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lol. My best play here will be to punt on 3rd down. I will never figure this out enough to be able to give my kid any guidance at all. I think I’ve decided not to even try. I’m just gonna nod knowingly and say “uh-huh” a lot. I do have the luxury of not caring a whit what she chooses and I’m betting that will come in handy.</p>
<p>Curmudgeon: Same here. My kid’s a third year, and figuring out the whole fourth year strategy is weighing heavily: what residencies to apply for, what month to schedule off for interviews, when to take boards, etc. I felt quite useful in helping him apply to medical school, but this new challange he’s facing has become a specatator sport for me.</p>
<p>mudge</p>
<p>In the same boat as mythreesons. Kid is more conflicted than I have ever seen him…this puts the angst about deciding to turn down Yale as an undergrad to shame…has done very well in all his rotations, all have tried to recruit him but he is really struggling about what path he wants next. </p>
<p>His surgery rotation is next and that may be telling…he has all along thought that was the path he wanted but has REALLY enjoyed his Peds rotation and has gotten absolutely stellar evaluations from all of his attendings. He just seems to have a “knack” with kids…they love him…his last attending said she had never before seen anything like it. He knows he doesn’t want to be a Pediatrician but at the same time wants some “medicine” component to whatever interventional path he chooses. He’s currently mulling Pediatric surgery, ENT, and a few others but also wants to have some degree of a life.</p>
<p>He’s meeting with a friend of mine later this week who was THE Pediatrician in Dallas for many,many years to get some advice. This friend (who’s a Yale med grad btw) headed Peds at Both UTSW and Baylor Hospital and is credited for almost single-handedly getting Zale Lipshy Hospital built. Hopefully he can help shed some light on things and help steer him on the right path. </p>
<p>Like you’ve told me about J, it’s hard to see your very confident, self assured kid so conflicted…especially when it comes to what may be the biggest decision of their lives.</p>
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<p>I need to comment on this, just because I can identify with this, and because I think it’s tough as a 3rd year to look at the medical subspecialties, and know what they offer - especially the critical care fields. This is probably especially true in pediatrics where most clerkships focus (appropriately) on the well child aspect of peds. </p>
<p>I’d suggest that he consider looking at Pediatric Critical Care (PICU), Peds Cardiology and Neonatology. These fields are quite different from being a general pediatrician and would likely appeal to someone who likes the idea of “doing something” to make patients better. Certainly if he’s dead set against doing a peds residency, then they’re not options, but I think (and I’m totally biased as a future Peds Intensivist) they’re all worth a look. PICU and NICU get to avoid almost all clinic. PICU tends to be a rapid turnover, NICU has greater “continuity of care” as some of those babies stay in the hospital for months at a time, while Cardiology has a better balance of clinic, intensive care and time in the cath lab. Unlike adult critical care, all three of these fields have the benefit that most of their patients will get better.</p>
<p>I’ve yet to meet a pediatric surgeon who had anything resembling a “good” lifestyle, and for the most part, the subspecialty surgeons (ENT, Urology, Ortho) who specialize in pediatrics tend to be significantly busier than their adult counterparts. </p>
<p>Your son’s time on surgery will indeed be a huge indicator. If he can’t leave the OR behind, then he needs to be a surgeon. If it’s just a “nice” place to be, then his decision is going to be that much tougher.</p>
<p>
…Could you elaborate? That sounds quite ominous.</p>
<p>If you’re a 3rd year, now would be the time to seriously start considering specialties. At my school, we’re currently starting to schedule electives and time off for next year. My school holds individual specialty info sessions (and I suspect many other schools do too) that are very helpful in getting into the nitty gritty of applying for specific specialties (in answer questions about the importance of USMLE scores, # of LOR’s to get, the need for research or away rotations, etc.). The info sessions are my school are usually hosted by the chairman of the respective department and/or the residency director of that specialty along with a handful of current residents/docs.</p>
<p>Thanks BRM…sent this on to him for his review…</p>
<p>I do have the luxury of not caring a whit what she chooses and I’m betting that will come in handy.</p>
<p>Very true…only the student can determine which way he/she wants to go. </p>
<p>Cuz…they gotta luv it!</p>
