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Opposed vs. Unopposed

Opposed or Unopposed, Academic or Community Based or Somewhere In-between?

These are unfortunate labels that are prevalent in describing residency programs. The truth always lies somewhere in the middle. There are community based, unopposed programs (in all disciplines) that can provide phenomenal opportunities in most if not all rotational experiences. However, this can be particularly challenging in some disciplines depending on available resources, colleagues, patient populations and educational dynamics.

On the same token you can have an academic based, opposed or partially opposed program that also can provide phenomenal opportunities in most if not all rotational experiences. However, this can be particularly challenging in some disciplines depending on available resources, colleagues, patient populations and educational dynamics.

In case you did not catch the identical nature of the above descriptions, read again. Depending on the dynamics of the program, the strengths and weaknesses are unique to each program and are often less related to 'opposed' vs. 'unopposed' and rather depend on how opportunities and their dynamics are structured. Here are some examples of great things we can offer in our "academic-opposed' residency.

Pediatrics:

Four different and unique rotations. Two of them take place with pediatric residents on a pediatric service. One at a busy Children's Hospital on general pediatric wards. The exposure to a large volume and wide spectrum of disease processes as well as the 'hands-on" nature of the experiences make the pediatric education at our program difficult to compete with. Examples of comments from Pediatric attendings at Riley Children's Hospital:

  • The resident did an outstanding job on her inpatient pediatric rotation. She is highly intelligent, hardworking and very motivated to expand her knowledge base. She has strong clinical instincts. She seeks to support her clinical decision making by looking to literature, and is very eager to provide evidence-based care. She was a pleasure to work with and has a very positive attitude. She will make an outstanding physician.
  • I felt the resident was driven, focused and a great asset to our team!

Emergency Medicine:

One month in a Level One Trauma Center with one of the best ER residencies in the country. Highly rated education/rotational experience by residents which work alongside ER residents. Evaluations from ER attendings include comments such as:

  • Difficult patient interaction. Handled very well by talking with patient after a period of "cooling off for her". Very bright. Hard working.
  • Very good resident. Confident and works hard!
  • Nice approach to a few difficult patients. Great call with the ECG on stroke symptoms in 2H. Good assessment of the likely radiculopathy in 9. Thanks for the hard work at the end and stepping up when things got really busy on this constant care shift.
  • Good resident. Eager to learn. Nice job with nursemaid's elbow reduction. Ran out of steam at the end of the shift.
  • Good shift. Nice differential diagnoses and good clinical plans. Real nice job of not ordering unnecessary testing. Hard working and aggressive about seeing patients. Nice knowledge base.

Obstetrics:

Unopposed Family Medicine Obstetric service with 10 Family Medicine Faculty, 5 of which have operative privileges. Additional opportunities (unopposed) with a large midwife service to give ample opportunities for residents to graduate with 80-100+ deliveries.

Family Medicine Inpatient:

Unopposed with high disease burden, high acuity patients that are directly compared on quality and cost parameters to hospitalist (non-residency) service.  The inpatient service comprises of four teams each with a teaching faculty, upper level, and intern.

Intensive Care:

Opposed at the VA or a local county hospital in conjunction with the IM residency in an all upper level unit. Unsurpassed patient care opportunities and teaching in a model designed for teaching residents. Examples of comments from ICU attendings:

  • She was one of the best residents I have worked alongside in the ICU in over 4 years of my tenure. She excels at many things but she especially surprised me in her ability to communicate with patients and their families and her procedural skills.
  • The resident is very confident and laid back which makes her perfect in an ICU setting. She seemed at home. Had no trouble handling stressful situations. Her knowledge base is very solid too.

As you can see from the above descriptions and comments from 'opposed attendings' this is not always a negative thing and with the right dynamics can actually be a strength that generates a level of training difficult to attain elsewhere. Other advantages of our academic status include vast resources for research, quality improvement projects, academic endeavors of faculty and a wide array of faculty from both academic and community settings to nurture resident growth.

Just some thoughts to ponder and maybe some questions to ask on your journey to find a training home.

1520 N. Senate Avenue | Indianapolis, IN 46202 | Ph: (317) 962-0857 | email: iumfamres@iuhealth.org