PGY1 Categorical Resident Here. Matched from TX.
Brown was my #1 choice. You get a very busy RIH c Level I Trauma exposure (Providence and surrounding areas very surprising level of knife/gun club patients), TMH (private hospital, plenty of OR time), and a VA. The program directors are amazingly supportive and I felt right at home when interviewing - two of my interviewers were SAMC trained burn surgeons who trained and lived in San Antonio so we had plenty to talk about. We have 6 categorical positions and just got approved for a 7th starting next year.
Let's walk through a potential schedule you may get from year to year, this is based on this year's Master Schedule from PGY1 to PGY5:
Intern Year: (My actual schedule this year) - 4 week blocks. 3 weeks vacation.
Nights, Vascular, Trauma, TMH, Surgery 3, Pediatric Surgery, TMH, TICU, Surgery 1, TMH, ACS, VA, TMH
PGY2 Year (Rotations a little longer, approximately 5 weeks). 3 weeks vacation.
Trauma, VA, Vascular, ACS (Acute Care Surgery), Elective, SICU, ACS, Surgery 3, TICU
PGY3 Year (Approx 6 week blocks). 3 weeks vacation.
TMH, SICU, Surgery 3, Trauma, Vascular/Transplant, Elective, Surgery 1/2
PGY4 Year (Also approx 6 week blocks). 3 weeks vacation (+) Interview Time.
ACS, Surgery 3, VA, Endoscopy, TMH, Pediatric Surgery, Trauma
Chief Year (Approx 8-9 Weeks per block):
Surgery 1/2, Surgery 3, Vascular, ACS, TMH
Night Float RIH (All Surgery patients in RIH - you are either covering Trauma/Vascular or ACS/Surg1/Surg2/Surg3). Scrub pants lined with pagers as you can imagine. This was my first month of residency. I grew up fast. Learned to triage accordingly, and to never trust your brain to remember things at 3am - write everything down! Over the course of this month I grew accustomed to adjusting pain orders, common postoperative problems (oliguria, chest pain, shortness of breath, Afib with RVR to name a few).
Vascular RIH: Floor heavy as an intern (to be expected), PA/NP assistance. Very sick patients. Shifts to more OR time as a PGY2 and above - PGY2s cover transplant service during this block, helping with AV fistulas, Donor Nephrectomies and Kidney transplants. You are basically the transplant fellow as a PGY2 which is awesome. PGY3 and up are in the OR with the attendings doing the big bypasses, EVAR/TEVARs, and bigger cases. As an intern I was able to be first assist on amputations (TMA, BKA, AKA), skin grafts, and debridements.
Trauma RIH:
Providence, while largely nice has its share of insane trauma (both penetrating and blunt) which was very surprising. We've got one of the top 10 busiest EDs in the country, Level 1 Trauma Center and Burn Center. Good knife and gun club here - coming from Dallas I was looking for a very strong trauma experience. As an intern you're on Trauma for 1 month and TICU for another month so definitely good exposure and tons of opportunities to learn. We have trauma conference every Monday where you are put on the spot to run through your ABCs and how you would run the trauma in front of all the attendings and your co-residents. Loads of floor work, but also a very strong PA/NP support staff which allow you to get into the OR at a much earlier stage in the game (esp compared to my home institution). They will teach you tons as you make the transition from MS4 to Intern. There a representatives from PGY1, PGY2, PGY3, and PGY4 (Trauma Chief) during this month. You will also rotate through trauma clinic and burn clinic during this month as well. Saw loads of burns, GSW, MVC, MCC, Pedestrian struck. You'll get your fill trust me --
TMH (The Miriam Hospital):
Our community hospital. Split up into "Red Team, Blue Team, and Night Float"
You'll spend one week on Surgery "Red" where you are the operative intern. You show up, round and help with orders and notes in the AM before going to the OR all day. This was a week in heaven. I was able to do hernias, gallbladders, appys, thyroids, parathyroids, first assist on MIS and bariatric surgery, BKA/AKA. *EDIT* Now done with my second month at the Miriam. In addition to more bread and butter (appy, hernias, gallbladders) this time I was able to do more junior level colorectal cases, vascular angio and endarterectomies which was awesome. Still my favorite week of residency so far.