<p>eadad - if he has any questions, I’d be more than happy to answer them. As mentioned, I’m going into a pediatric critical care fellowship (starting to go through my own application process - again - this summer). I can definitely speak about the other fields too.</p>
<p>Jasonleb
<p>Thank you that was very informative. Two more questions, is it common for pediatric surgeons to sub-specialize? If so, how does one go about doing so? Do they have to find a fellowship in pediatric oncology, neurology, neuro, etc or do they get a fellowship in just neurosurgery (as an example) and use their knowledge of pediatric surgery and neurosurgery to synthesize it all? I’d think it’s be hard to find pediatric sub-specialty surgery fellowships. And would that surgeon only do surgeries of their sub-speciality or all kinds of pediatric surgery with an emphasis on the sub skill? I ask because my teacher’s wife is a pediatric neurosurgeon and it got me thinking.</p>
<p>Pediatric surgeons usually don’t specialize - pediatric surgery is a sub-specialty unto itself. Very few hospitals have more than 1 pediatric surgeon, so they can’t specialize - they have to do all types of pediatric surgery.</p>
<p>The exceptions I can think of involve transplant, neurosurgery, and cardiac surgery. A kid needing a transplant, brain surgery, or heart surgery will go to a transplant surgeon, a neurosurgeon, and a peds cardiothoracic surgeon, respectively.</p>
<p>So ENT, Urology and Ortho all have pediatric subspecialty fellowships. After completing a residency in those fields, there is the option of pursuing a fellowship to just deal with pediatric patients - these are the specialists I was referring to when I said they’re usually busier than their adult counterparts. Certainly there are interests in each of these fields that by definition result in needing to be a pediatric specialist even if you weren’t particularly fond of kids. For ENT that would be cleft lip and cleft palate repairs, or treating osteogenesis imperfecta if you were an orthopedic surgeon.</p>
<p>Neurosurgery does not have a formalized fellowship training program that I’m aware of, but certainly if you had that as an interest you could obtain a position at a childrens’ hospital and make that your specialty.</p>
<p>Doing pediatric cardiothoracic surgery is a secondary fellowship - you do general surgery, then CT surgery, then pediatric CT surgery. There are very few programs across the country, so I’m actually willing to guess that doing a fellowship is not a hard and fast requirement - but I don’t know that for sure. It may be one of those things where after doing a CT fellowship, if you have an interest in pediatric cases, you can find a position and in a way, apprentice. It wouldn’t surprise me to hear that congenital heart surgery is one the aspect of CT surgery where there is actual overall growth, as compared to the rest of the field. Certainly the advances in neonatology have lead to an increase in cases that need PDA ligation as upwards of 50% of neonates born before 30 weeks gestation are likely to suffer from a a PDA and the incidence of congenital heard disease increases as gestational age decreases.</p>
<p>As far as pediatric cancer goes, there’s a much lower incidence of solid tumors (much more leukemia and lymphoma in peds) but resections would fall to the pediatric surgeons.</p>
<p>Transplant can be done by non-pediatric trained surgeons - that’s how it’s done at my institution for kidney and liver transplants. Heart transplants are done by our CT surgeons.</p>
<p>Cannulation for ECMO is most typically done by our CT surgeons though on occasion the peds surgeons are covering. As a center we do Extended CPR when necessary (that is cannulation for ECMO while doing chest compressions) and I’m not sure if that’s something the peds surgeons do or if it’s limited to only times when the CT surgeons are on call (obviously it’s something that doesn’t happen very often). We’re also one of only 3 centers in the country that does mobile ECMO but I think that’s only transport of patients already cannulated by the outside facility, not that we send CT surgeons on long distance helicopter or fixed wing flights…</p>
<p>Hi All,</p>
<p>Where can I find the rankings within each area of residency? Are these published every year?</p>
<p>Thanks much,</p>
<p>I’ve never found any. Seems to be gossip only.</p>
<p>
</p>
<p>The short answer is that you can’t.</p>
<p>The long(er) answer is that by asking people in the field, you can generally arrive at a consensus on a group of programs believed to be the best in the nation or best in the region. </p>
<p>You can also look up USNWR’s ranking of hospitals for various specialties and use that as a proxy for resident training rankings, but there are several pitfalls, the most obvious being that many of the categories ranked by USNWR would be fellowships, like “nephrology” or “heme/onc”, and not residencies like “internal medicine” or “general surgery”. </p>
