Fm programs with least CTU, gen sx, obgyne

[dooogs]

Or at least humane conditions during those rotations 

[robclem21]

You should rank where you want to go. A few months of tough work on some off-service rotations shouldn't really be a major deciding factor in where you do residency. Ya it can suck at times, but ultimately these rotations are part of your training and you will learn more by being on call and spending more time on these blocks. Especially when you are planning a long generalist career and these only make up a few months of your life.

I am all for pleasant working conditions and not abusing residents, but there is a trend towards new medical grads wanting to do as little work as possible and still somehow learn the same amount. Doesn't really work like that. You should focus on the short time you have to train and trying to maximize your exposure and experiences because before you know it, you'll be on your own with nobody to review your decisions. Just my two cents.

[Supervenience]

14 hours ago, robclem21 said:

You should rank where you want to go. A few months of tough work on some off-service rotations shouldn't really be a major deciding factor in where you do residency. Ya it can suck at times, but ultimately these rotations are part of your training and you will learn more by being on call and spending more time on these blocks. Especially when you are planning a long generalist career and these only make up a few months of your life.

I am all for pleasant working conditions and not abusing residents, but there is a trend towards new medical grads wanting to do as little work as possible and still somehow learn the same amount. Doesn't really work like that. You should focus on the short time you have to train and trying to maximize your exposure and experiences because before you know it, you'll be on your own with nobody to review your decisions. Just my two cents.

Hours worked and learning experience are not necessarily co-extensive. It all depends on the rotation structure, staff, etc... For many residents, heavy service rotations such as OB are quite poor learning experiences as they can and frequently do end up being repetitive, and too heavy and draining to leave time for adequate learning. On the other hand, CTU can often be an excellent learning rotation despite the hours due to its structure.

We know quite well that overworking is an absolute epidemic in medicine that contributes immensely to the unbelievable levels of mental illness and burnout in this population. There's nothing inherently wrong with reducing resident workload - it just requires rethinking and restructuring current programs and teaching methods. Some people can in fact learn as much, if not more, working 40 hours a week versus 80.

[Egg_McMuffin]

Hey OP, in general academic centre programs will have a higher ratio of hours worked/service to learning. Vs. at community programs, where wards and teams aren't dependent on resident presence to be operational.  I ranked all academic centre sites low for this reason. I'm at a community program and although it's a tough program for its own reasons, I'm very very happy with my learning to service ratio.

I also agree with the above poster. "Tough work" isn't always equivalent to great learning or even great use of your time.  I'd argue that because FM residency is so short, you owe it to yourself to choose a site where where you aren't paid peanuts to do repetitive scut and instead treated as a learner above cheap labour. Two years can also be a long time if it's a drag- long enough to do serious damage to your mental health, so you owe it to yourself to pick a site where you feel you will thrive- not just professionally but also like, as a whole person. For some,  that looks like hardcore and working 80 hour weeks, for others it's working 50 hour weeks and having energy left to do self-directed learning.

On that note, also pay attention to how flexible programs are when it comes to booking time off. So that you can easily book chunks of time off in rotations that you feel are lower yield or mental health days during the tougher rotations. 

[dooogs]

Yes exactly. I want to avoid going through the same issue of just service for 80 hours, barely any teaching, bad attitudes, and little learning from preceptors and little time and energy left for self directed learning 

i believe some fm programs do not have gen sx 

[Egg_McMuffin]

7 hours ago, dooogs said:

Yes exactly. I want to avoid going through the same issue of just service for 80 hours, barely any teaching, bad attitudes, and little learning from preceptors and little time and energy left for self directed learning 

i believe some fm programs do not have gen sx 

I think you'll be pretty hard pressed to find programs that have no surgery whatsoever because you do need to have some related competency in the area. I know some programs that are more longitudinal in nature have you do a handful of gen Surg clinics or ED consults, which can be great learning experience for recognizing acute vs non-acute presentations, and preliminary workup and management. Holding a retractor in the OR for half your block? not so valuable. Neither is rounding on gen Surg patients at 6am, going bed by bed, asking if they've passed gas. 

 

 

[frenchpress]

11 hours ago, dooogs said:

Yes exactly. I want to avoid going through the same issue of just service for 80 hours, barely any teaching, bad attitudes, and little learning from preceptors and little time and energy left for self directed learning 

i believe some fm programs do not have gen sx 

Those are all very reasonable things to look for. But I wouldn’t assume that avoiding the “notorious” rotations will get you there - many of my most exhausting rotations were actually ‘family med’ rotations like hospitalist or primary care obs or rural family. 

Unexpected, but my general surgery rotation in FM was actually one of my lightest and best off-service (I.e. off-FM) rotations. We had ample residents so I only had to do a handful of days of call. Those few days were pretty heavy with consult, etc. And sure we had to come in early to round every day. But aside from the days I was on call, after rounding my days were mostly self directed - some days I went to surgery clinic (I did a lot of breast clinic, and some general surgery clinic, both of which the surgeons made pretty relevant for FM) and I was done by 2 or 3pm at the latest. Other days I hung around the hospital and helped the resident on call if they got overwhelmed (which wasn’t often) and mostly just studied all day. We were invited to go to the OR, but it wasn’t expected, and I never did. I actually learned a lot, and mostly got enough sleep. 10/10 would repeat that surgery rotation over having to do something like family med hospitalist or psych or geri ever again.

[medisforme]

As someone above posted, its not the actual schools, its the location of your program that determines how much CTU etc... you have to do.  I can only speak for BC, here if you do FM residency outside of the provincial academic centers/campuses (Vancouver, PG, Victoria, Kelowna) there is basically no CTU.  GenSx and Obsgyne likely also variable between all the individual satellite programs.  GenSx at my program it was just you and the surgeon and they were really aware of making your experience family medicine based (ie. limited OR time holding a retractor [unless you want to that is], more focus on ER consults, outpatient clinics, lumps and bumps etc... There really wasn't even a focus on rounding as the surgeons you weren't preceptoring with don't really want you rounding and giving orders on there patients as this just slows them down (usually each surgeon only would have 3-4 patients on the unit at a time which made rounding quite easy).  IM at my school was basically consult based (did separate rotations in IM, cardiology and nephrology with option for ICU elective if you wanted).