Most important factors in ranking ob/gyn residencies

[wannabeOBGYN]

So what are people's main factors in considering programs for their rank list? I've heard people mention so many different things that I'm curious about what you guys are looking at or looked at when you were making your ROL. I'm referring to main factors, not small sideline issues that you consider later.

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[wannabeOBGYN]

Over 50 views and not a single vote. Why am I not surprised?

 

[OBGYN2016]

Pretty much all of the above are considerations for me. To be honest, how I weigh one thing over another (for example location vs. fellowship opportunity) is still to be determined as I make my list. I'm nearly done interviewing as still haven't decided what is most important to me.

 

[HumbleMD]

Starting out I was looking for a rigorous program (unafraid of rolling my sleeves up and getting my hands dirty), research opportunities and support, good Onc matches, and programs with a holistic and multidisciplinary approach to medicine (ie midwives on the labor floor). As a single person, the city also has a large influence. I've had a difficult time assessing "fit" with residents, perhaps because I applied to all very similar programs. I've really only had one place where the majority of residents rubbed me the wrong way (they seemed ditzy).

Rolling into the end of the process, I'm starting to put programs in "baskets" in my mind:
-Perfect program, Perfect city (luckily my # is clear)
-Pretty good program, pretty good city
-Great program, mediocre city
-Mediocre program, great city
-Private, easy, cush programs in great cities (I find Cornell, UCLA, Northwestern shockingly similar).

The challenge of the next 2 months is prioritizing life vs. career training.

 

[berger911]

It is pretty tricky. If you are interested in fellowships, I think it is of utmost importance to keep that door open. I interviewed at a very reputable program, in the perfect city, but the program has not been able to match residents into oncology. The residents and program were great but because of the low match rate, I have eliminated this program from my rank list. Even though I would be very happy as a generalist, I do not want to risk not being able to match.

Also while I agree UCLA and Northwestern are very similar, I found it interesting that you believe it to be a mostly private institution. Maybe they did a good job hiding their number of private patients? Also what is your definition of cush? Residents in some New York schools are drawing their own blood and carting patients from the floor to the OR. That doesn't sound like something a resident should be doing.

 

[FutureDoc734]

There are so many factors to consider, based on what each person is looking to get out of residency. I'm interested in fellowship training, so a program that has plenty of opportunities for research and good match rates are a must. I also want to try to see and do as much as possible - so high volume, although not hugely important, is also a plus for me. A good balance of gyn and Ob would be ideal - most programs are able to get their Ob numbers without a problem, but gyn procedures are the tricky ones to find. Location is high in my priorities as well - there have to be enough opportunities in the area for my significant other to also find a job.

Ultimately, though, my biggest factor is the current residents - are they nice, outgoing, down to earth, friendly? do they seem to get along? do they hang out together outside of work? do they seem supportive of each other? I'm going to be spending more time with them than at home, so a supportive environment is absolutely necessary!

 

[Miss Alyssa]

Starting out I was looking for a rigorous program (unafraid of rolling my sleeves up and getting my hands dirty), research opportunities and support, good Onc matches, and programs with a holistic and multidisciplinary approach to medicine (ie midwives on the labor floor). As a single person, the city also has a large influence. I've had a difficult time assessing "fit" with residents, perhaps because I applied to all very similar programs. I've really only had one place where the majority of residents rubbed me the wrong way (they seemed ditzy).

What are some of the programs you found that are more multidisciplinary? I'm also interested in programs like this. I found out that Brown is like this and I would love to know of more.

There are so many factors to consider, based on what each person is looking to get out of residency. I'm interested in fellowship training, so a program that has plenty of opportunities for research and good match rates are a must. I also want to try to see and do as much as possible - so high volume, although not hugely important, is also a plus for me. A good balance of gyn and Ob would be ideal - most programs are able to get their Ob numbers without a problem, but gyn procedures are the tricky ones to find. Location is high in my priorities as well - there have to be enough opportunities in the area for my significant other to also find a job.

What have you found to be a "good" number of gyn procedures?

 

[berger911]

Pitt and Columbia are also multidisciplinary.

