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The days usually start between 3-4 AM. I run into the hospital and I just get scutted to shreds. I round by myself, than with the chief resident, than with the attending, than solo constantly without end until around 9-10 PM when the madness stops and I can crash.... than wake up and repeat it all over again. I am supposed to memorize all the labs down to the decimal point on 10 patients. I am the king of note writing, its like writing all of the New York Times daily. Than I have to go down to medical records and sign endless dictations and orders. I do so much scut that I need directions to the OR because I forget where it is.
The faculty really suck to be mildly blunt. Hypotensive splenic lac grade V goes to angio and codes. People are scared of the OR. Teaching takes place when a screw up happens and I find out what NOT to do. Didactic sessions are just pimping sessions so the faculty can feel good about themselves. The last few years there has been one chief resident failing the boards. If there was an exam for scut we would rule the universe.
There is no camaraderie except with the massive quantities of paperwork I pump out on a daily bases. Half the residents are FMG and need to have their own interpreters just to be understood. Its so dark I have to turn on the lights.
If you crave paperwork, getting yelled at, dictating and writing notes than sign up here and you will be in heaven. Go to costco and but packs of pens prior to starting. If I finish I will advertise my self as a paperwork machine. I will be able to do an expert H+P... but probably will have to ask for an intra-op consult to staple off the appendix which will be cool.
I am a PGY-4 and have been in the program since intern year. "Day begins" differently depending on what service you are on, but all begin at 6AM. Rounding and "preoping" patients takes place from 6 to 7:30AM and most OR's start at 7:30 to 8:00AM. If you are in a busy service like vascular you will be in the OR most of the day and in-between cases you will finish rounding or doing consults. OR is done 80% of the time by 5-6PM. Sign-out is at 6PM to the night float team which consists of a Chief or PGY4 and an intern with a third person (PGY1,2 or 3) on call. Wednesday is conference day 7-9 or 10AM, which includes Quality Improvement conference, Grand Rounds and/or a topic lecture. Weekends: in a service of one person this person will round only one day of the weekend, in a service of more than one person then the rounding is distributed so that everyone gets onde day off per week. Eighty hours are taken very seriously in this program. General Surgery rotations are similar to vascular but start-up times vary depending on which hospital you are at. We rotate in three hospitals, the University Hospital and two private community hospitals.
Faculty are normal people who have a commitment to teach the residents. There is not a malignant attending in the program and since there are no surgical fellowships the operating gets done by us with a supervising attending. These attendings are good at teaching in the operating room. Lectures take place on Wednesday, teaching rounds for students and juniors are for the most part driven by chiefs. Didactic lectures are good. Topics in general surgery and subspecialties are reviewed throughout the year and the months before the ABSITE the residents hold a meeting in average every week to review topics usually with the participation of one faculty member. This has resulted in excellent score numbers. We use the Greenfield and Sabiston textbook for topic lectures.
Camaraderie is palpable. When you start the program as an intern it is expected that you will be able to do reading at home and continue to improve your fund of knowledge; that you will work efficiently and diligently. If you can do that you will earn the respect of your mid-level and senior residents. No one expects interns to be in the hospital past 6PM, but this requires good clinical and troubleshooting skills. Speaking of the classes I know best (second year and up) we call each other friends and we do, when possible get together for a cook-out or things of that nature. We support each other in the wards and call coverage when needed, no hesitation. For the most part the residents are all married and many have children and we DO have a life outside of the hospital. Our program has had several FMG residents and currently has approximately 40-50% FMG's. This percentage has varied year to year from 20% to 50%. More importantly what is valued in the program is the resident's abilities, attitude, enthusiasm and effort. Attendings and residents get along very well overall, some better than others. I myself call some of my attendings friends and mentors. There is no "I am out to get you" type of animosity. Research: the program is historically has allowed residents to step out and do research in a field of their choice for up to two years. This was strictly voluntary and in four years two residents took advantage of this. The incoming classes will be required to do 1-2 years of research in the lab. The way the model is designed that research person can also enroll in a masters program at the University of Toledo. There is opportunity for clinical research during your clinical years and many of us have taken this opportunity and presented and/or published in forums such as the American College of Surgeons Annual Meeting.
