How to Identify a Bad Residency

This one is difficult and likely to be a little controversial.  A residency is more of a commitment than an internship- if it’s not a good fit, three years can be long and unpleasant.  People leave residencies or are dismissed because of a bad fit. I have heard some program directors refer to choosing a resident to be similar to choosing a spouse.  Here are some criteria I would suggest you consider when deciding on a program.

#1: Board pass rate.  At the end of the day, the purpose of the residency is to train you effectively and prepare you to pass the specialty boards.  I believe good programs have a 100% pass rate for individuals within 3 years of finishing the program. You should be able to ask the program director for this data.  If a program has a bad pass rate, maybe it has to do with the residents and maybe it has to do with the program. It’s impossible to say, so tread carefully if the program has a poor pass rate.

#2: Resident dropout rate.  Ideally, residents don’t drop out or are dismissed.  I believe a good program has a 0% dropout or dismissal rate in the previous 10 years.  Programs spend a lot of time choosing candidates, and the candidates are usually the best of the best.  So there shouldn’t be any dropouts if everyone is doing their job correctly. A program with a non-zero dropout or dismissal rate either has a problem choosing good residents or is not a good program. Again, it’s impossible to say which, so tread carefully.

#3: Talk to the residentsJust as with interns, the current residents know what’s up with the program and can give you the inside scoop.  Ask the right questions and try to get honest answers and read between the lines. Just because there are unhappy residents doesn’t mean a program is bad, but it is suggestive of it.  It’s also possible it’s just a bad fit.

#4: Out-rotations.  Some specialties require you to spend time with other disciplines.  For most, it’s advantageous to spend some time away from your home institution.  Do you have time to do this, is it easy to do, and do they help practically or financially?  I got to do critical care at CSU, anesthesia at UCD, and a human anesthesia rotation in Perth and I believe these dramatically improved my professional competencies.

#5: Credentials acceptance rate.  Many disciplines require a research publication for acceptable credentials.  Does the program do a good job providing for this requirement, and others? I know some programs whose residents don’t get a publishable paper until 2-3 years AFTER the end of the program.  Don’t let credentials hang up your professional progress. Go somewhere that knows how to get residents what they need to get their credentials accepted.

#6: Collegiality.  Since a residency is a longer time period, you probably can’t “put up” with being treated poorly for that long.  Do the supervisors treat the residents with respect? Do you have time off to study and do research? Are you constantly on call?  You want a program that is aiming for resident success, not looking for cheap labor. At the end of the day, I think this boils down to respect and collegiality.  If they are supportive, that is a strength. If they are disinterested, that is a problem.

#7: Location.  Some people feel strongly about this, others not so much.  I’m not sure I could live for three years in East Lansing, or anywhere it snows 5+ months of the year.  Others may not tolerate the heat or may feel lonely and isolated in Pullman or Stillwater. This is at the end because I think it is the least important, but it is still an important consideration.  As always, be honest with yourself– can you ACTUALLY be happy living in this place?

Most of these variables focus on the program.  A good program is one that sets you up for successful credentials acceptance, passing the boards, and teaching you what you need to know to be a successful specialist.

How to Identify a Bad Internship

In contrast to vet schools, which are accredited by the AVMA, there is no governing body which accredits internship.  Any hospital can establish an internship, and some of them probably shouldn’t. There are some notoriously bad internships out there.  Some of them have turned around and become better programs. So, if you are looking at internships, how do you identify the problem programs?

#1: Talk to Current Interns.  I cannot possibly stress this enough.  If you want to find out about a program, you can ask your mentors, you can ask your friends but, at the end of the day, the ones that know are the ones who are there in the trenches.  The current interns are experiencing the program and can provide you the nitty-gritty. You have to ask the right questions and read between the lines because veterinary medicine is a small world.  Very few interns are willing to say outright, “This is terrible, don’t come here.”

