I recently led a workshop designed to help medical students prepare for residency and how to choose the right program. At the end of the workshop, one of the fourth year medical students came up to show me an app called, “Match Dr.” This app is designed to assist residency candidates keep track of all of the programs they are interested in. Moreover, it provides the opportunity for medical students to rate all of their programs on qualities like location, clinical diversity, academic characteristics, lifestyle, career goals, and prestige. I assume that one could formulate his or her rank order list based on the final ratings they assign to each of the programs. I enjoy learning from medical students and residents, which I consider a “reverse mentoring” of sorts, and I’m always happy to learn about a new tool that medical students and residents are utilizing to navigate the tasks of residency.
The app additionally assigned a global residency rating to each of the programs based on all users. It was an interesting exercise for me to investigate how other programs were rated (and yes, I admit, my own!), and I wondered how these overall ratings would impact how students rank their programs. The internet has provided an interesting environment to share personal preferences for movies, restaurants, hotels, among many other things without any insight into the qualities of those individuals doing the rating. These anonymous rankings have the potential to exert a powerful impact on how people make decisions about where to vacation or have a meal, and it is possible that these rankings could theoretically affect where medical students opt to apply to residency. For example, studentdoctor.net is a website that provides anonymous forums to discuss the relative merits and weaknesses of residency programs, among other subjects important to medical students.
It got me thinking about what other qualities should be important to residency candidates. There are other factors that are not on the traditional list of items to consider, but should be, when considering the kind of environment where one should train. To that end, I highly recommend the report, “What Kind of Physician Will You Be? Variations in Healthcare and Its Importance for Residency Training,” which was released by the Dartmouth Institute for Health Policy and Clinical Practice in October 2012. Here’s the link: http://www.dartmouthatlas.org/pages/residency.
The report acknowledges that every hospital has its own style and culture of practice – the so-called “hidden curriculum,” and it helps medical students and residents learn about those less visible characteristics that will impact how you learn to care for patients. We know that there is a strong correlation between where a physician trains and what kind of physician one becomes. For example, the institution’s stance on the following measures (among many other indexes discussed in the report) should be considered prior to making final decisions about where to train. Effective care refers to services that are of such proven value that every patient should receive them, such as influenza and pneumonia vaccinations. Supply sensitive care refers to the issue of whether the supply of physicians and other resources dictate the kind of care patients receive. Finally, preference sensitive care speaks to whether patient preferences guide care in decision making when it’s clear that patient preference is important and that there are choices to be made about treatment.
Training at the right institution could teach residents to provide higher quality care that respects patient preferences. Having knowledge of characteristics like these could give you a lot of insight into the kind of institution you’re considering for training. Clearly, the hospital in which the residency program is conducted informs the quality of the experience residents will have. Learn to think outside the box in terms of traditional ratings of residency programs. The kind of medicine you’ll practice in the future will be directly impacted by where you train, and this report has lengthened the list of qualities to consider when making decisions about where to apply and ultimately rank.
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