What stands out in this program compared to others?
What stands out immediately in this program is environment of camaraderie. The fact that there are no fellows translates into complex cases in every specialty being done by residents. There is a real and palpable environment of improvement. The support for scholarly activities is great. The program provides with a well-rounded and extensive surgical experience. Vascular surgery exposure is excellent and is evidenced by the number of resident matching this specialty. General surgery experience is excellent too evidence by the number of residents going into well established private practice groups around the country and performing well.
What are the drawbacks?
The drawback is the fact that this is a relatively young program in the process of growing, but support from the leadership at the University of Toledo and within the department of surgery is outstanding.
Would you feel prepared once finished?
Absolutely, we train well and the final product is very good across the board. The fact that our general surgery and vascular experiences are outstanding provides the resident with a degree of comfort while operating in the absence of fellows.
Would you choose this program if you had to reapply?
No doubt. The program has help me and my peers achieve my/our goals. I have seen our graduates go on to do private practice jobs around the country successfully, residents matching top programs in vascular, minimally invasive, cardiothoracic surgery.
Any other pertinent positives and negatives about this program?
Another positive is the leadership. Our chairman has been a true resident advocate, the president of the University and Dean of the medical school are both surgeons.
My conclusion is that this program will provide opportunities for those who are capable and willing to pursue them in an collegial environment.
What do most of the graduates end up going into?
Graduating class 2010
Plastic Surgery at University of Utah
Vascular Surgery at Cleveland Clinic Foundation
Vascular Surgery at Eastern Virginia Medical School
Cardiothoracic Surgery at Washington University in Saint Louis
Graduating Class 2009
Private practice in Virginia
Vascular Surgery at Washington University in Saint Louis
Private practice in Ohio
Minimally Invasive Surgery at University of Nebraska
Vascular Surgery at University of Texas in Houston
Graduating Class 2008
Private practice in Ohio
Academic surgery in Ohio
Vascular surgery at University of Utah
Graduating Class 2007
Private practice in Ohio
Cardiothoracic Surgery at Texas Heart Institute
Private practice in Ohio
Private practice in Kentucky
Please state whether or not you welcome inquiries about your experience with this program by prospective applicants.
For questions please refer to the website of the Department of Surgery at the University of Toledo.
Typical day is starting around 6:00am. Round on trauma patients, since my residents are not good, I write more than half the notes myself. Come to the program if you love tons of scutwork. During the 5 years and 1 research year I have done ~11 months of trauma. Since its all blunt I admit ~20 pts per operation.
The faculty blow hard. The program director and chairman really do not have a clue about how to run a program. Also there is allot of racism. If your a minority... this is the place for you.
Teaching take place one a week on Wednesdays. It consists of a M&M conference white lots of yelling and belittling of the resident occurs. Even if the attending did the whole procedure, its your fault.
there is no comaradeie. Everyone does their thing. The work environment is governed by fat chicks who sit at a desk. They think up new and exciting paperwork for you to fill out.
The program consists of ~70% FMG
If you love scut, paperwork, writing notes, endless rounding and getting yelled at, than this is the place for you.
I wish I was never accepted at this program,
Once I finish, I will be a paperwork machine, im not sure I can repair a hernia but thats ok.
We abide by the 80 hour work week rules and in general, it's pretty easy to accomplish. We have a night float system in place at both hospitals that we cover. The chiefs take 2 in house calls per month at one (with trauma coverage), and one week of home call at the other (no trauma). Juniors average 3-5 in house calls calls at both hospitals. Hours are on average 6a-6p. Seniors have a private practice preceptorship at a third hospital, and hours are even better (7-5ish). We have 4 weeks of vacation per year, and chiefs have an additional conference week. Minimal scut at both hospitals, with good PICC line support so you're not constantly putting in lines for the medicine teams.
