Ranking IM programs by Resident Wellness

[rainysunday]

Any insights on the residency training at the different schools across the country in terms of resident wellness? I know the schools have their own initiatives with different seasonal events (ex. Christmas party) but I'm moreso speaking of actual wellness on the day to day.  

[ACHQ]

2 hours ago, rainysunday said:

Any insights on the residency training at the different schools across the country in terms of resident wellness? I know the schools have their own initiatives with different seasonal events (ex. Christmas party) but I'm moreso speaking of actual wellness on the day to day.  

Internal medicine residency is hard, lots of call/nights/holidays/weekends, and I don't think any program can do anything about it because speaking as a staff now in retrospect, it is necessary in order to become a good clinician (as one day you'll be on your own with little to no back up).

Residency sucks in general. There are a lot of systemic issues for this that go away once you are a staff, and in general everywhere residents are basically free labor. I can't speak to how wellness is at other programs, most residents in IM across the country would probably say wellness can be improved even if they enjoy/like their program.

 

I went to UofT for IM. They were notoriously known to be poor for resident wellness (I think now they got probation for that??), not sure if anything has changed. Would I have gone anywhere else? probably not. Do I think I could have had a better time in residency from a mental health/wellness standpoint? Absolutely. Did it effect my actual clinical training? i would say no.

[jb24]

All residency is hard, but internal medicine at UofT is notoriously bad from a wellness perspective (from what I've heard, am not in that program). Being on 24 to 28 hour call isn't good for wellness. Residency in general (besides maybe FM, or psych) isn't exactly conducive to wellness. Residency overall is not terrible, but can be bad at times and takes sacrifice (that's expected IMO).

Also the best wellness is having reasonable work loads and time off. Yes, you still need the clinical hours and exposure, but this CAN be done humanely (in Quebec I think call is limited to 16 hours, not 24 --> which in reality is 28 hours or more).

[hero147]

44 minutes ago, jb24 said:

All residency is hard, but internal medicine at UofT is notoriously bad from a wellness perspective (from what I've heard, am not in that program). Being on 24 to 28 hour call isn't good for wellness. Residency in general (besides maybe FM, or psych) isn't exactly conducive to wellness. Residency overall is not terrible, but can be bad at times and takes sacrifice (that's expected IMO).

Also the best wellness is having reasonable work loads and time off. Yes, you still need the clinical hours and exposure, but this CAN be done humanely (in Quebec I think call is limited to 16 hours, not 24 --> which in reality is 28 hours or more).

It is night float in Quebec. 12 hours on 12 hours off. Honestly, having done both systems, I prefer traditional call over how Quebec does things. 

[rainysunday]

1 hour ago, hero147 said:

It is night float in Quebec. 12 hours on 12 hours off. Honestly, having done both systems, I prefer traditional call over how Quebec does things. 

What makes you prefer traditional call?

[rainysunday]

2 hours ago, jb24 said:

All residency is hard, but internal medicine at UofT is notoriously bad from a wellness perspective (from what I've heard, am not in that program). Being on 24 to 28 hour call isn't good for wellness. Residency in general (besides maybe FM, or psych) isn't exactly conducive to wellness. Residency overall is not terrible, but can be bad at times and takes sacrifice (that's expected IMO).

Also the best wellness is having reasonable work loads and time off. Yes, you still need the clinical hours and exposure, but this CAN be done humanely (in Quebec I think call is limited to 16 hours, not 24 --> which in reality is 28 hours or more).

What program/school are you in and how do you find the workloads and time off there?

[rainysunday]

5 hours ago, ACHQ said:

Internal medicine residency is hard, lots of call/nights/holidays/weekends, and I don't think any program can do anything about it because speaking as a staff now in retrospect, it is necessary in order to become a good clinician (as one day you'll be on your own with little to no back up).

Residency sucks in general. There are a lot of systemic issues for this that go away once you are a staff, and in general everywhere residents are basically free labor. I can't speak to how wellness is at other programs, most residents in IM across the country would probably say wellness can be improved even if they enjoy/like their program.

 

I went to UofT for IM. They were notoriously known to be poor for resident wellness (I think now they got probation for that??), not sure if anything has changed. Would I have gone anywhere else? probably not. Do I think I could have had a better time in residency from a mental health/wellness standpoint? Absolutely. Did it effect my actual clinical training? i would say no.

Is the quality of the training why you would not have chosen a different school should you have to do it again? 