#2: Review their past intern match statistics.  This may or may not be available to you. When internship descriptions were in hard copy, you could look back through previous years to see how a program had changed.  Nowadays, you would need some kind of access to prior years’ information. Alternatively, you can ask the program about their residency match rate and/or changes they have made over time.

#3: Reputation.  This can be problematic because different people hear different things.  For years, one university had a reputation for only taking students in the top 5% of their class rank as interns.  When I recently spoke to somewhere there, they vehemently denied this and gave several examples recently where this rule was not true.  So, things can change over time. If your mentors have recent information (less than 5 years old) or recently worked at the institution, they can probably provide valuable insight.  Otherwise, be reserved in the interpretation of a bad reputation.

#4: Type of work.  Will you be on emergency duty 25-33% of the time?  That seems like a lot and suggests they may just be using you for cheap ER doctors.  Will you get to rotate through a variety of different disciplines and otherwise get a broad experience?

#5: Number and type of specialists.  Is there a single internist at the practice, and it is otherwise staffed with ER doctors?  Or is it a large multi-specialty hospital? The former suggests a new or possibly dodgy program, the latter is more likely to support a robust, healthy program.

#6: Longevity of program.  Is this the first or second year the program has been active, or have they been doing this for 20 years?  A brand new program isn’t necessarily bad, but one that has been ongoing for a while is more likely to have worked out the kinks.

#7: Academic or private practice.  Statistically, there are probably more good academic internships than good private practice internships.  That’s not to say there are no bad academic internships or few good private practice ones. But generally, academic internships will be ‘safer’ than private practice ones.

In general, bad internships are those which are newer, where you don’t have much mentoring, don’t have exposure to many disciplines, work too much ER, and don’t progress your career to the next step.  Fortunately, bad internships are few and far between. Most programs are perfectly fine. As always, make sure the programs which you rank are ones where you would be OK working. And remember, it’s only a year.

How to Identify a Bad Vet School

This one is pretty simple: there ARE no bad vet schools.  I genuinely believe that. The AVMA maintains fairly high standards for accreditation.  If a school is accredited by the AVMA, I think it is a fine place to get an education to prepare you for life as a veterinarian.  So what is this post about? Well, I think there are some school programs that may not be bad, per se, but less than ideal. Let’s look at those characteristics.

#1: Cost.  Oh boy, this is so huge, and I wish more people thinking about becoming vets thought about it.  Being in debt to the tune of 2-3x your starting salary will dramatically impact EVERY DECISION OF YOUR LIFE for the rest of your life.  As such, I think schools that are very expensive should be avoided if at all possible.

#2: Faculty.  I don’t actually think that a vet school needs a faculty of hundreds with all the possible subspecialties to be successful.  But I DO think they need faculty in core clinical disciplines: equine medicine and surgery, food animal, and small animal medicine, surgery, community practice, anesthesia, and emergency.  Schools that don’t have these core faculty, or are very thin on those faculty (e.g. one member in the discipline) are just borderline. What happens if they lose that one faculty member? If the school can’t attract these basic faculty, that may reflect systematic problems.

#3: Accreditation.  Remember when I said in the intro that if a school if AVMA accredited, it’s probably OK?  The accreditation process will give schools minor and major deficiencies. If a school has several minor deficiencies or a single major deficiency, it is at risk of losing accreditation.  If you matriculate, you will still be guaranteed to graduate from a then-accredited school. But it indicates some potentially significant problems with the program.

#4: Metrics.  If a school’s pass rate on the NAVLE is relatively low, or their graduation rate is relatively low, these may be markers of a less-than-ideal program.  YOU may not suffer from these fates, but the fact that the program numbers aren’t great suggests a systematic problem.

At the end of the day, if you’re a good student, and you work hard, and you don’t incur too much debt, you’ll be fine in spite of where you go.  But if you need more support or help, if you can’t afford the school, or if you have grand ambitions to be a specific type of world-famous scientist, then keep an eye out for these variables when selecting a vet school.  As I have mentioned before: just go to your state school, or the least expensive one you can find.

