Top 10 General Surgery Residencies Rankings

[greg1184]

Would anyone else find it a little concerning that the program has doubled their complement in just 3 years? I sure hope they have enough volume to go around.

Considering residents rotate through 5-6 hospitals, there is plenty of volume to go around. Patient census in the busiest hospitals, Jacobi and Einstein/Weiler hospitals can be in excess of 30-40 pts.

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[thedrjojo]

Considering residents rotate through 5-6 hospitals, there is plenty of volume to go around. Patient census in the busiest hospitals, Jacobi and Einstein/Weiler hospitals can be in excess of 30-40 pts.

i think the question is, what massive has changed in the past 2 years to go from 5 a year (which it was when I interviewed there) and the 10 a year they take now... and what are the poor chiefs doing right now (unless they back filled some of the upper classes to the new approved size)...

that being said, if they were approved for 10 now, they were able to justify it to ACGME/ABS/ACS/Baphomet, so at least they on paper should be able to get the number of cases for those chiefs...

I hate our services with 30-40 patients. And when it hit 50, I shed a little tear.

 

[greg1184]

i think the question is, what massive has changed in the past 2 years to go from 5 a year (which it was when I interviewed there) and the 10 a year they take now... and what are the poor chiefs doing right now (unless they back filled some of the upper classes to the new approved size)...

that being said, if they were approved for 10 now, they were able to justify it to ACGME/ABS/ACS/Baphomet, so at least they on paper should be able to get the number of cases for those chiefs...

I hate our services with 30-40 patients. And when it hit 50, I shed a little tear.

They did. Monte merged with Wakefield program, so their residents are now in our program. We also got some residents from other programs.

 

[thedrjojo]

They did. Monte merged with Wakefield program, so their residents are now in our program. We also got some residents from other programs.

Seems like a sweet deal for Wakefield... Go from residents in a little community residency to be residents in a huge academic residency... You know, unless they wanted to be in a small community program... Womp womp

 

[greg1184]

Seems like a sweet deal for Wakefield... Go from residents in a little community residency to be residents in a huge academic residency... You know, unless they wanted to be in a small community program... Womp womp

Judging by how amazingly chill the Wakefield rotation is (and Dr Wilbanks is the best attending I have had) I wish it was aresidency program lol

 

[SouthernSurgeon]

Bumping this thread once more...now with new data!

So apparently USNews and Doximity have paired up to do residency program rankings. The "official" inaugural Top 10 programs are as follows:
1. Hopkins
2. MGH
3. UofM
4. B&W
5. UCSF
6. WashU
7. Vanderbilt
8. UWash
9. Duke
10. UPMC

**And because everyone knows a good top 10 list can't only have 10 programs:
11. Mayo
12. UTSW
13. Penn
14. Emory
15. UCLA
16. CCF
17. Northwestern
18. Stanford
19. NYU
20. BCM
21. OHSU
22. UNC
23. UWisc
24. UC-Davis
25. Mt Sinai
26. UChicago
27. Columbia
28. Cincinnati
29. Cornell
30. USC

Here is a link to the listings:
https://www.doximity.com/residency_navigator/programs#residency_specialty_id=44

And to the methodology:
https://s3.amazonaws.com/s3.doximit...ty_Residency_Navigator_Survey_Methodology.pdf

 

[Docbeme]

I guess after years of discussion, the question has been answered......maybe.

 

[Danbo1957]

You mean for Internal medicine, maybe? Because that Doximity list above is not even close to accurate for General Surgery, absolutely laughable

 

[Danbo1957]

My posting history reflects 27 years in the residency/fellowship business, and ranking programs of all kinds for internal use. I have no love for UTSW or Louisville, and understand some of the issues at both programs as I do others, but I know darn well their stature in current general surgery education. I would definitely put two community programs in any Top 20 GS list, and Emory in the lower half of the Top 10. But as I said, not a bad list for IM.

 

[Danbo1957]

"Not a surgeon"... I work on an academic GS residency oversight committee. I hire surgeons. I have a professional interest in GS education. That list above is not reflective of real world rankings by people who run this stuff. A problem with gauging the quality of GS residencies is that there are huge differences in regional approaches as to how to teach surgeons. But there are several methods of statistical analysis that are hardwired into our national evaluations that are added to metrics that reflect how surgeons perform over the ten years out of residency. There are quantifiable objective benchmarks that go into our GS residency rankings, which I consider conclusive when judging the quality of a particular program with another. We work every day on this for every residency out there... You need to yourself get one of these: https://sph.uth.edu/divisions/biostatistics/

 

[Danbo1957]

Fine. You've been told. Good luck messenger.

 

[droliver]

Did someone really cite a deficiency letter to the Louisville medical school (citing classroom sizes and lockers fpr MS1-2's) as related any way to their surgery program?

Lot's of immature understanding going on re. training programs and the relative comparisons between places. There's literally about a dozen places on that top 40 list I would be reluctant to let recent graduates operate on my dog based on my experiences with some of them in fellowship positions, the gaps in knowledge and experience I took for granted was stunning sometimes. Those lists being cited are often historical reputation disconnected from quality measures with a good bit of snob appeal thrown in. Many of them also are better places to be a surgical fellow rather then surgical resident, particularly some of the super tertiary programs in metro areas, where there can be no "general" surgeons on staff (it's all specialists) and they come out with lack of exposure to bread and butter cases. I recognize it's hard to sort through that as a student, but don't kid yourself that Maryland residents (for example) aren't usually getting better training then their cross town compatriots at Hopkins in general surgery

 

[SLUser11]

It's sort of a self-fulfilling prophecy if the list was made up by asking surgeons to rank programs....which is no different than what people have been doing in this thread for years. It's not surprising that our arbitrary rankings on SDN match the ones on Doximity.

I do think it would be interesting to make a rank list based on outcomes: board pass rates, fellowships, academic productivity, and even some quality metrics. Of course, that list would be just as worthless as this one, but more fun to look at. I think rankings are pretty silly, but I share docoliver's negative experience with the technical and clinical skills of some people from "top" programs, and I believe the primary objective of surgical residency should be to produce competent, board certified general surgeons.....