 

[FutureDoc734]

If the number of gyn procedures (TAH, LAH, vag hysts, etc) is at least at the 50th percentile, as compared to national averages, I find it to be acceptable. Although I'm definitely interested in a fellowship right now, I have no idea if I'll change my mind in the future, so I want to make sure that, if that were to happen, I could still go out into private practice and be prepared in terms of gyn surgery.

I also pay close attention to forceps deliveries - to me, it is a really important skill to have, and a dying art, so I hope to find a program where the faculty feel very comfortable at using them (this is the exception, and not the rule, nowadays).

 

[THP]

My opinion:

#1 - Goes without saying. You want to be well trained otherwise you have wasted your medical education. Even if the location is perfect, if you are not prepared to practice upon leaving don't go there. Fortunately, nearly all accredited residencies will provide you with this. Don't worry about board pass rates, you will get out of it what you put into it, that being said a high pass rate is nice to see.

#2 - Location. Granted you will be in the hospital most of the time but if your spouse or you hate where you live you can easily lapse into depression.

#3 - GYN surgery numbers, especially laparoscopy. Its a little misleading because you want to know how much of the procedure the resident is actually doing and there is no way to really know this unless you do an away rotation. You could always ask at interviews.

#4 - how easily do you mesh with the residents. I could be persuaded to combine this with location.

#5 - faculty accessibility. Do your attendings like to teach? Are you thrown to the wolves with little guidance?

#6 - Fellowship match rate if you are at all thinking about a fellowship, you want to go to a program that has all subspecialties represented.

#7 - How well are residents supported by the hospital in general and your program specifically.

#8 - a bunch of other stuff.

Also, I love the forceps comment, it never would have occurred to me to look at that. It really is a dying art (of note, dying along with it is the 4th degree tear repair).

 

[Miss Alyssa]

Pitt and Columbia are also multidisciplinary.

If the number of gyn procedures (TAH, LAH, vag hysts, etc) is at least at the 50th percentile, as compared to national averages, I find it to be acceptable. Although I'm definitely interested in a fellowship right now, I have no idea if I'll change my mind in the future, so I want to make sure that, if that were to happen, I could still go out into private practice and be prepared in terms of gyn surgery.

I also pay close attention to forceps deliveries - to me, it is a really important skill to have, and a dying art, so I hope to find a program where the faculty feel very comfortable at using them (this is the exception, and not the rule, nowadays).

My opinion:

#3 - GYN surgery numbers, especially laparoscopy. Its a little misleading because you want to know how much of the procedure the resident is actually doing and there is no way to really know this unless you do an away rotation. You could always ask at interviews.
.

Thanks for the above!
On the APGO site they have a section for Gyn and Ob number. And Question 31 seems to be broken down into what the resident actually does.

31. Approximate typical resident experience (total for 4 years)

OB EXPERIENCE
Procedure Surgeon / Assistant
Spontaneous deliveries 371 /13
Operative vaginal deliveries 34 /1
Cesarean deliveries 291/ 37
Surg procedures on antenatal pts 0/ 0

GYN EXPERIENCE
Procedure Surgeon / Assistant
Abdominal hysterectomy 82/ 2
Vaginal hysterectomy 28/ 0
Laparotomy w/o hysterectomy 51 /1
Surgery for urinary incontinence 87/ 11
Operative laparoscopies 62/ 0
Operative hysteroscopies 91/ 3
Conizations 17 /0
Vaginal probe USG 112/ 0

 

[FutureDoc734]

Also, I love the forceps comment, it never would have occurred to me to look at that. It really is a dying art (of note, dying along with it is the 4th degree tear repair).

I agree with the comment about 4th degree lacs! But, that's why I'd like to learn to use them really really well. I did a rotation with a private doc that used them all the time, and I noticed that forceps was what got the patient(s) out of having to get a c-section, or the baby out in time because of late decels, or it helped mom when she was exhausted from pushing. They made a huge difference, and, personally, as long as you know how to use them properly, they seem almost a bit safer than a vacuum extraction. Whether or not I'm correct based on evidence, I'm not sure.

 

[anonperson]

So what are people's main factors in considering programs for their rank list? I've heard people mention so many different things that I'm curious about what you guys are looking at or looked at when you were making your ROL. I'm referring to main factors, not small sideline issues that you consider later.