Podcast Episode #9 – Dr. Rachel Kreisler

Dr. Kreisler and I worked together, did research, and continue to pursue research projects together. She brings a terrific perspective on shelter medicine, a growing field of veterinary medicine.

The How to Identify a Bad Position Series

This series was inspired by people asking me how they could identify a bad vet school.  Over the past 20 years, I have had numerous people ask me about identifying bad internships.  When I advise those applying for residencies, we talk about identifying potentially problematic programs.  And I am blessed with having worked at institutions that were good and less good fits for me. So I have some perspective on the whole concept of identifying a bad program.

I have a caveat for this entire series: I genuinely stand by my assertion that there are no good or bad programs, there are only good or bad fits with the individual.  Nonetheless, some programs are bad fits for 90%+ of applicants. If I indicate a potential problem area and you think, “No, I think I could roll with that,” please feel free to disregard that point.  Deciding on your professional progression is highly personal, and no one else can tell you what is and is not a good decision for you.

As always, this is my perspective, based on my experience and discussion with colleagues.  Others would probably have different things to say and have a different perspective on what makes for a “bad” position.  Please reach out to trusted mentors to seek their advice, as well. Enjoy these for the next month!

How to Identify a Bad Vet School

How to Identify a Bad Internship

How to Identify a Bad Residency

How to Identify a Bad Faculty Position

How to Be Successful: Be Honest

Oh man, do I really need to write this post?  I do, but not for the reason you may think. Yes, there are people who lie, and we will deal with that.  The bigger problem is that, in our culture, honesty is a fluid concept with many different definitions. So let’s break them down.

Brutal Honesty.  This is often billed as “I just say what I mean and mean what I say.”  It’s possible I used to be one of these people. I believe this is a cover for people who don’t have good emotional intelligence. Most people use it as an excuse to say whatever they like and blame others for feeling hurt. Our culture is built on not being brutally honest.  Sometimes absolute honesty is necessary: if you’re not happy in your relationship, if your children need more direction, if you have a really good relationship with a boss, and if you have to give constructive feedback to students or subordinates. This can be done without being brutally honest. Think about what the word brutal means: savage, cruel, and inhuman. When you’re being brutally honest, you’re not considering the other person’s feelings at all.  The vast vast majority of the time, I think you can be authentic without being brutally honest.

Strategic Honesty.  You must always be authentic.  But that doesn’t mean you have to be brutally honest and tell everyone everything you’re thinking.  For example, if you’re currently in a bad job situation and are interviewing for a new position, don’t go on about how terrible the place you are working is.  Be authentic about why you’re looking for a new job: new or different opportunities, better family dynamics, more direct leadership and vision, whatever. If you are asked point blank, “Do you like where you currently work?” you should answer honestly.  But, again, strategically. “I like interacting with clients and my staff are great. I do have some challenges with leadership, as I feel they don’t give me enough direction or support in my decision making. I want to be better and so seek out feedback, which is difficult to get.”  Be humble- acknowledge what YOU could be doing to contribute to a less-than-ideal situation. “It’s not a good fit for me because I need leadership which will create clear expectations for me.”

Dishonesty.  Do not be dishonest.  Period. Being dishonest is not being authentic.  People will not trust you or have faith in you. Trust is the foundation for our entire civilization.  According to the book Sapiens, chimpanzees aren’t running the world partly because they don’t cooperate because they have no basis of establishing trust with chimpanzees who aren’t in their tribe.  If you make a medical error, accept responsibility. If you make a decision which turns out badly, accept responsibility. Don’t take actions for which you will have to lie.  I understand life is complex, but, if you want to be successful, you have to live an authentic life.

Honesty is a nuanced concept.  People wield the idea like a club to get others to do what they want.  At the end of the day, you’re the one who has to decide how you will live, and you have to deal with the consequences of those decisions.  My recommendation is Strategic Honesty.

