Serious misgivings about Penn Surgery

[bethpage]

The interview at Penn is coming up. Just wanted to bump this up. I am really interested in Penn in part because of location.

Any new thoughts?

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[SLUser11]

The interview at Penn is coming up. Just wanted to bump this up. I am really interested in Penn in part because of location.

Any new thoughts?

Epic thread, and I love the bump. Boy I used to get heated sometimes....I've really matured since then.

As for your question, if you didn't get enough info on Penn from our lengthy discussion, then there's nothing we can say to affect you. Please refer to my comments aimed at Logistic.

That being said, feel free to go there and see for yourself....just keep your bulls@$# meter on high.

 

[Winged Scapula]

Since the thread is just a few months old, I doubt there'd be any new information.

Like Marco Polo returning from Cathay, our strange-but-true stories of a bizarre and savage world at Penn are met with disbelief and our motives are questioned when we take the time to tell them to you.

Believe us, don't believe us. But you may be surprised at how accurate the information you are being given will turn out to be.

 

[JackADeli]

...Like Marco Polo returning from Cathay, our strange-but-true stories of a bizarre and savage world at Penn are met with disbelief...

I have heard they wear strange garb, share very large women, and eat their young when the tribe becomes too large. In unusual festivals around a fire, they reportedly ignite certain herbs and inhale these herbs through pipes made from the long bones of their fallen enemies...... there is also reportedly a very secretive tribal branding ceremony to identify those initiated

 

[SouthernSurgeon]

So since this thread got bumped up...

I'm sort of struggling on this same type of issue that some posters referenced last year in this thread. I interviewed at a "top northeastern program" (not penn but a program I'd consider part of its cohort) - I really enjoyed the visit, didn't get any hints of malignancy. And now I find that program sitting at the top of my very early draft of a rank list.

And yet when I think about it, compared to programs 2 and 3 on that list - the NE school has some "holes" in it - recent faculty turnover in some areas, a couple of departments that are behind the times, work hour struggles, not as many perks, etc. But I still have a really hard time thinking about dropping it down my list just due to the "prestige."

I don't really know why I'm having an issue with this - when it was time for med school decisions, I dropped a "top 5" med school in favor of the one I currently attend b/c I didn't think the prestigious school was the right choice for me; 3.5 years later I think that was the right decision. But now for some reason I seem to be getting sucked in by the prestige factor.

 

[SocialistMD]

But now for some reason I seem to be getting sucked in by the prestige factor.

That sounds like a personal problem that only you can solve. We could go over and over the list of "cons" for a program, but only you can let the prestige thing go from your decision-making process.

 

[JackADeli]

...I'm sort of struggling on this same type of issue ...a "top northeastern program"...

...compared to programs 2 and 3 on that list - the NE school has some "holes" in it - recent faculty turnover in some areas, a couple of departments that are behind the times, work hour struggles, not as many perks, etc. But I still have a really hard time thinking about dropping it down my list just due to the "prestige."...

This is my take.... This whole prestige thing is a sham! I am tired of hearing programs, attendings, "academics" speak about the ethical dilemma the 80hr thing creates for residents, etc..... It's time for them to get over it. The ACGME requirements have been in place for I'm guessing over 7 yrs. So, why are the "prestigious" programs still having such difficulty with it??? The "prestigious programs" have large alumni associations and massive capital..... Yet, they are the last ones to invest in modernizing teaching and resident support. They do so because they can always find some smuck willing to be "gung-ho" and "old-school" and match. It's BS!!!

When I hear another committe cry about dangers and undertraining and ethics of the 80 hrs, I want to heave. You can look at the Hopkins firing or other threads to get just a peak at the backwards excuses. Programs in violation... "well, it's the residents fault, they just refuse to go home, they insist on staying 100 hours a week" Or, "the poor residents are being put in such an ethical dilemma of having to abandon their patient care duties for these rules....". BS!!!! The central person responsible for that patient must be the ATTENDING. All this guilt tripping and peer pressuring of residents needs to end. Residents sacrifice their integrity lying on RRC/ACGME reviews and hours to "prove themselves"... for what??? I guess to allow a "prestigious program" to continue to function and match without actually moving into modern surgical education paradigms or complying with the obligations they have ALL agreed to abide by.

JAD

 

[SouthernSurgeon]

That sounds like a personal problem that only you can solve. We could go over and over the list of "cons" for a program, but only you can let the prestige thing go from your decision-making process.

Oh I know...I figure talking about it is the first step. Really it was just reading over this thread (and one of the linked ones) that got me thinking about how easy it is for us applicants to fall into the prestige trap.