We have a new chairman within the past year and he is spectacular. The program/hospital was previously called Medical College of Ohio, but we have merged in the last year with the University and we are now known as University of Toledo Health Science Campus. Our resident average on the ABSITE nears 90 percentile across the board, a result of increasing focus by the faculty and residents on education over the past three years. We have mock orals with outside examiners every year and our weekly M and M conference focuses on evidence-based practice. We have monthly reading assignments and quizzes, and encourage both the ACS and SESAP teaching curriculum. We work at three hospitals, all with different environments and learning experiences. The University hospital is a Level One trauma center; St Vincent's is also a Level One trauma center, but trauma is covered by the ER residents and one surgery midlevel (for operations only!); St Lukes is a private general surgery hospital preceptorship. We have a ridiculous (in a great way!) surgical oncology experience at the University hospital and ridiculous (ditto!) vascular experience at St V's. St Lukes is a bread and butter/bariatrics experience with a huge deal of operative autonomy. Trauma at the University hospital can be a drag, especially in the summer, but I suspect it's that way at most places. The new chairman is actively recruiting additional faculty, which will only enhance our general surgical experience. The best part is that there are no fellows at any of the hospitals, so all the cases are yours for the taking. I have easily passed all my surgery minimum case requirements, and I am just now in my last year. I would guesstimate that 75% of residents pursue fellowship training, and have matched in Vascular, Plastics, Cardiothoracic, Breast, Hepatobilliary, and Minimally Invasive over the past 3 years.
I love my group of residents. We have a 50/50 mix of US and foreign grads, and we all get along great. Many of us will go out as a group to dinner or drinks probably once a week. I can approach my chairman and program director about anything- their doors are always (literally!) open. After the merger, the University of Toledo dumped a ton of money into the University Hospital, with a new outpatient surgery center, rehab floor, a new orthopedic surgical center, DaVinci robot, and brand new simulation lab with laparoscopy and Medi-man simulation. About half of residents are married (some with kids), and half of us are single. Some people would say a detriment to this program is the city of Toledo, but I'm single and I think it's pretty fun. Toledo is a very cheap city, I have a beautiful house in a safe neighborhood that was very affordable. Toledo is not Chicago or New York, but there are enough things to do- Mud Hens Baseball, tons of restaurants, good shopping, little traffic. If you want Chicago, its a 3 hour train ride or 4 hour drive away, and the casino is 1 hour away in Detroit. Put-In-Bay Island and Cedar Point Amusement Park are fun in the summer and less than an hour away. Honestly, if you are worried about being in a big city with tons of stuff to do, you probably haven't realized what it's like to be in residency. Even working less than 80 hours per week is tiring, and you really need to read alot in residency!
The reason I decided to post this review is because our program has undergone many changes over the past 4 years. Unfortunately, our program was placed on probation 2 years ago, but we were re-evaluated by the RRC several months ago, and anticipate full accrediation at the end of this summer. To be quite honest, I have many friends in other programs--the issues that forced caused our program to go on probation (errors on the PIF, board pass rate, service vs education) are much more prominent in other programs, and have been nearly non-existent in our program for the past 4 years. It's a shame that our program had that black mark placed on it, but I really think it forced everyone to make changes that have made this program much stronger than when I started. I anticipate nothing but good things to come. I have been very well trained- I would be happy to compare both my operative skills and knowledge base with any other program. I would absolutely choose this program again.
