Scut work and schedules among top IM programs?

[cooljoe]

Hi everyone, especially for those who are current residents or who just matched, how would you rank the malignancy and amount of scut for residents among the top 20 programs?

Thanks in advance for the advice.

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[Deferoxamine]

*makes popcorn*

 

[Gpan]

May the slavery begin, muuuuhhhaaahaahaahaa!!!!

 

[rd31]

1. Everything in NYC
2-20. The rest

 

[RustBeltOnc]

No doubt.

 

[ArkansasMed]

Malignancy has improved a ton with the 80 hour work restrictions. No matter where you go, expect to work near 80 hours/week on general floors/inpatient rotations.

There is a ton of debate on SDN about probably every single top 20 program being malignant for some reason. In reality malignancy=subjective dislike for something that residency offers. In general, these are the things people tend to look at and use the term malignancy on this tread:
1. Workload- Is it intense upfront, is it spread out or is it the most intense 3rd year. Is the hospital fellow run or resident run?
2. Location- Hospitals in nicer cities tend to attract better applicants.
3. Program support- Does the support come more from the residency administration, your fellow residents or both.
4. Scutwork- Does other support staff help you take care of the patient to make your life easier (huge issue with NYC programs) or does the senior residents help you during rounds or expect you to do all the busy work.
5. Aloofness of the residents/program admin- Extremely subjective. Some people walk out of interviews thinking the residents are full of themselves, others feel certain programs are filled with more humble/down to earth people. Go to the dinners. Watch how the residents interact with each other and if they actually smile when they talk about their program. It is extremely telling.
6. Unique approaches to different residencies that you either love or hate- Examples being Bigelow for MGH or firm system for Hopkins.
7. How much inpatient time they have in the intern year.
8. Support at night and when the intern/resident gets to actually make the call on patients who are gravely ill- This is probably the biggest one. Some programs are known to have you running codes within the first few months of residency while others hold your hand the entire 1st year.
9. iCOMPARE study-If a program is randomized to overnight call (28 +/- 2 hrs shifts) or have 16 hour shift restrictions. If the residents actually like the schedule in place. Both have their pros/cons.
10. Rotation schedule- The program runs off of the traditional 28 day rotations with half day clinic or a schedule that has devoted inpatient and outpatient blocks (x+y scheduling).
11. Vacation time- Ranges anywhere from 3-5 weeks.
12. Wellness in the residency- Is it built into the curriculum? Are their resident retreats? Is there time for scheduling doctors appointments? etc.

Look at these residencies like potential partners in life. One person's type might totally not do it for another person. Some like green eyes, others like blue others do not even notice eyes. Its really what you feel comfortable with.

I would ask your friends how they would answer all these questions (actually interested to see how other people in some of these programs would respond to this).

 

[cooljoe]

Thank you ArkansasMed - that's a great checklist to help compare programs moving forward. Just wish there were already a nice repository of all this info!

 

[gutonc]

Union nurses.

 

[wire]

avoid new york city at all costs if you aren't interested in scut work, the nurses are absolutely worthless thanks to the unions

 

[Rocher]

I know BID has a comparatively nice schedule and is low on malignancy from what the residents there told me during my interview.

 

[ChessMaster3000]

I know BID has a comparatively nice schedule and is low on malignancy from what the residents there told me during my interview.

residents in literally every program will tell you they are low on malignancy. that is not a reliable assessment tool

 

[Rocher]

residents in literally every program will tell you they are low on malignancy. that is not a reliable assessment tool

So do tell, what is a reliable assessment tool for this?

 

[ArkansasMed]

So do tell, what is a reliable assessment tool for this?

Depends on what you see as malignant. Write up a list of things you would not want in a program and use that as a guideline. For example, some may say a program is "malignant" because they give a lot of intern responsibility. This is why programs like Hopkins or MGH are considered "malignant" by many applicants. Others may say the same thing because a program holds the hand of their interns on average more than other programs. Personally, I would hate this and ranked programs lower for this reason. I know this is most likely a minority opinion.

The only true malignant environment that I know of is the New York City residency system with the lack of resident unions to counter the very strong nursing unions. The lack of unions makes interns take on a majority of true scut work (bringing patients down to radiology themselves, doing your own lab draws etc). Even so, some programs like Mount Sinai are exceptionally supportive and a friendly environment to train. You really need to make sure other programs have similar support in this city, otherwise, I would avoid training in NYC as a resident and come back as an attending/fellow.

Less malignant in my eyes is more about some combination of support (from fellow residents and program leadership) and self worth that your training is preparing you well for the future. Some programs may push their residents to work hard, but the residents are happy because they are getting excellent training for their future career. Others hate their program, even when light on hours, because the attending and senior residents just do not want to teach or provide no support.