I'm still only about 1/3 through my interview season...I have a lot of programs left to see

 

[Spiker]

So..OP are you not scared of getting fired? Since you are a MD/PHD and clearly there are a few peers on the forum. Wont it be relatively easy to figure out who you are and report it to PD who probably dont like people bad mouthing their program?

 

[smq123]

So, why are the "prestigious" programs still having such difficulty with it??? The "prestigious programs" have large alumni associations and massive capital..... Yet, they are the last ones to invest in modernizing teaching and resident support. They do so because they can always find some smuck willing to be "gung-ho" and "old-school" and match.

Programs in violation... "well, it's the residents fault, they just refuse to go home, they insist on staying 100 hours a week" Or, "the poor residents are being put in such an ethical dilemma of having to abandon their patient care duties for these rules....". BS!!!!

Or, as MGH said, "But we cut educational conferences so that the residents would be under hours!"

Love the post, JAD.

So..OP are you not scared of getting fired? Since you are a MD/PHD and clearly there are a few peers on the forum. Wont it be relatively easy to figure out who you are and report it to PD who probably dont like people bad mouthing their program?

The OP is an MD/PhD?

 

[SocialistMD]

The ACGME requirements have been in place for I'm guessing over 7 yrs. So, why are the "prestigious" programs still having such difficulty with it??? The "prestigious programs" have large alumni associations and massive capital..... Yet, they are the last ones to invest in modernizing teaching and resident support. They do so because they can always find some smuck willing to be "gung-ho" and "old-school" and match. It's BS!!!

Just a comment; JHU and MGH are not the only "prestigious" programs out there. Most have come to terms with 80-hours and are as compliant (if not more, when looking at the programs that are willing to throw around all of that extra money) as the rest of the general surgery world.

 

[Neuronix]

Wont it be relatively easy to figure out who you are and report it to PD who probably dont like people bad mouthing their program?

The op never said they were an MD/PhD

 

[Spiker]

The op never said they were an MD/PhD

Yea my bad got all their names confused. But still wont it be pretty easy to figure out who he is...? After reading the residency dismissal thread, I probably will never say anything negative about my future program lol....

 

[JackADeli]

Just a comment; JHU and MGH are not the only "prestigious" programs out there. Most have come to terms with 80-hours and are as compliant (if not more, when looking at the programs that are willing to throw around all of that extra money) as the rest of the general surgery world.

I agree.... I am not about the declare what programs are or are not on the list of prestige. I just get pretty burned everytime I read some quote or comment from this attending/professor/institution about how the rules need to be more "malleable", etc.... for the purpose of "education" or "patient care". The war is done and the "old schoolers" lost. People that continue to push it do so at the expense of publicly sacrificing their own integrity and/or insulting those of us that have graduated and board certified over the last few years....i.e.:

attendings/prefessors have ALL agreed to abide by requirements established by RRC/ACGME.... If they are not or feel they can not, integrity would have demanded they resigned or left teaching faculty... I don't know, maybe 4+ years ago!!!

residents have graduated now having trained an entire 5 yrs under these guidelines. Their PDs have signed off on them being fully trained, meeting eligibility to sit for boards, and more importantly qualified to be unleashed upon the public patients at large.... To continue to argue the ACGME/RRC simply argues "we" are not trained and PDs that followed the requirements are lying when they have certified otherwise.

Yet, even this past week, I read some other stupid commentary from a surgery periodical about the 80hrs, poor residents being put in a difficult position, and the "ethical" conflicts it creates for the residents..... BS!!!! That conflict does not exist because first and foremost patient care responsibility rests with the ATTENDINGS. A resident's first priority, contrary to the brainwash mantra of PDs and attendings, is to be educated and trained. We did NOT attend residency because we wanted to be a resident.... we completed residency first and foremost to become trained.... so later we could focus on patient care as the primary, when we were trained.

Or, as MGH said, "But we cut educational conferences so that the residents would be under hours!"...

Unbelievable.... it's clear how their administrations views the purpose of having residents.

JAD

 

[SocialistMD]

I agree.... I am not about the declare what programs are or are not on the list of prestige. I just get pretty burned everytime I read some quote or comment from this attending/professor/institution about how the rules need to be more "malleable", etc.... for the purpose of "education" or "patient care". The war is done and the "old schoolers" lost. People that continue to push it do so at the expense of publicly sacrificing their own integrity and/or insulting those of us that have graduated and board certified over the last few years....

I don't disagree, but I do think that this is occurring at surgical residencies of all "prestige" levels; it just doesn't get the press when it happens at the smaller, less well-known programs. Your statement just came dangerously close to suggesting this was occurring predominantly at the programs with a lay-person reputation.

 

[beefballs]

i agree with JAD because if a small fish gets in trouble it scares off the applicant pool, while a Mass General gets in trouble and they still have people lining up to attach the Harvard name to their training.

