Disclaimer - I spent a month at the Mayo Clinic in Rochester on a IM subspecialty rotation, so I feel like I got a very good inside look at part of the program, although I didn't see much of the inner workings of the general IM teams. This review only refers to the Mayo - Rochester program.
Overall - The major strengths of the Mayo IM program is an absolute dedication to education, a strong focus on academic medicine, and an institutional culture of excellence. Disadvantages for some include the location, lack of patient diversity, and the emphasis of sub-specialty medicine over primary care.
The Program Director - The program director, Dr. Kolars, is one of the very few people to have been a program director at another program before - at the University of Michigan. Dr. Kolars is very nice and friendly on interview day, and each resident I spoke to said that he was great, very approachable, and a solid advocate for residents who has been effective in making changes. Nobody expects that he'll be leaving any time soon. He's also very active in the IM world, so he likely has some good connections.
The Chair - I never saw the chair nor do I know much about him. His role in the residency was never mentioned. I know a resident who works with him in a lab, and says that he's a nice guy.
Residents - This is a big residency program with 144 categorical residents; 48 per year, plus 4 chief residents, and 24 prelims. They come from 93 medical schools, with no particular medical school seeming to dominate, although typically the single biggest group comes from the University of Minnesota although this varies. Mayo Medical Schools seems too small to contribute many to their residency. About 20% of each class is made up of FMGs, all of whom I've interacted with have been amazing. The residents are typically the upper crust from midwestern medical schools, and in my experience they all range from excellent to amazing. About 35% of residents are AOA. They seem to get along very well even when very busy, and the culture of collegiality and teamwork definitely applies to the residents. It's common to see service pagers handed off from intern to senior for educational activities and if/when the intern get swamped, and other interns frequently offer to carry the service pager as well. Mayo Medical School is small but there are many visiting medical students; still, only about half the teams include a student. Residents at Mayo are expected to wear professional attire. On call and post-call they wear scrubs and a white lab coat, but at other times they are expected to be in a suit or shirt/tie/sport coat. The PD explained on interview day that this is to honor the patients just like one dresses up to attend a wedding to honor the bride and groom. In my experience the patients seem to appreciate it, and it also serves to reduce the apparent heirarchy as it's hard to tell who's who. Some may think that the suit thing makes Mayo pretentious, and while it's true that those at Mayo tend to regard the institution very highly, I've found the residents and staff to be very warm and welcoming. Every Mayo resident I met seemed very happy.
Faculty - Mayo has a huge number of faculty members, with 600 IM faculty including 140 cardiologists and 82 gastroenterologists. There is a web-based evaluation system ("ISES" I think) for the consultants (Mayo-speak for attending), residents, and medical students. Everybody evaluates everybody. The system seems to function very well with both rating scales and spaces for descriptive comments, required for everybody to complete, totally anonymous, and I was told faculty make adjustments based on the feedback, most commonly in reducing the amount of time spent rounding. Some faculty have been removed from the teaching services in the past based on their evaluations. There are no private attendings. Every faculty member that I saw made a point to teach above and beyond what was required, and treated the residents with great respect. I would regularly have nice, collegial conversations with consultants (Mayo-speak for "attending") only to later realize that they are world-famous.
Patients - 80% of their patients come from Minnesota, Wisconsin, and Iowa, which consists mostly of white farmers with some diversity provided by the Somali, Hmong, and Hispanic population. Mayo has a relatively huge number of patients flown in from across the US and the world, although this still makes up a small fraction of the total patients seen by residents. Mayo sees an amazingly large number of patients, and the PD said that with the number of patients they have he could double the size of his residency and is one of the reasons why the rumors about Mayo being "fellow run" are just not true. On my subspecialty rotation this was certainly true as my primary service was made entirely of residents and the fellows had their own service. The only rotation with significant fellow interactions are MICU in which the fellows and G3s tend to run the show, and oncology, where fellows write the chemo orders but leave almost everything else up to the residents.
