I was surprised to see this old thread bumped and wanted to anonymously weigh in as a fairly recent grad of the program. There's a number of pluses and minuses:
Plus:
-Tons of pathology is right. CRMC is the biggest hospital in the surrounding 5-6 counties and you'll see all kinds of stuff you imagined only ever reading about in a textbook. Rare cancers, late stage AIDS, whatever.
-Ever-increasing # of fellowships in house, rare for a more community program. They're up to cards, GI, pulm, ID, heme/onc, sleep, and palliative.
-Residents get along great, very few interpersonal problems. Most of us make friends for life, still keep in touch with our old prelims years later, etc.
-Free food at CRMC is a major plus. The two doctors lounges between them have hot breakfast/lunch M-F, snacks available pretty much 24/7, and if you're on call overnight or working the weekend you get $21 you can spend in the cafeteria or coffeeshop
-Lots of elective time as an intern, like 3-3.5 months. It's a lot more than most programs I interviewed at.
+/-
-Lots of Spanish speaking patients, especially if your continuity clinic is at CRMC.
-Quite procedure heavy for an IM program- great if you are interested, but not so great if you never want to do any. There's requirements for minimum number of line/LP/thora/para/art line/pap smear that most people exceed a fair bit.
-The schedule is variable and people either like it or they don't. The program directors tweak it every year based on resident feedback, but there's no way to make everyone happy. There's a minimal # of 28 hour shifts at the VA (something like 12 total split between your PGY2 and 3 years depending on your exact schedule) and otherwise there's night float but a pretty manageable amount: only 2 weeks total as an intern these recent years, something like 6 or 7 weeks each year as a PGY2 and 3.
-The PGY2/3 have a pseudo X+Y schedule, interns have a traditional clinical schedule.
-Fresno as a city is cheap and is only ~3 hours from SF or LA, within 2 hrs of the coast or mountains.
Minus:
-No food at the VA. There's a fridge with some sandwiches if you're on call, but that's about it. From what I hear, that's fairly typical for a VA though
-You're very busy. Caps are always set at 20 patients per team, and you'll typically hit them on call days q4 at CRMC and q3 at the VA.
-Research is not as big a focus as the major academic programs if that's your thing.
I never used the errand service discussed above, so I can't comment on it. I also was never accused of using drugs (and never heard of any residents being accused of that) so I can't speak to that either. What I can say is that the program will bend over backwards to try to work with any struggling residents. Most of the residents are DO/IMG/FMG, but there's a few US grads each year and I'd say one of the major reasons for that balance is really geography. I personally like Fresno, but it doesn't have the most amazing reputation amongst CA cities.
In addition, I can say that prelims and categoricals are treated completely identically, other than the fact that prelims probably are less expected to do procedures if they don't want to (the anesthesia prelims always did, the derm prelims not so much). Prelims even do a full IM continuity clinic for their year, unlike a lot of programs I've heard of.