It is a small university program and one has to prepare to work hard. Start time is dependent on the service schedule, but as a rule, not a single member of my team has come before 6 AM. This is chief dependent, however. Transplant service will require 5 AM start and 7 AM attending rounds. That service has an intern, that person is usually a miserable human being. Trauma is busy and can have 5:30 to 6 AM start, depending on the team efficiency. General surgery has 6:00-6:30 usual. There is no ICU team. We manage our own ICU patients. It will give you critical care experience throughout all 5 years of training. We are very comfortable with critical care issues, and we have an excellent Surgical ICU. Whenever you are on call you carry a trauma pager so you deal with trauma in the university hospital throughout your entire residency. There are two other affiliated hospitals. St. Vincentís Mercy Medical Center and St. Lukeís Hospital. The latter is only one three months rotation with a private group. It is very heavy on endoscopy, laparoscopy (hernias, lap choleís, lap appyís) and other bread and butter stuff. St. Vís is a heavy general and vascular surgery hospital and is a level I trauma center. With new hour requirements, we only deal with operative trauma. There is a considerable amount of penetrating trauma there; it is an inner city hospital. There used to be a vascular fellowship at St. Vís, but it was closed. The case volume remains however. University services are usually busier. Trauma, oncology, and complicated general surgery are typical. We cover ENT and Neurosurgery. There is relatively good exposure to head and neck oncology for interested individuals. Amount of time the resident works is dependent on how motivated the resident is. Most residents work very long hours. Everyone works. It is usual for the chief to change lines, write transfer orders, morning progress notes, dictate discharge summaries. Most residents work over 95-100 hours a week. Very little accommodation has been made to meet the 80-hour requirement at this time.
A competent, hard-working resident manages the service with very, very little attending involvement. Chief has a lot of independence. There is no in-house attending at night. This is a level I Trauma Center. Senior resident makes all decisions; attending is called only in an event of an operation. Few attendings would lead the resident through the operation, most of them will allow a competent resident to plan and perform the procedure without interference, sometimes without scrubbing (just watching a senior and a junior operate). Program provides good learning environment, but nobody will spoon-feed you. Five of 19 residents scored above 90th percentile on in-service. Number of residents did not score well. Formal weekly textbook, basic science lecture, and grand rounds take place on Thursday at 4 PM. All, but grand rounds are prepared by the residents. They are more helpful for junior residents. Quality varies. People are treated as doctors and responsible adults. You have to prove yourself to be trusted and handed a knife.
Camaraderie among the residents is very good. We keep our issues to ourselves. One of the chief is designated as an administrative chief, and he handles our internal affairs and call schedule. Back-stubbing is infrequent and viewed upon negatively. Relationship with attendings is very good both personal and collegial. There is only one malignant character. Program is ruled fairly. Hospital is relatively new. We really have a lot of fun here. Call rooms are good. Food is good only if you are seriously starving. There are four FMGs (three from Russia) and one from India (20%) and one DO. Many residents are MCO graduates that wanted to stay here for residency. I do not have much life outside of work, but I love what I am doing. Leaving is inexpensive. It has a small town life style.
This is a very balanced surgery program. We have very strong vascular, endoscopy, and critical care. We do not have specialty fellows that will take our cases and give us work. We operate early. There is a relative shortage of advanced GI surgery and oncology experience is only average. Liver, pancreas, and endocrine experience is modest at best. If you think about research you probably be better off taking two years of and going somewhere else. Medical College of Ohio is a good clinical program. You will be able to practice general surgery in the community, but in order to have an advanced academic practice, you will have to seek some additional training. Most common fellowship choices are vascular, cardiac, plastics. Our residents went to:
- Cardiothoracic: Boston U, UMAS, Ohio State, Loyola, Case Western U;
- Vascular: Penn State, Eastern Virginia U, Good Sam (Cincinnati), Wayne State
- Plastics: Vanderbilt, Mayo Clinic, UIC, MUSC
- Laparoscopy: UVA
- Colorectal: LSU
- Peds surg: U of Cincinnati
The majority of the graduate are in private practice. I feel comfortable entering surgery practice. Yet I will specialize. This program was my fourth choice, and I would still rank it as high. It is not the place that makes a person, but the person that makes a place. I am very satisfied with the quality of training I got, but I wish I have done more endocrine, pancreatic, liver, and advanced oncological surgery. We could also do better academically. Do not hesitate to contact me if you have questions.
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Last Update: 12-Mar- 2014 at 07:29:20