12-06-2017, 11:11 AM
Hello All,
This is my first post to this website but I thought I would interject my 2 cents. I am an outgoing chief resident at a large busy neurosurgery program in the country. I see that people are writing "tiers" and "program strength" and trying to bundle programs into places they think are where the top dogs get trained that go out into practice and are the bad boys of NSGY who get everything they want because they're the best.
The reality is that is absolutely a false and very misleading attitude to have about the programs around the country and the "tiers" they fall into.
Here's the actual truth of what you should be looking at for programs.
1. Does the program have stable leadership - Are the people in charge going to be there for your entire training. Nothing screws the pooch more than a drama filled training program where directors and chairman are retiring and political battles ensue during the meat of your training.
2. Does the program have the autonomy and case complex and volume to give YOU the opportunity to become a great surgeon - Well guess what? Any program that graduates residents with over 1200 cases logged is doing an outstanding job in training people on paper. But are they good surgeons? Do they know what they're doing? Can they choose the right patients to operate on? Will they be able to pass their oral boards? These are the questions that you should care about. It all begins with the attitude of the program, the style of the training -- is it autonomy or observer based as a junior resident? Do the senior residents do the critical aspects of cases? Are the chiefs clipping aneurysms or are they watching fellows? Who is doing what, when, and how the style of training is done at an institution is variable. Ask the each other on your interviews what the style and autonomy level was at the programs they rotated that is more important than anything else.
3. Does the program have the opportunities for me to be an academician? You can take a horse to water but you can't force them to drink. Not everyone will want to do academics and churn papers out. Not everyone will want to be on leadership committees and be involved in organized neurosurgery. It is ok to not want to be deeply involved in research and leadership, but a program has to have the ability to give you those opportunities if you want them.
4. Does the program have happy residents? Who the hell wants to go somewhere where you are on call literally every 3rd night for 4-5 years? Is there end in site for call? Do the residents have lives outside the hospital? Do residents see their families? How much night float do they do? I'll be frank and honest a program with less than 2 a year or a program with gaps in trainees is more demanding than a larger program due to the flexibility it creates in having more warm bodies in the call pool. This is so important for your sanity and out of hospital learning.
When you are building "tiers" you do nothing but bunch programs into an arbitrary system for you to split hairs.
I encourage you to think differently. If I were to tier programs I would simply put them as Established, Up and Coming, and Everyone Else.
For instance this list is ridiculous.
1. UCSF, Barrow, Pitt, MGH, Hopkins, Mayo, UWash
2. Brigham, Northwestern, Emory, Jefferson, UT Southwestern, Vanderbilt, Baylor, USC, Miami, UCSD, Penn, Duke, NYU, Cleveland Clinic, Michigan, Columbia, Stanford, Washu, Emory
3. Everyone else
It should look more like this:
Established Programs where you will get amazing training and have a bit more connections politically and maybe more publication ability --
UCSF, Barrow, Pitt, MGH, Hopkins, Mayo, UWash, Brigham, Northwestern, Emory, Jefferson, UT Southwestern, Vanderbilt, Baylor, USC, Miami, Penn, Duke, NYU, Cleveland Clinic, Case Western, UAB, Michigan, Columbia, Stanford, WashU, Florida, NYU, Cinci, UVA
Up and Coming Programs where you still will get amazing training and have to seek out those political connection and publications slightly more --
Maryland, Rochester, Mount Sinai, UCSD, OHSU, VCU, Yale, Wisconsin, MCW, USF, UNC, OU, UNM, Minnesota, Kansas, Colorado, Tufts, Rush, Penn State, Allegheny General
Everyone Else --
Still with ample opportunity to make an amazing surgeon and academician if YOU take every opportunity and challenge seriously and show the grit and dedication to be successful.
I cannot comment on the lifestyle of the residents in these programs and that is up to you as applicants and sub-Is to figure out where they fall in these lists.
I hope this thread is a little more helpful for how you should view programs than these silly lists put together elsewhere.
