WASHINGTON UNIV RESIDENCY PROGRAM UPDATE

Well, I can say that you didn't do anything to clear up the arrogance rumor:

Give me a break, everyone has a different idea of a top tier program. I am sick of all these research geeks coming in and posting that HJD, HSS, Harvard, Pitt, Mayo, or WashU are the begin and end all in ortho.

The fact of the matter is that these are great research programs and you will well published and have a lot of ties in the academic world when you are finished. It doesn't mean you are going to learn squat about operating, or becoming a surgeon.

I am going to do my training at a smaller community program and I will have 2500 cases as 1st assist or primary when I am finished. I may not be able to do a hemi-pelvectomy or a total femur when I am done, but I will guarantee that I will run a scope better, do primary joints better, and do any other bread and butter ortho case better and more efficiently than someone graduating from a "top tier" program that held a hook and did floor scut for their first three years. That is what I consider a top tier program.

By the way, almost every commuinity program where I interviewed has never had a resident fail boards in 30+ years, or had one at the most, so your seven years at WashU doesn't impress me.

Sorry if I have come off as a prick. It is nothing personal against you are WashU. Like I said, I am sick of hearing how only the big name academic places are "top tier" Top tier is dependent on what an applicant wants to get out of their training.

Glad you will be happy at your program, that is all that matters, wonder why you are so mad about the "research" type programs being called top tier? You didn't come off as a prick, just as someone who is bitter... Evidently there is arrogance at community programs too
Quote " I may not be able to do a hemi-pelvectomy or a total femur when I am done, but I will guarantee that I will run a scope better, do primary joints better, and do any other bread and butter ortho case better and more efficiently than someone graduating from a "top tier" program that held a hook and did floor scut for their first three years"

I probably should have said "as well, or better" in that. I don't know if I would say I am bitter, but I am tired of reading the assumption that only the academic programs with big named faculty are top tier.

Everyone has their own idea of top tier programs. For me, it is a place where I can operate a ton and learn bread and butter ortho like the back of my hand. I have no desire to publish or work in academia, so the so called top tier places I read about are pretty much useless to me.

I feel as though every time I read these "top tier" lists, people are belittling the training I am choosing to do because I am not watching Rockwood and Green work.

Insecure Ortho2003,

Your "bread and butter ortho" was developed in academia. While you think what the rest of us are doing is "useless, " remember that cutting edge treatments, techniques, and implants begin in the world of academics!

Good luck, Dude. By the way, has the match already occurred?
Rendering Error in layout BBCode/Image: Layout 'BBCode/Image:default' Not Found. Please enable debug mode for more information.

That was my entire point Nailit. I never said what was going on in academia was useless. I said it was useless to me.

As a private general pod, I will never in my life do a major tumor case, so why should is spend 4-6 months of my 4 years of training doing complicated tumor cases. I will not be doing 3rd time revision total hips and knees, so why would I want to train where a good portion of my joint experience will be learning to do so.

Along the trail, I talked with a Sports attending that trained at Mayo for his residency. He said that he did more hemi-pelvectomies during his five years there than he did ACL's. He may have been exagerating, but that seems like useless time for someone that wants to be a general pod.

For someone that wants that type of training, or desires that type of practice, it is far from useless, but for me it woud be a waste of time. A place where I can get in 2000-2500 cases with 90% being primary joints, sports, and long bone fractures is top tier for me.

great point ortho2003.

why do hemipelvectomies when you want to end up in sports. and why spine, or hand, or peds, or anything besides sports for that matter.

and why med school - i don't need to know about the Krebs cycle to find a knee and stick a scope in. medicine? bah, as long as i know the medical consult pager number i'll be good.

listen to yourself man, real sad to see you in medicine.

