Tiers in EM Residencies?

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migm said:
Ok so, how does one assess the culture of a program?
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THIS is the money question. Several programs I've visited have been much different than how they're portrayed on the interweb, etc.
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fahimaz7 said:
Put it in there to see what people would say. It's a great program, but for some reason doesn't have the same reputation as the others in that list. Who would you add?
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im sorry but.. christiana?? case in point why this is so ridiculous, its entirely a list of 20-30 people's opinions on this website that has been self-perpetuated over the years.
 
In-and-Out Burger has by faaaar the, hands down, best, ever residency program.

(Sorry guys, I had to. I juuuust had to.)
 
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I went through this process a year ago, and had some of the same feelings as the MS4's out there, but if I had a time machine, I would go back my 8/2011 self and beat the crap out of me for being such a *****. I did rotations based on the names I knew from the USN&WR rankings of their med schools and undergrad campuses, and had a couple real disappointments, like NYP (whose inclusion in your tier 1 was mind-bottling). I ranked 3 of your tier 3 programs above tier 1 and 2 programs, some of which were at the bottom of my list, and geography had little or nothing to do with it.


Feeling the need to pigeon-hole programs into tiers is like like hooking up with a ugly chick - when you have no other good option, it seems reasonable so you rationalize it to yourself and go for it because you have the goggles on, but when you wake up in the morning and you view what you've done with a clear head, you're just ashamed you let yourself do that and then you itch a few days later.

I'm in the itchy stage right now - I matched at my #2 and I'm grateful that it happened, because I based my #1 on this elusive reputation BS, and almost caught The High Five instead of just the itch because I was a stupid, inexperienced *****. I LOVE where I am now, and wouldn't go anywhere else if you offered to double my pay. I have never EVER heard anyone else here mention where someone trained in either a positive or negative light - 95% of the people who come to the ER do so for one of like 30 reasons that are all pretty much the same regardless of what program it is. For the most part, your patients aren't EM referrals where they need some sort of magical Tertiary-level EM care that they only provide at the Ivory Tower U the same way it is with some of the medical and surgical specialties. So far, my satisfaction with my training program is based 47.765% based on the personalities 44.217% based on the location I'm living in, with that remaining piece being left to the reputation largely because of the fact that they love to give us free stuff with the name printed on it. So go pick your place based on some magical rating system that means nothing to anyone who knows anything, and see if your ability to predict the future is any better than when the "experts" pick their Super Bowl/World Series/Whatever champions before even a single game is played. Me, I would rather just start the season, find a team that feels good to root for, and enjoy the ride.
 
mrh682 said:
im sorry but.. christiana?? case in point why this is so ridiculous, its entirely a list of 20-30 people's opinions on this website that has been self-perpetuated over the years.
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Your missing what he did there. He put a good program in that list of "elite" programs to draw you out, thus pointing out the fact that there is indeed a notion that a solid program is not as good as the "elite" ones.

I'm done with this thread. Good luck this year!
 
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I have been refraining, but I just soooo want to buy a vowel. Perhaps an "A"?

And besides, I went to the best program. Duh.
(I didn't do a fellowship, but the Fry Fellowship at In-And-Out would have been my top choice if I had stayed in *real* academics.)
 
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Turn around those letters, Vanna !

F - A - T - T - Y

_ - _ - F - A -T - T - Y

_ - A - _ - T - _


(As an aside, do Pat Sajak and Vanna White still do Wheel of Fortune ?) No idea. If its not sports or news, or sports news, I generally don't watch TV.
 
M.

Game of Thrones on HBO is pretty good.
 
P.

I watch each season on my computer. The download is available approx one year after it's on the TV, which I don't have.
 
RustedFox said:
(As an aside, do Pat Sajak and Vanna White still do Wheel of Fortune ?) No idea. If its not sports or news, or sports news, I generally don't watch TV.
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Yes. I was at Epcot recently and saw Vanna White filming a package for one of the prizes. She looked like she would have been blown over by a strong wind.
 