<p>The less obvious pitfall is that a hospital can be highly ranked within a certain sub-specialty, which often is reflected in the strength of its fellowship program, but the type of residency program that feeds into it may be weak because most of the decisions made and procedures performed are done by the fellows, as opposed to the residents. For example, Cleveland Clinic is generally considered to have an outstanding colorectal surgery fellowship, but its general surgery residency is considered weak to the point where I’ve heard graduate of the general surgery residency program are highly advised to seek fellowship training because they’re not considered well-trained enough to operate on the level of an attending, despite having ostensibly completed the number of cases required to sit for the boards.</p>
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<p>The quality of residency programs, including their prestige and popularity, may change every few years. They are very susceptible to changes of Department Chairs and faculty members.</p>
<p>A program considered great 5 years ago may have become “malignant” now, (by the way they treat residents, etc.) The best way to find out is by talking to others currently in the field.</p>
<p>Many thanks for your input, Shades and MyOpinion. </p>
<p>Now that DS is in MS1, he is traversing a territory neither me nor my hubby are educated about. I gotta educate myself about the next steps in order to understand DS’s future decisions better.</p>
<p>Ok, my H and I are clueless about this residency process and we are a dr and nurse!!! I asked him about matching for residency and he said, “In my day, there wasn’t a match program. You just went out and found your own residency!” Haha! (He has been in a general internal medicine practice for 30 years in a smaller city.)</p>
<p>In h.s. you “create” a resume/CV to get into college. In college you have done the same to get into medical school. This consists of grades, ECs, volunteering, research, test scores, etc. So, from the first day of medical school, we assume you do the same thing, but what are the “essentials” that a competitive medical school resume/CV should contain? How do you go about creating the correct resume not having any idea what specialty you are interested in?</p>
<p>Here is what I have gleaned from reading the forums related to residency. You walk into medical school and from day one you should .</p>
<ol>
<li><p>Get the best grades you can. Graduate with “honors”, if that distinction is available.</p></li>
<li><p>AOA hopefully if your grades are top notch and you have been active, you will be awarded this honor.</p></li>
<li><p>ECs - ??? At this stage, are they all medically related?? Work at the free clinic run by the students? Join groups of interest affiliated with your medical school? How about off campus activities such as joining a community orchestra, playing a sport in a rec setting do medical students even have time to do those types of things?</p></li>
<li><p>Research lots of questions about this. Do you attempt to do research all four years? Is that possible? Is the time spent doing research just in the summers, or do you have time otherwise in the first two years? What about the last two years where do you find the time do fit it in? Should the type of research you are involved in be related to your future area of practice? How is that possible if you are trying to keep an open mind as to specialty?</p></li>
<li><p>Publish articles regarding said research.</p></li>
<li><p>Dont go through medical anonymously get to know your professors, the doctors you work around, etc. Going along with this is dont be a wallflower in clinical settings. Speak up, volunteer, etc.</p></li>
<li><p>Shadowing do students have time to do this during their first two years? When do you fit it in?</p></li>
<li><p>Obtain the highest board scores you can.</p></li>
</ol>
<p>Other semi-related questions -</p>
<p>A.) If you intend to subspecialize, are you required to do just one year of an internal medicine (or pediatrics or surgery) residency, or do you have to complete the entire 3 years? </p>
<p>B.) Also, do you do this pre-fellowship residency at the same place you do your fellowship or are they entirely separate entities? </p>
<p>C.) In my H’s day, everyone did “rotating internships” PRIOR to their residency - basically the same as M3 and M4, but you were officially a “doctor”. Is that done any more? If so, is this counted as the first year of your residency?</p>
<p>D.) Are you called an “intern” in the first year of any residency now?</p>
<p>We hate not understanding and would love to be educated!! What else is missing??</p>
