Friday, September 28, 2012

How can an applicant really tell what a surgical program is like?

Dear Sir,

I am a 4th year medical student currently in the process of applying for residency training in general surgery. I am sure this is a perennially impossible question to address adequately; do you have any advice on how to begin to discern the true quality of various programs at which one interviews? As interview offers begin to come in, I've spoken with my own chairman and various faculty of differing age groups. I have spoken with our program's residents about other places they interviewed. I've read the reviews written on online forums like and SDN. I've looked at the ACS board pass rate data and the program's individual websites. I suppose I am asking if there are any generalizable factors that you would consider either positive or negative when considering a program. If it matters, my current long-term goals are to practice some type of general surgery or one of its specialties in a small-medium sized academic medical center...of course, that's open to change.

Name withheld by request

Great question. You have done an excellent job of investigating already.

It is very difficult for an applicant to gain insight into a program’s real nature in a half-day interview. Obviously programs try to spin things in the best light possible. Unless they have a death wish of their own, even the residents who show you around may not tell you the unvarnished truth. The down side would be that they will hurt themselves by denigrating their program because fewer good candidates might rank it highly.

Ask more than one resident some of these questions when the faculty is not present.

Are most of the residents happy?
Are residents or attendings doing the most of the cases?
Do PGY-1 and 2 residents get to do any cases as the operating surgeon or are the first two years spent covering floors and/or admitting patients?
Are any residents finishing the program not having performed enough complex procedures?
Are the busiest attending surgeons letting the residents do meaningful portions of their cases?
How much autonomy do the residents have regarding postop care?
Every year, the RRC for Surgery sends an on line confidential questionnaire to all the residents in every program. What were the issues raised on the last RRC questionnaire? Have they been addressed?
How good are the important support services like anesthesia, radiology, laboratory, pathology, ED and nursing?
Is the main hospital in good financial shape? Are they laying off personnel or cutting back services?
If you were sick, would you want to be treated at this hospital?
Are there any scut-heavy rotations and how many are there?
Are the outside rotations good? Are there problems with their locations? How’s the teaching?
Are the program director and the chairman of surgery supportive of the residents?
If you had to do it over, would you still choose this program?

If you are still interested in a program after your interview day, I suggest you call a couple of random residents who are on call at night or on a weekend. You are more likely to find candid responses to the above questions in that setting.

You need to have some questions ready for the faculty who interview you and the PD and chairman too. You need to review the program’s website and be careful not to ask a question that you could have learned the answer to on line. I used to hate that. Clarifications are OK, but don’t ask about factual information that is available on line. Below are some questions for the faculty. You can use some of the ones you asked the residents but exercise good judgment. Some of these questions can be a little edgy. You don’t want to provoke the interviewers.

When was the last RRC site visit? Were there any concerns or citations? If yes, what were they and have they been corrected?
Is the main hospital in good financial shape? Are they laying off personnel or cutting back services?
Are any residents finishing the program not having performed enough complex procedures?

Take notes. Compare resident and faculty answers. Good luck.


  1. I obviously didn't do surgery interviews, but I did find one universal truth. You can always tell if the residents like each other, and whether they know each other.
    In bigger programs, it was really easy to see when the residents showing us around actually knew each other. I went on some interviews where residents from the same program were introducing themselves to each other.
    It was important to me to be in a program with a close knit group of residents. It made the work that much easier.
    I always asked the residents that took us on tours specifically what they wish they could change about the program, and whether they would come back if they had it to do all over again.
    In the end, I would choose the program feels the best to you. Trust your gut. Your first choice will be obvious to you.
    Residency interviews are the freaking worst. They all run together after the 4th or 5th one.

  2. Hollywood,

    You make some good points. I agree with you.

    I also agree that interviews are the worst. It was bad for us on the other side too.