What are circumstances you have encountered which have challenged your ability to be authentic?

Podcast Episode #8 – Dr. Jason Eberhardt

Dr. Eberhardt and I worked together as “middle management” at one institution. Despite our different life philosophies, we bonded well and became great supporters of each other. He discusses his path in internal medicine, and provide perspective for those wishing to pursue a similar path.

How to Interview Potential Research Mentors

Photo by   Sergey Korshunov  on  Scopio

I know what you’re thinking, “Mentors interview ME, not the other way around!”  Well I have something important to tell you: all interviews are two-way streets.  You need to show yourself off AND make sure that your potential mentor would be a good fit for you.  I believe most students ‘fail’ in their research projects because they didn’t find a good fit with a mentor.  So you need to ask questions to make sure you will get the experience you want from participating in research as a student.  You will also probably make a better impression on potential mentors if you show that you’re engaged, interested, and aware of what may be required of you. Here are some suggestions.

“What will be my role in the project?”  It is very important that you understand what you will be doing _before_ you commit to doing it!  If you want to get hands-on experience with animals, and the research only involves sitting at a lab bench, you will be unhappy.  If you want to help in the design of a project, and you will only be another cog in the system, you will be unhappy. Figure out what your role will be.  If the response is, “We will adjust as necessary based on your interests and aptitudes,” that’s undefined but hopefully reflects a positive attitude towards getting you what you want from the experience.

“If the work leads to a publication, will I be listed as an author?”  Although research experience on a CV is helpful, having your name on a publication is much more meaningful.  Being a first author on a publication- having your own project- is even better! Make sure you know the ‘payoff’ you will get in terms of authorship at the beginning.

“Who will be supervising me?”  You want to know if you will be working directly with the faculty (best), a post-doc (OK), or a grad student (less than ideal).  You not only want experience from doing research, but develop relationships which may lead to a positive letter of recommendation.  A letter of recommendation from a faculty member who worked directly with you, so knows you more closely, will be much stronger than a letter from a faculty member who didn’t work directly with you or from a post-doc.

“With whom will I be working?”  Are there other students involved in the research?  Grad students? Lab assistants or managers? Getting an idea of who the cast of characters are is useful.  Will you be the sole undergraduate student in a small lab or one of ten in a massive lab?

“What does a really good research student look like for you?” I think this is probably the most important question, because this will help you make sure you will be a good fit for this faculty member.  My own response to this question would be something like, “Someone who promptly responds to emails, who tackles the weekly tasks they are given in a timely fashion, who is able to act independently and have internal motivation to get things done, and who asks appropriate questions when they need help.”  I want students whom I don’t need to ‘ride herd’ on- I want them to be doing their own thing. Some faculty may want to micromanage more. This question will help determine if you meet what they want, and consequently how happy you will be in the position.

Research can be extremely rewarding, both personally (it’s fun!) and professionally (publications, letters of recommendation, experience on your CV).  But you have to set yourself up to be successful if you do research. If you end up in a bad fit, you may be turned off of research for the rest of your career, which would be a shame.  So, please, ASK QUESTIONS.

Are there any questions you think need to be added?  What are your concerns asking questions when talking to a potential mentor?

Lessons from Working a 24 Hour Shift

We love visiting Saskatoon in the summer.

I occasionally do locum work at different universities.  Locum is short for locum tenens, a Latin term describing temp work for doctors.  I assume they don’t call it “temp work” because doctors would rather be called “locums” rather than “temps”.  In any event, I am usually on call the entire time, and during my last locum position I got called in at 2:30 am for a horse with colic, worked the whole day, then did a back dog and a spay dehiscence after hours.  I learned and relearned some things and thought there were good lessons to share with you.

The colic case did reasonably well until they untwisted the colon torsion.  Then all hell broke loose- the blood pressure tanked and the heart rate rapidly climbed from 40 to 90.  The horse was resistant to all treatment and ultimately died. It was only the second horse I’ve had actually die under anesthesia in 20 years.  I was frustrated, sad, angry, ashamed, and felt powerless. I acknowledged those emotions, then talked with one of the other anesthesiologists and the new second-year resident about the case.

