Compare and contrast of IM programs

[Organomegaly]

Hi all,

 

I know there have been threads on this topic on the past, but they are getting a bit dated and I was wondering if anyone could contribute to a discussion on the pros and cons of internal medicine residency programs across the country. I'm having a hard time making a decision, and am wondering if there are important differences besides geographical aspects. I'll start by contributing to a few schools:

 

1) Ottawa -- Pros: Collegial, new program director, heart institute for top notch cardiology training if interested, only general internists attend on the CTU Cons: Have to round post-call, don't see much cardiology on GIM services because it all goes to the heart institute, a little service heavy

2) Queen's -- Pros: very chill program director, very collegial atmosphere, small community feel, 1/5 or 1/6 call even on CTU, solid teaching Cons: one hospital, pathology a bit limited as Toronto, Ottawa and Montreal are proximal referral centres, perhaps the call schedule is a bit too lax?, limited research opportunity

3) Western -- Pros: similar to Queen's with a less intense call schedule, residents seem happier here Cons: London as a city leaves a lot to be desired, very high IVDU population so pathology can get a bit repetitive and frustrating 

4) Toronto - Pros: access to world-class experts, abundance of research opportunity, make connections to match to a U of T fellowship Cons: large program and less cohesiveness, harder to get some procedural skills, I also heard Toronto residents have the highest unmatch rate in Ontario 

5) McMaster - Pros: new PD and one of the best I have met so far, program is extremely strong with early (but supervised) responsibility, collegiality, world-class research opportunities not unlike U of T in some areas Cons: reputation for being very service heavy right now though the PD is making changes, Hamilton as a city is not perfect

6) Calgary - Pros: Awesome hospitalist system that leaves no ALC patients for residents and a high acuity CTU, good EMR in Alberta, very tight-knit group of residents, good bedside teaching by staff: Cons: formal teaching is lacking in my opinion 

7) UBC - Pros: I like their call model on subspecialty services (don't fly-in CTU but cover consult services instead), Vancouver as a city Cons: rep for being service heavy, Vancouver is expensive

These are just my cursory thoughts and not fact by any means. Please discuss if you are applying to IM/are a current IM resident so we can all make an informed decision!! 

Thanks

 

[ACHQ]

On 1/28/2018 at 5:45 PM, Organomegaly said:

Cons: harder to get some procedural skills, I also heard Toronto residents have the highest unmatch rate in Ontario

I wouldn't say that getting procedural skills is harder at UofT, but more variable. I know people who have done tons and tons of procedures and others who haven't done many. My personal experience has been good with getting lots of procedural experience

I don't know where you heard Toronto residents have the highest unmatch rate in Ontario... most of the fellows I know are former UofT IM residents, and most of the PGY-3's that matched this year got what they wanted where they wanted

[Organomegaly]

43 minutes ago, ACHQ said:

I wouldn't say that getting procedural skills is harder at UofT, but more variable. I know people who have done tons and tons of procedures and others who haven't done many. My personal experience has been good with getting lots of procedural experience

I don't know where you heard Toronto residents have the highest unmatch rate in Ontario... most of the fellows I know are former UofT IM residents, and most of the PGY-3's that matched this year got what they wanted where they wanted

 

Hey, thanks for your reply. Do you think with procedural skills it is mainly your own initiative that makes a difference, or do other externalities like luck and hospital site also play a role?

The unmatch statistics I am basing off some of the data and comments I've heard repeated on the CaRMS tour 

This year (multiple Ontario Schools had a bad year) had 8 unmatched graduates: https://www.carms.ca/wp-content/uploads/2017/08/Table_2_Number_of_participants_and_positions_by_school_of_residency_English.pdf

Particularly in 2015 U of T had 11 unmatched graduates: http://carms.ca/wp-content/uploads/2015/07/Table-2-Number_applicants_and_positions_in_2015_MSM_by_school_of_residency_en.pdf

[ACHQ]

A bit of both. I think hospital sites play less of a role than luck and own initiative. But there are certain rotations that given more procedural experience.

Those numbers are somewhat skewed as a lot of people will only apply to one specialty in one location and go unmatched otherwise. They do this purposely because they would be happy with community GIM. Also UofT now makes us enter the CaRMS match even if someone doesn't want a subspecialty (meaning they want to default). This is a more recent phenomena though.

