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Best Internal Medicine Programs in the country?


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My only experience with Toronto IM residents is in the MSICU at St Mike's. Seemed to be about the same as anywhere else, and you can assess for yourself how much autonomy one gets where there are five other residents and four fellows, +/- a few due to post-call days, and there's always a fellow on overnight.

 

At my centre, there might be two other residents on, no fellows, possibly an NP, and you cover CV too. And we do senior call after Christmas of PGY1.

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Don't be fooled. There is more autonomy in Toronto than any other IM program in Ontario. Western R2s aren't even seniors. Residents from all over the country go to Toronto to do electives and you can really see the difference. See for yourself.

Are you trying to convince everyone or yourself?

 

There are flaws to every program and Toronto isn't well-known for giving their junior residents early autonomy. The sooner you accept this, the sooner you can figure out how to work around it.

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My thoughts:

 

1. Toronto - large, academic, lots of good teachers. Downsides - large city, travelling to multiple hospitals but primarily based at one (you could be at the TWH for most of your residency). Had multiple friends who went to Toronto and weren't able to get into their subspecialty of choice (cardiology, respirology). Just because you went to Toronto doesn't mean you will get a subspecialty spot which is the most important part of doing internal medicine. Most residents are happy in Toronto - but know that the subspecialty services steal most of the good internal medicine cases and you're left admitting COPD and low risk GI bleeds all night. Did an elective there at TWH -

 

2. McMaster/London - good training but residents and staff are quite aggressive. Well organized but very de-personalized. Difficult atmosphere to be in (or so I've heard). London is a terrible city but a great University to be at.

 

3. Ottawa - great internal medicine program. Many Royal College examiners live and work there. Lots of exposure to quality staff and they have fantastic subspecialty training (ex. Cardiology). They seem to be willing to take their own internal medicine residents into subspecialty spots. Almost all of the cardiology fellow are originally from Ottawa internal medicine.

 

4. Queen's - best program director in Canada for internal med, recently re-organized CTU and internal medicine staff are great. Single hospital, and all the subspecialties are in one place and they have great hands on experience. I did an elective there and they have the best morning report in Canada because of Dr. Morton and ALL the internal medicine residents get together every morning. They don't have all the subspecialties to match to (endocrine and allergy), but the medicine subspecialty match rate from Queen's this year was excellent. Every single resident got their specialty of choice in the city they wanted (Allergy in Toronto, Cardiology at U of A, Rheumatology at UBC, etc.). The residents seem very happy there.

 

5. Dalhousie - similar program to Queen's. Hope you don't live out West because travelling to and from Halifax is like travelling to Europe. Two hospitals with a good case load. My experience is that Halifax seems to take their own medical student and they have a small program. If you really want to move far away and start fresh - go to Dalh!

 

6. Edmonton - residents experience is poor. They don't treat their residents well and they overwork them. Good experience, but apparently the rotation at the Royal Alex is horrendous. No staff support, chaotic, scut monkey. They have good subspecialties but they don't take good care of their residents.

 

7. Saskatchewan - new program director (they've been through three so far). He's old and they have a poor match rate into internal medicine. Residents always seem to get their subspecialty of choice - but not always where they wanted to go (hope you enjoy ending up in Winnipeg!).

 

8. Winnipeg - fantastic training experience (infectious disease capital of Canada) because of the severely ill Northern population. Winnipeg, however, is a terrible place to live. If having the Jets and wanting to be an ID doctor is your goal - then you should really think about Winnipeg. Residents are generally happy, once they get over the shock of being in Winnipeg.

 

9. Calgary/UBC - I don't know much about these programs, but UBC had a hard year for the subspecialty match. 16 people wanted cardiology and a lot of them went empty handed. Not a lot of support for residents who want to stay or get into a competitive specialty. Publish or perish.

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6. Edmonton - residents experience is poor. They don't treat their residents well and they overwork them. Good experience, but apparently the rotation at the Royal Alex is horrendous. No staff support, chaotic, scut monkey. They have good subspecialties but they don't take good care of their residents.

 

I am supposing you mean on CTU teams? In my experience, the internal medicine residents are NEVER placed on the scut teams - it is always two off service residents with no senior resident and no medical students. The internal medicine residents are on teaching teams (one senior, one internal med junior, one off service junior, two med students).

 

Just based on my experience, I feel the IM program treats their residents better than they treat the off-service residents.

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I am supposing you mean on CTU teams? In my experience, the internal medicine residents are NEVER placed on the scut teams - it is always two off service residents with no senior resident and no medical students. The internal medicine residents are on teaching teams (one senior, one internal med junior, one off service junior, two med students).