Arcan57 said:
Bumping your own quote? Do you really need someone to answer your question or did you just put no effort into thinking it through?
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In this forum of like-minded medical students pursuing identical goals but coming from different backgrounds and experiences, it doesn't seem unreasonable to compare notes, now does it?
 
migm said:
In this forum of like-minded medical students pursuing identical goals but coming from different backgrounds and experiences, it doesn't seem unreasonable to compare notes, now does it?
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If you are unable to assess a program's culture, or more specifically how you would fit into that culture, anonymous postings on this forum are unlikely to be of substantive value in making your decision. But you were asking how to evaluate a program's culture which is a question that is too broad to easily answer in this format while also calling into question an understanding of the words contained in your query. See the numerous posts in this thread about the importance of fit, and that other than direct experience it is very difficult to ascertain fit. You will most likely enter and leave the match with only a small glimpse of all the possible training environments that exist. And you will never know if you picked the best possible program, although you will likely come out of residency with the belief that there was no where else you'd rather have gone if you could do it again.
 
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Arcan57 said:
You will most likely enter and leave the match with only a small glimpse of all the possible training environments that exist. And you will never know if you picked the best possible program, although you will likely come out of residency with the belief that there was no where else you'd rather have gone if you could do it again.
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First of all, I totally agree with this.

Second of all, this make anybody else think of the Architect from the Matrix movies:D?
 
I have something for you guys. Taken a few days ago on the interview trail...

IMAG0122_zps749229d4.jpg
 
The "B" in the sign is kinda blurry in the shot, and the first thing my mind "read" was "IN-N-OUT SURGERY"

also, nobody has solved the puzzle.
 
Wow, In-N-Out is tier 3? I had them as my #1 but I really can't deal with the shame of being at a tier 3 place. Do you think it's too late to get an interview at Wal-Mart if I can get my home PD to make a call on my behalf?
 
Dang, you got an interview at the elusive in-n-out burger? I heard they're the best. Like only take people with 260/270, from a top 5 NIH school, AOA with a phd and several nejm pubs. Congrats.
 
RustedFox said:
and FSU2013 would like to solve the puzzle ! - G'head:
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Is it F-A-T-T--Y M-C-F-A-T-T-Y P-A-N-T-S, Pat?

(sorry for the much anticipated solution, I've been on interviews. Oh, and I'M DONE WITH INTERVIEWS!!!!!)
 
Oh, and how to you quote multiple posts? I've always seen people do it, but I don't know how.
 
FSU2013 said:
Oh, and how to you quote multiple posts? I've always seen people do it, but I don't know how.
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You have to mix and match the "
FSU2013 said:
-
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." So with you post " (QUOTE=FSU2013;13529822]Oh, and how to you quote multiple posts? I've always seen people do it, but I don't know how.[/QUOTE)" and then bracket in the other post in a similar manner
quoted said:
other quote here
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. Easiest to just open up two tabs and copy paste the info from into the other.
 
FSU2013 said:
Dang, you got an interview at the elusive in-n-out burger? I heard they're the best. Like only take people with 260/270, from a top 5 NIH school, AOA with a phd and several nejm pubs. Congrats.
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Wow really? I didn't think they were that competitive...is it the location or the animal style fries you think?
 
FSU2013 said:
Oh, and how to you quote multiple posts? I've always seen people do it, but I don't know how.
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It's easy but not intuitive.

See that "MULTIQ" button down there? Click that on every post you want to quote, then click the orange POST REPLY button on the bottom left of the screen. That will bring all of the posts into your post with appropriate quotes.
 
FSU2013 said:
Oh, and how to you quote multiple posts? I've always seen people do it, but I don't know how.
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Just...
SserPrun95 said:
You have to mix and match the "." So with you post " (QUOTE=FSU2013;13529822]Oh, and how to you quote multiple posts? I've always seen people do it, but I don't know how.[/QUOTE)" and then bracket in the other post in a similar manner . Easiest to just open up two tabs and copy paste the info from into the other.
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like...
DreamingTheLive said:
Lol, me too. I'm not very bright though.;)
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this.
 
gutonc said:
It's easy but not intuitive.

See that "MULTIQ" button down there? Click that on every post you want to quote, then click the orange POST REPLY button on the bottom left of the screen. That will bring all of the posts into your post with appropriate quotes.
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I

gutonc said:
Just...

like...


this.
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Think
FSU2013 said:
Now you're just rubbing it in, lol.
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I got

DreamingTheLive said:
Lol, me too. I'm not very bright though.;)
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this.....Amazing.
 
bad virus said:
I think I finally figured out how s/he has something upward of 8,000 posts.
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I think I've seen gutonc post in like a million different forums...times 7-8 years
 
QuaerensIntelle said:
Do your away rotation in EM early, like immediately after your home EM...I think that makes a big difference.
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I totally agree!! I did my away very late and I think it really hurt me both on the rotation and in terms of securing interviews.
 
gutonc said:
It's easy but not intuitive.