Gyn numbers should be high on your list.
How are the vaginal surgery numbers, laparoscopic numbers etc.
When are residents getting in on these cases etc? For straightforward abdominal hysterectomies, interns should be scrubbing just with the attending on these cases.
Types of cases and complexity of cases, etc.

Obstetrics wise
-Is your program getting good obstetrics volume? Are they sending out any patients for whatever reason? Generally this boils down to problems with the NICU. If they are unequipped to handle something, then that 24 weeker with PPROM is going else where then, even if the obstetricitian is able to manage things on their end.

As far as forceps goes. It's a dying art and honestly, it's just a matter of 10-15 years probably before it's completely vanished for whatever its worth. When I interviewed, I thought for sure that this was something important to me, but in all honesty I have seen both sides. I work with attendings very skilled in forceps deliveries in which doing a Scanzoni maneuver is no big deal and although it does come in handy it isn't without its morbidity to the patient in terms of fairly significant lacerations (4th degrees etc). Now what exactly is better now, a 4th degree laceration or having a c section. I can't answer that and am not sure which is.

But you can still practice effective obstetrics without knowing the art/science of forceps.

Fellowship
If you want to do a fellowship, go to a place that matches them well. This does not have to be a big name institution. Look for places that have good mentoring from faculty. You need people to back you up and offer their guidance.

Peer interaction
There will always be some friction in any residency program. It's just a matter of the amount and whether people can be civil with each other. This is hard to judge unless you did an away or have an inside source.

CREOGS/Boards etc
Look for a program that offers some support/guidance for CREOGs and written boards. Askl current residents how they felt in terms of how/if the program assisted in their prep for these tests.

Pertaining to the CREOGs, although it isn't used officially for advancement, it is a decent indicator of your knowledge base. In addition the scores may play a role in fellowship down the line.

Time off/Perks
How does the residency treat its residents in general? Are there any extra benefits or are you just slave labor?

Attending interaction
A lot of cases, especially GYN will be done with private attendings. Do they let residents do the cases or are they using them as retractors? In my program, our upper levels will sit for any vag hysters that any of the privates have scheduled.

I was able to do my first classical C/D as a intern on a private patient with my attending with me holding the knife and delivering the kid.

You want a program in which the attendings do embrace or at least tolerate having residents.

 

[sia_simba]

1. Board pass rate
2. GYN surgeries
3. Attending and resident friendliness

If I had to pick again, those would be my top 3 choices.

1. You need to be board certified.

2. When you are on your own, you need to know how to do a variety of gyn surgeries. People will DELIVER themselves... we just stand there and catch. At our program, the residents are usually the main surgeons. The Attendings are 1st assist. Even today, I had a vag hyst a/p repair tvt-o and sacrospinous ligament fix and it was a pgy4 in the center operating. So the interaction and opportunity to do major surgery is VERY important.

3. You need to feel that everyone gets along. Therefore, friendly environment is very important.

Goodluck!

 

[Isame]

If the number of gyn procedures (TAH, LAH, vag hysts, etc) is at least at the 50th percentile, as compared to national averages, I find it to be acceptable.

I have been given the numbers for the places I've been interviewing or finding them on the APGO website, but looking back on my notes, I didn't always write down the percentiles. Is there a resource where the average numbers or percentiles are posted? I haven't been able to find them.

 

[berger911]

I have been given the numbers for the places I've been interviewing or finding them on the APGO website, but looking back on my notes, I didn't always write down the percentiles. Is there a resource where the average numbers or percentiles are posted? I haven't been able to find them.

i also would love to know if anyone has this information.

 

[THP]

I have been given the numbers for the places I've been interviewing or finding them on the APGO website, but looking back on my notes, I didn't always write down the percentiles. Is there a resource where the average numbers or percentiles are posted? I haven't been able to find them.

Any place that you have interviewed and they disclosed those numbers, just e-mail the contact from the residency and I am sure they will send them to you.

 

[Isame]

Well, I found it.

