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Best Internal Medicine Programs in the country?


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Hey everyone,

 

I'm just looking for general opinions on what the "better" Internal Medicine programs are around the country - at least from an R1-R3 perspective. I know at the end of the day it's about how much work you put into it, but just looking for what some of the more reputable programs are.

 

Thanks!

 

OMB

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I'd agree with those choices, though Toronto tops mainly for research/academics rather than clinical experience (or, perhaps better phrased, clinical responsibility) per se.

 

Mac is a very strong academic program and the Hamilton hospitals have a lot of volume and tend to be pretty busy. I'm not sure it's as flexible for research training, though (I didn't get that sense during my interview there).

 

I'm not sure there are really any "bad" programs around, though I've never heard anything great about UBC, and Sask is disadvantaged by its routine "second iteration" composition. Ottawa is pretty service-oriented considering it's one of the larger programs, but they have a really strong GIM group. Dal is smaller and has almost all fellowships locally, but does not have such a strong GIM group (if only in numbers rather than quality). Queen's and Western would provide similar experiences to Dal, but I don't really know much about them. NOSM is very new, small, and very much still developing, but I have a friend there who's pretty happy with the training.

 

McGill is putatively fairly "old school", and honestly I would stay away from the poor facilities and low resident salaries in Quebec.

 

Smaller programs will be more collegial and close-knit, but may not have many fellowships at the same centre. This is a theoretical disadvantage, but I'm not sure it ends up mattering much (and usually means more and earlier responsibility and greater procedural experience). Bigger programs have considerable volume, more flexibility, and greater access to more academic tracks.

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  • 5 months later...

I'm a fourth year medical student applying to CaRMS and would be interested in other opinions on the best IM program(s) out there...

 

My 0.02:

-Toronto is great for research opportunities and clinical volume, lots of exposure to interesting pathology, etc. However its a big program that might be difficult to stand out in, and also has a competitive environment

-McMaster I've heard referred to as being an excellent IM program. I did an elective and saw that the staff were top notch and really interested in making sure you learned. Apparently they only like to take their own though?

-Alberta is supposed to be very good as well but I never did an elective there.

-Calgary - I'm not sure how strong its reputation is, but I did an elective though and really enjoyed my time there and found the staff excellent.

-Manitoba - I've also heard great things about this program. Big cachement area so you'll see lots of interesting things.

 

I'd be interested in hearing what people's thoughts on Ottawa, Queen's, and Western for IM are.

 

I haven't heard much about Memorial, NOSM, or Saskatchewan. I've heard mostly negative things about Dal and UBC.

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I'm a fourth year medical student applying to CaRMS and would be interested in other opinions on the best IM program(s) out there...

 

My 0.02:

-Toronto is great for research opportunities and clinical volume, lots of exposure to interesting pathology, etc. However its a big program that might be difficult to stand out in, and also has a competitive environment

-McMaster I've heard referred to as being an excellent IM program. I did an elective and saw that the staff were top notch and really interested in making sure you learned. Apparently they only like to take their own though?

-Alberta is supposed to be very good as well but I never did an elective there.

-Calgary - I'm not sure how strong its reputation is, but I did an elective though and really enjoyed my time there and found the staff excellent.

-Manitoba - I've also heard great things about this program. Big cachement area so you'll see lots of interesting things.

 

I'd be interested in hearing what people's thoughts on Ottawa, Queen's, and Western for IM are.

 

I haven't heard much about Memorial, NOSM, or Saskatchewan. I've heard mostly negative things about Dal and UBC.

 

It's tough - last year Mac notoriously took 16 of their own students as residents. I think you probably need to do an elective at Mac to have a good shot of matching there. That being said, I think the focus overall is very resident-centered and trying to ensure your learning needs are met. Staff are super collegial. No free lunches though.. Lol

 

Toronto has lots of formal teaching by top notch specialists, but has less of a sociable environment amongst their residents which is understandable given their size. Lots of focus on research and mentorship, but I think Mac can also boast that.

 

Ottawa I thought was a very similar culture to Mac, and I felt very supported as a student on elective there. Strong resident-focused program for sure, but a very busy specialty because of lots of inpatient vs clinic experience. Residents all seemed very happy and knowledgeable.

 

Queens has had a major change to their curriculum lately. I heard it was not the best program before but has made lots of changes. Don't know much about it otherwise.