I would imagine that regardless of the school you would come out being a good clinician.

[medafter30]

Just pick the one where you are close to home and with people that you know can support you through difficult times. Any program will have their pros and cons, but the support system is crucial through your training. 

[ACHQ]

14 hours ago, rainysunday said:

Is the quality of the training why you would not have chosen a different school should you have to do it again? 

I would imagine that regardless of the school you would come out being a good clinician.

I chose UofT because i wanted to stay in the GTA, I just had gotten married, and both of our families were in the GTA, and my partners job at the time (which she had only started a year ago) was in the GTA as well (although she probably could have gotten a job in a different city, the opportunities in the GTA for non-medicine jobs is no comparison).

With all the negatives on wellness on UofT's IM program, I can't complain about the clinical training and exposure, teaching and academic opportunities (if that's what your into) there. That being said you are right you will be a good clinician anywhere, and in my humble opinion it is the largely  the *learner/resident physician* that will determine if someone is going to be a good clinician.

 

2 hours ago, medafter30 said:

Just pick the one where you are close to home and with people that you know can support you through difficult times. Any program will have their pros and cons, but the support system is crucial through your training. 

this x100. People fret too much about programs (both for medical school and residency) when in fact it all comes out in the wash when you are a staff.

The fact we are lucky enough to get training from a Canadian institution which are held to such high standards by the Royal College/CCFP, is truly good enough.

[hero147]

17 hours ago, rainysunday said:

What makes you prefer traditional call?

You likely put in more hours in the hospital doing night float than traditional call. You get like 1-2 post call days on night float rather than the 6-7 you get with the traditional system. Also keep in mind that with 12 hour shifts, someone during the day (or the entire team) has to stay until 8 pm everyday. I guess some programs already stay until 8 because of rounding but at least the possibility exists. I have left CTU at 1-2 pm some days. 

[No Name Brand]

Definitely intriguing seeing a number of programs shifting towards a night float system... I agree with everyone above in saying that wellness is where your family and support system is. After a long week, being able to spend it with your loved one's makes all the difference!

[Edict]

I heard Queen's tends to have a good program for wellness, 1 in 7 call on CTU, this may not actually be correct but was just what I heard?

[pyridoxal-phosphate]

Has anyone heard much about what UofT IM has been like recently? Particularly since the accreditation stuff?

I'm well aware of some of the name/shame posts in the past but just curious if anyone has heard much if things have gotten better. I recognize that any IM residency will be hard work but just curious how much worse UofT is. I don't have much insider info as I did not do med school in Ontario. 

[wetbeans]

On 3/5/2023 at 12:03 PM, pyridoxal-phosphate said:

Has anyone heard much about what UofT IM has been like recently? Particularly since the accreditation stuff?

I'm well aware of some of the name/shame posts in the past but just curious if anyone has heard much if things have gotten better. I recognize that any IM residency will be hard work but just curious how much worse UofT is. I don't have much insider info as I did not do med school in Ontario. 

Curious about this too. Did they change anything? 

[Supervenience]

1 hour ago, wetbeans said:

Curious about this too. Did they change anything? 

Not much has changed from what I have heard except that staff have been generally more available, however I am not in that program so I can't speak much to it.

 

In general, the intent to withdraw accreditation statements are nothing more than slap on the wrist warnings. I am not aware of a single real consequence from their issuance. The unfortunate truth is these larger programs with academic hospitals involved require residents. Without IM residents, UHN would collapse and we would have a genuine healthcare disaster on our hands, thus the most severe consequences of these warnings are nothing more than theater.

 

Specialty residency programs will very often abuse and overwork their residents. Internal medicine is perhaps on the lighter side of this compared to some surgical programs, where there is often a culture of expectation that one does not take post call days. Many programs can and do violate the PARO contract regularly, and residents often have little recourse and stand to face heavy ostracizing in particularly brutal programs.

 

If resident wellness is truly a large priority for you, I would consider family medicine on a general basis even though it has its cons like all fields do. There's also PHPM, pathology, etc... Which (from what I've heard) are quite light on their residents. If you're set on internal or surgery, it's going to be a grind anywhere, with some places worse than others.

 

[zxcccxz]

I am not in the IM program in Calgary but have heard very good things from the residents, especially those who did their MD at other schools, in regards to the culture of the program. Also heard that while call frequency is similar to other schools (~1-in-4 on GIM), workload both during day hours and when on call is more manageable.
All very anecdotal though so you may have to do some more digging to verify.