Conferences - Mayo has a number of conferences for residents. Generally there will always be a ~45 minute, small group, protected teaching session specific to the service you're on led by one of the attendings or sometimes a fellow. This frequently is spent going over questions from the Mayo board review book with some good discussion after each correct answer is given. There are also noon conferences 5 days/week with lunch provided. Then there are numerous subspecialty conferences, which you can attend in place of your regular conference if you wish. The quality of the conferences that I saw was excellent. The conferences all seem to be very well attended, and I remember it being very rare that a resident or intern missed a teaching session unless they were on a "late start" day. There is also an EBM curriculum in which interns present a question, search strategy, article, and discussion, and from interview day these seemed very high quality with good discussions. The program also provides a board review course. Their board pass rate is among the top 5% in the US, so they're clearly teaching the core topics well.
Sites/Facilities - The IM residents spends about 2/3 of their time at St. Mary's Hospital and 1/3 at Methodist Hospital. St. Mary's is located about 8 blocks from the "downtown campus" which includes the main Mayo buildings and Methodist Hospital, and is serviced by shuttle running most of the hours of the day and typically includes a 5 minute wait and 3 minute ride between campuses. Residents only typically need to hit both campuses in a single day if they have clinic or are on a consult rotation covering two hospitals, or if they want to hit one of the many specialty lectures. St. Mary's is an old hospital that has been very well kept up. I believe all rooms are singles, at least in St. Mary's but probably Methodist as well. Mayo has what I suspect is the oldest EMR, most of which was developed in-house. It unfortunately requires multiple applications, but after logging into the computer your logon info is passed to each program, and when you switch between patients in one program it's updated in the others. Text order entry is done by computer but labs and radiology are done on paper forms. Admission H&Ps, discharge ("dismissal" in Mayo-speak) summaries, consult notes, clinic notes, and imaging are in the computer, with in-patient daily notes currently being hand written. They are working on moving daily notes into the EMR. There is a computer mounted on the wall outside each room, and teams all have computers on wheels. The main resident work room and conference room looks nice and well-used and is on the floor with the general medical services; other work rooms I've seen are less spacious and the computer is not so modern and sometimes there are people waiting to use it. The large cafeteria serves standard food but has a good variety. Call rooms are large, have a computer in each, and are generally either located right by the clinical area covered (MICU) or on the top floor of the hospital. I've walked through Methodist briefly once and it looks like maybe a newer building but similar to St. Mary's. Ancillary services have to be among the best, if not the best, anywhere in the US. For example, there is not only a catheter team, but a male and female catheter team. Everyone is very professional, from the doctors to the janitors and transport people. In my experience, patients were already very happy with their care by the time I met them to do the admission H&P up on the floor as everyone who worked with them so far had been very professional, polite, and courteous; needless to say, it made for a much more pleasant experience for me to have patients so well treated. The clinic buildings downtown are gorgeous and look more like 5 star hotels than anything else. I've never seen any of the primary care clinics that the IM residents cover. There are extensive tunnels under the main campus, obviating the need to spend time outside. There is also a federal prison that residents have an option of spending time at if they wish. There is also a local free clinic and a new charity clinic specifically for residents. Mayo has a new simulation center that residents in their MICU rotation practice running codes on. Mayo residents can also spend a month at the Arizona or Florida campus, and are provided with the flight, a car to use, and housing while there.
Location - Mayo is located in Rochester, Minnesota, a town of 90,000 people. It is frequently cited as one of Money magazine's Best Places to Live as housing is cheap, the local schools are good, and the population tends to be well-educated and seems to consist mostly of Mayo and IBM people. There have been influxes of Hispanic, Somali, and Hmong people recently, however, giving the primary care clinics some diversity. Rochester is located an hour and half south of the Twin Cities of Minneapolis and St. Paul, and residents seem to get up to "the cities" with some regularity to shop, eat, etc. Rochester does get cold, and it snows a lot, making the tunnels around Mayo very useful. Most residents live within 10-15 minutes, and close parking is provided so transportation and dealing with the cold isn't difficult.
