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 residents.  Just 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.