ACGME Summary #'s for 09-10 from a presentation given during an interview.
Procedure: 10%, 30%, 50%, 70%

OB
SDel: 193, 238, 273, 320
CDel: 159, 201, 236, 274
ODel: 13, 19, 25, 32
Forcep: 1, 3, 6, 10
VAVD: 7, 13, 17, 23

GYN
AHYST: 40, 54, 64, 79
VHYST: 9, 14, 18, 24
LSC HYST: 10, 16, 23, 32
ISPF: 40, 63, 86, 111
LAPS: 52, 71, 88, 107
OP HSC: 33, 50, 64, 81
ABORT: 15, 24, 35, 51
TV US: 43, 74, 104, 140
Total HYST: 79, 97, 112, 130
Total LSC: 70, 94, 113, 137
Inv CA: 23, 43, 54, 79


Happy comparing

FYI, I believe ACGME requires only 15%ile from programs.

 

[Geekchick921]

I believe Pennsylvania Hospital also has midwives participating in resident training. I'm not sure about HUP, though. Pennsy mentions it on their website (well, they say mid-levels but they have about a dozen midwives on staff there so I'm sure they're included in that).

I have always been very interested in Ob/Gyn and I have two children, one I delivered with a doctor (induction -> C-section), another with a CNM (spontaneous labor -> VBAC). If I ultimately choose Ob/Gyn for my specialty, a program that's multidisciplinary would be really important to me.

 

[wannabeOBGYN]

How well does everyone feel they have been able to assess the friendliness of the residents during interviews? I ask because I interviewed at a particular program prior to doing a rotation there and my feelings about the residents were vastly different (and sadly to say, not for the better in the long run). I am now second-guessing my feelings about all the other programs that I thought had friendly residents. I am usually a very good judge of character; I guess the charade of interview days and people being on their best behavior fooled me. I'm just not sure if I should go with my initial feelings or try to set aside residents being friendly as a factor and look more at other stuff now.

 

[anonperson]

How well does everyone feel they have been able to assess the friendliness of the residents during interviews? I ask because I interviewed at a particular program prior to doing a rotation there and my feelings about the residents were vastly different (and sadly to say, not for the better in the long run). I am now second-guessing my feelings about all the other programs that I thought had friendly residents. I am usually a very good judge of character; I guess the charade of interview days and people being on their best behavior fooled me. I'm just not sure if I should go with my initial feelings or try to set aside residents being friendly as a factor and look more at other stuff now.

What does friendly really mean anyways? Not trying to be sarcastic but I would like to know what your perspective is. Do you want an environment where everyone is best friends and hangs out together after work etc?

What's important is that upper levels aren't abusing lower levels or treating them unfairly and that people can get along well enough to do a good job in taking care of patients.

I get along with everyone reasonably well at my program. Like any type of work environment, I get along better with some versus others. But you still are able to be civil with each other and know that they have your back in difficult situations.

 

[wannabeOBGYN]

What does friendly really mean anyways? Not trying to be sarcastic but I would like to know what your perspective is. Do you want an environment where everyone is best friends and hangs out together after work etc?

What's important is that upper levels aren't abusing lower levels or treating them unfairly and that people can get along well enough to do a good job in taking care of patients.

I get along with everyone reasonably well at my program. Like any type of work environment, I get along better with some versus others. But you still are able to be civil with each other and know that they have your back in difficult situations.

I'm not looking for everyone to be best friends and hang out all the time. I'd just like to be somewhere with residents that get along for the most part, are friendly with each other (e.g. care about one another's lives enough to ask how they're doing), and the lower levels are treated fairly and not abused, as you said. It'd be nice to get close with a few residents that I could hang out with, but I by no means expect to be BFFs with everyone I work with. If I had to pick one factor, it would be how lower level residents are treated. I would take respect and a solid learning environment even if nobody cared about me as a person outside of being a part of the team.

 

[wannabeOBGYN]

Well, I found it.

ACGME Summary #'s for 09-10 from a presentation given during an interview.
Procedure: 10%, 30%, 50%, 70%

OB
SDel: 193, 238, 273, 320
CDel: 159, 201, 236, 274
ODel: 13, 19, 25, 32
Forcep: 1, 3, 6, 10
VAVD: 7, 13, 17, 23

GYN
AHYST: 40, 54, 64, 79
VHYST: 9, 14, 18, 24
LSC HYST: 10, 16, 23, 32
ISPF: 40, 63, 86, 111
LAPS: 52, 71, 88, 107
OP HSC: 33, 50, 64, 81
ABORT: 15, 24, 35, 51
TV US: 43, 74, 104, 140
Total HYST: 79, 97, 112, 130
Total LSC: 70, 94, 113, 137
Inv CA: 23, 43, 54, 79


Happy comparing

FYI, I believe ACGME requires only 15%ile from programs.

