Harvard Combined Ortho

Hey - thinking about applying to Harvard - what's the deal with the Chief Resident letter, you know, the one I don't have? Need I not bother applying if I haven't got it?

thanks

of course you should apply.

first, it doesn't have to be an orthopedic chief resident, secondly you can substitute a letter from any senior resident.

Yes, but what I'm asking is - if I haven't got a resident letter at all, will my application be looked at?

Question for harvardcombined...

What kind of stats/profiles do the people getting into harvard have? I imagine everyone has excellent gpa/step 1/AOA, etc. Do most of the residents also have extra research outside of medical school or other advanced degrees?

bbmf03 - i can ask our program director about this, but until then i would assume that if he puts it in the requirements, he would like to see it in your application. but it shouldn't be a problem to get a letter from a resident that you have worked with, you still have some time to the deadline.

CollesFx - i can't give you any hard numbers, the admissions people wouldn't say. but most residents would be >90% for any of these.
most people have done research during college/med school, only a few have advanced degrees or took time off for research.
good scores help you to get past the first round of sorting, after that every application will be looked at by attendings who pick applicants that they find interesting.

Harvardcombined:

Nice web site. Two questions regarding the program.
1. Any problems getting good cases when working along fellows?
2. How many cases are residents doing, on the average, for the whole residency?

Thanks

thanks

1) far less fellows than in most other programs, they also don't steal cases. if there's a complicated revision case and you're a junior, they'll do the majority of the case. but even without fellow it wouldn't be you, but the attending doing the case. if you're a senior than you do the case.
2) don't know about totals, but i did 300 cases as a PGY-2 last year, with maybe 50 where i didn't do the majority of the case.

I heard Harvard was renowned for trying to select students from big name medical schools? Is that true? What chances do students from small-name med schools have if everything else (ie. step 1, grades, research) is all there?

4+ major hospitals with 100+ attendings.

Hard to find mentors you really get to know?
Tendency to get lost?

Thanks,
FB

By my own asessment (as lame as it may be) if you're NOT from a top 10 school then you need AOA/250 step 1/fancy schmancy research OR something special like an ex-NFL player. If you're in the top 10 school category, you may not need all of that, and just gel well during the interview, AI, or got the ties somehow. Just my own feeling, and personally I hope I'm wrong.

About the chief resident letter. If you can't scrounge up at least one chief resident letter out of all of the time that you spent on third year then you have some serious problems. With the exception of psych, any of my chief/senior residents from 3rd year would have been more than happy to write me a letter.

As for feedback from someone who interviewed last season: I thought the Harvard interview day/ resident dinner was one of the most organized and laid back interview days that i had on the trail. I thought Harvard was a phenomenal program and boston is an awesome city. With that said, Harvard landed at #4 on my list. Mainly because of rumors of malignancy. And during the interview day/dinner it seemed as if people were trying TOO hard to dispel the rumors about Harvard's malignancy. . . . .almost as if they were trying to cover things up. I do believe that the program has made some huge changes recently (i.e. getting rid of the "super chief" thing), and Herndon is a great guy for the program, but I heard too often on the interview trail and at least from one resident that the program still is a bit malignant. Just my 2 cents.

getting lost in the crowd: it is a big program and that has positive as well as negative effects on your training. in my opinion, the positive effects are overwhelming: you have not only one, but 10 guys who do total joints. so when you do that rotation every year, you get to scrub with different attending, who might have a different approach to things. that way you can assemble your own bag of tricks from what you liked best. also, you will be assigned a mentor at the start of your training. then at the end of third year, when you have rotated through all hospital and services, and might know what to subspecialize in, you choose a new mentor, who then will help you with fellowship applications and research projects in your chosen area. to me, having many attendings is ideal. first of all, you don't have to compete with your classmates, many of whom might want to go into the same area - we have several renowned sports attendings for example. secondly, the more choices you have, the better the chance that you can pick a person that might not only be famous enough to get you into the fellowship of your choice, but who you also like and get along with.

