Akron Interview Recap

Hospital: Akron Children's Hospital
Number of Beds: 303
Number of Peds Residents (per year): 17
Affiliated University: Northeast Ohio Medical University
Location: Akron, Ohio
Interview Date: 11/29

The day started with attending the residents' morning lecture followed by a general presentation about the program.  I then had two 20 minute interviews with a faculty member and one of the chief residents.  We were then given a quick talk on the benefits of the program.  Next we had an "open forum" where we could ask the chief residents anything we wanted to know.  We went on a tour of the hospital, ate lunch with some more residents and then were dismissed for the day around 1:00pm.
 

My interviews felt much more like real interviews than my previous sessions at Indy.  I was asked a lot of the standard questions: "Why a doctor?", "Why a pediatrician?", "Where do you see yourself in 15 years?", etc.  I didn't get any extremely challenging questions and my interviews seemed to go smoothly.

A large Rube Goldberg type machine in the lobby that moves large marbles through a complex system of ramps and contraptions

Things I liked about the program:

• ACH uses the electronic medical record system "Epic" which is the same one that is used in Columbus.  I'm quite familiar with the system and think it is the best one available.
• The program has a good class size around 17 which provides enough residents to share the work load but not so many that it is hard to get to know everyone.
• A great board review course is built into the curriculum to assist residents with the licensing boards.
• They have great elective choices for primary care, global health (trips to Haiti, Ethiopia and Kenya), and many other areas.
• There are several affiliated camps (diabetes camp, trach/vent camp, asthma camp) that residents can be involved in as a counselor.  I would love being able to be involved in a summer camp again - even if just for a week.
• ACH does offer the highest level of NICU care (level 3) which means they can provide for any needs that a premature baby may have.
• The call schedule (overnights, weekends, etc) is not very intense and it sounds as though residents get more days off than I've heard in other programs.
• Their residents have good fellowship placement rates in top programs. 
• There is a lot of time available for electives and primary care exposure.  Primary care (community offices) opportunities are also open for preferences (urban, suburban, rural, close to home, etc).

Petie the pony that comes to visit kids after he goes through an intense sterilization ritual

Things I didn't like about the program:

• The number of patients admitted at ACH seems drastically lower that what I'm used to at NCH.  for example, on Infectious Disease at ACH they tend to have about 5 patients where we usually have about 30 at NCH.  I'm concerned that being involved in so many fewer patients would mean that I wouldn't see as many things and wouldn't have as much hands on learning.
• The team structure seems jumbled.  At NCH, there is a separate team for most specialties.  At ACH, there are 4 inpatient teams.  Green (general peds), Yellow (Infectious Disease, Pulmonology, Allergy/Immunology, and Neurology), Orange (Adolescent, Cardiology, Endocrine, Renal, GI, Rheumatology, Physical Med & Rehab, and Genetics) and Red (Hematology and Oncology).  Because the yellow and orange teams cover such a strange mix of patients I feel as though I would constantly be juggling so many different concepts, attendings and styles.  A large part of a resident's job is to figure out how attendings like things done and I'm not sure how you could accomplish that when you could be working with eight attendings on one team.
• Standard work hours are 6am-6pm while I'm used to 7am-6pm at NCH.  While that one hour difference doesn't seem like a drastic change, one extra hour of sleep per day in residency doesn't take long to feel significant.
• The trauma center is a level 2 (level 1 is the highest level of care) which means that the services offered are not as comprehensive.
• Research is required as a resident.  This wouldn't be a deal-breaker, but research is not enjoyable for me and not all programs require research.
• There are certain services that just aren't offered because it is a smaller hospital: solid organ transplants, dermatology, etc.  I probably wouldn't miss them much if I did attend here, but it seems like a good indicator of the comprehensiveness of a program.

The expressive therapy room that allows kids to put on performances, dance, do art projects or any other expressive therapy they desire

Things I liked about the location:

• All of our family is in or around Akron.  The convenience and luxury of being able to see family even if I'm only free for dinner would be a huge benefit.  This is by far the biggest plus of the Akron program.
• Akron feels like home for me to a certain extent.  Growing up in the area gives me a lot of comfort with knowing and understanding the area, know the patient populations in different parts of town, and knowing people in the area.
• The cost of living is the lowest of everywhere I'm applying (as far as I know).
• There are a lot of fun things to do around Akron including some amazing parks.