See that "MULTIQ" button down there? Click that on every post you want to quote, then click the orange POST REPLY button on the bottom left of the screen. That will bring all of the posts into your post with appropriate quotes.
Click to expand...

Wow, so much easier!
 
Entirely medical student problems that residents and attendings don't worry about. Our new attendings from "mega programs" have difficulty doing things because they are used to having multi specialty backup and minimal autonomy. Our new attendings from smaller programs can't keep up with acuity and volume.

Go where you fit in and want to be, you will be fine

The things that students don't realize, in the grander scheme of things:
http://www.epmonthly.com/columns/oh-henry/dave-packo-on-the-em-workforce/

So, quite frankly, the community residencies to me probably do a better job of that. I don’t want to get the academics upset at me, but the fact is the community residencies are a little bit more in tune to what’s going on in the real world at the community hospital; which is a lot of what we see and what we do. The academics are great. And some of the academic places are fantastic too and they can bring that aspect in. And some of the community places aren’t great. But some are very good at training people for today’s healthcare environment.
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Soccergoon13, great article. That sentiment has been echoed by above posters whose opinions I respect, by PDs at community shops I was fortunate to interview at, and even some folks at my home institution. Moreover, I really can't argue against it.

However, I have to admit that my rank list is also plagued by "mega name" bias. To be honest, completely honest, it has nothing to do with superior didactics, patient populations, trauma experience, sunny beaches or rocky mountains. It all really distills down to name dropping.

Hence, when you bump into dude/dudette on your cake rotation and pretentiously state where you've interviewed. Or when the match list is distributed at your school and the entire bureaucracy of medicine comes to a screeching halt to examine who went where, who didn't match. No one wants to be the name on the list where everyone says, "Damn, that stinks, dude is heading to Jim's Podunk School of Medicine, Dentistry, and Wizardry."

In summary, the light bulb is flickering. Hopefully it will turn on soon!

Just another student trying to figure this crap out.
 
Em0617 said:
Soccergoon13, great article. That sentiment has been echoed by above posters whose opinions I respect, by PDs at community shops I was fortunate to interview at, and even some folks at my home institution. Moreover, I really can't argue against it.

However, I have to admit that my rank list is also plagued by "mega name" bias. To be honest, completely honest, it has nothing to do with superior didactics, patient populations, trauma experience, sunny beaches or rocky mountains. It all really distills down to name dropping.

Hence, when you bump into dude/dudette on your cake rotation and pretentiously state where you've interviewed. Or when the match list is distributed at your school and the entire bureaucracy of medicine comes to a screeching halt to examine who went where, who didn't match. No one wants to be the name on the list where everyone says, "Damn, that stinks, dude is heading to Jim's Podunk School of Medicine, Dentistry, and Wizardry."

In summary, the light bulb is flickering. Hopefully it will turn on soon!

Just another student trying to figure this crap out.
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Really? No offense, but would you mind stating your top 3 so that I can be sure to drop those on my list.
 
Em0617 said:
Soccergoon13, great article. That sentiment has been echoed by above posters whose opinions I respect, by PDs at community shops I was fortunate to interview at, and even some folks at my home institution. Moreover, I really can't argue against it.

However, I have to admit that my rank list is also plagued by "mega name" bias. To be honest, completely honest, it has nothing to do with superior didactics, patient populations, trauma experience, sunny beaches or rocky mountains. It all really distills down to name dropping.

Hence, when you bump into dude/dudette on your cake rotation and pretentiously state where you've interviewed. Or when the match list is distributed at your school and the entire bureaucracy of medicine comes to a screeching halt to examine who went where, who didn't match. No one wants to be the name on the list where everyone says, "Damn, that stinks, dude is heading to Jim's Podunk School of Medicine, Dentistry, and Wizardry."

In summary, the light bulb is flickering. Hopefully it will turn on soon!

Just another student trying to figure this crap out.
Click to expand...

Common' man. Go to the place where you'll be the happiest. If you end up at Harvard but hate Boston, the program and the people, you will be happy only as often as you see your mother-in-law and she asks how residency is going. (don't get me wrong, I was super impressed by both BIDMC and the BWH/MGH programs - not bashing either programs, just an example). If you're not happy outside of work, you won't be happy at work. And if you're not happy at work, you won't be happy outside of work.

You could look at my rank list see no trend about prestige. If you consider "EM prestige" (I.e. programs that are big names in EM but your grandma wouldn't know), one is my top choice, one is my bottom choice (which I may not rank). If you look at "big names" to lay people, one is near the top and some are near the bottom. If you look at "medicine big names" that wouldn't be well known to lay people but are great hospitals, some are near the top, some are near the bottom.

