say having all fellowships represented is good for a program, others say having few fellows is good because your surgical #s will be better. So, anyone have perspective on this?

There is no secret in what makes a good quality residency program. These factors have been reiterated ad nauseum before:

1) High volume patient encounters. It is good to have clinics from a variety of courses (e.g. resident clinic, attending clinics, VA clinics, etc). Preferably, a program that is not competing with other Ophtho programs nearby (e.g. *not* NYC programs...)

2) Busy VA.

3) Busy city/county hospital.

4) All subspecialties represented. And preferably, more than 1 faculty member per subspecialty. The more attendings you have, the more people you have to operate with. And hopefully some of these attendings are big names to help you with fellowship placement if you so desire.

5) Efficient operating rooms. Is there a cataract surgery backlog because the residents can only do 4 cases a day in their slow-turnover OR, or are they that backlogged doing 15 cases a day?

6) Significant surgical volume in a VARIETY of procedures (i.e. not just cataracts).

7) Fellowship match success.

8) Friendliness/collegiality among attendings. Do you want to spend 3 years in a malignant environment with lots of politics?

9) Formal didactics. Do you learn better "on the job" or do you need some structure toward your learning?

10) Research opportunities. I think this is the least important factor for most residents. The only thing this is good for for most people is for fellowship placement.

11) Amount of scut work and travel. Do you want to spend your time operating or spend your time seeing b.s. corneal abrasion consults and commuting between 5 satellite hospitals?

12) Overall resident happiness. It is usually very easy to see which residents are genuinely happy when you interview. If the program is "hiding" their residents from you (or the residents aren't enthusiastic enough to give their high praise of their program), I would be suspicious.

I think that having fellows is good for the "prestige" of an Ophthalmology department in general. Plus, it gives you some additional attendings with which to operate. However, I think your overall surgical #'s are less when fellows are present in a program. This is a debatable subject, but I would prefer to have no fellows competing for surgery.