The Akron Aeros stadium is across the street from the hospital (you can see the hospital in the background on the left) and you can watch fireworks when at the hospital at night.

Things I didn't like about the location:

• While Akron is familiar, Columbus is a city I've fallen in love with and it's hard to be excited about the city of Akron when I'm used to all that Columbus has to offer.
• Growing up in Akron and ending up in Akron would make me feel as though I had never branched out to some extent.  Diversifying my experiences will only add to the value of care I can provide.

Cuyahoga Valley National Park (10 miles from ACH)

Overall Thoughts:

• A smaller, older and less technologically advanced hospital than what I'm used to.  While I'm sure I could be happy in Akron, I think working in ACH would feel like settling because I know the alternative options.  I think Akron provides solid training and good patient care, but when I've started training in a place that is among the best in the country, other places seem to fall short of my expectations.  I think it would be irresponsible to choose a residency based solely on the location of my family when I wouldn't have much time off to see them anyway.  When 90% of my awake hours are going to be spent in my residency location, I need to choose where I feel I can get the best training for the sake of my future patients.

Dr. Google and Mindless Optimism

~~~~~

One night on call, I heard this overhead page: "Code Blue - In front of Cheryl's Cookies."  Typically the [seemingly] 1000 calorie cookies just aid in killing you slowly, but I guess they worked more swiftly that time.

[The patient was fine for those of you insulted by my dark humor.]

~~~~~

A term we use often in medicine is "functional" to describe something that we can't explain and by process of elimination assume that it is rooted in psychological distress. If a surgeon diagnoses a patient with "functional abdominal pain" the underlying message is often - "it's all in her head" because there is no pathology we can find associated with the symptom.

A patient with psychogenic non-epileptic seizures (aka "pseudoseizures") was being interviewed about how her life has been affected by these seizures.  PNES are thought to be psychological in origin and have no biological basis.  In an attempt to explain that she wanted to get back to her normal activities, the patient exasperatedly stated, "I just want to be FUNCTIONAL!"  If she had only known that she had just made her own diagnosis.

~~~~~

A patient who had been consulting Dr. Google came in stating, "I think I have Bell's Palsy.  I don't have the facial droop, but I have everything else!"  Apparently Dr. Google didn't tell her that the ONLY diagnostic criteria for Bell's Palsy is facial droop (unilateral facial paralysis).

~~~~~

One patient suffering through a terrible case of paralysis as a result of Guillain-Barre syndrome had a poster on his wall that said "PMA" which he explained to us stands for "Positive Mental Attitude".  As he was explaining his mantra, my German attending interrupted him saying, "It's so American - this mindless optimism.  You have a right to be grumpy if you want to be!"

~~~~~

Pt: "Hey Doc, can I get some Viagra?"
Dr: "Tell me more about what's going on."
Pt: "I don't know, but my wife really needs it!"
Dr: "Wait, so you want a prescription for your wife to take it?"
Pt: "Yes!  It works that way too, doesn't it?"