This is my first post to this website but I thought I would interject my 2 cents. I am an outgoing chief resident at a large busy neurosurgery program in the country. I see that people are writing "tiers" and "program strength" and trying to bundle programs into places they think are where the top dogs get trained that go out into practice and are the bad boys of NSGY who get everything they want because they're the best.
The reality is that is absolutely a false and very misleading attitude to have about the programs around the country and the "tiers" they fall into.
Here's the actual truth of what you should be looking at for programs.
1. Does the program have stable leadership - Are the people in charge going to be there for your entire training. Nothing screws the pooch more than a drama filled training program where directors and chairman are retiring and political battles ensue during the meat of your training.
2. Does the program have the autonomy and case complex and volume to give YOU the opportunity to become a great surgeon - Well guess what? Any program that graduates residents with over 1200 cases logged is doing an outstanding job in training people on paper. But are they good surgeons? Do they know what they're doing? Can they choose the right patients to operate on? Will they be able to pass their oral boards? These are the questions that you should care about. It all begins with the attitude of the program, the style of the training -- is it autonomy or observer based as a junior resident? Do the senior residents do the critical aspects of cases? Are the chiefs clipping aneurysms or are they watching fellows? Who is doing what, when, and how the style of training is done at an institution is variable. Ask the each other on your interviews what the style and autonomy level was at the programs they rotated that is more important than anything else.
3. Does the program have the opportunities for me to be an academician? You can take a horse to water but you can't force them to drink. Not everyone will want to do academics and churn papers out. Not everyone will want to be on leadership committees and be involved in organized neurosurgery. It is ok to not want to be deeply involved in research and leadership, but a program has to have the ability to give you those opportunities if you want them.
4. Does the program have happy residents? Who the hell wants to go somewhere where you are on call literally every 3rd night for 4-5 years? Is there end in site for call? Do the residents have lives outside the hospital? Do residents see their families? How much night float do they do? I'll be frank and honest a program with less than 2 a year or a program with gaps in trainees is more demanding than a larger program due to the flexibility it creates in having more warm bodies in the call pool. This is so important for your sanity and out of hospital learning.
When you are building "tiers" you do nothing but bunch programs into an arbitrary system for you to split hairs.
I encourage you to think differently. If I were to tier programs I would simply put them as Established, Up and Coming, and Everyone Else.
For instance this list is ridiculous.
1. UCSF, Barrow, Pitt, MGH, Hopkins, Mayo, UWash
2. Brigham, Northwestern, Emory, Jefferson, UT Southwestern, Vanderbilt, Baylor, USC, Miami, UCSD, Penn, Duke, NYU, Cleveland Clinic, Michigan, Columbia, Stanford, Washu, Emory
3. Everyone else
It should look more like this:
Established Programs where you will get amazing training and have a bit more connections politically and maybe more publication ability --
UCSF, Barrow, Pitt, MGH, Hopkins, Mayo, UWash, Brigham, Northwestern, Emory, Jefferson, UT Southwestern, Vanderbilt, Baylor, USC, Miami, Penn, Duke, NYU, Cleveland Clinic, Case Western, UAB, Michigan, Columbia, Stanford, WashU, Florida, NYU, Cinci, UVA
Up and Coming Programs where you still will get amazing training and have to seek out those political connection and publications slightly more --
Maryland, Rochester, Mount Sinai, UCSD, OHSU, VCU, Yale, Wisconsin, MCW, USF, UNC, OU, UNM, Minnesota, Kansas, Colorado, Tufts, Rush, Penn State, Allegheny General
Everyone Else --
Still with ample opportunity to make an amazing surgeon and academician if YOU take every opportunity and challenge seriously and show the grit and dedication to be successful.
I cannot comment on the lifestyle of the residents in these programs and that is up to you as applicants and sub-Is to figure out where they fall in these lists.
I hope this thread is a little more helpful for how you should view programs than these silly lists put together elsewhere.