malignancy: used to be a somewhat malignant program in the past. i've been here since 98, first in the lab, then residency. during my research time i encountered some chief residents that were not exactly warm and fuzzy, but they are long gone. the current ones i consider good friends that come over for dinner. there is (virtually) no junior-senior hierarchy, and dumping is generally frowned upon by residents and attendings. in general (except trauma) you eat what you kill - meaning that on a service you round on who you operate on, even when that means that the senior on the service has more patients than the junior. that being said, the senior has first choice of cases.

during the last year, we had 5 babies in the residency, several of the dads have taken paternity leave (including 1 intern taking 2 weeks off), and one of the (female obviously) seniors took several months off for maternity leave. yes, it makes life a little bit harder for everybody else, but i assume you'd like to be home with your newborn, too.

this by no means is intended to picture the residency as a piece of cake, you work hard, you operate a lot, you get to clinics at least once a week, and you care for your floor patients.

but during 2nd year you take q4-7 inhouse call (depending on the hospital and rotation), during 3rd year you do q5-7 inhouse while doing peds for 6 months. the rest of 3rd year you do 1 month of ER night float 6pm-6am 6 days a week at the Brigham, and the rest is home call.
4th year is a month of ER night float at MGH, the rest trauma backup home call. all of 5th year is home call.
that doesn't sound too traumatic to me.
the whole malignancy issue really is a non-issue, and dr herndon has changed several rotations to reduce scut and improve hours. he meets with us once a month for breakfast (he pays) to go over the program, talk about issues, and give us an update on political and social changes/factors affecting medicine.

speaking of hours, next year RRC limits continuous duty-time to 24hours, which we will adhere to, details to be worked out until july.

last thing regarding malignancy: you guys are surprisingly paranoid. in the past we have been criticized for not trying enough to make the applicants feel welcome. now that we do people feel that we are trying too hard, as if we have to cover up something. we don't! i don't want to convince you to come here, we get enough applications not to feel left out, but i hate to see someone like bone_jock, who seemed to have liked the program, not come here because of unfounded rumors.

top10 med schools: look at the website with the current residents ( ). there is a certain concentration of some schools, but each year there are schools that have never sent anyone before.

I don't want to start any feuds but I worked with an attending who had trained at Harvard last year as a med student and the man was just horrendous in the OR. His wound closures were aweful and when you compared his end to the other end of the incision that the chief had done, there was a significant difference (with chief's being much better)...often the difference was so significant we would all be embarassed to look at the wound at the end and sometimes the attending himself would look at the wound and note the difference too, and then walk away as if to say "What the F__, I suck". Everyone including the nurses would notice it too but wouldn't say anything.

The same was true during the operation. He was just so technically deficient in the OR...there were numerous times when he was struggling with something and the chief would get it done on the first try.

I don't know. Obviously Harvard is a top notch academic institution, but I wonder how much HANDS ON experience residents really get. I wonder if you compared a Harvard trained surgeon to one who was trained at a highly clinical in-the-trenches program, which would be a better surgeon? I'd put my money on the latter. I have no doubt that the academic experience you get at harvard is among the best, if not the best. And you'll learn how to turn anything and everything into a publishable paper with as much significance as my bedroom wallpaper, but after seeing this attending at work, and let me say that he was very accomplished in the research arena -- which is to say he was in the 'rat race' of publishing...nothing significant perhaps but if you like quantity then he was accomplished), it made me think about it a bit.

Again don't want to start any feuds. Just my observations. Obviously Harvard is a top name and anyone who questions the reputation of the place is a fool. I just question the quality of surgeon you become at the end.

Micky, I am glad someone finally brought it up. Being a top tier program doesn't mean you are getting the best training. It means you are going to an institution with the greatest numbers of NIH grants and the most published research. If you want to be a skilled surgeon, go to a small program where you will gets tons of OR time. If you want to be a publishing academic machine, Harvard and the other "top 10" programs.