If i go on an interview at BFE city hospital or ST whatshername and they have hanging over their head I can easily go to another program of equal #s, opportunities prestige etc.

At least as an applicant this is how I am thinking

full disclosure Penn and Mass General wouldn't pee on my application if it was on fire

 

[SocialistMD]

i agree with JAD because if a small fish gets in trouble it scares off the applicant pool, while a Mass General gets in trouble and they still have people lining up to attach the Harvard name to their training.

If i go on an interview at BFE city hospital or ST whatshername and they have hanging over their head I can easily go to another program of equal #s, opportunities prestige etc.

The other way to look at it is like this:

Residents at "small fish" programs have the same fears as residents at larger, more well-known programs. Those fears are that their program closes and they are left without a training program. Therefore, residents at those smaller programs are just as likely to lie about duty hour violations if told to do so by their programs because they want to finish their training.

You don't hear about the smaller programs because they aren't under the same microscope as the big programs, as they won't generate as much press and won't set as much of an example to other programs. The effect of "BFE city hospital" going on probation won't have nearly the ramifications that MGH going on probation did. For example, there are seven general surgery programs on probation this year, yet I hadn't heard about any of the others.

 

[JackADeli]

It's all hogwash. When initially mandating the ACGME/RRC work restrictions/framework (i.e. days off, length of continuous work hours, average hours per week averaged over four weeks), ACGME left open the possibility for institutions to apply for authorization of up to 10% more work hours per week. A small handful of programs did and were granted 85 hour weeks initially. However, after several years and the vast majority proclaiming they were in compliance with the initial ACGME/RRC requirements, the exemptions for additional hours were canceled.... because, ~programs are able to successfully train under the original plan and very few programs have requested or demonstrated an educational need for work hour extension.

Some other links:

http://www.cns.org/advocacy/wc/archives/gradMedEdu/ACGMEWorkHoursPolicy2002.pdf

http://content.nejm.org/cgi/content/full/347/16/1296

http://www.hopkinsmedicine.org/hmn/W04/top.cfm

http://www.uillinois.edu/trustees/a... Committee Report Academic Year 2006-2007.pdf

http://www.journals.elsevierhealth.com/periodicals/cursur/article/PIIS0149794406000869/abstract

June 2009
...the council is stepping up enforcement, and 5 percent to 10 percent of surgery programs were cited last year, including many of the country's most prestigious training programs. Beth Israel Deaconess Medical Center was threatened with probation last year, but has since reined in residents' workloads...

...Dr. Thomas Nasca, head of the accreditation council ...residents are placed in an "ethical quandary'' because "we compel them to lie ...if they do the right thing for their patients.''...

November 2009
...The surgery training program at Massachusetts General Hospital has been put on probation by a national accrediting organization...
Even though the hospital made "enormous changes" and is now in "100 percent compliance" with the rules...
Warshaw said the decision was based on the surgery program's past performance...
Warshaw said he had canceled certain clinical rotations....and educational conferences in order to reduce their hours, among other measures...

The amazing thing to me is how a program seems so unable to be in compliance for over five years.... until they are cited and/or placed on probation. Suddenly there is great magic and they are "100% compliant".... almost overnight!!!

 

[SouthernSurgeon]

It's all hogwash. When initially mandating the ACGME/RRC work restrictions/framework (i.e. days off, length of continuous work hours, average hours per week averaged over four weeks), ACGME left open the possibility for institutions to apply for authorization of up to 10% more work hours per week. A small handful of programs did and were granted 85 hour weeks initially. However, after several years and the vast majority proclaiming they were in compliance with the initial ACGME/RRC requirements, the exemptions for additional hours were canceled.... because, ~programs are able to successfully train under the original plan and very few programs have requested or demonstrated an educational need for work hour extension.

One program I interviewed at still has the authorization to go over hours

 

[JackADeli]

One program I interviewed at still has the authorization to go over hours

Maybe ACGME changed its stance. I looked at there website about a year ago.... They stated that since so few programs saw it necessary to apply for hours extension, and of those that did, so few could show and educational reasoning, while the vast majority were claiming to be in compliance, the ACGME stated it would no longer allow for this exemption and would not renew those few it had granted.

 

[SouthernSurgeon]

Maybe ACGME changed its stance. I looked at there website about a year ago.... They stated that since so few programs saw it necessary to apply for hours extension, and of those that did, so few could show and educational reasoning, while the vast majority were claiming to be in compliance, the ACGME stated it would no longer allow for this exemption and would not renew those few it had granted.

I haven't looked at the ACGME site - this was in the program's information session on the interview day so I had no reason to doubt it.