 

[SLUser11]

They do claim to have included "objective data" in their rankings including board passage (based on self-reporting - which is weird since the actual passage rates are readily available) and academic productivity. To what degree or how exactly they included it...the methodology pdf is more than a little vague. If you click on an individual program it will give you academic markers such as %ile for peer-reviewed pubs and funding.

I wonder how much the rankings are limited by limiting themselves to the doximity community. By definition I would say that slants you towards a younger and heavily academic subset of the actual surgery community.

A question for you (and docoliver) - do you really feel like you have had enough exposure to the graduates of other programs to effectively evaluate the program as a whole? In other words, what "n" of graduates do you need to see to determine that there is a program level deficiency? Within the years I've been at my program, I'd say there is a wide level of proficiency of the graduating chief residents - I would like to think that all of their "floor" is high enough to call them competent, but it's not like graduating trainees are coming off an assembly line identical to one another...And we had one chief in particular that I'd shudder to think others were judging the quality of our program based on him...

I also wonder how much the knocking on graduates of "top" programs tends to be a matter of confirmation bias. Of the new faculty we've hired since I arrived at my program, I'd anecdotally say the technically best two of them both came from programs on that top ten list (*though they also did fellowships post-graduation).

I'm not meaning to be a defender or apologist of this list; as I've said for years I think these kinds of rankings are arbitrary. But I enjoy the debates about them and I'm sick of this forum being dead so I thought I'd add fuel to the fire with this new ranking

I doubt anyone has extensive exposure to multiple graduates from the same program over time....unless you're specifically at that program, or there's a pipeline from that program to your hospital. I agree that when someone from a "top" program is incompetent, people typically find it ironic, and hold on to that info for longer.

On a similar note, I don't think many people have a real understanding of how "good" or "bad" a surgeon is. If you are a nurse or scrub tech, it's based on how nice and fast the surgeon is. If you're a family doc, it's who treats you the best and sits with you at lunch in the doctor's lounge. If you are a resident, it's who gives you the most autonomy and does the coolest/least tedious surgeries. Of course, you can look at outcomes, but most national and institution-specific databases don't capture enough patient and disease-specific information to really compare apples to apples. So, most people can identify someone who's horrible, and makes frequent egregious errors, but those surgeons are rare.

Most likely, there is not as much variation in the end-product as we think. So, we're left to look at objective variables. If someone is intelligent, well-read, and well-trained, then they should pass their written boards. If they have solid clinical judgment from appropriate and graduated autonomy, and they have basic communication skills, they should pass their oral boards. If board pass rates are low, then the ivory tower probably has a major deficiency.

As for technical abilities, volume certainly doesn't always guarantee proficiency, but we all know we're more comfortable doing cases we've done many times before, and our bosses were likely to give us more autonomy/freedom in the cases that were done often. So, without watching everyone operate, I think case volume and complexity is another appropriate way to judge a program. If a top 10 program routinely graduates residents with 750-800 cases, those residents are unlikely to be ready for independent practice, especially once we start thinking about number-padding, role as surgeon junior, etc.

From the top 20 list, I've had direct clinical interaction with graduates from 7. None of those surgeons fall into my personal top 10 list in terms of technical ability or decision making. However, that certainly does not mean that all residents from ivory towers are incompetent. And, I am only referring to clinical abilities, not their abilities as researchers or administrators.

The top clinicians and technicians I've encountered have been from Louisville, UT Houston, KU Wichita, Akron City Hospital, etc, but their residency training is only a small fraction of what makes them great, especially considering the vast majority of what they do, they probably learned after residency graduation.

 

[Docbeme]

I'm a 4th year Vanderbilt med student going into neurosurgery. What seems counterintuitive on some of these posts which disparage the top programs is that the top programs are typically where the best medical students matriculate for residency. Students with the top Step I scores, AOA, research, etc. are where they are because their performance metrics are typically better over at least three years of medical school. The obvious conclusion is that students with the top academic metrics are better than others with lower grades, scores, etc. They have also performed well in their clinical phase or they would not be AOA.

Notwithstanding anecdotal evidence that some posters in this thread may have in limited cases, it would seem that the logical conclusion is that residency programs with the best reputations get the best residents. It would also seem that the top hospitals get the cases that docs in community hospitals may not want to do because of the complex nature of certain cases, as well as the cases that go south and end up at the major medical centers to fix what went wrong when the obvious was not quite as obvious at first blush. This seems to be the case at Vanderbilt, and I suspect we are not unique in this regard.

The one negative that I see about top programs is that your experience may be a bit limited, depending upon the program, by fellows doing work that otherwise might be done by residents. OTOH, you get considerably more exposure to highly complex cases as well as the clinical exposure of managing very sick patients, research opportunities, top people in their field, etc.

 

[SLUser11]

I'm a 4th year Vanderbilt med student going into neurosurgery. What seems counterintuitive on some of these posts which disparage the top programs is that the top programs are typically where the best medical students matriculate for residency. Students with the top Step I scores, AOA, research, etc. are where they are because their performance metrics are typically better over at least three years of medical school. The obvious conclusion is that students with the top academic metrics are better than others with lower grades, scores, etc. They have also performed well in their clinical phase or they would not be AOA.

Notwithstanding anecdotal evidence that some posters in this thread may have in limited cases, it would seem that the logical conclusion is that residency programs with the best reputations get the best residents. It would also seem that the top hospitals get the cases that docs in community hospitals may not want to do because of the complex nature of certain cases, as well as the cases that go south and end up at the major medical centers to fix what went wrong when the obvious was not quite as obvious at first blush. This seems to be the case at Vanderbilt, and I suspect we are not unique in this regard.

The one negative that I see about top programs is that your experience may be a bit limited, depending upon the program, by fellows doing work that otherwise might be done by residents. OTOH, you get considerably more exposure to highly complex cases as well as the clinical exposure of managing very sick patients, research opportunities, top people in their field, etc.

You are assuming that the most academically accomplished students will turn into the best surgeons, and I would disagree. You are also assuming that the most academically accomplished medical centers will provide the best surgical training, where I disagree again. There are many other variables that factor in to the production of an excellent surgeon. And, classically, there has been a disconnect between book smarts and clinical skill, although this is not always the case.

