otouser wrote:

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Wow, I wish I could have read this kind of stuff about a year ago. Here is what I think about the top two programs on my list. I'll just mention a few things about these two because they are the ones where I rotated, so I know more about them than just an interview day impression.

The three key factors that I kept in mind when I went to interview at different places were 1) academic strength and quality of training 2) personality fit 3) location. The last two ended up carrying a lot of weight because there would be nothing worse than moving somewhere and working with a group of people for the next half a decade if you didn't enjoy being there.


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MUSC
This is a great program that has made tremendous progress in the last few years. I really think that what Dr. Lambert has done with the program should be a model for chairmen across the country to take note of. You can read more about the history of the department on the newly updated website which also has a link to a department newsletter that is worth checking out.
Head & Neck is certainly a strength at this program. There are a handful of very skilled faculty dedicated to H&N and they work well with the other multi-disciplinary teams. Most of the free flaps are done by two faculty members (trained at MUSC and OHSU), and they are probably knocking out at least one flap per week on average. The H&N fellow works very well with the residents and is definitely an assett to the overall experience. The new Cancer Center is about as nice as it gets.
The rest of the department is very well-balanced with strong faculty who are fellowship trained in the majority of fields. Otology and Rhinology would probably stand out the most if I had to pick. One obvious weakness right now is in Facial Plastics after the unfortunate loss of Dr. Ross. However, the training structure also includes cosmetics exposure when you rotate through a local private practice setting as an upper-level. In addition, one of the attendings that I mentioned who does flaps trained at the same place as Dr. Ross and is able to add some teaching. Also, they were interviewing to fill the FP spot a few months ago. I would imagine that has all been taken care of by now and will prove to turn out well in the long run.

Research experiences are plentiful with a variety of basic science and clinical. There is a dedicated research block which seems to be very productive. Publications and trips to meetings are plentiful.
Didactic teaching is well structured and seems comparable to many of the other solid programs out there.
Rounds are chief driven with some input from the fellow if applicable. I like the efficiency of this system as opposed to a more formal bedside teaching setup with the attendings there all the time, and it helps to foster autonomy. There is a very nice level of student involvement with rounding and inpatient care and decision making, assuming the student is not an incompetent fool. Most attending/resident teaching happens in the OR and in clinic. The OR environment is good with residents getting exposure to a variety of cases early on as a PGY-2 or 3. Nice clinic exposure throughout training with the added bonus of a friendly staff. Hours and call are fine. However, be prepared to work hard especially when taking care of flap patients, but don't worry -- it's not a malignant environment at all. Residents end up going into a mix of private practice and quality fellowships.

The residents are a great group of people who get along very well and are also easy to like as an outsider. There is often one MUSC student who matches, and they also like rotators. This is not necessarily a bad thing because they end up matching some exceptional people. Likewise, the faculty are all nice to work with and are very approachable. I think this is often an overlooked quality that can really be a strength. There is also a good dynamic between the residents and attendings. It's friendly and casual but appropriately professional. Residents are looked out for by each other and the entire department. One last point: the department is growing and with that comes more research money, financial stability, and political clout within the university.

Location is a no brainer. Charleston is without a doubt one of the best places in the country, and MUSC is a solid university that is growing rapidly. How could you go wrong with a good sized city on the coast full of history with a ton of culture, amazing restaurants, outdoor activities, and just about anything else you could ask for.

Residents -- 3 per year
Fellows -- 1 H&N, 1 Rhinology

This is really a great place to train overall. I would definitely put it up there with Vanderbilt as a stand out program in the southeast, but it is strong enough to deserve a solid reputation on a national level.


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Jefferson

Another exceptional program. It was incredibly tough to decide between here and MUSC but the final decision came down to an overall gut feel. I think the two issues that really set this place apart from most other programs would be the operative experience and level of autonomy. I've been there and can tell you that the case logs are no joke. If anything they're underestimated. With all that volume comes autonomy. Residents appear very comfortable in the OR as they continue along in their training. As a chief doing advanced H&N resections or Otology you will be performing nearly the entire procedure on your own with the attending stepping in to help during a few key steps. You will definitely be able to handle most cases that might come your way when you graduate and are on your own.
I could go on and on, but for a more lengthy discussion go to this post by a resident from a year or two ago. I can say that I really can't find anything to disagree with.

The overall training experience is great and also very well-balanced. Sinus exposure is very underestimated. You will do enough cases to feel comfortable and probably would only need to add on a fellowship if you wanted to do a high volume of advanced cases or land some cush academic spot. Dr. Boon does some really cool sleep apnea surgery that you won't get at most other places. There is an amazing exposure to Facial Plastics here. In addition to the experience with Dr. Pribitkin and the rest of the department, something that a lot of people don't know is that you also get to operate with an oculoplastics guy whose name I won't even try to spell. This guy is one of the attendings across the street at Wills Eye (which is the real deal by the way). He comes over to Jefferson every once in awhile without an ophtho resident and helps with some oculoplastics and trauma stuff.

