What to look for in a residency

[Colbert]

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I'm nearing the end of my second year and I'm still very interested in pediatrics. I want to begin to plan my rotations and elective rotations around landing the best residency I will be able to obtain. Truth be told, I'm not sure what separates a great education from an adequate one. I realize a large part of it will center around who is teaching me, but what else should I be considering? Is it better to go to a stand-alone pediatrics hospital or one that is directly connected to a larger hospital? Should I be looking at the fellowships offered at each? What about patient volume? How much does research and the availability to do research factor into the residency? Also, in terms of my third and fourth year rotations, I am thinking about doing an elective in a pediatric specialty (like cardiology or gas). Would it benefit me more to do a specialty rotation if that is the direction I'm currently leaning in or would I gain more from doing a less-specialized rotation like PICU? What about a pediatric surgery rotation?

I know I've thrown a lot out there but I'm just looking for the advice and direction. Thanks in advance for all the help!

 

[Sweet Tea]

I think a big thing that you're leaving out is the other residents. Look for happy residents, residents that don't hedge on answering your questions when you go for interviews, and residents that do things you like to do. You will spend the next 3 years up each other's *****es...make sure you enjoy the company you keep! Seriously though, it's nice to have people to hang out with in your off time that do things you like to do.

Peds isn't competitive like, say, ortho or surgery, so it's more about ending up in a place you want to be instead of looking for any spot you can find. What do you mean by "best"? What's best for you?

 

[BigNavyPedsGuy]

I got some good advice when I was a med student, "Unless you go to 'Joe's Tires and Pediatrics' you'll get good training. Go somewhere you like."

There are good programs all over the place. There are good and bad programs that are both big and small.

I defnitely agree that the happiness of the residents is a HUGE factor. The majority of any job is who you work with. The other advice I'd give is to keep options open. Meaning: if you want to do a fellowship then some programs might make you more competitive for a fellowship later on due to research opportunities or just by being an established program.

As far as rotations: You'll get a good well-rounded exposure during your 3rd year. If you know you want to do peds then try and do the peds-subspecialties within the core rotations (example" I did peds ortho, peds urology, etc).

 

[oldbearprofessor]

1. Is it better to go to a stand-alone pediatrics hospital or one that is directly connected to a larger hospital?

2. Should I be looking at the fellowships offered at each? What about patient volume? How much does research and the availability to do research factor into the residency?

3.Also, in terms of my third and fourth year rotations, I am thinking about doing an elective in a pediatric specialty (like cardiology or gas). Would it benefit me more to do a specialty rotation if that is the direction I'm currently leaning in or would I gain more from doing a less-specialized rotation like PICU? What about a pediatric surgery rotation?

You post questions renumbered for ease of response...

1. There are benefits to stand alone children's hospitals. However, you can also get great training at non-stand alone programs. A lot depends on your interest in small vs large programs. Location is more important (where do you want to live) than this issue.

2. Not that important. We've debated this one before. There are pros and cons to going to programs with lots of fellowships. The pros include more folks to teach you, often higher acuity and the chance to see what a fellowship entails (or to stay in place for your fellowship). The cons, highly program dependent, may include less attending contact time, fewer procedures and less responsibilities. Research is not usually a big issue in residency selection.

3. Do what you are interested in. Pediatric anesthesiology is not a specialty within pediatrics (i.e. you don't train in pedi, you train in anesthesiology, then fellowship in pedi). Pedi ID and Pedi GI are popular. Pick what and where you are interested in getting some experience in and that is known for good 4th yr rotations.

 

[DarthNeurology]

I realize a large part of it will center around who is teaching me, . . . but what else should I be considering? Is it better to go to a stand-alone pediatrics hospital or one that is directly connected to a larger hospital? Should I be looking at the fellowships offered at each? What about patient volume? How much does research and the availability to do research factor into the residency? Also, in terms of my third and fourth year rotations, I am thinking about doing an elective in a pediatric specialty (like cardiology or gas). Would it benefit me more to do a specialty rotation if that is the direction I'm currently leaning in or would I gain more from doing a less-specialized rotation like PICU? What about a pediatric surgery rotation?

I know I've thrown a lot out there but I'm just looking for the advice and direction. Thanks in advance for all the help!

Some factors I considered important when selecting a pediatric residency:

1. Having and knowing that you have the opportunity to do the research that you want to do is important. If you think you might want to do some research or are interested in more competitive peds specialties like hem/onc, AI, etc . . . then I would go somewhere where you can explore these opportunities. Who knows how competitive pediatric specialties will be in three years or more when you finish residency, they may be significantly more competitive. I made my decision based mostly on available research opportunities.

2. I think that who will teach you in pediatrics is overated as more in pediatrics than other specialties you are required to do more self-study, and most pediatricians are pretty decent teachers. More so you should feel that you would mesh well with your fellow pediatric residents. If you know that you want to do a specific fellowship, then by all means go to a program that offers this fellowship. Fellows are a resource to learn from as a resident, and you can *always* be more aggressive in getting procedures, in the end a place with fellows is more academic and you may have slight less time with attendings, but the time is much more high quality than what you would get at a program without fellows IMHO.

