I'm currently a 2nd yr. CCF medicine resident and will try to be as objective as possible however will obviously have an inherent bias.
Our program does offer a fairly comprehensive IM foundation for those that want to pursue general medicine as well as subspecialty medicine. The first myth I should try to expel is regarding 'fellowship' driven services. First and foremost, our wards services are broken down into subspecialty teams: ie. Green team = GI/hepatology primary admitting service, Cards, Renal, Heme/Onc, and so on like most academic training programs. I, assuming that most medicine residents are on the same boat, don't know how to write dialysis orders(unless you want to do nephrology) nor can I perform a LHC. Likewise, we don't write Chemo infusion orders on cancer patients, and yes that is the fellow's job. We do, on the other hand are given 99% autonomy to run our services as senior residents, and if your intern is competent, will allow the junior to take the bull by its horns and run the show (usually the case by the end of an intern's year). We are fairly proficient at caring for acute situations, be it complex or 'bread and butter' cases (whatever you consider those to be). Mainly b/c of the population of patients we care for here. There aren't any fellows or attendings inhouse at 2am when you're admitting patients- you have the option to ask for help if you need it but by no means required to call your 'superiors' (whoever they are to you). The fellows step in when A) you need help B) performing subspecialty procedures (ie. EGD/c-scopes, blah blah) as these are not 'medicine resident jobs' unless you're super interested, etc. If other teaching hospitals allow their residents to write chemo orders w/o the input of their staff, great for them.
2nd, I do not think our residency 'sucks'. in4mthsMD obviously didn't have a good impression during his/her time here, that's too bad. I don't think judging all of our residents' competency based on exposure to a selected few is a fair statement, but he/she is allowed an opinion though. There are many other reasons why people have crappy experiences when doing rotations at away hospitals: ie. not being competent themselves, getting pimped and not knowing the right answer and wondering if their attending will write them a letter of recommendation, not getting enough attention as 4th year students doing sub-Is would like, working w/ residents who aren't interested (hence less teaching) or 'less knowledge'/good at a particular field (I know very little about allergy/immunology as its pretty boring) or whatever the case may be as I can only speculate on my own experiences as a student.
Our residency is busy. Internship can suck but most places do. Have to agree that that's the nature of that first year. Our primary care training may not be the strongest IF your longitudinal clinic is off site (ie. satellite PCP centers) but is excellent at the Main campus. How many candidates applying to large academmic centers want to do outpatient PCP medicine in the first place? In regard to our General internal medicine training, very strong. I'd like to say excellent but I have never done 1.5 year of medicine anywhere else. 'The bread and butter' medicne that folks like to hum and haw about is a mute point. Most medicine programs in inner cities will provide that (be it at CCF, Metro or CWRU in town). It's the extra exposure that you need to see that should make the difference in your residency of choice. Cards services- manage plenty of MIs (again if they are in cardiogenic shock, does 'in4mthsMD' think he/she can care for that on the floor? probl. needs balloon pump, swan, blah blah), CHF exacs, but plenty of fresh aortic dissections, acute symptomatic valvular disease and so on. My last week on service last month admitted 3 wegener's exacerbations (just dumb luck), acute GI bleed in a gal w/ cryoglobulinemia/CKD/CAD/clots all over the place- the 'bread/butter' GI bleed's there, but somewhat complicated by all her other problems. Again, the daily medicine cases are there imbeded in a complex history about 2/3's of the time. Cared for 2 aortoenteric fistula folks as an intern (obviously a surgical problem, not medical). How many alcohol/cocaine abusers and fresh MIs do you need to see before one is competent.... So in regardings to this individual's comment about variable knowledge amongst the senior residents, I don't know how many residents he was speaking of nor do I know which part of the year he had rotated (obviously, 2nd year residents senioring in July/Aug/Sept are not as proficient as 3rd residents senioring those same months for obvious reasons)- but this was also the case when I trained at several large academic california institutions. Speaking for my class, I would say 90-95% of my colleages are excellent, very knowledgable to bounce questions off of (especially when moonlighting) and reliable/trustworthy/loyal (the most important factors beyond the 'intelligence' thing).
Our board pass rate this recent class was reportedly 100%. Will find out about fellowship stuff in a few months after the match. I don't think that being born and raised in Pakistan/Canada or Germany should make you any less cometititive/smart than any US grad; just means they weren't born in the US. wasn't Osler from McGill Univ. in Canada? hmm... I interviewed at Mayo recently and would have to say a large # of staff (or 'consultants') were your 'less competitive, booksmart preparing for the USMLEs' foreign medical doctors.
Overall 2 second opinion:
strong academic/case exposure and knowledgable teaching staff (92-95% of the time, but was the case when I was a student at home as well)
busy work environment
research in every specialty is plentiful
great camaraderie amongst us (w/ the rare exception of a selected few, just the same at Mass Gen, Baylor, UC colleges)
The training is there whether you want it or not (you have to learn how to care for DKA/ARF/tumor lysis syndrome/acute mitral insufficiency etc. in the middle of the night by yourself someday)
Don't create your own impression based on someone else's opinion until you see it yourself (if you practice medicine that way you'll 'suck')- you're welcome to see what we're about in person (or email)
hope that sheds some light on our humble program.
peace