I'm finally comfortable with my rank list. If you rank a place that you don't love because you want to be able to tell the girl at the grocery store that you're a doctor at Hopkins, you will be miserable and you will make the people around you miserable. Do yourself and your future coresidents a favor and rank the places you will be most happy at the top.
 
:thumbup:
FSU2013 said:
Common' man. Go to the place where you'll be the happiest. If you end up at Harvard but hate Boston, the program and the people, you will be happy only as often as you see your mother-in-law and she asks how residency is going. (don't get me wrong, I was super impressed by both BIDMC and the BWH/MGH programs - not bashing either programs, just an example). If you're not happy outside of work, you won't be happy at work. And if you're not happy at work, you won't be happy outside of work.

You could look at my rank list see no trend about prestige. If you consider "EM prestige" (I.e. programs that are big names in EM but your grandma wouldn't know), one is my top choice, one is my bottom choice (which I may not rank). If you look at "big names" to lay people, one is near the top and some are near the bottom. If you look at "medicine big names" that wouldn't be well known to lay people but are great hospitals, some are near the top, some are near the bottom.

I'm finally comfortable with my rank list. If you rank a place that you don't love because you want to be able to tell the girl at the grocery store that you're a doctor at Hopkins, you will be miserable and you will make the people around you miserable. Do yourself and your future coresidents a favor and rank the places you will be most happy at the top.
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Dreamingthelive,

Didn't intend to offend anyone. just saying and admitting that my list is burdened by ivory tower bias. Yes, my duplicity on the the topic must be annoying to read as it is write. However, it's there. Can't deny it. Also, I doubt I'm alone with this.

Furthermore, I think my post was an attempt to explain why mega name bias exists - not defend it.

Anyway, I will introduce myself as em0617 to my fellow residents when we meet. Feel free to punch, kick, throw beer can at my head then.
 
Em0617 said:
Dreamingthelive,

Didn't intend to offend anyone. just saying and admitting that my list is burdened by ivory tower bias. Yes, my duplicity on the the topic must be annoying to read as it is write. However, it's there. Can't deny it. Also, I doubt I'm alone with this.

Furthermore, I think my post was an attempt to explain why mega name bias exists - not defend it.

Anyway, I will introduce myself as em0617 to my fellow residents when we meet. Feel free to punch, kick, throw beer can at my head then.
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Lol. Nice post. I didnt mean anything by it, heck we could end up being BFFs in residency. But, ya I'm not shy about how I feel concerning residents chasing prestige, I guess I always thought/hoped EM was a field where egos are left at the door....thats all. You know, like a big, united, happy family.

Best of luck with your decision though, sincerely.
 
FSU2013 said:
Common' man. Go to the place where you'll be the happiest. If you end up at Harvard but hate Boston, the program and the people, you will be happy only as often as you see your mother-in-law and she asks how residency is going. (don't get me wrong, I was super impressed by both BIDMC and the BWH/MGH programs - not bashing either programs, just an example). If you're not happy outside of work, you won't be happy at work. And if you're not happy at work, you won't be happy outside of work.

You could look at my rank list see no trend about prestige. If you consider "EM prestige" (I.e. programs that are big names in EM but your grandma wouldn't know), one is my top choice, one is my bottom choice (which I may not rank). If you look at "big names" to lay people, one is near the top and some are near the bottom. If you look at "medicine big names" that wouldn't be well known to lay people but are great hospitals, some are near the top, some are near the bottom.

I'm finally comfortable with my rank list. If you rank a place that you don't love because you want to be able to tell the girl at the grocery store that you're a doctor at Hopkins, you will be miserable and you will make the people around you miserable. Do yourself and your future coresidents a favor and rank the places you will be most happy at the top.
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I can relate to how he feels, but I side mostly with your way of thinking. I interviewed at the prestigous named places (MGH, BID, Vandy, Stanford, etc) and non of them appear in my top 5. It's not for lack of quality, but instead all about the fit of the program and the COL in the area. If I end up falling down my list and match at these "prestigious" places, I'll be happy to match and will get a great education.

Happy resident = better resident. Go where you will be happy and the rest will work out just fine.
 
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A residency is a lot like everything else in life...you'll get out of it what you put in. You could go to a theoretical top residency and come out a worse physician than someone that went to a theoretical terrible residency and, of course, vice versa.
 
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