Your "logical conclusion" is also a self-serving conclusion since you put yourself in the category of "top" medical students.

Nobody is saying that the top medical centers listed are bad places. We are simply saying that there are many more important aspects of surgical training than prestige.

I've never liked these "logical" (nearsighted) explanations of things because they eliminate choice from the equation (all top students pick top specialties at top institutions). Plenty of smart and accomplished people choose their college, med school, and residency based on a multitude of factors, including geography, friends/family, religion, etc.

 

[rongeur]

You are assuming that the most academically accomplished students will turn into the best surgeons, and I would disagree. You are also assuming that the most academically accomplished medical centers will provide the best surgical training, where I disagree again. There are many other variables that factor in to the production of an excellent surgeon. And, classically, there has been a disconnect between book smarts and clinical skill, although this is not always the case.

Your "logical conclusion" is also a self-serving conclusion since you put yourself in the category of "top" medical students.

Nobody is saying that the top medical centers listed are bad places. We are simply saying that there are many more important aspects of surgical training than prestige.

I've never liked these "logical" (nearsighted) explanations of things because they eliminate choice from the equation (all top students pick top specialties at top institutions). Plenty of smart and accomplished people choose their college, med school, and residency based on a multitude of factors, including geography, friends/family, religion, etc.

I have personal experience (during my GS and subspecialty years) with one of the top 5 programs that has been called out in this thread but also with two of the "unappreciated non-mecca gems". The reality is that there wasn't nearly as much difference as people would like to think. At US News superstar place, attendings took the residents through the lap choles and vascular bypass... and they did at the other place too. There is probably a bit of truth in a general concept that the highly specialized famous places give their residents more exposure to complexity but at the cost of less hands-on practice. But what I saw over and over was that most respectable US programs -- community and academic both -- provided enough rope for the residents to either climb up or hang themselves (metaphorically..). The community programs had the same % of technically terrible residents, it just wasn't grist for people rubbing it in like when they see an MGH grad who sucks. IMO the reality is that the output quality has far more to do with the starting material that rolled in intern year than the program brand.

 

[Docbeme]

You are assuming that the most academically accomplished students will turn into the best surgeons, and I would disagree. You are also assuming that the most academically accomplished medical centers will provide the best surgical training, where I disagree again. There are many other variables that factor in to the production of an excellent surgeon. And, classically, there has been a disconnect between book smarts and clinical skill, although this is not always the case.

Your "logical conclusion" is also a self-serving conclusion since you put yourself in the category of "top" medical students.

Nobody is saying that the top medical centers listed are bad places. We are simply saying that there are many more important aspects of surgical training than prestige.

I've never liked these "logical" (nearsighted) explanations of things because they eliminate choice from the equation (all top students pick top specialties at top institutions). Plenty of smart and accomplished people choose their college, med school, and residency based on a multitude of factors, including geography, friends/family, religion, etc.

 

[dienekes88]

I have personal experience (during my GS and subspecialty years) with one of the top 5 programs that has been called out in this thread but also with two of the "unappreciated non-mecca gems". The reality is that there wasn't nearly as much difference as people would like to think. At US News superstar place, attendings took the residents through the lap choles and vascular bypass... and they did at the other place too. There is probably a bit of truth in a general concept that the highly specialized famous places give their residents more exposure to complexity but at the cost of less hands-on practice. But what I saw over and over was that most respectable US programs -- community and academic both -- provided enough rope for the residents to either climb up or hang themselves (metaphorically..). The community programs had the same % of technically terrible residents, it just wasn't grist for people rubbing it in like when they see an MGH grad who sucks.

Agree. When you see someone with pedigree fall on his face, people eat it up. Schadenfreude.

I think exposure to complexity is good, but I have the academic bias.

IMO the reality is that the output quality has far more to do with the starting material that rolled in intern year than the program brand.

I think there is only some truth to this. The people who were destined for greatness will be high achievers independent of their program.

However, for the rest of us, I am sticking to the adage, "you can teach a monkey to operate."

 

[Kaustikos]

You mean Louisville didn't make the list?

*snickers*

 

[DermViser]

My posting history reflects 27 years in the residency/fellowship business, and ranking programs of all kinds for internal use. I have no love for UTSW or Louisville, and understand some of the issues at both programs as I do others, but I know darn well their stature in current general surgery education. I would definitely put two community programs in any Top 20 GS list, and Emory in the lower half of the Top 10. But as I said, not a bad list for IM.

 

[vhawk]

And, classically, there has been a disconnect between book smarts and clinical skill, although this is not always the case.

Why would this be true? You are implying here that there is actually a NEGATIVE CORRELATION between "book smarts" (whatever that means) and clinical skill. Romantic equality fantasies aside, I find that to be a fantastic claim. I think you are describing human cognitive bias and not an actual phenomenon, but I'd be very interested to hear the proposed mechanisms supporting this negative correlation.

 

[SLUser11]

Why would this be true? You are implying here that there is actually a NEGATIVE CORRELATION between "book smarts" (whatever that means) and clinical skill. Romantic equality fantasies aside, I find that to be a fantastic claim. I think you are describing human cognitive bias and not an actual phenomenon, but I'd be very interested to hear the proposed mechanisms supporting this negative correlation.

You are assuming that all skill sets come from some inherent ability/talent. My theory is that people with a rockier ascent had to work harder to get there, and this effort was beneficial to their abilities. They also have dealt more with diversity and defeat, so it doesn't frazzle them as much. I also believe that they are often more receptive to negative feedback, while the all-star resident just gets pissed off when you tell him/her something is wrong or inadequate.

An example would be a recent chief resident of mine from a previous institution. He was remarkably intelligent and did extremely well on all tests, but frequently over-thought clinical problems and missed the main point. He also was overly-confident in his knowledge, so he was often frustrated when he did not know an answer (or would assume there is some fault in the questioner), and he would often be very defensive when his judgment was questioned. If you simply pinned him down and forced him to make an important judgment call, he couldn't do it....but I would literally re-phrase it in the form of a test question and he'd figure it out. "So, what should we do for Mr. Johnson? WBC is up again, and he's extremely tender, increasingly tachycardic...." "I don't know....you could do x....or maybe y....let's re-assess in a few hours." "So, you have a 45 yo male who is POD #3 from a colectomy with increasing leukocytosis, diffuse tenderness, tachycardia...." "Oh, then we should operate." Scary phenomenon.