 

[JackADeli]

I haven't looked at the ACGME site - this was in the program's information session on the interview day so I had no reason to doubt it.

I will look for the link later... they may have changed their position again and bowed to political pressure.

 

[Smoke This]

JackADeli, bravo. I wish you were my program director.

There is a reason that surgery still has around a 20% attrition rate, and I think that reason is that the emphasis continues to be on service instead of education. It's always interesting to me that our private hospital rotations are actually busier than the university but there is more operating, less scut, and higher morale because there is more help and even the staff share in some of this.

 

[filter07]

JackADeli, bravo. I wish you were my program director.

There is a reason that surgery still has around a 20% attrition rate, and I think that reason is that the emphasis continues to be on service instead of education. It's always interesting to me that our private hospital rotations are actually busier than the university but there is more operating, less scut, and higher morale because there is more help and even the staff share in some of this.

 

[JackADeli]

JackADeli, bravo. I wish you were my program director...

Thanks.... I appreciate the compliment. I always find it interesting as I travel amongst threads the differing perceptions and opinions that are expressed.

...i hope none of u guys, esp jackadeli, are my co-interns next year..

In any event, I hope you folks obtain a residency that is a "match" and that you do get the training you will work so hard for....

Merry, merry,
JAD

 

[Winged Scapula]

Thanks.... I appreciate the compliment. I always find it interesting as I travel amongst threads the differing perceptions and opinions that are expressed.

Of course, the difference is perhaps that the "pros" are residents and the naysayer is a medical student.

 

[JackADeli]

Of course, the difference is perhaps that the "pros" are residents and the naysayer is a medical student.

That fact did not escape my attention.... but, I figured if I mentioned it, it would just feed the obnoxious paradoxical cries of folks that haven't graduated from med-school calling actually licensed and trained surgeons as "know it alls" when it comes to how you get into residency, complete residency, etc..... But, I suspect that obvious point is not lost on the, as you say it, "pros"

 

[Winged Scapula]

That fact did not escape my attention.... but, I figured if I mentioned it, it would just feed the obnoxious paradoxical cries of folks that haven't graduated from med-school calling actually licensed and trained surgeons as "know it alls" when it comes to how you get into residency, complete residency, etc..... But, I suspect that obvious point is not lost on the, as you say it, "pros"

Probably.

But my skin is much thicker than it used to be, so let the name calling begin. I can take it.

 

[LucidSplash]

For what its worth, not all medical students (can I facetiously use the term pre-interns?) would prefer someone unlike JAD as a co-intern. Some of us might be relieved to experience that year with persons who have such a firm grip on reality.

 

[JackADeli]

...not all medical students ...would prefer someone unlike JAD as a co-intern. Some of us might be relieved to experience that year with persons who have such a firm grip on reality.

I again appreciate the sentiment.

In general, my experience is that most intern classes form together around each others' strengths & weaknesses. There is a bond. I have always prided myself on believing I was there when my class needed me and I had their backs as they generally had mine. I think most have similar experiences... though there are the exceptions that just prove the rule. I am certain WS had similar bonding points with her class. There were probably times when she needed them and they needed her. That isn't just internship, that is life, teamwork.... reality (as opposed to wishfull hopes & dreams).

 

[HouseHead]

Thanks, JAD. Very well said.

I, for one, am a med student that likes the new way. I couldn't (not wouldn't, couldn't) consider gen surg if it were the old way, no matter how much I adore it.

I am always surprised and a bit disturbed by my co-applicants who complain about the work hour restrictions. Do they not see that programs with work hour issues have systemic flaws that, more likely than not, the residents will have to pay for in the long run? And I don't mean just by working longer hours.

I've seen those PDs who lay blame on the residents, acting like they are totally innocent in the mess (aww, but she's so sweet!). They may be hamstrung by finances- can't afford the PAs or NPs or competent staff that prevents unnecessary hours of scut- I get that. But that should not be for us, as current or prospective residents, to solve. If you say you are investing in your residents, and placing emphasis on education, then do it. Particularly with big-name programs- where they are more likely to have the money to comfortably cover the physician-extenders- there is no excuse for the continued abuses. Not to mention that if they are saying that residents regularly go over hours "for the sake of their patients", that means they don't have the necessary slack in their system to account for these (necessary?) patient care hours. Which means THEY are putting other things ahead of patient care, no?

To those who say they prefer a program or it's resident be up-front about the work hour violations (as some have said to me after hearing my stories about the interview trail)- if they say it's 100 hr/wk, do you think that's true? I assume that 80 hr/wk is an underestimation, and I assume that the 100 hr/wk "truth" is too. Then what?

Time for sleep. Might as well get it while I still can