What are some programs with a good mix of both...OR experience and Research. Does this mean 6 year programs are the way to go?

you guys bring up an excellent point - how can programs evaluate applicant's physical skills. HSS is trying with different tests, and if your hand-eye coordination sucks you're out.

maybe we should consider implementing these tests, because some people are unfortunately manual idiots. brilliant in research but just not good with their hands. and that's something that is very hard to evaluate in an applicant. i would say it's even hard to evaluate in oneself, given that most students don't get that much opportunity to not only watch but actually do surgery.

we had a couple terrible graduates, skills and/or academics-wise. and all programs do. the big question is, what should programs do with them - fire them halfway through the residency? very hard decision.

anyway, as i said, i did close to 300 cases last year, which i am pretty happy with. i'm sure that there are programs out there where you do more. if you find the program that lets you do 500 cases a year, have a life outside the hospital, and give you more than a basic academic education, go for it. but as life in general, residency programs are compromises. and after having looked at many programs over the years to help perfect this one, i still haven't found a better one than this.

i think still the best idea for students is to rotate through your No. 1 and #2 choice programs if you have the opportunity. then you can experience first hand how much OR time residents get, and what the skill level of the attendings is. if you can't get the rotation, next best bet is to talk to your buddies who did the rotation, but don't rely on rumors that are floating out there.

if somebody asked me about boston university, i could tell him that it's terrible. because that's what it was when i was looking. but since then it has completely turned around, with a great chairman. it is still tough, but much better than it used to be. how do i know? i asked students who rotated there, don't owe the program anything and therefore can afford to be honest.

but to judge anything by information that is outdated is risky at best.

Micky's point has also being my observation with attendings from other well-renowned programs, and has been my concern for some time. It is not that easy to find out which are the programs that consistently put out excellent clinical surgeons. From reading the pages of this web site, I think many seem concerned more with the big-name programs. Having said that, though, I think residency is mostly what you make of it. I think most people with the strong will to come out an excellent clinician can do so regardless of the program attended. But it surely helps to attend a program with strong clinical training.
I would still love to go to Harvard, though.
Rendering Error in layout BBCode/Image: Layout 'BBCode/Image:default' Not Found. Please enable debug mode for more information.

hey guys, gotta agree with the harvard resident on this one. sure, every program will have its occasional freak who needs to run to the bank at the most inoppurtune times (i hope the resident screening process at harvard has advanced to the point where they can weed out the 'freaks of the industry'), but really the onus is on the individual resident. i rotated at mgh recently, and its pretty tight over there. I worked with some of the "big name" surgeons and they were pretty amazing not just in their academic aptitude/accomplishments but their surgical skill...on the trauma service i felt that the senior resident definitely did the majority of the case based on his/her comfort level...very rarely did i see an attending just jump in without guiding them first. On say a sport service, attendings would talk a pgy-2 through the approach and let him/her struggle (which i think is very important as far as getting through that surgical skill learning curve)...on the other hand i would occasionally hear a resident say something like "how the heck can i go into private practice, if he (attending) doesn't let me do the whole hip replacement?" but that was not the usual and that happens at every institution where there's always a funky attending...overall i thought it was a great program that does focus on teaching its residents...as far as the dude talking about the attending who couldn't close a wound, i would question the truthfullness/BS/reality of that, cuz they were letting me close on most of the cases i scrubbed in on because the residents had already found it boring...i still say the trauma service there is pretty harsh...at mgh anyway...but that's the nature of ortho trauma ANYWHERE....its more pallatable with the two awesome attendings running the trauma show there anyway.

oh yeah, as far as the residents, the majority are cool there right now, i probably encountered 1 knucklehead but with a big program like that, its a pretty good ratio...definitely very less of an ego amongst them as a group than i had assumed, and most worked hard, taught each other, helped each other out...the one knucklehead was alright, he was just a bit too lazy and dumped a bunch on the junior residents/interns

oh yeah, just my own take but you probably learn diagnosing/treatment options/managing/surgical stepss/basic surgical skills during your residency....more of the same during your fellowship, just focused...and then really develop into the surgeon you're gonna be as a junior attending or first few years in practice

On the attendings closure/surgical skills,

don't base your view on a program based on one attending's skill in the OR. Harvard has 50 residents in the program at any given time. As with any program (big or small) a few guys with all-thumbs will slip through the cracks. We have a fellow at my institution who's from Harvard and is doing a pretty good job. I agree that residency is what you make of it. And I have no doubt that with a program that has the volume that harvard has your clinical experience will be pretty damn good by the time you're finished.

Bone Jock

Step 1 >230 but <250
college, medschool research (non-ortho but working on getting some ortho)

can i get through the door?