A well-rounded program with some emphasis in that which I want to practice is top tier for me. That would include some exposure to hemipelvectomies but a good number of primary stuff to feel competent doing them. I think all this "top tier" business depends on the eye of the beholder. I agree with ortho 2003 in some stuff, although I think it is importatnt to get some exposure to the zebras of ortho (for familiarity, if anything) and to research. I think a way to differentiate the average orthopod from the excellent one involves seeing how well they discern the literature and critically analyze studies. Just because something gets published in JBJS does not make it standard of care. Knowledge in statistics and the scientific method can help discern the good papers from the bad ones. Did the study enroll enough patients? What was the power? Did they apply the right statistical tests or just the one that would make the study look good? These are all questions we should ask about what we read regardless of whether we like research or not, or whether we practice in a rural hospital or large academic center.

Podster, you must be a much better judge of character and who should be in medicine than the attendings who gave me honors in every clinical rotation and wrote glowing letters of recommendations for me. I wish I would have read you post before I decided to apply to med school. Perhaps I would have looked for a more suitable career for a low-life like myself.

I never said that I shouldn't do any hemipelvetomies or major tumor cases. I said I want to train somewhere where that type of sub-specialized ortho is not the emphasis. It will be very beneficial for me to see a few cases here and there and learn the work up and management, but ,as a person who wants to general ortho, I would rather train somewhere were the majority of the cases are scopes, primary joints, and long bone trauma. I also don't see any reason to go somewhere where I will be lucky to get 300-400 cases a year, when I can go to a smaller program and get 500+ cases a year.

This is getting old, so this will be my last post in this thread. I just wanted to make a point that "top tier" is dependent on what an applicant wants to get out of their training, not how much NIH funding you get, or how well published your faculty happens to be. For some, it will be a place that is hard core academia with outstanding research and sub-specialized ortho, for others, it will be smaller places where you get great operative experience and you are saturated in bread and butter ortho, and for others, it will be somewhere in between.

I think this horse has been dead for several posts, but I might as well get a shot in at it too. I think that what ortho2003 is saying is by in large true and that future applicants can gain valuable insight into this process if they pay attention to this thread.

Top program is a completely personal thing that depends on your goals. That is precisely the reason that we have different types of programs that cater to different types of applicants. If you dream of private practice with a mercedes in the garage and time to get your golf handicap down, then a less academic program is probably better for you than a hardcore research experience. If your goal is to be on the cutting edge defining what the standard of care will be in the future, then you should strive to get into an academic program. I think what people should look out for are two things. If you are a stud applicant that could match anywhere and wants to do private practice, then don't let your ego force you into ranking top programs so you can say you went to "top program x". This will only serve to have you spending five years somewhere that might not be the best place for you. On the other hand if you train in a community program where you get a high level of technical proficiency you really should take the time and extra effort to learn what research is about and how to critically evaluate the literature so that as you grow older you have the skills necessary to remain abreast of what the standard of care is as it evolves (which is happening faster than ever and will continue to accelerate in my opinion). Figure out where you want to be after training and find a place that will serve to help you reach those goals regardless of what US News or other orthopods say about a given program.

I do echo the sentiment that it is ridiculous for people to go around with their noses in the air saying their program is the best. It is pretty funny how they look down on people and their training just because it is different and designed to arrive at a different destination than their own. That arrogant attitude by some residents and attendings is not helpful to anyone and just makes them look like jerks.

I have no interest in research as a career, but I am very thankful that there are docs out there willing to devote their lives to finding the best way to treat pathology. It is on the fruits of their labors that I will be able to give my patients the best care possible and for that I am thankful. I do not, however have any desire to spend my life doing what they do.

One other point:
There exist very academic programs that allow residents to do tons of cases and get a very high level of technical proficiency. There are also community programs that get tons of cases but that the residents aren't actually doing them. This issue is not nearly as black and white as some would have you believe. It takes a good deal of effort to really get to know what the true character of training at any given institution is. You only match once (hopefully), so go to the effort of really finding out where you fit rather than going on some silly "rankings" you read.