The biggest shift recently has been the addition of free flaps. Ryan Heffelfinger trained at Jefferson then went out to UCLA for his fellowship and returned on faculty. He is doing some really complex stuff with good results so far. Once again, like at any other program flaps add a huge work load on the residents but the learning potential is tremendous no matter what subspecialty of ENT you gravitate toward. Howard Krein is another person who trained at Jefferson. He then went to MCV/VCU for Facial Plastics and returned to be on faculty. He helps out some with the flaps and if I remember correctly will be building his niche within the department to add more cosmetic work.
The department continues to grow with new additions including 2 more former Jefferson residents who will be starting this coming year: 1 H&N and 1 in Otology.

The program also tends to accept people with whom they are familiar (ie Jeff students or rotators). This can all be seen as "inbreeding" by some and labeled as a weakness. I would have to disagree. The residents are a good mix from different schools. Also, despite learning the basics at Jefferson the faculty who have returned have done so after going away to some very competitive fellowships. It is there that they developed a lot of the skills they will be using in their subspecialty, and the department benefits by having them come back and share what they have learned. But the biggest benefits are that the department is getting someone they know and like. At the same time, the people who return do so because they absolutely love the department and the city. That says a lot in my opinion.

This place often gets dinged for not being a strong research institution, but the opportunities are definitely there. Basic science is lacking somewhat. Fortunately, I have done enough of that to know that clinical is the way to go for me, and there is some great stuff going on at Jefferson. I'm not sure if you are familiar with a little green journal that comes out every month. Perhaps you've heard of it. It's nearly impossible to pick up an issue from the last year and not find an article from a Jefferson resident. How's that for research?

Structured teaching is good and the best part is that everything (including the Grand Rounds, tumor board, and all scheduled lectures) occurs on Wednesday mornings. Although it can be an exhausting morning of power points, it's nice to have that time blocked off with the rest of the week free.

The majority of training is at Jefferson. There are two services (H&N and then everything else). Rounds are chief driven, and everyone shares the workload. The only downside is that the service is really set up to be self-sufficient without the need for medical student free labor. The residents are very up front about this, but still it occasionally gives you flashbacks to third year when your notes were relatively meaningless and there was always someone coming behind you to do everything all over again. I think this was more of an issue because visiting students don't get their own computer access, which means you often feel out of the loop.
The residents are very busy when they are at Jefferson. Without a doubt they work very hard and probably push toward 80 more often than not, but just remember that residency is not the time to slack off and work on your tan. The reason that the residents are so good by their chief year is that they have put in the effort to get to that point.
The other rotations are much better as far as work load. There is great Peds experience at DuPont and a good exposure to general private practice with the West Jersey rotation. The only drawback to these is the travel. These rotations are where residents get the majority of clinic experience. The lack of clinic was a plus for me as it is for some other applicants. During residency I would always choose learning on the floor and in the OR at the expense of clinic time versus the other way around.
Residents are well prepared after training and many of them go on to do some pretty nice fellowships. You can check the website to see.

In-house call is one more thing that people gripe about. I would actually agree that it is a slight drawback. I think my ideal would be in-house for all junior residents and back up from home as an upper level. There is just so much that can be learned by being in house when on call, especially with trauma and emergent situations.

Overall an awesome group of residents who are the kind of people that you would want to hang out with both in and out of the hospital. The attendings are also very easy to get along with. Someone commented earlier about Dr. Keane being a little hard to read which is true to some degree. He kind of has an old school paternalistic vibe as the chairman, but he is a solid guy who will definitely stick up for you and always treat you fairly. He has a lot to offer both in and out of the operating room, you just have to get to know him a little better.

The location is the absolute best in Philadelphia. Jefferson is in Center City near Society Hill and Old City. You couldn't ask for anything better. Most of the residents live in apartments or houses within walking distance. A few take public transportation, but parking might as well be non-existent. The city of Philadelphia is a really great place. I absolutely loved being there for a month and can't wait to go back. It has what most big cities offer, but it does so without you getting lost in the crowd. There are great neighborhoods all over the place, and it is super easy to get around on foot. There was some study recently that voted Philadelphia as the place with the ugliest people in America. Well I hate to break it to you, but there are fat ugly people all over the place. It's not as bad as what you have heard. The best part about the city is that the people who live there are proud to be from Philly and it shows.

Residents -- 4 per year
Fellows -- none

Jefferson is a great place to train in a great city. It has a strong reputation in the northeast but is somewhat unknown in the south. I'm not sure what the west coast thinks.



While I didn't match in my top two I ended up slightly lower on the list but am very happy. I have no regrets about doing away rotations. They were without a doubt the most valuable two months of medical school for me. I am just below average on paper, so I can assume that I wouldn't have matched at either of these places based on a few statistics alone. MUSC and Jefferson will both continue to be highly ranked by many applicants in the future. I had some good feedback at both places which let me know that doing the away rotations was a good thing in the long run. I would suggest the same thing for any applicant in a similar position. Hopefully, this review will help someone in the future. I will try to remember to come back and add a few thoughts about the place where I matched once I get there and learn more.