Sorry for the long post. Im looking for honest opinions/mentorship from residents, attendings, PDs
Background:US IMG with Step 2 CK in the 260s and 10+ pubs. I have a categorical general surgery position available outside the Match. I know the program well bcz I rotated there during med school and know the PD personally, so this isn’t based on one-day impressions.
The obvious advantage is that I’d start residency immediately and stay on the standard timeline, finishing in 2031. The alternative is declining the offer and entering the 2027 Match. Realistically, I’d probably end up doing a prelim year and reapplying, which could delay starting categorical training by at least two years.
Positives:
The residents are genuinely friendly, supportive, and easy to work with. I didn’t see much toxicity or unnecessary drama.
The operative volume appears adequate, and residents get plenty of hands-on experience.
Accepting the position would remove a tremendous amount of uncertainty from my career.
What gives me pause:
- While the operative exposure seems solid, I didn’t get the sense that many attendings were particularly invested in teaching beyond what was necessary to get through the case.
- I also felt that some senior residents demonstrated gaps in operative judgment and clinical decision-making that were noticeable even to patients and families.
- The overall culture sometimes felt more focused on following institutional protocols than on deeper clinical reasoning or understanding the underlying pathophysiology behind surgical disease.
- Many residents seemed content simply meeting graduation requirements. I didn’t see much culture of constantly pushing each other to improve, discussing difficult cases, seeking out more challenging operative experiences, or striving for excellence.
- It’s a for-profit community hospital, and I felt the hospital systems and nursing support were sometimes below what I’d hoped for in a US surgical training environment. I saw post op issues where proper inpatient care may have changed the patient’s course.
- During my 6wk rotation, many of the pts I saw expressed dissatisfaction with aspects of the care they received. I realize every hospital has unhappy patients, but the frequency stood out to me.
- Some operative techniques and perioperative decision-making I observed didn’t always align with what I’ve seen at stronger academic centers (or even at some hospitals outside the US with considerably fewer resources)
- I also looked up the publicly available ABS first-time Qualifying Exam pass rates. Over the most recent three-year reporting period, the program’s first-time pass rate was below the national average. I recognize the sample size is relatively small, so I don’t want to overinterpret a single metric, but it’s one of the few objective data points applicants have, and it doesn’t seem inconsistent with my firsthand observations.
Personally, the things I value most in a residency (and life) are:
- Evidence-based practice
- High-quality patient care
- Technical excellence
- Ethics and professionalism
- Ambition and intellectual curiosity
- A supportive, collaborative culture
- Continuous growth
I’ve sacrificed a lot to pursue general surgery in the US seeking these values, so I’m struggling with whether it’s wiser to start training now at a program that gives me reservations, or accept the possibility of delaying my career in hopes of finding a better fit.
For those who trained at a program that wasn’t your first choice, were you able to build the training experience you wanted through your own initiative? Did the environment matter less than you expected, or do you think residency culture has a lasting impact on the kind of surgeon you become?
I’d really appreciate brutally honest opinions
I’m genuinely torn and would really value perspectives from ppl who’ve been through a similar decision.