<p>Side note - H was visiting with a cardiologist from a group who sends a doctor down from the big city twice a week to see patients. She was a little late one day and gave him a deer in the headlights look. He asked her what was up and she said they had been interviewing cardiology fellowship applicants. TONS of them. She said she had no idea how she ever got into the fellowship she did, looking back on what her resume/CV was like and shes not that old!! She said the applicants were amazing, several had published multiple articles, and some had only missed one or two on their boards. The hospital they work out of has a USNews cardiac care ranking in the 40s. The competition at that stage of the game sounds fierce!</p>
<p>^ I agree about the competition. We have a family friend who’s a urologist. He interviewed somewhere between 40 and 60 students in 4 days to fill 3 residency slots. He said it was crazy! His chief complaint–he was only allotted 20 minutes per interview.</p>
<p>Here is what I have gleaned from reading the forums related to residency. You walk into medical school and from day one you should….</p>
<ol>
<li><p>Get the best grades you can. Yes this is a given.</p></li>
<li><p>AOA – Fewer than 16% of medical students will receive AOA before graduation, and an even smaller proportion will get “junior AOA” which would be on their application for residency. In most specialties, this is not anywhere close to “vital”</p></li>
<li><p>ECs - EC’s are rarer at this stage. Anything counts including stuff off-campus, but the importance of these things are highly variable. Personally, I was on the executive committee of my schools student run free clinics. Several years after my term, the same executive committee (with new students obviously) actually managed to organize an international conference of student run clinics - so there’s still opportunity to do impressive things.</p></li>
<li><p>Research –Research is research. Most people will start a project just to get something started. If it ends up being applicable, great, if not, it’s not a huge deal. It’s easier during the first two years, and then during the 4th year. It’s rare to be doing any sort of independent project.</p></li>
<li><p>Don’t go through medical anonymously - NOT volunteering or showing enthusiasm as a third year student will RUIN evaluations. This is simply non-negotiable </p></li>
<li><p>Shadowing –** Most schools have some sort of preceptorships that are required. Early clinical exposure is a selling point for many schools, so this is done for you. Beyond the minimum requirements you can always do more.**</p></li>
</ol>
<p>Other semi-related questions -</p>
<p>A.) If you intend to subspecialize, are you required to do just one year of an internal medicine (or pediatrics or surgery) residency, or do you have to complete the entire 3 years? </p>
<p>No, you have to complete the entire residency. For example, I’m going to be doing a Pediatric Critical Care Fellowship - I will be applying starting this summer, while also starting my 3rd year of my peds residency. In fact, most residents come into residency NOT knowing exactly what they want to do, so they need the exposure to various fields to make this decision.</p>
<p>B.) Also, do you do this “pre-fellowship” residency at the same place you do your fellowship or are they entirely separate entities? </p>
<p>They are separate, but you can do the entire process at one place IF the hospital has a fellowship program in your desired specialty. For example, my hospital does have a peds CCM fellowship program, but I have friends who are peds residencies in other places that want to do CCM that do not have a fellowship program, so they, will absolutely be forced to move.</p>
<p>C.) In my H’s day, everyone did “rotating internships” PRIOR to their residency - basically the same as M3 and M4, but you were officially a “doctor”. Is that done any more? If so, is this “counted” as the first year of your residency?</p>
<p>**In some fields, there is a required transitional year - Anesthesia, Radiology, Ophthamology, Dermatology, and some others require a year of more generalized fields before starting on specialty training - which could be either internal medicine, general surgery or the highly coveted transitional years (which are more like the rotating internships). Subspecialty surgical fields also require a year of general surgery. **</p>
<p>D.) Are you called an “intern” in the first year of any residency now? Yes, and the new work hour rules that in July to further limit the 2003 rules, make an even bigger distinction between interns and upper level residents. Interns will be limited to no more than 16 consecutive hours on duty.</p>
<p>Side note - The competition at that stage of the game sounds fierce!
Depends on the field. Fellowships out of Internal Medicine are much more competitive than those out of Pediatrics (ie, there have been more spots than applicants into Peds Critical Care for the past 4-5 years). Personally don’t know much about the competition for fellowships out of other fields such as surgery or anesthesia or psych.</p>