Anyway, I'm not saying there is an inverse or negative correlation, as you've cap-locked. I'm saying there is a disconnect. They are not as related as you'd think. Of the many surgical residents I've encountered at multiple institutions, the most academically accomplished ones (pedigree, USMLE, ABSITE, publications) were rarely the best clinicians or technicians. That certainly doesn't mean, however, that they were the worst. The worst ones are usually bad all around....

 

[DermViser]

But we also had one who had the book smarts/PhD, and was kind of similar to your example - indecisive clinically and unable to think "outside the textbook". He also couldn't operate his way out of a paper bag.

Maybe bc medical education has professionalized things so much when it comes to promotion from one year to the next that one can be book smart (great ABSITE scores), and only know things when they fit the book, and actual surgery stuff (technique, etc.) you don't get as much points for?

 

[vhawk]

You are assuming that all skill sets come from some inherent ability/talent. My theory is that people with a rockier ascent had to work harder to get there, and this effort was beneficial to their abilities. They also have dealt more with diversity and defeat, so it doesn't frazzle them as much. I also believe that they are often more receptive to negative feedback, while the all-star resident just gets pissed off when you tell him/her something is wrong or inadequate.

An example would be a recent chief resident of mine from a previous institution. He was remarkably intelligent and did extremely well on all tests, but frequently over-thought clinical problems and missed the main point. He also was overly-confident in his knowledge, so he was often frustrated when he did not know an answer (or would assume there is some fault in the questioner), and he would often be very defensive when his judgment was questioned. If you simply pinned him down and forced him to make an important judgment call, he couldn't do it....but I would literally re-phrase it in the form of a test question and he'd figure it out. "So, what should we do for Mr. Johnson? WBC is up again, and he's extremely tender, increasingly tachycardic...." "I don't know....you could do x....or maybe y....let's re-assess in a few hours." "So, you have a 45 yo male who is POD #3 from a colectomy with increasing leukocytosis, diffuse tenderness, tachycardia...." "Oh, then we should operate." Scary phenomenon.

Anyway, I'm not saying there is an inverse or negative correlation, as you've cap-locked. I'm saying there is a disconnect. They are not as related as you'd think. Of the many surgical residents I've encountered at multiple institutions, the most academically accomplished ones (pedigree, USMLE, ABSITE, publications) were rarely the best clinicians or technicians. That certainly doesn't mean, however, that they were the worst. The worst ones are usually bad all around....

I dont know how you know how related I think they are, but I will agree with you that the correlation is less than 1. It is also much much higher than 0.

People, perhaps not you, are very susceptible to what I call the Dungeons and Dragons fallacy (because I'm a ****ing dork.) This is the myth that somehow we are all allocated so many "attribute points" and so if you are good at something that means you are less likely to be good at other things. Everyone thinks jocks and cheerleaders are stupid, and the geeky weirdo is smart. In reality the exact opposite is true. Jocks are smarter than geeks. Cheerleaders are smarter than the flute section. This offends some innate sense of parity, but alas.

This is a rant that is only tangentially related to the thread. Other than that your post is full of a lot of nice-sounding narrative fallacy that is largely untestable and in places where it is testable is probably not gonna come out favorable to the feel-good story.

 

[dienekes88]

I dont know how you know how related I think they are, but I will agree with you that the correlation is less than 1. It is also much much higher than 0.

People, perhaps not you, are very susceptible to what I call the Dungeons and Dragons fallacy (because I'm a ******* dork.) This is the myth that somehow we are all allocated so many "attribute points" and so if you are good at something that means you are less likely to be good at other things. Everyone thinks jocks and cheerleaders are stupid, and the geeky weirdo is smart. In reality the exact opposite is true. Jocks are smarter than geeks. Cheerleaders are smarter than the flute section. This offends some innate sense of parity, but alas.

This is a rant that is only tangentially related to the thread. Other than that your post is full of a lot of nice-sounding narrative fallacy that is largely untestable and in places where it is testable is probably not gonna come out favorable to the feel-good story.

Generally agree.

You forget that there is a fetishized "rags to riches" ideal. The guy who worked his ass off in community college to go to State U for medical school and then goes on to be a surgical resident at a solid community program or an academic program or the so-called communiversity programs is celebrated. He pulled himself up by the bootstraps. Meanwhile the guy who busted his ass to go to Ivy League undergrad and then had to bust his ass to go to Hopkins/Harvard/etc. and then went to an academic powerhouse general surgery residency... he must have had it easy.

There is a lot of self-fulfilling prophecy, selective memory, and anecdote in this discussion. As mentioned above, everyone remembers when name-brand resident ended up being a Lemon or maybe even average. Nobody remembers when average Joe resident ended up being... an average Joe. It's all about expectation.

You are assuming that all skill sets come from some inherent ability/talent. My theory is that people with a rockier ascent had to work harder to get there, and this effort was beneficial to their abilities. They also have dealt more with diversity and defeat, so it doesn't frazzle them as much. I also believe that they are often more receptive to negative feedback, while the all-star resident just gets pissed off when you tell him/her something is wrong or inadequate.

Why can't someone have a rocky ascent and still be at a name-brand institution? Places like Harvard and Yale have incredible financial aid packages for undergrad and medical school. Why can't the "all-star resident" be someone who has worked hard and suffered defeat?

Everyone works hard. Your hypothesis that people who reached higher ranked places or score well on tests/arbitrary measures of "all-star resident" have somehow worked less hard is mind boggling. Maybe a lot of people started off at the same level... and the people who went on to MGH or Wash U, two of my favorite programs when I interviewed in general surgery, just worked that much harder. It's not always the case, but it's also not always the case that someone at a less prestigious program with a less impressive "pedigree" worked harder for it.

 

[SLUser11]

Generally agree.

You forget that there is a fetishized "rags to riches" ideal. The guy who worked his ass off in community college to go to State U for medical school and then goes on to be a surgical resident at a solid community program or an academic program or the so-called communiversity programs is celebrated. He pulled himself up by the bootstraps. Meanwhile the guy who busted his ass to go to Ivy League undergrad and then had to bust his ass to go to Hopkins/Harvard/etc. and then went to an academic powerhouse general surgery residency... he must have had it easy.

