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Archive for the ‘Residency’ Category

Residency Switching – Prevalence and Methods

Posted by medliorator on April 21, 2010

by Elizabeth Losada, MD @SDN…

Anecdotally it is said that as many as ten percent of all residents switch specialties each year.

Studies looking at resident attrition rates have yielded some data on specialty switching among residents.  Attrition rates account for all residents who leave residency programs, not just those who change specialties.  This includes residents who leave medicine completely and those who switch to another program within the same specialty.  A study of Ob-Gyn resident attrition by McAlister et al. in 2008 (1) noted 2004-2005 ACGME reported annual resident attrition rates of 5.8% in Surgery, 5.1% in Ob-Gyn, 4.7% in Family Medicine, and 2.1% in Internal Medicine.  Of 1055 categorical Ob-Gyn residents who entered programs in 2001, 21% (228 residents) had left their original program after four years and were categorized in the attrition group.  Within the attrition group 33% (75 residents) switched specialties and 39% (29 residents) moved to primary care residencies.

Longo et al. (2) examined resident attrition from a general surgery residency program over a 20-year period and found a 30% attrition rate.  Of the 30 residents who did not complete their training at the program, 63% (19 residents) switched to other specialties, including plastic surgery and medicine most commonly.  The most common reasons cited for leaving the program included “lifestyle” and “passion for another specialty.”

How one goes about finding a new residency position varies, depending on the type of switch being made.  For some residents, especially those who decide to switch early on or who are switching to a field that is drastically different from their current specialty, the easiest way to switch may be to re-enter the match.  Going through the match again provides the most options for finding a new first-year position.  For residents who have completed training that may count towards the requirements for another field, looking for a position outside the match may make the most sense.  Simply calling area programs to ask about openings has been successful for some residents.  Additionally, several websites (see below) offer notification of off-cycle positions and application services.

Switching Specialties [SDN]

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The Medical Bottleneck – Residency Shortage & Health Care Reform

Posted by medliorator on April 14, 2010

a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC.

But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions… There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.

Doctors’ groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn’t make it into the final bill… The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

Medical Schools Can’t Keep Up [WSJ Health]

Posted in News, Residency | 1 Comment »

Top 10 Most Competitive Residencies (2010)

Posted by medliorator on April 7, 2010

Combined Programs:

PGY-2 Programs:

Advanced Data Tables 2010 [NRMP]

Correlate: Top 10 Most Competitive Residencies (2009)

Correlate: Top 10 Most Competitive Residencies (2008)

Correlate: Top 10 Most Competitive Residencies (2007)

Posted in Matching, Residency | 2 Comments »

How to Create a Rank Order List of Residency Programs

Posted by medliorator on January 8, 2010

Kendra Campbell shares her approach to the creation of her rank order list at The Differential:

I created a spreadsheet with 10 different variables across the top. Next, I added each program as a separate row, and then put a ranking (1-5) for each variable …For each program, I added up all the numbers, sorted them from highest to lowest, and voila! I have a rank order list of residency programs… here are the variables I used (in no particular order):

1. Location
2. Patient population
3. Faculty
4. hospital setting
5. Residents
6. Salary/benefits
7. Opportunities for research
8. Hands-on/procedural experience
9. Hospital and facilities
10. hospital’s reputation

How Do I Choose a Residency Program? [The Differential]

Posted in Matching, Residency | Comments Off on How to Create a Rank Order List of Residency Programs

Speciality Overview – Physical Medicine & Rehabilitation

Posted by medliorator on November 6, 2009

by Sara Cohen, MD

PM&R involves the diagnosis and restoration of functional ability and quality of life in patients with disorders of the nervous and musculoskeletal systems.

Residency training in PM&R includes 1 year of internship, which can be a preliminary or transitional year, followed by 3 years of specialty training in PM&R. Some residencies combine the 4 years into 1 program. Generally, the first year focuses on the inpatient rehabilitation aspects of the field, whereas senior residents practice more outpatient physical medicine with a lighter call schedule.

The rehabilitation part (the “R” in PM&R) involves the long-term care of patients with disorders of the central nervous system, such as brain injury, spinal cord injury, and stroke. We also care for patients with amputations and orthopedic injuries. Our job as the physician on the inpatient rehab unit is to oversee the care of these patients and work with a team of therapists and other staff to maximize the patient’s function. Although the interventions we use will not “cure” patients, we help them to make the most of what they’ve got.