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Mac can be tough to get an interview at, though perhaps not as difficult as UofT, which also almost certainly favours its own grads. I don't think there are really any bad programs per se, but there will be "bad" locations if you're not from the area, and there are some that are more hands-on and provide more early responsibility than others. As ever, apply wide, interview wide, and ranks anywhere that seems halfway acceptable.

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My opinion from electives/hearsay/interviews

 

toronto - lots of specialized pathology. less resident cohesiveness, less autonomy, excellent teaching. mecca for basic science reserach

Overall: so-so for core IM, excellent for fellowships. Obviously competitive b/c location plus access to fellowship

 

mac - good responsibility, good teaching. CTU i felt was less learning vs other places but thats IMO. Has good rep, mecca of epidemiology/EBM research if you're into that.

Overall: very good for IM, variable for fellowship

 

western - very strong clinically with early responsibility/procedures, less formal teaching. Apparently R3s some of most impressive elective time? outstanding resident collegiality. compared to toronto/mac research is not comparable

Overall: very good for IM, variable for fellowship

 

Queens: smaller catchment area, only one hospital. Very collegial, supportive it seemed. Teaching unknown, havent heard much. Overall: Don't know much other than usually not popular

 

McGill: aside from city, lots of pathology, good autonomy, formal teaching is poor. Quebec healthcare system issues are for real and pisses a lot of people off. Overall: good program if you are self directed but Quebec might make you want to avoid it.

 

NOSM: went to the interview. Looks like high autonomy and pathology. Crazy # of procedures. R1s have done endoscopy/TEEs, insane stuff. Formal teaching poor, fellowship non-existent. Overall: probably very good if you want GIM and are self directed, otherwise probably not

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Just to add to the above:

 

Dal - good clinical exposure, somewhat more limited autonomy earlier on, and not especially great procedure exposure. Excellent teaching, especially on subspecialty services, but speciality rather than GIM focus.

Overall: good speciality and fellowship exposure, average procedure availability

 

MUN - excellent pathology and acuity, early autonomy, procedural exposure (no TEEs, but marrows, LPs, lines, taps), but less service-based teaching, very collegial, teaching/academic program apart from halfday very resident-driven/delivered, nephro, med onc only fellowships

Overall: lots of early autonomy/responsibility, small friendly program, limited local fellowships (though everyone gets what they want)

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My opinion from electives/hearsay/interviews

 

toronto - lots of specialized pathology. less resident cohesiveness, less autonomy, excellent teaching. mecca for basic science reserach

Overall: so-so for core IM, excellent for fellowships. Obviously competitive b/c location plus access to fellowship

 

mac - good responsibility, good teaching. CTU i felt was less learning vs other places but thats IMO. Has good rep, mecca of epidemiology/EBM research if you're into that.

Overall: very good for IM, variable for fellowship

 

western - very strong clinically with early responsibility/procedures, less formal teaching. Apparently R3s some of most impressive elective time? outstanding resident collegiality. compared to toronto/mac research is not comparable

Overall: very good for IM, variable for fellowship

 

Queens: smaller catchment area, only one hospital. Very collegial, supportive it seemed. Teaching unknown, havent heard much. Overall: Don't know much other than usually not popular

 

McGill: aside from city, lots of pathology, good autonomy, formal teaching is poor. Quebec healthcare system issues are for real and pisses a lot of people off. Overall: good program if you are self directed but Quebec might make you want to avoid it.

 

NOSM: went to the interview. Looks like high autonomy and pathology. Crazy # of procedures. R1s have done endoscopy/TEEs, insane stuff. Formal teaching poor, fellowship non-existent. Overall: probably very good if you want GIM and are self directed, otherwise probably not

 

A note about research. I don't know if you have any idea how you want to practice, but this is coming from a guy who wants an academic, research focused career.

 

Re: compared to western not being comparable to research at Toronto and Mac. Forgetting that I'm at Western for a second, please remember that as a single resident you really don't need eleventh billion PIs. You will likely only get involved in a few research projects. The variety that exists and even the smaller institutions in Canada will be more than enough to satisfy your needs. You don't need the ridiculous diversity that exists in cities like Toronto or UBC. To pick a school like Toronto over a school like Mac because it has more research opportunities is frankly naive.