Then I had a little time to go home, get a shower, and get back for the day.  I had only gotten 3 hours of sleep the night before, so I was a little groggy, but I had cases for which I was responsible, so in I went.  The day progressed fine, then we had the first emergency around 6 pm. That case did fine until it recovered, when it started screaming. I was basically alone- there were no students, the techs were all busy with other cases, and the surgeon was getting ready for the next case.

I had a relatively brief but powerful anger wash over me.  What the hell is wrong with a system where I’m doing a case by myself and there’s not enough staff to help me get this patient comfortable?  I felt like screaming and swearing and cursing the ridiculous system. It may have made me feel a little better, but it would have upset everyone else and the situation was, frankly, beyond my circle of control.  What COULD I do? I asked one of the techs to get the surgeon and we were able to get the patient comfortable and settled.

Between that emergency and the next, I had time to get some water and a bathroom break.  It was about 10 pm by this time, I was working on four hours of sleep (I got a little nap in during my afternoon lunch break!), and I had been up for 20 hours.  I hit my second wind and thought, “This is hard, it’s not what I WANT to be doing, but yes I am having fun and feel pretty good.”

The last case finished around 2 am and I got home but was still on edge from the day so I got to sleep by 4 am.  In veterinary medicine, if you’re not doing 24-hour shifts at least once a year during your training, I would suggest that you’re probably not working hard enough.  I rarely do them now as I am a fairly senior faculty member, so it was an experience I haven’t had for a few years. I realize some jobs require shifts that last 48 hours or longer, so I’m not saying this was incredibly arduous or amazing.  But it was an experience I haven’t had recently. This experience reinforced some ideas and philosophies I want to share; lessons I would like to pass on.

  1. When you have a poor outcome or something bad happens, you have two options: ignore it and assume you did everything you could or contemplate it and talk to others to see if they have ideas you don’t have.  The resident had a couple of decent questions which helped me reflect on the case. Being able to seek outside help or input, and accepting that from anyone- even those who may know less than you- is about humility.  Everyone can work on improving their humility. I was reminded that you can learn something from anyone and humility is critical to success in life.
  2. You Do The Work.  Because you’re a god-damned professional.  I don’t care if you didn’t sleep well last night, or you’re feeling out of sorts, or you don’t wanna.  You do the job. I understand if you’re actually sick, or someone died, or you’re starving from not having eaten all day.  I also understand different people have different tolerances. But, at the end of the day, others are relying on you. If you can’t get the job done, arrange for someone else who can.  You can’t just not show up or show up and put in a poor effort. As a veterinary professional, you are expected to act professionally. I really didn’t want to go back in after that colic case, but I took care of myself as much as I could, took a deep breath, and went in because others were relying on me.  It reminded me of the difference between professionals and everyone else.
  3. There are three types of happy lives: the pleasurable life, the good life, and the meaningful life.  The good life includes flow and using your strengths in your life to enhance flow.  Even though I worked long hours during this shift, I was in a state of flow for much of it.  It was… fun. It made me feel satisfied and, ultimately, happy. The takeaway here is: make sure what you’re doing for work makes you happy.  There’s no need to be in a miserable position you hate. Life is too short.

I suppose you could say that I just found justification in a difficult experience for decisions I’d already made earlier in my life.  A narcissistic sociopath who has someone praise them may interpret it as validating their life decisions. Ah well, I think my life is terrific, I’m very happy, and I hope you can have a happy, satisfying life.  Above are some ideas I believe would be helpful in the pursuit of that, in your career.

Podcast Episode #7 – Dr. Jaren Williams

Dr. Williams and I worked together at one institution and we had a great relationship. His enthusiasm and positivity are infectious. He shares with you a path to excellence in equine surgery.