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Program structure
#11
(05-18-2019, 05:19 PM)Guest Wrote: While sure it is great to be able to specialize to your interest at the PGY6/7 year, you also have to account for several factors:
- Your institution has to be cool with their resident being gone for a year. Why would they pay their resident to work for someone else?
- An outside institution has to be okay taking an outside resident (not fellow). This can be a tough sell as PGY8 fellows can be 'attendings' to help with call stuff, they can bill, etc
- There is a difference in many people's eyes about an enfolded fellowship and PGY8 fellowship; I think that saying a PGY6/7 enfolded spine fellowship is not 'as legit' as a PGY8 fellowship is stupid but have certainly heard that argument made
- If you do an enfolded at an outside institution, do you really think that the residents at the new place will get bumped for someone not even belonging to their program?
- Aside from spine and endovascular, I don't know of too many opportunities for enfolded away fellowships in open vascular, skull base, etc. If there are, I would highly suspect they are essentially observer years where you don't actually improve surgically

I realize there are some exceptions, and we would all love to be able to do an enfolded PGY7 fellowship that is seen as legit and beneficial to all, but I don't think it should be the priority of a rank list. I think having a PGY6/7 year that gives you a chance to subspecialize in some form is def optimal, but I would argue having that PGY7 year as a mini attending year where you call the shots for the most part and run your own service, have extreme autonomy at your home institution where the attendings know you and you can call to help with advanced cases while doing the bread and butter by yourself is the way to go. Just my two cents

senior resident here. this response is spot on. would have wished my program had the "mini-attending" or "transition to practice" year. it gives you so much freedom and guidance prior to the real thing. in hindsight, would have liked to rank my programs based on this, but what can i say. as a medical student, i knew nothing about programs and what their culture is like. just really ranked on where i felt i'd be happiest.
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#12
(05-18-2019, 11:46 PM)Guest Wrote:
(05-18-2019, 05:19 PM)Guest Wrote: While sure it is great to be able to specialize to your interest at the PGY6/7 year, you also have to account for several factors:
- Your institution has to be cool with their resident being gone for a year. Why would they pay their resident to work for someone else?
- An outside institution has to be okay taking an outside resident (not fellow). This can be a tough sell as PGY8 fellows can be 'attendings' to help with call stuff, they can bill, etc
- There is a difference in many people's eyes about an enfolded fellowship and PGY8 fellowship; I think that saying a PGY6/7 enfolded spine fellowship is not 'as legit' as a PGY8 fellowship is stupid but have certainly heard that argument made
- If you do an enfolded at an outside institution, do you really think that the residents at the new place will get bumped for someone not even belonging to their program?
- Aside from spine and endovascular, I don't know of too many opportunities for enfolded away fellowships in open vascular, skull base, etc. If there are, I would highly suspect they are essentially observer years where you don't actually improve surgically

I realize there are some exceptions, and we would all love to be able to do an enfolded PGY7 fellowship that is seen as legit and beneficial to all, but I don't think it should be the priority of a rank list. I think having a PGY6/7 year that gives you a chance to subspecialize in some form is def optimal, but I would argue having that PGY7 year as a mini attending year where you call the shots for the most part and run your own service, have extreme autonomy at your home institution where the attendings know you and you can call to help with advanced cases while doing the bread and butter by yourself is the way to go. Just my two cents

senior resident here. this response is spot on. would have wished my program had the "mini-attending" or "transition to practice" year. it gives you so much freedom and guidance prior to the real thing. in hindsight, would have liked to rank my programs based on this, but what can i say. as a medical student, i knew nothing about programs and what their culture is like. just really ranked on where i felt i'd be happiest.
To clarify for a Med student, a “transition to practice” year implies a PGY6-chief year so the PGY7 can be Transition to Practice
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#13
(05-18-2019, 02:33 PM)Guest Wrote:
(05-10-2019, 02:12 PM)Guest Wrote: Not sure about CAST accreditation, but I think assessing available additional training options is very important when deciding on a residency program.  An enfolded fellowship can save you a year of tough training in exchange for a year of the practice you want.  Regardless of what you want to do as a medical student, your interests will likely change during residency.  Good to go to a program that will support your career plans, whatever they might be.  More importantly, what a program will allow you to do to achieve your career goals is a good metric of their respect for you as a person.  Denying a career opportunity like an enfolded fellowships is a red flag in my opinion.

I specifically ordered my rank list to match at a program that has the chief year in PGY6.  This way I can do a fellowship at an away institution where I want to be hired as faculty. It also means the hard chief year is done one year sooner and I can focus on my subspecialty in my PGY7 fellowship year. 

It’s too bad that several programs had the opportunity to switch into this PGY6 chief model when the program extended into 7 year programs but failed to do so: Rush, UNC, etc. 

PGY6 chief followed by fellowship is the better model
Any examples of programs that follow this model?
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#14
No such program exists
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#15
MGH with the north resident is the prototype for a TTP. I think a few other programs like Duke allow the 7th year to be a transition to practice/fellowship.
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#16
(05-19-2019, 02:02 PM)Guest Wrote: MGH with the north resident is the prototype for a TTP. I think a few other programs like Duke allow the 7th year to be a transition to practice/fellowship.

So it’s so rare that only elite institutions can do it. Not helpful to most applicants on neurosurgeryhub
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#17
(05-19-2019, 02:12 PM)Guest Wrote:
(05-19-2019, 02:02 PM)Guest Wrote: MGH with the north resident is the prototype for a TTP. I think a few other programs like Duke allow the 7th year to be a transition to practice/fellowship.

So it’s so rare that only elite institutions can do it. Not helpful to most applicants on neurosurgeryhub

Louisville does it
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#18
MGH doesn’t have a North service as of a few years ago so they don’t do TTP. Miami is doing this
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#19
Doesn't have to be called a "transition to practice" year-- any good program will give chief residents almost complete autonomy in running service. Chiefs should be leading standard cases and taking juniors through them. Complex cases, chiefs ideally lead with attending assisting or coaching them through it.

Flexibility in research/elective time is important. You don't want to go to a program that forces everyone into a lab if your goal is mainly to excel in the OR. Even academic programs need to realize 1 or 2 years of basic science are not right for everyone.
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