~~~~~

One attending I was working with described a patient as having "nascar-opathy".  I later found out that this was his way of describing patients with fever than 4 teeth.

~~~~~

Riley Interview Recap

A view from the outside of the newest part of the children's hospital

Hospital: Riley Hospital for Children
Number of Beds: 455
Number of Peds Residents (per year): 25
Affiliated University: Indiana University
Location: Indianapolis, Indiana
Interview Date: 11/2

Most interview days are structured similarly: they include presentations on the program, tours, observing a part of the daily life of the residents, and of course, the interviews.  Riley's day was no different.  The tour took us through a few parts of the old hospital building and through much of the new hospital building (pictured above) which they will fully move into by this time next year.  We also saw a state-of-the-art simulation center as well as rode on the "people mover" monorail that connects several medical campus buildings.
 

"The People Mover" (Yes that is the official name)

My interviews were mostly relaxed.  My first interview was with a woman who asked me some difficult questions. She asked, "Tell me about a difficult attending and how you handled them." and "If you were the dean of your medical school, what's one thing you would change?" among other challenging questions.  Mostly, the interview was conversational and I felt it went well.  My second interview was with a man who didn't ask me a single question about myself.  Not one.  He asked me if I had any questions about the program and proceeded to talk to me about how great the program was for the entire time.  While I didn't mind the pressure being off of me, I'm not sure on what basis he can evaluate me.

The lobby of the new building

Things I liked about the program:

• Riley is the only comprehensive children's hospital in the state of Indiana (Ohio has 3).  This is a positive because they pull from every corner of the state which drastically increases the diversity of patients and conditions they see.
• They offer one of the best benefits packages of any program I have seen.  All insurance is included without premiums, the salary is competitive, and the vacation policies are generous.
• The program has a unique partnership with Moi University in Kenya.  Residents have an opportunity to rotate through Kenya for two months and experience a different world and culture while practicing medicine in a completely different environment.  (The partnership is so unique that it has been nominated for a Nobel prize twice).
• Camp Riley is a summer camp for youth with physical disabilities where residents have an opportunity to be the camp physician for a week.  I would love reliving some of my camp counselor days in this type of setting.
• Riley has a unique partnership with the community that allows residents to spend two entire months working on community advocacy.  Projects can include working with a women's domestic violence shelter, working on breast feeding advocacy, working on a national pediatrics podcast, or any other project a resident wanted to develop. 

A nurses' station and hallway of one of the new patient wards

 
Things I didn't like about the program:

• Riley is the only comprehensive children's hospital in the state.  While I also mentioned this as a positive, it concerns me that they are in many ways, "the only show in town."  I know that competition within Ohio has driven many of the hospitals to improve in ways they may not have been able to do had there been a feeling of security in knowing you didn't have any direct competition.
• Their electronic medical record system is not as good as the one I am used to in Columbus.  Being a constant seeker of efficiency, cumbersome systems are a great frustration for me and I could see this system being a major source of headaches if I were to work at Riley.
• Some systems seem antiquated beyond where they should be for the capabilities of the hospital.  For example, in Columbus, if we want to page someone then we click a web page and in about 3 clicks and 10 seconds we can find the exact person we need to page who is on call for a particular specialty and send a page.  At Riley, you have to call the operator, request that they look up what you need (while trying to accurately describe exactly who you are trying to reach), write down the pager number once they've found it, hang up, then page the person on call.  While I'm sure it wouldn't be a major deal once there, it seems like a sign of other antiquated systems.

One of the new patient rooms: the small TV you can see is just for the parents and the kids have a big screen TV just for them

 Things I liked about the location:

• Indianapolis feels very similar to Columbus, which I have come to love.  The size and feel is nearly identical.  Indy is also a fun sports town (though not for teams I particularly care about) with a lot to do.
• The cost of living is incredibly affordable.  The cost of living is also nearly identical to Columbus, but combined with the incredible benefits package, the money would go further.
• Great outdoor activities abound.   Eagle Creek Park is just outside downtown and is six times the size of Central Park in NYC.  There are also miles and miles of amazing bike trails around town.
• The downtown area is really neat and newly revitalized.  Hosting the Superbowl in Feb 2012 brought in a lot of development and created a great downtown area right around the med center.

One of the many gorgeous bike trails in the city

Things I didn't like about the location:

• Indy is somewhat in the middle of nowhere.  There isn't much within a short drive of Indianapolis but cornfields.
• The location would be somewhat far from family.  While 5 hours is certainly drivable, I'd prefer to not spend a big portion of my precious time off driving to my destination.

Eagle Creek Park

 

Overall Thoughts:

•  A great hospital within a great city.  The similarities to Columbus and Nationwide Children's Hospital would assist in a seamless transition if I were to end up here, but I don't see the positives being strong enough to pull me away from where I feel at home in the Ohio area.

Step 2

I should probably mention briefly that I passed both parts of Step 2 (for US medical licensing boards).  The test wasn't nearly as frightening as Step 1, but it did have two lengthy parts:

Step 2 CK = Clinical Knowledge.  This test was a multiple choice, 9 hour long exam meant to gauge if we'd absorbed anything over the past 3 years of med school.  We get a numerical score that most residency programs want to see before they decide if they will grant us an interview.

Step 2 CS = Clinical Skills.  This test involved 8 hours of talking to standardized ("fake") patients.  This exam is strictly pass/fail and we don't receive a score for it at all.  2/3 of the score assesses if we speak English and can communicate effectively.  I was not too concerned about preparing for this exam (99% of OSU students pass on their first attempt).

The worst part of these exams was the cost (~$1700 between the two of them).  My biggest fear of failing them involved having to pay those fees again!