 

Just based on my experience, I feel the IM program treats their residents better than they treat the off-service residents.

 

don't surprising that :) Everyone's program to some degree protects their own.

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Don't be fooled. There is more autonomy in Toronto than any other IM program in Ontario. Western R2s aren't even seniors. Residents from all over the country go to Toronto to do electives and you can really see the difference. See for yourself.

 

Western Resident R2s are seniors. Not for your sake, but so everyone else gets accurate information. We've had recent staff grads from Toronto GIM who have said that seniors have almost too much autonomy at Western.

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My thoughts:

 

1. Toronto - large, academic, lots of good teachers. Downsides - large city, travelling to multiple hospitals but primarily based at one (you could be at the TWH for most of your residency). Had multiple friends who went to Toronto and weren't able to get into their subspecialty of choice (cardiology, respirology). Just because you went to Toronto doesn't mean you will get a subspecialty spot which is the most important part of doing internal medicine. Most residents are happy in Toronto - but know that the subspecialty services steal most of the good internal medicine cases and you're left admitting COPD and low risk GI bleeds all night. Did an elective there at TWH -

 

2. McMaster/London - good training but residents and staff are quite aggressive. Well organized but very de-personalized. Difficult atmosphere to be in (or so I've heard). London is a terrible city but a great University to be at.

 

3. Ottawa - great internal medicine program. Many Royal College examiners live and work there. Lots of exposure to quality staff and they have fantastic subspecialty training (ex. Cardiology). They seem to be willing to take their own internal medicine residents into subspecialty spots. Almost all of the cardiology fellow are originally from Ottawa internal medicine.

 

4. Queen's - best program director in Canada for internal med, recently re-organized CTU and internal medicine staff are great. Single hospital, and all the subspecialties are in one place and they have great hands on experience. I did an elective there and they have the best morning report in Canada because of Dr. Morton and ALL the internal medicine residents get together every morning. They don't have all the subspecialties to match to (endocrine and allergy), but the medicine subspecialty match rate from Queen's this year was excellent. Every single resident got their specialty of choice in the city they wanted (Allergy in Toronto, Cardiology at U of A, Rheumatology at UBC, etc.). The residents seem very happy there.

 

5. Dalhousie - similar program to Queen's. Hope you don't live out West because travelling to and from Halifax is like travelling to Europe. Two hospitals with a good case load. My experience is that Halifax seems to take their own medical student and they have a small program. If you really want to move far away and start fresh - go to Dalh!

 

6. Edmonton - residents experience is poor. They don't treat their residents well and they overwork them. Good experience, but apparently the rotation at the Royal Alex is horrendous. No staff support, chaotic, scut monkey. They have good subspecialties but they don't take good care of their residents.

 

7. Saskatchewan - new program director (they've been through three so far). He's old and they have a poor match rate into internal medicine. Residents always seem to get their subspecialty of choice - but not always where they wanted to go (hope you enjoy ending up in Winnipeg!).

 

8. Winnipeg - fantastic training experience (infectious disease capital of Canada) because of the severely ill Northern population. Winnipeg, however, is a terrible place to live. If having the Jets and wanting to be an ID doctor is your goal - then you should really think about Winnipeg. Residents are generally happy, once they get over the shock of being in Winnipeg.

 

9. Calgary/UBC - I don't know much about these programs, but UBC had a hard year for the subspecialty match. 16 people wanted cardiology and a lot of them went empty handed. Not a lot of support for residents who want to stay or get into a competitive specialty. Publish or perish.

 

I can't speak as much for other programs, but I'd have to respectfully disagree about western's assessment. The best strength about this place is that it is the most collegial I have experienced through my electives across the country. Staff really look out for you, are always there for you, and you never feel like you are alone or unsupported. I've had staff hold 30 minute phone conversations doing teaching when I was reviewing a case overnight and senior residents who would message me to check up on how things were going. I even had a senior who wasn't even on the service help me out with something when I was on call.

 

I don't know why you thought UWO was very depersonalized, but in my experience here, it couldn't be further from the truth. I think this will become clear when you guys come to our social this year.

 

my advice, to everyone who has yet to do electives, is go out and find what programs work for you. If you are on the interview trail, you'll go ahead and see for yourself what the facilities are like, what the residents are like, and feel free to ask all the questions you want, even if it puts them in a tough spot. You are interviewing them as much as they are interviewing you.

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As a clerk just coming off of internal CTU (and having no stake in the program, because I'm not planning to do internal), I have to agree with Alastriss.