Next is surgery "Blue Team" where you are the Consult Intern and are responsible for working up surgery consults on the floor and in the ED - loads of responsibility here very quick, but it's your chance to really build your confidence as you begin putting together surgical differentials and management plans before you present to your seniors. You will actually staff consults with attending surgeons yourself here - sometimes in the middle of the night which is pretty daunting but helps you learn and get better. One of my favorite rotations of intern year thus far as I felt I learned a ton and was able to really think through surgical problems. *EDIT* Some more consults you may see include SBO, Acute Chole/Appendicitis, Pneumoperitoneum from perf duodenal ulcer, large hiatal hernias, ischemic extremities, perforated colon CA,
Next week is spent as the night intern where you essentially cover all the surgical patients in the hospital while simultaneously working up new consults on the floor and in the ED. These have been the hardest nights of my residency so far- but many seniors have told me that if it wasn't for this, they wouldnt have been ready for ACS consults as PGY2s. Plenty of immediate support here so don't freak out, but bottom line you are the first one in the ED bay for that free air that arrives.
You grow a lot as a resident this month - both on the floor seeing consults and as a budding surgeon learning techniques in the OR during your operative week. You can see from my schedule above that this is a staple of intern year (will be here four months total).
ACS (Acute Care Surgery) RIH:
Have not done yet. Appy/Chole/Hernias - bread and butter. Will update when I do this.
Surgery Team 1 and 2 RIH:
Have not done yet. Thoracic-focused service. Lobectomies, Wedge resections. Surg 2 is the Colorectal Service.
Surgery Team 3 RIH:
Surg Onc/Breast/Pancreas (HPB) Service. Excellent PA help here for floor stuff, allowing you to get into the OR quite a bit which was wonderful. On this service I was able to do plenty of breast cases - needle localization lumpectomies, partial as well as full mastectomies with sentinel nodes as well as axillary dissections - awesome learning experience. For the lump cases as you progress and your attendings get to know you they will allow you to perform the majority of the lumpectomy which was great. You'll also do junior level skin/soft tissue cases here (Melanoma wide local excisions) which will teach you lots while helping you practice closing skin nicely and how to manage squamous cell and melanoma skin cancers. You will be first assist on Thyroid and Parathyroid lobectomies which are beautiful anatomy cases. Big pancreatic and liver cases are saved for the upper levels (of course) but I was able to double scrub on plenty of Whipples, Hepatectomies, as well as a Puestow (Longtitudinal Pancreaticojejunostomy) which was my favorite case I've seen so far. You will attend a 1 hr tumor board once/wk with RadOnc/Path/and SurgOnc which was very educational. The week is capped off on Fridays with an educational conference organized by your team of fellow residents and medical students giving the attendings chances to test your knowledge.
Pediatric Surgery Hasbro Children's Hospital:
Good service - NP help here as well. This is a 2 intern service where you alternate being the floor/consult intern and the operative intern. Great junior level first assist cases, as well as the chance to double scrub senior level cases. I saw plenty of inguinal hernia repairs on babies as young as 5 weeks, port placements, lap appys, esophageal atresias. You rotate here as a PGY1, PGY2, and PGY4. We had one of our chiefs match in this specialty last year.
Education:
Monday is Trauma Conference where you get your face pimped off. Helps you build confidence which is nice - it is not malignant. 1 hour long and you'll run through as many cases as time permits, your attendings will call on random people - starting with ABCs and progressing to more senior level operative/management level questions.
Tuesday is Grand Rounds with topics that change week to week followed by Intern Conference. We started the year off with "intern boot camp" which was basic intro to intern year stuff which I missed because I was on nights. Now this has progressed to 1-2 interns being responsible for building a 1hr lecture on an assigned topic with an attending proctor who sits in and asks questions. This is followed by 2-3 case presentations by a couple of different interns followed by short discussions. Last week we talked about hereditary breast cancer followed by 2 short case presentation on pancreatic pseudocysts as well pyloric stenosis (cases picked are random - just whatever case you feel is interesting and you'l like to teach about). Gives you a great chance to begin building your public speaking/presentation skills.
Wednesday: M&M Conference. About 3 cases presented with literature discussions following each case.
We just had Mock Oral Examinations where you get mock cases by your senior residents and attendings to help give you feedback so by the time you get to the real thing you're ready. I had to talk my way through a postoperative pulmonary embolism, Level 1 trauma MVC, acute appendicitis, and
The above conferences are attended by all the residents regardless of service.