There is a lot of self-fulfilling prophecy, selective memory, and anecdote in this discussion. As mentioned above, everyone remembers when name-brand resident ended up being a Lemon or maybe even average. Nobody remembers when average Joe resident ended up being... an average Joe. It's all about expectation.



Why can't someone have a rocky ascent and still be at a name-brand institution? Places like Harvard and Yale have incredible financial aid packages for undergrad and medical school. Why can't the "all-star resident" be someone who has worked hard and suffered defeat?

Everyone works hard. Your hypothesis that people who reached higher ranked places or score well on tests/arbitrary measures of "all-star resident" have somehow worked less hard is mind boggling. Maybe a lot of people started off at the same level... and the people who went on to MGH or Wash U, two of my favorite programs when I interviewed in general surgery, just worked that much harder. It's not always the case, but it's also not always the case that someone at a less prestigious program with a less impressive "pedigree" worked harder for it.

I think you guys are getting your panties into a bunch over things that I never really said. As much as there are "rags to riches" fetishes, there are also a lot of people overly-defensive of their accomplishments, and convinced of their unique abilities....these people often get offended when their awesomeness is questioned.

I don't have a "rags to riches" story myself. I was always accomplished and got everything I wanted on my first try, and I was largely being self-deprecating in my previous comments. The only thing that separates me from ivy league mentalities is my midwest location, my self-awareness, and my priorities. I promise that I was raised with the same unique snowflake mentality as everyone else, and I felt bulletproof through a lot of my schooling. I always worked hard, of which I'm very proud, but I never had to pull myself up by my bootstraps. But, I was always impressed by those that had a rockier ascent than myself, and I don't hesitate to give them kudos.

When I was a medical student interviewing for surgery, I was looking for a place with 1) a strong curriculum that would give me a solid fund of knowledge and allow me to pass my boards, 2) adequate case volume and complexity to make me a strong technician, 2) appropriate, graduated autonomy to prepare me for tough surgical decision-making, 3) history of job and fellowship placements that matched my own long-term goals, and 4) geographic proximity to my family (and in-laws). What I did not have much interest in was manufactured prestige and research. This ultimately came back to bite me, however, as I'm now an academic surgeon, and I'm having to catch up with my colleagues in the area of research and academic politics....but two years later, I feel well-adjusted. My top 10 list looked very different in 2004 than is does right now, and will probably look different 10 years from now as well.

But, I agree with the comments that this discussion is based on anecdote. I'm not sure how else such a worthless internet discussion could be conducted. Go back and read this thread again, and you'll see that my main point has been that the exercise of arbitrary ranking is not useful, so I choose to have a little fun with it. That being said, look at our only objective measurement of residency quality, which is the ability to be a board certified general surgeon when you're done (http://www.absurgery.org/xfer/5yr_summary.pdf), and you'll see that the ABS's top 10 list differs from the ones listed here.

 

[SLUser11]

I think board passage rates are important, to a point. They can highlight the programs with major deficiencies. But when you're looking at such a small sample for each program, trying to divine differences in program quality over small percentage differences (which likely reflect one individual failure) seems dubious.

At what percentile do you say a program has a "problem" with board passage? (I'm genuinely asking - I don't know. Maybe if they are below the national pass rate?). But 88% vs 92% - when that difference likely indicates one person over a five year period failing? Not sure what to do with that information.

I don't think there's much difference. I also don't think there's much difference in a lot of small variations among programs, hence the arbitrary nature of ranking them. But, we have very little objective measures to use, so I think it's one of the best tools we have.

I think if you're below the national average, there's a problem. I think that even the national average is scary low, and I would be wary of a program where 1 in 4 residents fail their boards. Undoubtedly, they will blame their numbers on "individual" failures as well. However, one of the reasons the ABS uses 5 years of data is to show trends. If you have 4 residents a year, then a single failure will only bring the pass rate down by 5% (obviously).

 

[balaguru]

Don't forget to investigate the attrition rate. A large academic program with a high board pass rate and low attrition rate with a reputation of training academic and clinical surgeons might be worth considering if such a unicorn exists

Two questions worth putting in your back pocket for those moments when you get asked, "so what questions do you have for me?":

Is there a recent example of a program change requested by the residents that the program chose to implement?
And the corollary, is there another example that the program chose not to implement?

The answers and discussion that follow can give you alot of insight into the administration and current residents from the point of view of whoever you are asking.

 

[JayDoc06]

Nice to see my former program causing an argument. See my previous posts for my thoughts on Louisville. I will say autonomy is alive and well there, certainly compared to national trends.

I am a firm believer that your program doesn't make you anything. It merely facilitates you reaching your goals, whatever they may be. My feeling is that someone's ability to be a surgeon: hall of famer, butcher, or level headed work horse depends most on intelligence, goals, motivation, personality and natural ability. Numbers of cases, breadth of cases, institution name on your certificates matter less and less as you go on. Of course certain programs help you get certain fellowships. And of course if you aren't taught how to operate correctly, that's a problem. There are just as many poor teachers at your "top" programs as the average community program.

Also remember that surgery is all about judgement, learning what to do and when is the most important thing. That is learned with experience- therefore, despite what I said above above case volume, clinical exposure is vitally important. Pick a busy program that will allow you to reach your goals in a location that is acceptable to you. Also remember that goals change.

I went to average state undergrad, average state medical school, busy clinically "traditional" program mentioned previously and competitive but not big name fellowship and couldn't be more pleased with career and life 2 years out of training.

Relax.

 

[Poquito]

Bump!

Starting to put together my rank list. I have no idea how to choose between the "top 20" programs I interviewed at. They all seem so similar, and location isn't that big of a deal for me. Anyone else in a similar situation? How are you choosing?

FWIW, I did interview at some some lesser-known-but-"clinically excellent" programs too. I did really like a couple, but I have to admit it's hard to ignore the fellowship placements that the big guys consistently get.

 

[Poquito]

No fun without a list...

::Sigh:: Yes, I know. Don't want to out myself though.