There is no good tool. The only way you can judge these is to apply, meet the residents to see if you are similar to your personality. I would also watch the mannerisms of how residents explained why they liked their program. Almost everyone I met on the interview trail "loved" their program. Probably 50% had body language that matched their words. There will be at least 1 or 2 programs you rank low (or not at all) due to this vibe.

Hope this helps.

 

[Rocher]

Depends on what you see as malignant. Write up a list of things you would not want in a program and use that as a guideline. For example, some may say a program is "malignant" because they give a lot of intern responsibility. This is why programs like Hopkins or MGH are considered "malignant" by many applicants. Others may say the same thing because a program holds the hand of their interns on average more than other programs. Personally, I would hate this and ranked programs lower for this reason. I know this is most likely a minority opinion.

The only true malignant environment that I know of is the New York City residency system with the lack of resident unions to counter the very strong nursing unions. The lack of unions makes interns take on a majority of true scut work (bringing patients down to radiology themselves, doing your own lab draws etc). Even so, some programs like Mount Sinai are exceptionally supportive and a friendly environment to train. You really need to make sure other programs have similar support in this city, otherwise, I would avoid training in NYC as a resident and come back as an attending/fellow.

Less malignant in my eyes is more about some combination of support (from fellow residents and program leadership) and self worth that your training is preparing you well for the future. Some programs may push their residents to work hard, but the residents are happy because they are getting excellent training for their future career. Others hate their program, even when light on hours, because the attending and senior residents just do not want to teach or provide no support.

There is no good tool. The only way you can judge these is to apply, meet the residents to see if you are similar to your personality. I would also watch the mannerisms of how residents explained why they liked their program. Almost everyone I met on the interview trail "loved" their program. Probably 50% had body language that matched their words. There will be at least 1 or 2 programs you rank low (or not at all) due to this vibe.

Hope this helps.

Thanks, that's helpful. I agree in that most residents said they loved their program but quite a few gave the impression that it was a forced response. For me it was definitely a "these are my people" vibe that led to my decision, it's a very subjective process.

 

[ChessMaster3000]

So do tell, what is a reliable assessment tool for this?

I'm really not sure--i did not mean to infer I knew what the right assessment tool for this was. But having gone through the interview process, every single program I went to had residents saying their program was not malignant, even from programs who were notorious for being malignant (at least in the past--UTSW). There's no right answer, and it can be very difficult to know. Resident perspective on the program is invaluable, but their direct comments about a program not being malignant has zero value

 

[gutonc]

Thanks, that's helpful. I agree in that most residents said they loved their program but quite a few gave the impression that it was a forced response. For me it was definitely a "these are my people" vibe that led to my decision, it's a very subjective process.

@jdh71 and I have been saying this for-f'n-ever. Go with your gut. Ignore this advice at your peril.

 

[Elixir6]

@jdh71 and I have been saying this for-f'n-ever. Go with your gut. Ignore this advice at your peril.

But I want *your* gut feeling gutonc - my guts are inexperienced and malignancy naive

 

[Beacopp665]

But I want *your* gut feeling gutonc - my guts are inexperienced and malignancy naive

You'd be surprised how accurate your "inexperienced" gut will be when you actually go interview. I could tell from the pre interview dinner in a lot of cases where the program would roughly fall on my rank list

 

[gutonc]

But I want *your* gut feeling gutonc - my guts are inexperienced and malignancy naive

We have different microbiomes. Your gut and mine are probably completely incompatible. That's why you shouldn't give a s**t what I, or anyone else thinks about any particular program.

Which is not to say that you can't solicit opinions. As long as you remember that opinions are like dinguses, everyone has one and they all stink.

 

[Instatewaiter]

@jdh71 and I have been saying this for-f'n-ever. Go with your gut. Ignore this advice at your peril.

Strongly agree.

Call schedule, front loaded or not and the like make no difference and quite frankly people cant make an informed decision without having actually gone through it. So all those spreadsheets people make are just a waste of time. If you don't fit (or do for that matter) with a program, schedules and the specifics aren't going to make a lick of difference.

 

[thehundredthone]

Your gut and mine are probably completely incompatible. That's why you shouldn't give a s**t what I, or anyone else thinks about any particular program.

Which is not to say that you can't solicit opinions. As long as you remember that opinions are like dinguses, everyone has one and they all stink.

No pun(s) intended?

 

[gutonc]

No pun(s) intended?

All puns painstakingly crafted in fact.

 

[thehundredthone]

All puns painstakingly crafted in fact.

Yeah, I thought the post smelled funny.

 

[gutonc]

Yeah, I thought the post smelled funny.

What are you talking about? My s**t don't stink.

 

[thehundredthone]

What are you talking about? My s**t don't stink.

Yeah well, you know, that's just like your opinion man.

(But opinions all stink, right?)

 

[Elixir6]

Yeah well, you know, that's just like your opinion man.

YOU'RE OUT OF YOUR ELEMENT DONNY

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[pulmoblast]

I would look at the average BMI of nursing and support staff to gauge the level of malignancy of a program...