I loved my time at Carilion Children's, and I hope you strongly consider the residency program. There are many things that I loved about my time in Roanoke. The attendings were extremely supportive, and as a resident, you are able to care for your patients from admission to discharge. The only fellows are in Child Psychiatry, otherwise, you are working directly with your attendings and specialists. This allows you to learn from your cases in a unique, hands-on manner that is unlike many larger programs. I have found this extremely valuable thus far in my career. Carilion is the largest hospital in a 2-3 hour radius in all directions which means that you will be able to manage a variety of unique conditions, from snake bites to sepsis, starting in your intern year. The program has many wonderful, supportive doctors who are committed to working with residents. Carilion Children's is by no means cut-throat and was the right pace for me.
There are also parts about the quality of life living in Roanoke that I miss. Cost of living is extremely low, and there are many opportunities in Roanoke during your free time, from hiking the many local trails, enjoying great restaurants (River and Rail was my favorite), breweries, wineries, and shopping. The fact that many residents in the program have stayed in the area after graduation is a testament to this.