 

After spending 6 weeks with the residents and chatting about the program's strengths and weaknesses - the assessment of everyone I have spoken with, juniors and seniors as well as rotating elective students trying to get a feel for things, is that Western is one of the most collegial and friendly programs they have experienced.

 

I have also seen seniors and staff staying late and being available by phone and text all night to support more junior trainees. And a couple elective students have told me that they were surprised to see how approachable staff are here.

 

Obviously, I don't have a resident's perspective on it, but it seems to be a point of agreement between many of the trainees here.

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  • 2 months later...
My thoughts:

 

1. Toronto - large, academic, lots of good teachers. Downsides - large city, travelling to multiple hospitals but primarily based at one (you could be at the TWH for most of your residency). Had multiple friends who went to Toronto and weren't able to get into their subspecialty of choice (cardiology, respirology). Just because you went to Toronto doesn't mean you will get a subspecialty spot which is the most important part of doing internal medicine. Most residents are happy in Toronto - but know that the subspecialty services steal most of the good internal medicine cases and you're left admitting COPD and low risk GI bleeds all night. Did an elective there at TWH -

 

2. McMaster/London - good training but residents and staff are quite aggressive. Well organized but very de-personalized. Difficult atmosphere to be in (or so I've heard). London is a terrible city but a great University to be at.

 

3. Ottawa - great internal medicine program. Many Royal College examiners live and work there. Lots of exposure to quality staff and they have fantastic subspecialty training (ex. Cardiology). They seem to be willing to take their own internal medicine residents into subspecialty spots. Almost all of the cardiology fellow are originally from Ottawa internal medicine.

 

4. Queen's - best program director in Canada for internal med, recently re-organized CTU and internal medicine staff are great. Single hospital, and all the subspecialties are in one place and they have great hands on experience. I did an elective there and they have the best morning report in Canada because of Dr. Morton and ALL the internal medicine residents get together every morning. They don't have all the subspecialties to match to (endocrine and allergy), but the medicine subspecialty match rate from Queen's this year was excellent. Every single resident got their specialty of choice in the city they wanted (Allergy in Toronto, Cardiology at U of A, Rheumatology at UBC, etc.). The residents seem very happy there.

 

5. Dalhousie - similar program to Queen's. Hope you don't live out West because travelling to and from Halifax is like travelling to Europe. Two hospitals with a good case load. My experience is that Halifax seems to take their own medical student and they have a small program. If you really want to move far away and start fresh - go to Dalh!

 

6. Edmonton - residents experience is poor. They don't treat their residents well and they overwork them. Good experience, but apparently the rotation at the Royal Alex is horrendous. No staff support, chaotic, scut monkey. They have good subspecialties but they don't take good care of their residents.

 

7. Saskatchewan - new program director (they've been through three so far). He's old and they have a poor match rate into internal medicine. Residents always seem to get their subspecialty of choice - but not always where they wanted to go (hope you enjoy ending up in Winnipeg!).

 

8. Winnipeg - fantastic training experience (infectious disease capital of Canada) because of the severely ill Northern population. Winnipeg, however, is a terrible place to live. If having the Jets and wanting to be an ID doctor is your goal - then you should really think about Winnipeg. Residents are generally happy, once they get over the shock of being in Winnipeg.

 

9. Calgary/UBC - I don't know much about these programs, but UBC had a hard year for the subspecialty match. 16 people wanted cardiology and a lot of them went empty handed. Not a lot of support for residents who want to stay or get into a competitive specialty. Publish or perish.

 

I'll just comment on the bit about UBC. Cardio interest was crazy this last match but there weren't quite 16 ppl in our cohort it was actually 9 (out of 40-ish residents). All 9 ended up getting cardiology with 4 staying at UBC and the others taking other spots across the country.

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I was a pgy-1 resident in psychiatry but recall doing one of my last internal med rotations at st joes CTU. I have to say for an off service rotation for me it was one of the more memorable rotations (not just because I was nearing the end of internship). I found the staff and residents very helpful and told me to call them anytime. It was an enjoyable rotation and of course it helped that my last on call ever in internal med I slept through the night....no pages- I thought my pager was broken or battery had died. I also found the palliative care team very helpful on this rotation to call and get advice so my suggestion would be not to overlook asking other services for assistance (informal consult) if you need it or think a patient would benefit from their involvement

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  • 9 months later...

Every program is "academic", though the organization (and sometimes quality) of teaching will vary. 