This table shows the the majority of people in there home school end up doing a fellowship at their home school (for obvious reasons, including UofT).
https://www.carms.ca/wp-content/uploads/2017/08/Table_13_Applicants_by_originating_school_of_graduation_and_school_applicants_matched_to_English.pdf

All the PGY-3's I talked to (in multiple separate years) got spots in the locations they wanted.

[A-Stark]

I've generally heard that UofA has a good program, but I don't know too much about it otherwise. Edmonton is a much more laid back city than Calgary and has better pathology from a somewhat more "interesting" referral base. And it has all the transplant stuff. I didn't like the Calgary residents that I met on elective there, but that was my experience of exactly two people. 

Sask historically was something of a dumping ground for the second iteration. I think it's a reasonable program, but Saskatoon is small and flat and far from everything. 

I'm on a rotation in Toronto right now and it's been nice. I find their call system fairly problematic though - you end up as "backup" call and can be pulled in semi-randomly for coverage. Worse, people can call in "sick" leading you to be "activated" as a backup. In my core program, you couldn't get away with anything like that because we were small enough that anyone abusing the goodwill of their colleagues would get called on it immediately. Harder to do that when you have 50-odd PGY1 colleagues. 

I don't know much the NOSM program except that they do some rotations in Ottawa. It does not have a good reputation as a strong program. 

Dal generally trains good people and has recruited some strong GIM staff in the last several years. They still have a preponderance of subspecialists covering GIM call, but it's likely improving. Halifax is a lovely city but everyone is forced to go to Saint John for several months during more than one year of core training. Subspecialty spots have gotten really tight as the government has cut back. I don't think acuity is great on GIM there. Their EMRs are awful. 

MUN has the whole "intent-to-withdraw" accreditation business hanging over the program, but that will be a non-issue going forward. I don't think the decisions were made based on the especially accurate evidence. In my time, we tended to have a lot of early autonomy both on CTU and other rotations. There's more CTU than most programs and a lot more cardiology call (with CCU coverage) than average. Acuity is good, particularly since there's a "co-admission" structure where you will see sick patients in emerg first before ICU gets there. I do think that some of the Royal College requirements for "more supervision" may be diluting the experience somewhat, though. Procedural experience can be excellent but depends somewhat on initiative. Although MUN is not a big research centre, it tends to be easy to get involved, especially for any interested in cardiology. Newfoundland has lots of weird pathology and money-by-way-of-oil has helped create something of an ongojng IVDU/endocarditis spike. I have a lot of issues with more administrative things at the level of the hospital and health authority, but that has little to do with the program or the core resident experience. There's also a two-night annual retreat away in cabins next to Terra Nova National Park which is always a good time. 

[Epona]

nil

[Edict]

A pro for UBC is their unit based CTU at VGH, less running around and way less pager beeps during the day and also CAs cover the ward at night (but only one SMR for VGH ER consults). A con for UBC probably is weaker research program in GIM, but that can be said for a number of schools as well. Otherwise, relatively decent list. Western has food and is less service heavy as pros. 

 

 

 

[Monkey D. Luffy]

Anyone have experience with Mac's KW program? Do most of their grads end up in community medicine (likely by choice?) or do they match to competitive subspecs like GI? Would it be significantly harder to do that from this site (more community based) than from Hamilton?

[Edict]

1 hour ago, Monkey D. Luffy said:

Anyone have experience with Mac's KW program? Do most of their grads end up in community medicine (likely by choice?) or do they match to competitive subspecs like GI? Would it be significantly harder to do that from this site (more community based) than from Hamilton?

I've talked to someone who went there and it seemed like it was doable, their numbers are small so I don't know how useful statistics would be anyways especially when you consider that their population will also be different. 

[nnst]

On 4/22/2018 at 9:56 AM, Monkey D. Luffy said:

Anyone have experience with Mac's KW program? Do most of their grads end up in community medicine (likely by choice?) or do they match to competitive subspecs like GI? Would it be significantly harder to do that from this site (more community based) than from Hamilton?

Interested to hear more on this! Thoughts on the KW program and how does it compare to the Hamilton site, Western, Queens, Ottawa, etc?