3. Location, it helps to be in an area of the country that you like. But also, you need to feel that you are getting good patient volume and will see enough or the right kind of pathology for where you will practice. If you don't see many sickle cell patients, but plan to move to an area of the country where there are a lot of sicklers, this may not put you at a big disadvantage if you have seen enough sickle cell patients, but you may not feel confident in how you were trained. I would recommend trying to train where you want to practice.

I think being in a stand-alone hospital for some residents is important as they want the support staff/experience of working in a hospital devoted to children, however, there are great training opportunities to be had in programs that don't have a stand alone hospital, wasn't an issue for me.

 

[Colbert]

Thank you all for the replies. I really appreciate the time and thoroughness of the answers!

I have been thinking more about fellowships lately. I'm not really sure what the day-to-day of pediatrics specialties is like. For example, I don't know how much time a peds cardiologist spends with patients, doing research, procedures, etc. Does anyone know a good site or thread about where I could find out more about different pediatrics specialties?

Thank you again for all the help everyone!

 

[oldbearprofessor]

I have been thinking more about fellowships lately. I'm not really sure what the day-to-day of pediatrics specialties is like. For example, I don't know how much time a peds cardiologist spends with patients, doing research, procedures, etc. Does anyone know a good site or thread about where I could find out more about different pediatrics specialties?

In general, pediatric specialties are 3 years in length and most now have a matching program. They require some form of scholarly research although the nature and rules for this are a bit of a moving target over time and specialty. In general, most will spend about 30-40% of their "months" of fellowship on a primary clinical service and the rest of the time on research. Of course, when on the clinical service, some will be able to do a little bit of research work and when or research, there may be some clinic responsibilities. During both time periods, fellows will be expected to attend regular conferences - usually 3-5 hours/week of didactics overall if one includes things like pediatric grand rounds.

As far as the daily grind when on the clinical service, that is, of course, specialty dependent. If there is one specialty you are particularly interested in you could create a thread about it. For pedi cards, when on the clinical service, one will have a very busy and often long day. This will include things like prerounding, rounding with the attending, talking to families, reviewing Echos and other diagnostic tests and of course doing procedures on patients. There will also be a bit of paperwork such as daily and admit/discharge notes and some teaching of residents, etc.

You will be bound by ACGME work rules in these fellowships, but it's impossible to predict what those work hour rules will be for a current medical student when you start fellowship.

 

[BigNavyPedsGuy]

Thank you all for the replies. I really appreciate the time and thoroughness of the answers!

I have been thinking more about fellowships lately. I'm not really sure what the day-to-day of pediatrics specialties is like. For example, I don't know how much time a peds cardiologist spends with patients, doing research, procedures, etc. Does anyone know a good site or thread about where I could find out more about different pediatrics specialties?

Thank you again for all the help everyone!

Almost all of the answers to your questions will be answered during your third year. It's a lot easier to see it in practice or ask someone you're working with than to try and gain understanding through our written responses.

During your third year clerkship you should get a good variety of expsoure to several pediatric subspecialties. During these times, most fellows and staff are happy to talk about career progression (at least that was my experience).

 

[SplenoMegastar]

In general, pediatric specialties are 3 years in length and most now have a matching program. They require some form of scholarly research although the nature and rules for this are a bit of a moving target over time and specialty. In general, most will spend about 30-40% of their "months" of fellowship on a primary clinical service and the rest of the time on research. Of course, when on the clinical service, some will be able to do a little bit of research work and when or research, there may be some clinic responsibilities. During both time periods, fellows will be expected to attend regular conferences - usually 3-5 hours/week of didactics overall if one includes things like pediatric grand rounds.

As far as the daily grind when on the clinical service, that is, of course, specialty dependent. If there is one specialty you are particularly interested in you could create a thread about it. For pedi cards, when on the clinical service, one will have a very busy and often long day. This will include things like prerounding, rounding with the attending, talking to families, reviewing Echos and other diagnostic tests and of course doing procedures on patients. There will also be a bit of paperwork such as daily and admit/discharge notes and some teaching of residents, etc.

You will be bound by ACGME work rules in these fellowships, but it's impossible to predict what those work hour rules will be for a current medical student when you start fellowship.

If someone is an MD/PhD, could a "real" post-doc be worked into the fellowship years? I know there are a few of programs with research residencies and defined tracks for this, but nowhere near as many as IM.

 

[oldbearprofessor]

If someone is an MD/PhD, could a "real" post-doc be worked into the fellowship years? I know there are a few of programs with research residencies and defined tracks for this, but nowhere near as many as IM.

Yes. There is a lot of flexibility in how the timing can be arranged for clinical vs lab time so that something approaching a "real" post-doc is possible especially for those with "real" knowledge going into fellowship. Folks with a serious basic science interest may also choose to do a 4 year fellowship or try to end their fellowship by submitting a K08 or similar grant. This is obviously easiest at the larger research oriented programs.

 

[BigRedBeta]

Also, in terms of my third and fourth year rotations, I am thinking about doing an elective in a pediatric specialty (like cardiology or gas). Would it benefit me more to do a specialty rotation if that is the direction I'm currently leaning in or would I gain more from doing a less-specialized rotation like PICU? What about a pediatric surgery rotation?

Definitely do what interests you, but also talk with the upperclassmen at your school about what rotations are good ones (or have easy hours 😉). You may not be super interested in Peds pulm or peds rheum, but if the teaching is really superb, doing that rotation could be super beneficial...