 

I suppose it depends on what you mean by "autonomy". At my centre, I rarely do anything but work directly with staff - no intervening seniors let alone fellows. But of course some staff are micromanagers and others make a point of letting you run your own team. 

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Is it true that subspecialty matching results are poor at Toronto? I find that hard to believe as resident appreciation seemed to be high there when I went. Is day-to-day teaching strong?

 

Regarding support for research etc., are they a good institution? Do they help you find a compatible supervisor and support you through the process or is it more of a "figure it out yourself" kind of attitude?

I haven't heard much about McGill, what is the opinion on clinical exposure and teaching? Do they have a decent academic program that allows students to pursue research interests? I know they are coming out with a new hospital that might shake things up a bit...

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My thoughts:

 

1. Toronto - large, academic, lots of good teachers. Downsides - large city, travelling to multiple hospitals but primarily based at one (you could be at the TWH for most of your residency). Had multiple friends who went to Toronto and weren't able to get into their subspecialty of choice (cardiology, respirology). Just because you went to Toronto doesn't mean you will get a subspecialty spot which is the most important part of doing internal medicine. Most residents are happy in Toronto - but know that the subspecialty services steal most of the good internal medicine cases and you're left admitting COPD and low risk GI bleeds all night. Did an elective there at TWH -

 

 

 

Going to multiple hospitals is a pain, especially since you'll probably have to learn 3-4 different EMR systems in your first year as you rotate around. Lots of UofT residents did not match this year to any subspecialty, which is particularly bad considering the climate change in the GIM 4 vs 5 year issue.

 

As for the "most residents are happy in Toronto", I strongly disagree with that.

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Lots of UofT residents did not match this year to any subspecialty, which is particularly bad considering the climate change in the GIM 4 vs 5 year issue.

 

I know some of the residents who didn't match only ranked a single program, and were comfortable going unmatched to do the 4 yr GIM in Toronto.

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Trying to clarify some things with London, Saskatoon, and Winnipeg. My experieces: 

1. London- SUPER friendly and collegial, not as many unique pathologies to see though. 

2. Saskatoon- Fun interview experience, great vibe from residents, however have heard they have some internal strife/turmoil.. Not really sure what exactly this means (can anyone from Sask comment as this was not at all addressed during the interview?). Also have heard that all the paper charting can be very frustrating. 

3. Winnipeg- Again got a good vibe from residents, PD seems super chill, however also heard that it has significant amount of 'shame-based learning'. Is this true? 

 

Any comments/thoughts would be greatly appreciated. =) 

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I find this thread has a lot of *garbage* posted about U of T IM largely by people who are not in the program. I will call this interesting, at best. I would never dare comment about programs that I was not intimately familiar with and will state on the record that I actually think most other programs in the country are pretty fantastic.

 

That being said, I honestly think Toronto IM is great. The program is situated in one of the best cities in the country/ world (consistently at the top of world ranks) and supported by one of the best universities in North America. Toronto is easily the largest city in North America to have only one medical school and the variety of hospitals is a major strength, not weakness (people on this forum who say otherwise are incredibly myopic about their careers). Sunnybrook, St Mike's and UHN could not differ more from each other. Add in Sinai, Women's College and the partially affiliated sites and you have incredible variety. 

 

Autonomy is appropriate. Residents perform their assessments, come up with their own plans, and implement them. They also receive early feedback from seniors and staff. If you think that you are smart enough to work completely independently, then why are you in residency? And where do you develop that hubris? IMHO, extreme resident autonomy is fancy PR for high patient loads and poor supervisor presence. 

 

Research is great in Toronto and is great elsewhere. Toronto is one of the top 5 biomedical research hubs in North America. There is a lot of cross pollination that comes with that. Toronto is especially attractive if you have very niche research interests (which should be unusual). Toronto does have some unique advantages I think - the Institute for Clinical Evaluative Sciences, for instance, is without easy comparison. 

 

Collegiality in the program is just fine. Everyone is super friendly while we work. Those who are looking for a colleague-based social circle have been able to easily form one. However, really think why this is important to you. You will be working long hours and in your free time you will primarily be sleeping. With what you have left, after you spend time with your significant other, you will have a world-class city at your disposal. As a Canadian, you will likely also already know people in Toronto. IMHO, placing emphasis on close-knit residents is PR meant to distract from more important aspects for consideration. 

 

Teaching is great, both through formal half-day, morning report and regular seminars. These things are also great elsewhere....