How about this: In no particular order, and with a couple thrown in that I didn't interview at...

OHSU, U of Chicago, Pitt, Emory, NYU, Wisconsin, Michigan, Vandy, UT-Southwestern, Northwestern, Maryland, UCLA

 

[DigStim22]

I'll bite too. Any thoughts are appreciated

UofChicago, Northwestern, WashU, OSU, UTSW, Baylor CM

Baylor and Wash U seem like great training places with happy residents. UTSW seems like you will finish a BAMF, but will be miserable in the process. UofC and Northwestern are strong programs in a great city.

 

[SouthernSurgeon]

::Sigh:: Yes, I know. Don't want to out myself though.

How about this: In no particular order, and with a couple thrown in that I didn't interview at...

OHSU, U of Chicago, Pitt, Emory, NYU, Wisconsin, Michigan, Vandy, UT-Southwestern, Northwestern, Maryland, UCLA

Ok I'll shoot. I'll go by region

NE:
1. Pitt: Really high volume. Good academic reputation. Reportedly fellow heavy. Strong in HPB and transplant. We have a poster here who is a current resident but I haven't seen him post in a while so not sure if will get much from him.
2. NYU: You basically have to decide if you want to live in Manhattan. Expensive and very different flavor. Lots of autonomy but also lots of scut because of the Bellevue thing. Has had a lot of turnover in the leadership since I interviewed there so I don't know how it is now.
3. Maryland: Didn't interview there, no nothing about it

South:
1. Vandy: I really loved this program on the interview trail and ranked it very highly. Dr. Tarpley is a really awesome guy and makes a unique impression. Buuuut if I recall correctly he just retired? He seemed like a force in that program so I don't know what the impact of him stepping down will be. Oh and their top surgical oncologist just left for a new institution - but faculty attrition happens all the time so I don't know that I'd factor that in too much.
2. UTSW: Huge program. Reputation for lots of autonomy and high quality training. Parkland shapes a lot of the experience there. You have to decide based on the list you've given here whether you want a residency that centers around a big public hospital (UTSW, Emory, NYU), or one that centers around a big academic medical center (Vandy, Michigan, Pitt, UCLA, etc). @balaguru is public about having trained there so I don't think they'll mind me bat-signaling them.
3. Emory: I wanted to like this program more than I ended up liking it. I don't really remember anything in specific about it. Also has had a lot of leadership change - I believe they still have an interim chair and are in a search for a new chair? I really like their current PD - he interviewed me but he was the associate PD at that time. I didn't like how many hospitals they have to go to - seemed decentralized.

Midwest:
1. Michigan: Really strong for academics/research. Their residents seem to be at a lot of the meetings and very active/productive. I really loved this one on the interview trail too and thought they sold themselves really well on the interview day - very clinically busy in addition to the academics, good resident cameraderie.
2. Wisconsin: One of the biggest pleasant surprises to me on the interview trail. I didn't know much about it ahead of time but I really liked their residents and seemed like a great place. They are likely to lose one of their biggest names (Herbert Chen) in the near future as he is frequently talked about as someone who will be a dept chair soon. They just hired Caprice Greenberg a couple years ago who is a big name in outcomes research.
3. Northwestern: I know a couple people here who seem very happy with their experience. Very strong connection with the American College of Surgeons NSQIP - since they are in Chicago. Karl Bilimoria is probably one of the biggest up and comers (I think he's only been a faculty for 3 or 4 years?); very productive researcher and is heading up the FIRST study.
4. Chicago: I didn't interview at this one and don't know it as well. But I really like Dr. Posner - head of surg onc. They had two really strong students last year applying and both of them chose to stay (I think?), which usually says good things about the place.

West:
1. UCLA: This was a weird interview day for me. One of my interviewers had to cancel last minute so they brought in a faculty who was super negative and basically told me not to go there because the residents have no camaraderie and backstab each other. Then after that, I interviewed with one of the chiefs who basically said "OMG they let you talk to Dr. XXX - they don't let him interview anyone because he's so negative!". So yeah that whole thing gave me a weird vibe. Very impressive fellowship match list. Lots of research. Beautiful hospital.
2. OHSU: Didn't interview there, don't know much about it.


*Disclaimer - I'm just one person, and I'm just a resident. It's also been 5 years since I did this so a lot has changed over time. These opinions are a combination of my impressions from the interview trail combined with what my faculty have said and I've observed/heard from other residents over time.

 

[DigStim22]

Thanks for the insight! Anyone else have additional thoughts?

 

[Poquito]

Ok I'll shoot. I'll go by region

NE:
1. Pitt: Really high volume. Good academic reputation. Reportedly fellow heavy. Strong in HPB and transplant. We have a poster here who is a current resident but I haven't seen him post in a while so not sure if will get much from him.
2. NYU: You basically have to decide if you want to live in Manhattan. Expensive and very different flavor. Lots of autonomy but also lots of scut because of the Bellevue thing. Has had a lot of turnover in the leadership since I interviewed there so I don't know how it is now.
3. Maryland: Didn't interview there, no nothing about it

South:
1. Vandy: I really loved this program on the interview trail and ranked it very highly. Dr. Tarpley is a really awesome guy and makes a unique impression. Buuuut if I recall correctly he just retired? He seemed like a force in that program so I don't know what the impact of him stepping down will be. Oh and their top surgical oncologist just left for a new institution - but faculty attrition happens all the time so I don't know that I'd factor that in too much.
2. UTSW: Huge program. Reputation for lots of autonomy and high quality training. Parkland shapes a lot of the experience there. You have to decide based on the list you've given here whether you want a residency that centers around a big public hospital (UTSW, Emory, NYU), or one that centers around a big academic medical center (Vandy, Michigan, Pitt, UCLA, etc). @balaguru is public about having trained there so I don't think they'll mind me bat-signaling them.
3. Emory: I wanted to like this program more than I ended up liking it. I don't really remember anything in specific about it. Also has had a lot of leadership change - I believe they still have an interim chair and are in a search for a new chair? I really like their current PD - he interviewed me but he was the associate PD at that time. I didn't like how many hospitals they have to go to - seemed decentralized.