 

Secondly, you have to be a bit more astute when you REALLY want to get the low-down about research. For one, if you are serious about research, then you need to ask about grants/funding options that you can apply to. Having applications/grants accepted is something that goes on your CV and builds your research portfolio. Secondly, the more important thing, is ask what kind of supports are there for Research. Are there dedicated staff that ensure a good pair-up with a mentor or facilitate that? do they help ensure you are getting a good experience?

 

Finally, the most important thing, ask what you will be doing. Will you help from the get-go by submitting an REB, helping with the project design, synthesizing/generating the hypothesis, or will you be just a data miner?

 

Based on that, McGill was by far the most impressive school in my opinion and I interviewed across the country. I have to put Toronto towards the bottom in that regard. My interviewer at McGill was personally responsible for matching residents with mentors who fit their needs/interests/and career goals, and made sure that residents who wanted to be in the 'driver seat' for projects could have that role if they wanted to, and they strived really hard to get residents first authorships so that they can start building their research portfolio. I ended up ranking them pretty high even with a 10k pay cut and being in a french school.

 

Toronto, on the other hand, nicely said that they had a lot of big-shot doctors who wouldn't be letting any resident come near to the driver-seat and I almost felt like an idiot for even asking such a question from the answers I got. It might have been the interviewer who wasn't as informed and maybe there are great opportunities, but you do what you can with the information you have.

 

So just a note, for all you guys serious about research, ask the right questions and you'll get the answer you want. Remember that having a first author publication in a low impact journal is more significant than being 15th author in the NEJM for building your research career. You'll also gain valuable skills on the way if you are taking more of a 'driver-seat' role. If you just want to do research casually and just want to remotely affiliate yourself with a research powerhouse, well, then the 'here-say' provided here is adequate advice.

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Honestly, I feel that the IM programs across Canada are more or less the same. If you want to be a top-notch clinician, that's an onus you take upon yourself -- read more, find more clinical opportunities, work harder etc. There will be top notch internist clinicians across the country and you'll see they trained at various institutions. The problem of quality becomes a bigger issue if you train down south I believe.

 

All that being said, I personally think the centres where you get higher volume of patients, ie: Mac, BC (I've heard), certain hospitals in Toronto, are places where you have more opportunities to learn.

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Honestly, I feel that the IM programs across Canada are more or less the same. If you want to be a top-notch clinician, that's an onus you take upon yourself -- read more, find more clinical opportunities, work harder etc. There will be top notch internist clinicians across the country and you'll see they trained at various institutions. The problem of quality becomes a bigger issue if you train down south I believe.

 

All that being said, I personally think the centres where you get higher volume of patients, ie: Mac, BC (I've heard), certain hospitals in Toronto, are places where you have more opportunities to learn.

 

I think volume is one thing, but autonomy is important too. If you're carrying out plans someone else came up with, no matter how much volume, its not as good as making your own plans/decisions and carry them out in a moderate volume.

 

Also it depends how sick/active the patients are. If you are taking care a whole bunch of ALC patients (like i found on Mac CTUs) vs more active patients, its way different day to day.

 

It difficult to say which are the best. I think a mix of academic + community experiences would be best. A place like Western and Ottawa in Ontario and I've heard Calgary offer the best of both worlds, but thats IMO

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Honestly, I feel that the IM programs across Canada are more or less the same. If you want to be a top-notch clinician, that's an onus you take upon yourself -- read more, find more clinical opportunities, work harder etc. There will be top notch internist clinicians across the country and you'll see they trained at various institutions. The problem of quality becomes a bigger issue if you train down south I believe.

 

All that being said, I personally think the centres where you get higher volume of patients, ie: Mac, BC (I've heard), certain hospitals in Toronto, are places where you have more opportunities to learn.

 

I think I'd have to respectfully disagree with you on a couple of points. I'd say that, wherever you go for IM, you will get a good education. But I don't think it's accurate to say they're more or less the same. Different places have different strengths that we've touched on in the thread already.

 

I also think that, with respect to volume, there are diminishing returns if the volume is too high. One program director (I won't say where) even told me he actually thought one of the weaknesses of the program was that its CTU could be too busy at times. As medicine man said above, you'll get more out of actually formulating plans yourself and carrying them out in a medium-volume centre with lots of autonomy, compared to a higher-volume place with limited autonomy. I've found as a med student when I've been on particularly busy rotations I have learned less than when I've been on a somewhat lighter rotation where I have the time and energy to actually read when I'm not at the hospital.