Electives:
Tenwek Mission Hospital - Bomet, Kenya:
I don't know much about this, but this is available as a 1 month rotation to our PGY3s. I'm rotating on night call next month with one of my seniors who just returned from this elective and will update with details once I know more. We have actually had some of our chief residents sign on as faculty here. Hopefully will get to go my PGY3 year as I think they select about 3 surgery residents a year to go. Here's a link to the official page:
http://www.brown.edu/academics/medical/about/departments/surgery/international-rotation
Regarding our Oral Boards, we've got 92% pass rate on both Qualifying and Certifying exam from 2010-2015 with
n values of 23 and 24 respectively.
Fellows:
2 MIS Fellows. 2 Colorectal Fellows. 1 Trauma Fellow. 1 Pediatric Surgery Fellow.
Research:
Not mandatory. If you choose to do research it is between the PGY2 and PGY3 year. We have very active basic science labs, though some residents have gone to do research elsewhere. One of our rising chiefs just did multiple years at Sloan and is Surg/Onc bound, total whiz and a wonderful teacher and surgeon. We have three residents active in the lab currently.
Medical Students:
Brown Medical Students on nearly every rotation that you do, which gives you plenty of opportunity to teach which was important to me. The vast majority of the students I've worked with thus far have been great team players, very bright, and very eager to learn which has been refreshing.
Weaknesses?
Colorectal Surgery; We've got 2 fellows which is probably overkill given our volume does not seem to correlate. Wish we saw more of this.
Liver Transplant: This was my favorite rotation as an MS4 but did not make this program a deal-breaker in my book based on how much I loved everything else. Kidney transplant center but not livers - and all adults, no pedi transplants. We do however match very competitively in transplants for the past several years and one of our rising chiefs is also transplant bound so despite this shortcoming it doesn't seem to be drawing us away from Transplants.
2015 INTERVIEW DATES
We just got word about our interview dates and they are as follows:
Fri, Nov 20
Fri, Dec 4
Fri, Dec 11
Tues, Dec 15
Mon, Dec 21
Wed, Jan 20
I love my class - honestly - we get along great and it helps the long, tough hours go by. I feel like I've made a good home here. Providence has its old-school charm - if you swing by make sure you check out the East Side around Brown campus with all the beautiful old homes and neighborhoods. Also check out Thayer Street which is a good little strip of good eats, shops, and people. We have Johnson and Wales with the graduating chefs from the culinary school usually staying close by to open delicious restaurants. You've got the RISD kids walking around with their easels and sketching on every street corner. And the Brown kids being nerds... I have seen that the city really picks up (as expected) once the school year comes around, as all the bars and restaurants were dead when I started residency have picked up pretty nicely, though still might not be the best for singles. I'm engaged as is the majority of my intern class - but the few who are single say Providence is more college-towny - people coming and going rather than settling down here.
Regarding my intern class - Your new class will be like your family - you'll actually spend more time with them then your actual family, so go to the damn socials. There are 6 of us categoricals with 6 more preliminary gensurg interns. You'll also rotate in the same mix with Ortho, Plastic, Neurosurg and Urology interns for a good chunk of your intern year. For the subspecialties they match 4 to Ortho, 2 to Plastics, 2 to Urology, and 1 to Neurosurg - and our class was great at getting everyone out at the beginning of the year to have some fun. Regarding the night-before socials, I know it's hard to feel out certain places. I always tried to spend a little more time exploring each city before the social to try it on a bit. I know one night of free drinks and one morning and afternoon sitting anxiously in suits is hardly enough time, but there is a certain "feel" to these things that you should listen to when deciding on places. Also... Providence is so damn small it's a 5 minute drive to each hospital if you live downtown (which I do) --- buying you those oh-so-precious extra few minutes of snoozage.
Regarding our website -- it is stupid out-dated as everything needed to go through Brown Undergrad and seemed to take forever. The residents really spoke up this year and it is in the process of being revamped with each resident having a profile page with their own snippet of life as a surgery resident. Hope it is up by the time you guys come around and, if not, hope this helps in the meantime.
tl;dr
Brown is awesome. Providence is old-school New England charming as hell. You'll get in the OR sooner. Tons of NP/PA support. Busy trauma/burn center. Your seniors and attendings will push you to be your best.
Also... fun fact: John Dorian from Scrubs is based off of Dr. Jonathan Doris who was a college buddy of series creator Bill Lawrence. Doris was an Internal Medicine Resident at Brown... so one of our Surgery predecessors was the inspiration for Turk!
Best of Luck to all of you - If i don't see you on the trail, good luck in your careers and congrats on choosing surgery and if I see you on the conference trail let's grab calamari. Welcome to the grind---
~RC