Schedule - ISES, the evaluation system described above, is also used to log duty hours anonymously. Hours violations are handled in a systems-based approach, and residents have been pulled from services that can't meet the ACGME guidelines and program expectations. Mayo does not use a day or night float system, but instead uses a "late start" system in which those on call arrive at 1 pm so they can stay later the next day to get all their work done. The intern year includes 8 months of q6 call and one month of elective which can be a research block. Interns admit up to 5 patients per call day. The G2 year typically has 3-4 months of call, 2 of which are q4 and 1-2 is q6. The G2 year has one selective month and one elective month. G3 year typically has 6 months of q4 call and they strive to treat the senior residents as "junior faculty." The G3 month includes two selective months and one elective month. Late in the G2 year or early in the G3 year there is a curriculum in the science of teaching and medical education. Mayo is one of the 17 original EIP programs. Their EIP focuses on educating residents to improve patient care, and seems to include a huge number of smaller initiatives, one of which includes a root cause analysis presented at the end of each M&M. I've been told that some changes have been made stemming from these analysis. And of course, the EIP designation also is some assurance that it's a quality program. Residents have their continuity clinic a half day per week, which is either the clinic for local residents of Olmsted County, or for those outside Olmsted County. This seems a bit odd as some residents see almost nothing but bread and butter general IM, whereas some only see those who travel in to the Mayo and sometimes will literally bring suitcases of outside medical records with them. Like residents at every other place I've visited, the most commonly sited weakness of the program is the emergency department. The ED at Mayo has a very short wait time and no observation unit, so patients tend to get admitted very quickly leading to a decent number of questionable admissions. Also, the ED chooses not only if a patient will be admitted, but also to which service, so subspecialty services will get admissions that clearly don't belong on their service. Mayo may be putting a senior resident in the ED to help with such decisions.
Tracks - Mayo has two research tracks, a fairly traditional "short track" and a Clinical Research Training Program which people can do after residency and sometimes includes a master's degree. There is no primary care track. The PD does have funding up to $2000 per resident to provide the opportunity to do an international rotation, about half of which are to a site that no Mayo resident has been before. The Mayo program typically sets up residents with no less than 3 advisers, one of which is an Associate PD, one is a career mentor, and one is a continuity clinic advisor. Residents report getting excellent guidance even during their first year.
Research - They said that every year a few graduates go on to community-based practice and they are supportive of this, but they are clearly geared towards academic, research-heavy, subspecialty medicine. Residents can get a month for research per year of training, and any work accepted for presentation at a national meeting is automatically funded and coverage is arranged by the program. The same is also provided for one conference during residency in which you do not have a presentation. Residents commented that they typically accumulate multiple patients to write up as case reports per year of training and they they have have more opportunities to do case reports than time to write them up. Residents average 6-7 projects, 3-4 abstracts or presentations, 1 manuscript published, 2 manuscripts in press, and 2.67 Mayo-sponsored trips for presentations. Mayo ranks #1 in ACP resident research competition winners.
Fellowships - The focus of the residency does not seem to be primary care, and with such a research focus it's not surprising that fellowships are very popular. From my count about 80% per year go on to subspecialty fellowships not counting those who might do a fellowship in general IM. The three most popular fellowships are cardiology, GI, and heme/onc. Mayo has very strong fellowships in most areas, and it's not surprising that many residents come to Mayo hoping to stay on for fellowship and many do. Mayo publishes a match list of institutions where Mayo residents have gone from 2001-2006 but does not provide a yearly breakdown with numbers to each location so it's hard to fully evaluate their match list, but their match list seems solid to excellent.
the intern quality did seem not up to what I have seen at comparable hospitals: there was one fmg on the team I rounded ( was kickass as someone suggested in a previous post: shd have been an attending somewhere, I am not so xenophobic after all you see) . but the intern I rounded with was from some Southern medical school ( accent yeah!) and was pretty basic ( read more like a fourth year medical student): so is resident quality hurt by Rochester??? are people there just for the MAyo tag?
