What's the problem with being inbred...

[sprinkibrio]

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...in terms of going to medical school, residency, fellowship, and becoming faculty at the same medical center. (Or 3 out of 4 or something.) Is it the cockiness of knowing how everything works at a place or the disadvantage of not getting to see more than one way of doing things?

 

[osli]

Never quite figured that one out either. I've heard various "theories" but none really made a whole lot of sense. The most believable usually have something to do with not wanting everyone to know about all of your screw-ups during the learning process... as if we are all to believe that when a new doctor/professor/whatever comes to town he was the hot **** all through his education and never messed up.

The same "advice" seems to apply to pretty much everything. Don't get your BS, MS, and PhD from the same place. Don't teach where you get your PhD. Don't be a physician in the town where you did your residency. Don't teach at an institution where you did your residency.

Here's the ones I really love... Don't do a residency and fellowship where you want to practice/teach - go somewhere else for one or the other and come back.

 

[Hayden2102]

What?

 

[deleted77919]

One theory is that it can be tough for a resident who just finished at that program to be seen as a full equal because the other attendings are used to seeing that person as a resident. Tough to get rid of that.

 

[thedelicatessen]

In general, different experiences can be invaluable for perspective, and I'm sure you can gain more skills by being a part of different institutions.

 

[bubbachuck]

imaging growing up in one place your whole life. all your experiences will be based upon a localized view. there are obvious advantages to seeing how things are done in other places.

it's the same as being genetically "inbred." Negatives are magnified and there is not a good opportunity to incorporate positives from outside sources.

 

[Ashers]

imaging growing up in one place your whole life. all your experiences will be based upon a localized view. there are obvious advantages to seeing how things are done in other places.

it's the same as being genetically "inbred." Negatives are magnified and there is not a good opportunity to incorporate positives from outside sources.

I've talked to a bunch of people in my class who went to elementary-high school near the med school, college either in the state or in the same county, they plan on doing residency here, and they plan on practicing here, and some have never left the Midwest.

I hadn't thought of the other reasons mentioned to want to do residency etc at different locations, but I was stunned when I asked "You don't want to see what it's like to live in another part of the country?" And some people would just say, "No, my whole family's always lived here."

 

[Doctor Bagel]

I've talked to a bunch of people in my class who went to elementary-high school near the med school, college either in the state or in the same county, they plan on doing residency here, and they plan on practicing here, and some have never left the Midwest.

I hadn't thought of the other reasons mentioned to want to do residency etc at different locations, but I was stunned when I asked "You don't want to see what it's like to live in another part of the country?" And some people would just say, "No, my whole family's always lived here."

That's a pretty common mindset around here, too, and it's something I've never gotten.

As for wanting to train elsewhere, if you train at the place where you went to medical school, you're going to work with the same people, and yeah, you might miss out on some new viewpoints. Also, if maybe something is not ideal in your location, you might never know it because you've never seen anything else.

 

[45408]

I hadn't thought of the other reasons mentioned to want to do residency etc at different locations, but I was stunned when I asked "You don't want to see what it's like to live in another part of the country?" And some people would just say, "No, my whole family's always lived here."

I like my family. It would be a drag to be far away from them. Yesterday I went to the cemetery with my all my siblings and both my parents, because it was 20 years ago that my brother died. On Sunday morning, my brother received a really significant award that I'd always been telling him that I hoped he would attain. Later that night, I went over to my in-laws for dinner. I'd rather not miss these things in life.

 

[Ashers]

I like my family. It would be a drag to be far away from them. Yesterday I went to the cemetery with my all my siblings and both my parents, because it was 20 years ago that my brother died. On Sunday morning, my brother received a really significant award that I'd always been telling him that I hoped he would attain. Later that night, I went over to my in-laws for dinner. I'd rather not miss these things in life.

Ok, so I should've added to mine, that some of these people, the ones that have never left the Midwest, didn't even want to travel anywhere. It's like, c'mon, don't you even want to see somewhere else? I figured college, med school, and possibly residency are chances to see different parts of the country that I wouldn't necessarily spend too much time in otherwise, and maybe I'll like one of them enough to move back, since I'm sure not going home. At least I know you're willing to travel places to experience something other than the midwest.