So if a program has less than that, should it be a huge red flag, or should we take it with a grain of salt? These numbers were for 09-10 and some of the places I'm ranking gave numbers for different years.

Also, how many months of each subspecialty do you guys think is sufficient? I've seen some places with only 1 month (usually urogyn) and others with as many as 6 per subspecialty. Thanks!

 

[chsekar987]

Im an Indian Medical Graduate. I graduated in 2010 march. Im starting writing STEPS now. Im interested in OBGYN residency. But i hear people telling me that OBGY for IMGs is not possible. IS it true? what are the chances of gettin a research or externship? I need OBGY residency. Is it possible to get it? What would be the requirements for that?
Plz help me with info.

 

[Miss Alyssa]

Bump!
Any more advice on ranking? I have a 5 way tie for #3. Each program has its own pros and cons and I keep going back and forth over whats most important for me

 

[wannabeOBGYN]

I originally posted this last year. I have since matched and am 7 months into my intern year of OB/GYN. While I love what I do, I don't particularly like the location and to be honest, I don't have any friends here. If I could go back, I'd take a long hard look at the relationships among the residents at every program I visited. You're going to get a fine education wherever you go as long as they're not on probation. Most of your education is done on your own time anyway, so it doesn't matter where you are. Find people you gel with, who you feel you could work with and be friends with, people that hang out once in a while and who do not need to be forced to show up to what should be enjoyable events. That's what I would do.

 

[THP]

I agree with the comment about 4th degree lacs! But, that's why I'd like to learn to use them really really well. I did a rotation with a private doc that used them all the time, and I noticed that forceps was what got the patient(s) out of having to get a c-section, or the baby out in time because of late decels, or it helped mom when she was exhausted from pushing. They made a huge difference, and, personally, as long as you know how to use them properly, they seem almost a bit safer than a vacuum extraction. Whether or not I'm correct based on evidence, I'm not sure.

My 4th year of residency I really sought out forceps deliveries and I now much prefer to use them. I had a subgaleal bleed as a resident, the baby did fine but man I was nervous.

I especially prefer forceps for the prolonged second stage with a significantly moulded head.

Since I've finished residency and joined a large private practice in August I have done 2 forceps deliveries. Both with 2nd degree lacs. I don't think any of my partners do them.

 

[Miss Alyssa]

I originally posted this last year. I have since matched and am 7 months into my intern year of OB/GYN. While I love what I do, I don't particularly like the location and to be honest, I don't have any friends here. If I could go back, I'd take a long hard look at the relationships among the residents at every program I visited. You're going to get a fine education wherever you go as long as they're not on probation. Most of your education is done on your own time anyway, so it doesn't matter where you are. Find people you gel with, who you feel you could work with and be friends with, people that hang out once in a while and who do not need to be forced to show up to what should be enjoyable events. That's what I would do.

How do you judge the relationship between the residents? I found it kinda difficult at the preinterview dinners and on the interview day. There were a couple places where the residents didn't seem too happy, but it was hard to tell if they really liked each other. And of course every program said that one of their strongest points was their residents.

 

[jv24601]

How do you judge the relationship between the residents? I found it kinda difficult at the preinterview dinners and on the interview day. There were a couple places where the residents didn't seem too happy, but it was hard to tell if they really liked each other. And of course every program said that one of their strongest points was their residents.

I feel the same way. You basically have 24 hours to see if you like the residents and the residents like each other, but is that really possible? I went to some preinterview events where the residents spent a lot of time talking to each other, but it seemed like it was more catching up since they very rarely get time off together than super-close friendship. I feel like the other hard part is that there's no way to know who your fellow residents will be. Unlike in med school where you get accepted and then go to revisits, the match process doesn't really make it possible to pick you want to have as classmates.