Midwest:
1. Michigan: Really strong for academics/research. Their residents seem to be at a lot of the meetings and very active/productive. I really loved this one on the interview trail too and thought they sold themselves really well on the interview day - very clinically busy in addition to the academics, good resident cameraderie.
2. Wisconsin: One of the biggest pleasant surprises to me on the interview trail. I didn't know much about it ahead of time but I really liked their residents and seemed like a great place. They are likely to lose one of their biggest names (Herbert Chen) in the near future as he is frequently talked about as someone who will be a dept chair soon. They just hired Caprice Greenberg a couple years ago who is a big name in outcomes research.
3. Northwestern: I know a couple people here who seem very happy with their experience. Very strong connection with the American College of Surgeons NSQIP - since they are in Chicago. Karl Bilimoria is probably one of the biggest up and comers (I think he's only been a faculty for 3 or 4 years?); very productive researcher and is heading up the FIRST study.
4. Chicago: I didn't interview at this one and don't know it as well. But I really like Dr. Posner - head of surg onc. They had two really strong students last year applying and both of them chose to stay (I think?), which usually says good things about the place.

West:
1. UCLA: This was a weird interview day for me. One of my interviewers had to cancel last minute so they brought in a faculty who was super negative and basically told me not to go there because the residents have no camaraderie and backstab each other. Then after that, I interviewed with one of the chiefs who basically said "OMG they let you talk to Dr. XXX - they don't let him interview anyone because he's so negative!". So yeah that whole thing gave me a weird vibe. Very impressive fellowship match list. Lots of research. Beautiful hospital.
2. OHSU: Didn't interview there, don't know much about it.


*Disclaimer - I'm just one person, and I'm just a resident. It's also been 5 years since I did this so a lot has changed over time. These opinions are a combination of my impressions from the interview trail combined with what my faculty have said and I've observed/heard from other residents over time.

Wow, thanks!!!

One thing that concerned me about UT-SW is the frequent violation (and encouragement to violate) work hours. Aren't they afraid they will get into trouble? That said, I felt like I would come out of that program bulletproof...

 

[Poquito]

You have to decide based on the list you've given here whether you want a residency that centers around a big public hospital (UTSW, Emory, NYU), or one that centers around a big academic medical center (Vandy, Michigan, Pitt, UCLA, etc).

So... yep. But how do I choose?? Arrrgh. Public hospitals seem to be where people get the most autonomy, but big academic centers have the crazy cases and whatnot. I find myself leaning towards the places with all of the above... for example, Emory has the University Hospital, Grady, and the Atlanta VA. True it's a lot of hospitals, but doesn't the breadth of experience make up for it? Or is it just exhausting to learn three systems?

 

[Poquito]

To me I struck the balance by going a place with a big university hospital and a big VA (i.e. you go to the VA every year as part of the regular rotation, not once or twice out of the whole residency).

I felt like the result of being at so many hospitals for Emory (your list didn't include the children's hospital, Emory Midtown or whatever they're calling it these days, St. Jo's in the burbs, and Piedmont) was that the residents are decentralized and didn't see each other (or the core faculty) as much as a result. Also having grown up in Atlanta I am allergic to the traffic. But again I don't go there so take my thoughts with a grain of salt

Hmm I guess I didn't get the impression that general surgery residents were at those other hospitals very much, but that may be what they wanted me to think. I have heard from Emory med students that the residents don't seem to be very close, and I kind of got that impression on my interview day too. Being spread all over the place would explain that...

I have to say as far as residents go, Maryland had the most "fun" group. Cornell's seemed the closest, perhaps because they all live in the same building. How much did that weigh into your decision?

(I realize this is off topic, but who really cares about the "ranking" of programs when it's more about finding the best program for you, anyways)

 

[balaguru]

Wow, thanks!!!

One thing that concerned me about UT-SW is the frequent violation (and encouragement to violate) work hours. Aren't they afraid they will get into trouble? That said, I felt like I would come out of that program bulletproof...

I suppose things could have changed over the year and a half since my graduation. I'm not going to ask you for specifics since such second and third hand information would be inappropriate. Plus, it's been my experience that people tend to exagerate just how much or how hard they are working or generalize one bad night to the entire month. When I was at UTSW, there was little tolerance from the leadership down for work hour violations. And yes, they are afraid of getting into trouble--hence why they take it seriously. The program is so large it would be foolish to think you could somehow design service schedules that were not workhour compliant and keep all 13x5=65 residents from calling the RRC hotline and reporting the program. I rarely worked more than 70 hrs per week except for an intern month on transplant when I was grossly violating work hours. I reported my hours truthfully that month and the rotation was changed the following month. Nobody asked me to explain what happened or held it against me in any way. They just changed it. With that said it was one of my more enjoyable months in residency. I was doing access cases as a intern while the chief was transplanting livers. Neither of us slept. I will say that I, at times, violated the shift duration rules to do cases post call and also the rules specifying the minimum amount of time between shifts to come back to the hospital to see a patient who wasn't doing well. There was never an expectation to do that, I just did it to fill gaps in my experience or because I wanted to know what was happening with a patient.

I agree that comraderie is important. Unfortuntely, even if you think you have it pinned down there is no guarantee that it won't change over time within the same program. Everybody is a victim of the match and some classes are going to gel and some aren't. The more dysfuncional classes make the whole program miserable as they advance through.

 

[Poquito]

I felt like the result of being at so many hospitals for Emory (your list didn't include the children's hospital, Emory Midtown or whatever they're calling it these days, St. Jo's in the burbs, and Piedmont) was that the residents are decentralized and didn't see each other (or the core faculty) as much as a result.

BTW, I used the Doximity website to look up the amount of time residents spend at each location, and you were spot on.

I suppose things could have changed over the year and a half since my graduation. I'm not going to ask you for specifics since such second and third hand information would be inappropriate. Plus, it's been my experience that people tend to exagerate just how much or how hard they are working or generalize one bad night to the entire month. When I was at UTSW, there was little tolerance from the leadership down for work hour violations. And yes, they are afraid of getting into trouble--hence why they take it seriously. The program is so large it would be foolish to think you could somehow design service schedules that were not workhour compliant and keep all 13x5=65 residents from calling the RRC hotline and reporting the program. I rarely worked more than 70 hrs per week except for an intern month on transplant when I was grossly violating work hours. I reported my hours truthfully that month and the rotation was changed the following month. Nobody asked me to explain what happened or held it against me in any way. They just changed it. With that said it was one of my more enjoyable months in residency. I was doing access cases as a intern while the chief was transplanting livers. Neither of us slept. I will say that I, at times, violated the shift duration rules to do cases post call and also the rules specifying the minimum amount of time between shifts to come back to the hospital to see a patient who wasn't doing well. There was never an expectation to do that, I just did it to fill gaps in my experience or because I wanted to know what was happening with a patient.

