Residency Programs and Lifestyle

I have heard that you need to sack up and find a program that will make you the best orthopaedic surgeon possible.

Haha I was waiting for this response. Well then what midwest programs do you think make the best surgeons? Do you think the more you are beat down in residency the better you will be at operating?

I think the more you operate in residency the better you will be at operating. You need a combo of bread and butter and complex cases.

I think what you really need to ask is how are the residents treated by faculty. Look for a place where the relationship is friendly, nurturing of your skills, and educational. Avoid excessive fear mongering. Look for trauma and resident autonomy. This is where you will operate the most. This is also the foundation of orthopedics (broke bone, me fix).

I break my hours voluntarily to scrub cases post call because it will make me a better surgeon. Bad rules are meant to be broken. The ACGME 80 hour work week (soon to be 56???) is a bad rule in my opinion. If I am too tired post call to gain from operating (or a danger to patients), I go home. Nobody asks questions.

I would like to echo the above posters. 80 hours is 80 hours. If you spend 80 hours in fear of being berated at every turn by attendings it will feel more like 120. Meanwhile, if you are able to laugh and joke with your attendings while still learning, you will be much happier and less worn down in the long run.

Home call is a useful adjunctive strategy to Orthopaedic residency in those respects.

To the original post... I interviewed at MSU-Kal and Beaumont which I both ranked highly. I didn't end up matching at either and so I can't speak to the inside line, but both seemed like excellent non-malignant experiences. Kali is more private and Beaumont a bit more busy, but I'm sure you can't go wrong with either. Actually, I haven't heard of any program anywhere which is discussed as "damn, their graduates suck".

"Malignancy" is a more difficult concept. Again, my imnpression is that most folks get good training everywhere. If you mean "malignancy"="long hours" then you're misled, because many programs work long and hard and are quite happy. If you mean "reasonable hours but a$$holes" then welcome to surgery.

The advice I give to all of our interviewees (because we interview earlier than most other programs) is to go to the dinner on the night before and assess several things:
1) the percent of residents attending the dinner
2) the general appearance of the residents (happy, pissed-off, super-tired, etc.)
3) how the residents get-along (are they drinking together or forced to be there, etc.)
4) presence of spouses--- our program typically has many spouses/kids attend, and the wives (don't get pissed, there are more wives than other everywhere) usually provide more honest answers to lifestyle than residents. Ask about the families and you'll get an idea, along with the above 1, 2, and 3. For example, If you come to our dinner on Monday, you'll meet my wife and 8 month old little girl who DOES recognize my face.

I suppose the "sack up" line comes in response to any such question where there's an opportunity to look hard core, etc. Unfortunately, many with that attitude talk a big game and let the rest of us down when there's work to be done post-call. They do stay for cases they want to do, but leave when there's work to be done.

I would agree with the thought about good staff to resident relationships. That is where your learning is. I'd also say that resident relationships in the program are important. If there is a good team atmosphere it's much easier to be there for your family at important times because your fellow residents will step in for you, and you will do the same for them. Programs with a lot of "sack up" residents will likely leave you high and dry at critical times.

Not every minute of residency is high yield learning. A lot of service work (some learning, but not as much) is neccessary. Find a program with maximal high yield learning and minimal low yeild learning service work. As above, 80 hours can be used in very different ways.

I agree that home call can enable a resident to stick around for cases post-call and maximize learning. Staying up all night draining puss and splinting ankles then going home post-call is not as high yeild as operating at night or seeing a few consults and operating all day the next day. Ask the questions when you interview.