 

Fellowship - for many, Toronto is advantageous because of the access you have to Toronto sub-specialties. It stands to reason that working with these sub specialists on clinical rotations and research will increase your competitiveness. Toronto did have a tough year in the match, however that is because the majority of Toronto wants Toronto, the far-and-away most popular location for all subspecialties. Ultimately though, Toronto applicants do better when applying to Toronto specialties than applicants from other schools. This is fact, borne out by data. I would encourage applicants to use critical analysis. If your residents largely apply to non-competitive specialties in non-competitive locations, they will do better. You need to compare apples to apples.

 

Downside - the program is larger. If you need coddling and swaddling then Toronto is probably not for you. The program is very open about this. 

 

Anyways, just thought I would try to temper the Toronto misinformation.

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  • 2 weeks later...
 

My thoughts:

 

2. McMaster/London - good training but residents and staff are quite aggressive. Well organized but very de-personalized. Difficult atmosphere to be in (or so I've heard). London is a terrible city but a great University to be at.
 

 

Good to see a discussion about IM on premed. I agree with a lot of what has been said previously - most IM programs across the country offer great residency training. At interviews a few years back, Manitoba's IM PD said it best: "you can attend the best IM program in the country but if you don't put in the work you'll still be a mediocre resident". Although I chose to train elsewhere that piece of advice has stuck with me to this day.

 

That being said, I do take issue with Mac being portrayed as having 'aggressive residents and staff'. This is simply not the case. Next to London, Mac has a reputation for creating one of the most collegial working atmospheres. The PD is incredibly approachable and receptive to resident feedback. The CTUs see incredible volume and SMRs get to manage complex and interesting cases with near complete autonomy and unconditional support from our staff. 

 

As for the program, the training is top notch. Mac has some of the highest volume centres in Canada. In PGY1 alone you do close to 60 calls and gain invaluable experience and exposure to incredibly sick patient populations. On SMR call, you admit an average to 18-24 inpatients/night. The recent night float system has been well received across the program and there's always a second SMR on from Friday-Sunday. Residents walk into their PGY2 (SMR) year having done 2 months of ICU in PGY1 with numerous central lines, intubations, thoracentesis, paracentesis, LPs etc. As someone mentioned earlier, Mac is the Mecca of EBM and is also an emerging leader in medical education (routinely taking awards at ICRE). Research opportunities with internationally renowned researchers are abundant for residents. This is a centre with the international reputation of a University like Toronto and the collegiality of a University like NOSM.

 

McMaster residents are well regarded and the PGY3s match very competitively every year. Case and point, this year we had all but one resident match to their top subspecialty program (mostly at McMaster and Toronto). 

 

In the future, I would refrain from making sweeping statements about schools and programs that you may not know much about. Much like medicant, I felt the need to dispel some of the misconceptions being perpetuated on this board. Training in IM is fantastic across Canada and each school has its strengths.

 

Best of luck to those of you who plan to pursue a career in IM.

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Excellent post. Mac was in my top 3 ultimately. The only real downside is that Hamilton - while it does have its nice spots - remains something of a hole, and I'm not keen on the General as a hospital. At a certain point all programs have their strengths and weaknesses, but location may become a deciding factor. Proximity to family/friends and personal life stuff may end up being more important. 

 

I do think that the early ICU exposure is a nice feature of Mac's program. I assume that entails buddy call? I'm not sure if that's better than simply being thrown into solo call as an R2 in July. Though I imagine you don't cover CVICU at Mac...

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Indeed, Hamilton as a city leaves much to be desired for - won't argue with that! But still pretty good in terms of location to Burlington, Oakville and TO (where many residents and faculty choose to live). There are a lot of nice places in Westdale, Ancaster and Dundas. Plenty of nature trails and waterfalls too. All in all, Hamilton is not that bad a city.

 

As a PGY1 doing ICU call (it'll be at the Juravinski or SJH), you are buddied with a PGY2/3 for the first month then it's solo for the second month (with a CCA in house if you need them). Although they're pretty good about giving you your independence when you're on call both months. The backup really only exists if you get slammed or want to run a complex case by a senior.

 

Doing CVICU at HGH is not mandatory and can only be done in PGY2 or 3 (but you have to ask for it). 

 

In terms of SMR call, you cover and can admit to the CCU at Juravinski and SJH overnight in addition to the usual codes/ward emergencies/ER consults. Tough year but lots of experience to be had.

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  • 8 months later...

I'm quickly approaching CaRMS and would really like to live in Calgary. However I've heard mixed messages about their program. I did an elective at foothills that was not overly impressive and I noticed they had the lowest R3 rank rate in 2015.

Could anyone comment on Calgary's IM program, and whether the relaxed attitude negatively affects the required volume to become a great resident?

Thanks

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