I've never lived near family, other than my parents. The closest was college when I was 100 miles away from my aunt and uncle.

Sorry about your brother. =(

 

[WiscDoc]

I agree about the whole not being seen as a "full equal." However, it is likely that you weren't everybody's resident, and so, not every attending is used to seeing you as that resident. Plus, during your residency/followship, the way attendings view changes basaed on your preformance and skills you acquire. I'm sure surgical residents is their 4th-5th year or followship are view much different that surgical interns. I'm sure most of them do procedures on their own and are tursted with a lot of tasks. So, by the time they have completely finished their training, they will be viewed as almost "a full equal" anyways, and with a few more years of practice, they will be FULL equals.

As for why institutions don't like being inbred, is that they like diverse epxeriences and also want to send their graduates to other places as a form of "advertisement" or to become better known. that's what my undergrad chair of engineering told me about grad school.

 

[thedelicatessen]

While I still stand by my original theory that varying experiences provide good perspective and growth, I can see how if you're absolutely sure you want to stay in the same area for the rest of your career, it really doesn't matter if you go elsewhere or not. I know at my institution they really want us med students to stick around and practice in the area, and the majority do.

However, if you're looking to advance your knowledge base and career options, it is definitely better to get lots of different experiences everywhere. I personally have a loyal tumbleweed philosophy, going far for my undergrad but coming back closer to home for med school, but ideally, I would like to go elsewhere for further training.

 

[Writer1985]

I've heard of inbreeding as something to be avoided with grad school (getting your bachelor's and master's/PhD at the same place) but never with medicine. I've always thought of residency as vastly different from med school, just like med school is so different from undergrad, even if you do both at the same university.

The match list from my school seems to place an awful lot of people in residency programs here. I think it's consistently like half the class. And one of my interviewers (at another school) had done undergrad, med school, residency, and fellowship at that school and was now faculty there. I can see the value of getting diverse training and teaching, but when you are older and have a family, isn't it much harder to keep moving every few years?

 

[g3pro]

Regarding inbreeding, my uncle used to tell me that not playing to win is like sleeping with your sister. Sure she's a great piece of tail with a blouse full of goodies, but it's just illegal. Then you get into that whole inbred thing. Kids with no teeth who do nothing but play the banjo... eat apple sauce through a straw... pork farm animals.

 

[45408]

Regarding inbreeding, my uncle used to tell me that not playing to win is like sleeping with your sister. Sure she's a great piece of tail with a blouse full of goodies, but it's just illegal. Then you get into that whole inbred thing. Kids with no teeth who do nothing but play the banjo... eat apple sauce through a straw... pork farm animals.

You only lose 6 IQ points for every 10% of the coefficient of inbreeding, which is only 25% at most (that's if you knock up your sister).

 

[MattD]

I think one of the big issues with 'inbreeding' is the student-teacher dynamic that develops during training. Some people have already mentioned that your former instructors may not see you as an equal, which is surely valid. However, I think even more important than that is the need for the former student to cut the umbilical cord and sink or swim on his/her own. If you stay at your home institution, you're always going to have that impulse when you run into trouble to go to your old mentors and ask for their help. Eventually, you have to get out from under their shadow and do your own work. This is why even at institutions that adamantly refuse to hire their own grads out of school, they'll often take them after an extended period elsewhere.

 

[Sean2tall]

I would agree that the main thing is deficiency in the training at any one place. Let's see you go to a place that is known for having good Hem/Onc, but no Trauma or Transplant, then stay there for residency, you are never going to have much insight into Transplant, which is fine if you don't intend to ever do that, but it's just something missing from your education.

Also, I can see the peer status issue also, which is generally minor.

 

[soeagerun2or]

I don't see a problem with the thought that if you train at a place and stay on as faculty it's tough to shake the image of being younger and less experienced. That's the fact. Even if you leave for another institution you often get paired with an older, more experienced physician to be your mentor and aid your maturation.

Inbreeding at programs creates a cult-like culture wherein the way things are done here are how they're done, and they've always been done that way. Programs which have an exceptionally high proportion of their own graduates are more resistant to change and less able to adapt to new technology and teaching paradigms.

 

[TexasTriathlete]

 

[Depakote]

One theory is that it can be tough for a resident who just finished at that program to be seen as a full equal because the other attendings are used to seeing that person as a resident. Tough to get rid of that.