I agree that comraderie is important. Unfortuntely, even if you think you have it pinned down there is no guarantee that it won't change over time within the same program. Everybody is a victim of the match and some classes are going to gel and some aren't. The more dysfuncional classes make the whole program miserable as they advance through.

Thanks a ton! I'll keep it in mind.

 

[thedrjojo]

So... yep. But how do I choose?? Arrrgh. Public hospitals seem to be where people get the most autonomy, but big academic centers have the crazy cases and whatnot. I find myself leaning towards the places with all of the above... for example, Emory has the University Hospital, Grady, and the Atlanta VA. True it's a lot of hospitals, but doesn't the breadth of experience make up for it? Or is it just exhausting to learn three systems?

You are going to get the big crazy cases at public hospitals, difference is you will be much more likely to be doing them instead of watching them imo.

Autonomy was my biggest driver in my rank list. I was vocal when I was applying, but I was very turned off by Cornell and really enjoyed NYU, and I was Nyc centric on my application.

 

[chapulin colorado]

I apologize for the length of my first post but this thread has really got me thinking about rankings and "the top 10." What seems to get repeated is that there may be some argument up or down as to where certain programs actually rank, but for the most part there is agreement that the top 10 (maybe 20) belong there, albeit without a specific, settled order. That's useful information and I have no reason to disagree.

But how many GS applicants are actually in the running for a categorical at a top 10 school? Is there room for a Consumer Reports-like, second tier or average applicant top 10?

It's great to know that Cathay Pacific has the best lay flat seats, highest regarded lounge, and some of the best meals, but if I'm not getting a bump into business class or shelling out $9,000 for my flight, knowing that CP is #1 is useless to me. It's never going to happen. Take the leftover carriers that I can actually fly/afford (let's say 7) and it's not TOO difficult to decide on an airline. But with GS residencies multiple that by 25 and you now have the possible programs an average applicant would have to consider (excluding top and bottom ~15%). It's overwhelming [the location discussion, IMHO, falls a little flat and does little to guide. I would make location sacrifices to get into a better residency if it were possible, assuming the subjective "better" is accurate for my situation. But sure, if program X and Y are the same, I'd rather be in San Diego than El Paso].

So stretching the boundaries somewhat, I'm curious about what programs would be the "all things considered top 10." Maybe this is for the handful of posters that disagree strongly with the Dox ranking. I don't know if that means underrated, diamond in the rough, etc. but I've read here and other threads on SDN where residents have considered other factors more important than what goes into a US News/Dox ranking.

Considering some of those aspects, (eg board pass %, autonomy, moonlighting, salary, clinical training/exposure, or whatever residents or post residency surgeons believe are important) what programs would comprise that top 10?

 

[SLUser11]

This is easily one of my favorite threads on SDN. Unfortunately, SDN is different than Facebook, and I cannot "like" my own posts....

 

[SpikesnSpookes]

Can anyone comment on which programs offer a good amount of autonomy to the residents? At my school, there were 3rd year residents who were 3rd assisting on thoracic surgeries (obviously to the fellow and head surgeon) but I just thought it was a waste of a rotation for that resident. Seems like the smaller the institution and less residents/fellows, the more autonomy you get?

 

[thedrjojo]

Can anyone comment on which programs offer a good amount of autonomy to the residents? At my school, there were 3rd year residents who were 3rd assisting on thoracic surgeries (obviously to the fellow and head surgeon) but I just thought it was a waste of a rotation for that resident. Seems like the smaller the institution and less residents/fellows, the more autonomy you get?

I can only speak for my program, but I've done probably 200 cases this academic year and attendings have scrubbed for less than 50% of them, and when they have its only been mostly for small portions or just to retract cause they can't get themselves not to put on gloves at least. My intern even got to do a case all by herself without an attending scrubbed (a small leg Lipoma, she almost had a heart attack). We have 4 hospitals, and 8 residents a year.
This mainly happens in VA hospitals and in county/city public hospitals, much less in private hospitals. So I'd focus on those opportunities.

 

[kemper6036]

Can anyone comment on which programs offer a good amount of autonomy to the residents? At my school, there were 3rd year residents who were 3rd assisting on thoracic surgeries (obviously to the fellow and head surgeon) but I just thought it was a waste of a rotation for that resident. Seems like the smaller the institution and less residents/fellows, the more autonomy you get?

sometimes this is true, but every program is different. thedrjojo comes from a larger program that seems to offer a fair amount of autonomy. i'm in a small program almost exclusively out of a county safety net facility so depending on the resident and the case, the attending may scrub in or may not show up at all and just want you to call with problems. usually its somewhere in the middle of this spectrum. just keep talking to folks until you find the combination/setup you're looking for

 

[SpikesnSpookes]

Thanks for the responses. Now as for the top 10 programs, what is the best way to get into them other than good board scores? How can you figure out what sort of student they are looking for? I've read on their websites but can't find any specifics.

 

[ThoracicGuy]

There's no secret/magic here.

You get into these programs by having great grades, great board scores, research, and great LORs from big names.

And usually graduate from a "top" med school too.

 

[slaveofthehealer]

Does one need to attend a top-tier med school to match into one of these top surgical residencies. What are the chances of matching into them if one went to a lower/middle tier allopathic school in America.

 

[thedrjojo]

Does one need to attend a top-tier med school to match into one of these top surgical residencies. What are the chances of matching into them if one went to a lower/middle tier allopathic school in America.

Get aoa, score ridiculous on step 1/2, and it may happen from whereever.

I'd call my med school middle tier, and I could have ended up in NYU, Columbia, or Cornell most likely, both because my scores/aoa, and because my letter writers had connections to them