Rehab patients remain on the unit for weeks or even months. As a result, during my residency I was able to build relationships with them and their families, as well as see the long-term outcomes of treatment. I have a shelf in my apartment filled with gifts from patients who were very grateful for the treatment they received on our unit.

What Is PM&R? [Medscape]

Posted in Residency | 1 Comment »

Choosing a Specialty – A Straightforward Approach for the Uncertain

Posted by medliorator on September 21, 2009

from Anne Vinsel, MS, MFA (Project Administrator, Graduate Medical Education, University of Utah Medical Center)

Research those specialties in your institution. Go to the departments and make friends with the residency program coordinators. If you haven’t already done so and haven’t rotated in the program, arrange to shadow a faculty member for a day. Talk with 1 or 2 residents and check out the pros and cons of the specialty. Finally, ask the program coordinator if your board scores would be in a competitive range. Most program coordinators won’t share their board score cut-off, but they likely would tell you if your scores are within range.

Twelve Steps for Choosing a Specialty [Medscape]

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Resident Work-Hour Reform & Patient Safety

Posted by medliorator on September 9, 2009

Reductions in resident physician work-hours at teaching hospitals in 2003 were associated with an increase in complications related to surgery to repair hip fractures, a new study found.

“Our investigation identified that the rate of change of perioperative morbidity in patients with a hip fracture increased significantly in teaching hospitals following resident duty-hour reform.”

Browne and colleagues compared the surgical outcomes from before (2001 to 2002) and after (2004 to 2005) the reform was implemented by reviewing records from the Nationwide Inpatient Sample for 48,430 patients treated for hip fractures at teaching and non-teaching hospitals across the United States.

“It is our anecdotal experience that continuity of care has become more challenging in the orthopaedic teaching environment following duty-hour limitations,” the authors wrote. “Handoffs, particularly problematic in patient care and known to increase the risk of adverse events, appear to occur relatively more frequently in the surgical services after reform.”

Resident Duty-Hour Reform Associated with Increased Morbidity Following Hip Fracture (The Journal of Bone and Joint Surgery)

via Resident Hours Cut, Hip Surgery Complaints Rise [Medpage Today]

Correlate: On the 80-hour Workweek Cap – Part 2

Correlate: Residency: 56 Hour Work Week?

Posted in Residency | Comments Off on Resident Work-Hour Reform & Patient Safety

Top 10 Most Competitive Residencies (2009)

Posted by medliorator on June 10, 2009

[Click here for 2010 match data]

Preliminary data from the 2009 Match has been released by the NRMP.  The most competitive PGY-1 residencies of 2009 are listed below:

medliorate - pgy1 - 1500

Combined residencies are ranked separately below:

medliorate - pgy1combo - 1500

2009 Advance Data Tables (pdf) [NRMP]

Correlate: 2008 Data

Correlate: 2007 Data

Posted in Residency | 3 Comments »

What to do After the Match?

Posted by medliorator on April 18, 2009

4th year mudphudder shares valuable lessons learned from his own mistakes:

what I should have done in hindsight:

1) get ACLS/ATLS certified ASAP – most of you will take a month off in december or january for interviews, get certified on one of your off days.  Also, most of your medical schools will offer these courses for free, so no excuses.

2) Start looking for residency housing ASAP.  If you know where you will be (to varying degrees of certainty), start looking even before the match.  Look in a few different cities if you have a gut feeling of where on your rank list you will land, but LOOK.

Think Ahead [mudphudder]

Posted in Housing, Matching, Residency | Comments Off on What to do After the Match?

Personal Statement ‘Don’ts’

Posted by medliorator on April 7, 2009

  • Don’t rehash all the entries of your CV.
  • Don’t get too fancy with the fonts, style and paper.
  • Don’t tell life stories. This isn’t autobiography.
  • Don’t try to be too dramatic or poetic, this isn’t English assignment.
  • Don’t run of pages, residency directors want a concise statement.
  • Don’t uses clichés to describe why the specialty appeals to you or why you are suited for that specialty.
  • Don’t apologize for bad grades, etc; you may simply call their attention.

Dos and Don’ts of Personal Statement [DoctorsHangout Forum]

Correlate: How to Write a Personal Statement

Posted in Residency, Writing | Comments Off on Personal Statement ‘Don’ts’