 

I strongly agree with your point that regardless of where you go, a lot of the onus is on you to make sure you read around cases you see and stay on top of learning things. A good program won't make you a good clinician if you aren't trying to be one. And if you go to a so-so program you can still be great if you put the hours in and work hard.

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UofA is phenomenal when it comes to formal teachings and its fairly good with respect to giving you autonomy. A top notch program but the location is poor.

 

UBC was actually bad and has notoriously poor teaching and disinterest by staff. Most of the teaching is by fellows rather than faculty. VGH is extremely big on volume, very much service oriented and does give you TOO much autonomy. As a student I was doing my **** and I don't think staff even laid eyes on any of my patients. It's good that you get room to do what you want but it's of no value when it's in a vacuum without good feedback and teaching.

Also it's potentially going on probation this year....

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UofA is phenomenal when it comes to formal teachings and its fairly good with respect to giving you autonomy. A top notch program but the location is poor.

 

UBC was actually bad and has notoriously poor teaching and disinterest by staff. Most of the teaching is by fellows rather than faculty. VGH is extremely big on volume, very much service oriented and does give you TOO much autonomy. As a student I was doing my **** and I don't think staff even laid eyes on any of my patients. It's good that you get room to do what you want but it's of no value when it's in a vacuum without good feedback and teaching.

Also it's potentially going on probation this year....

 

Our location is not poor. Edmonton is a lovely city and I find the people very welcoming and there's always something to do around here. As far as hospitals, as I can recall we have - the University, the Royal Alex, the Mis, the Grey Nuns and the Sturgeon (St Albert) - the IM experience is a little bit different at every one, but I suppose as an IM resident you would rotate through different rotations at different sites.

 

As an off-service resident, I felt that the IM program here at U of A looks after their own well. They also listen to the concerns of the off-service residents and there have been changes to the program since I went through as a junior last year. I felt well-supported 95% of the time (there was one night from hell) - and the staff are incredibly supportive.

 

The for-service rotations generally IM residents don't rotate on, so I wouldn't worry about that. You guys use us for that - and we provide you the service.

 

I think IM prepared me well for the LMCC this year; and the teaching from the senior residents was good, both at bed-side and formal teaching. The grand rounds were actually kind of interesting. The IM subspecialties that I rotated through were also quite excellent - I highly recommend cardiology - and once again, staff and residents and the fellows were great.

 

Their IM residents are generally happy - and their senior shifts are split into 12 hours.

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Our location is not poor. Edmonton is a lovely city and I find the people very welcoming and there's always something to do around here.

 

It's a personal thing I guess. If you enjoy frigid, unrelentless cold, mosquitos in the summer, few trendy neighbourhoods to walk through, an airport that's not in the city, etc, than it sounds amazing! It's only saving grace is all the festivals in the summer (even though the vast majority of them are actually not worth attending) but if you really care about that, drive up from Calgary on a weekend!

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It's a personal thing I guess. If you enjoy frigid, unrelentless cold, mosquitos in the summer, few trendy neighbourhoods to walk through, an airport that's not in the city, etc, than it sounds amazing! It's only saving grace is all the festivals in the summer (even though the vast majority of them are actually not worth attending) but if you really care about that, drive up from Calgary on a weekend!

 

Don't worry, the hospital is temperature controlled, there are no mosquitos inside, you won't have time to walk through trendy neighbourhoods, you can take transit to the airport - if you have time to leave said hospital.

 

It is IM residency after all ;)

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It's a personal thing I guess. If you enjoy frigid, unrelentless cold, mosquitos in the summer, few trendy neighbourhoods to walk through, an airport that's not in the city, etc, than it sounds amazing! It's only saving grace is all the festivals in the summer (even though the vast majority of them are actually not worth attending) but if you really care about that, drive up from Calgary on a weekend!

 

I've always thought the area near UofA and the neighbourhoods just west of downtown were pretty nice.

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It's a personal thing I guess. If you enjoy frigid, unrelentless cold, mosquitos in the summer, few trendy neighbourhoods to walk through, an airport that's not in the city, etc, than it sounds amazing! It's only saving grace is all the festivals in the summer (even though the vast majority of them are actually not worth attending) but if you really care about that, drive up from Calgary on a weekend!

 

Oilers!

 

/aware they are serially terrible but a fan anyway.

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