I did research in a Heme/Onc/BMT group for 2 years. Both years, senior fellows were hired on as Attendings. This seemed to be a nice/easy transition b/c everyone already knew the fellows and as July 1st got closer the fellows picked up more and more responsibilities. I saw it as a positive.

 

[SemperJeff]

I think one of the marks of a good training institution is that they wean you off the need to keep running to your attending. That's why the number of responsibilities increase as you spend more time in a residency. A chief surgical resident might not need an attending to scrub in. A good program teaches you to become independent.

And, going to a colleague for a consult isn't a bad thing... so seeing an old mentor for advice shouldn't be a negative unless you do so every single time out of a lack of self-confidence in your own diagnosis.

I think one of the big issues with 'inbreeding' is the student-teacher dynamic that develops during training. Some people have already mentioned that your former instructors may not see you as an equal, which is surely valid. However, I think even more important than that is the need for the former student to cut the umbilical cord and sink or swim on his/her own. If you stay at your home institution, you're always going to have that impulse when you run into trouble to go to your old mentors and ask for their help. Eventually, you have to get out from under their shadow and do your own work. This is why even at institutions that adamantly refuse to hire their own grads out of school, they'll often take them after an extended period elsewhere.

 

[Smurfette]

The thing about "inbreeding" is that you don't get exposed to other systems or other people's views. Different institutions have different policies, different ways of dealing with certain situations, different strengths and different weaknesses. Only going through training at one institution (though not uncommon) can leave someone with a false sense of security (i.e. great nursing at hospital of training, mediocre nursing where practice can initially leave you assuming you would be notified of certain problems with your patients or that certain protocols would be done to facilitate you patient to get specific type of care, only to discover an adverse outcome by not realize a difference in philosophy), and a narrower perspective on ordering certain tests or procedures because your institution of training didn't do things that way.

There's nothing wrong with staying at the same institution, it is simply that people who do so often find when they leave that institution that they are exposed to other methods of doing things, and need to keep an open mind toward these methods.

 

[brewmeistervi]

There is an excerpt from Feynmen's autobiography that discusses how he thought the world rotated around his undergraduate institution ( MIT ). When he was making a choice about his graduate career, he thought the decision was simple until he talked around, and looked up other grad schools. When he went to Princeton for his Ph.D., he learned to see everything interesting new light...

Not everyone is a Nobel Prize winner, but if he can stand to learn a few new tricks, I'm sure we all can.

 

[akpete]

I've never lived near family, other than my parents. The closest was college when I was 100 miles away from my aunt and uncle.

See that's why you just don't quite understand. You aren't used to having family around, so to move away isn't really as big of a deal.

My entire extended family lives in a 30 mile radius. So for me, it is a big deal if I would move to the east or west coast (in contrast to the 4 hour drive it is now). When you grow up around all your family, you feel like you're missing a lot when you move away.

I'm open to moving somewhere, but I'd really prefer to stay in WI or MN. I like the twin cities, Madison, Milwaukee. I'm perfectly fine with just visiting other parts of the country. There's nothing wrong with people wanting to stay close to family.

Anyway, back to the main topic of the thread.

 

[t33sg1rl]

I just finished a rotation with a brand new attending who'd just finished residency at the same hospital. She was having quite a bit of trouble adjusting and so was everyone else. Granted, I think a lot of the problem was her inability to project authority, but she also had difficulty with getting respect-she repeatedly got pages that should have gone to the intern and it drove her nuts. Other people kidded with her constantly about how she was a big, bad, attending now... and I'm pretty sure she didn't find it funny.

Then again, I'm considering doing the same thing she did, so call me crazy.

 

[baylormed]

I was about to post some of my recently acquired knowledge of genetic disorders, until I read the actual posts more carefully.

 

[HoboCommander]

The problem with inbred children is that often they have genetic defects. It's best to not inbreed.

 

[sprinkibrio]

I was about to post some of my recently acquired knowledge of genetic disorders, until I read the actual posts more carefully.

Haha! Yeah, and I can't tell if hobocommander is kidding or not. Premeds need to teach me a thing or two about genetics. 🙂 Thanks for the answers guys, no question has ever been so exhaustingly answered!