I recently heard that the ER program at UMKC was really weak. My source was from a group of internal medicine residents. They told me of various cases of mismanaging of patients by ER residents and attendings!!! I hope someone out there can give me a second opinion (good news about the program).

What you describe is not uncommon among programs. ALL programs in ALL specialties mismanage numerous patients each year. It's called medical error, human error, training, etc.

Are you sure your IM friends aren't just bashing the program just to bash it?

It seems that all specialties bash the other specialties... with exception to psychiatry. The shrinks just ask the other specialists "what makes you upset?" and "what makes you sad?"

:laugh:

johnson,

let me assure you......UMKC's EM program at Truman Medical Center is just fine...It is one of the older programs in the country. I believe it started in 1973. Very well established. My medical school just matched several people into it for next year and they were all very excited. all of the attendings at a local private hospital I work for graduated from that program in the 70's, 80's and 90's. They are all great docs. I've never heard anyone say anything negative about the place. It is very well established and I'm sure it isn't going anywhere.

later,

Asking IM about EM at any program is pretty much guaranteed to get a negative response. Just as they see all of our inappropriate admissions and missed diagnoses, we see all of their bouncebacks after inappropriate discharges or inadequate inpatient workups.

I think a lot of that animosity comes from IM not understanding that the priorities are very different in the ED. That and the fact that it's the ED that usually makes them crawl out of bed at 3:00 am for more than 15 minutes.

One of the best conferences I ever went to was a joint EM. IM, critical care, psych, pathology conference that followed the progression of a patient from the ED to the morgue via the floors and ICU. It was very interesting seeing the difference in priorities being bantered about with thinly veiled animosity. I think it was beneficial because in the end people started to understand those priorities a little better.

Welcome to Emergency Medicine. It is called the "fish bowl" effect. All specialties (especially residents) bash the ED. That is because every single admission is seen by other specialists that study it for days and weeks, and find many things that they "would have done differently" with an extra week to think about it and a quiet room to scratch their beards in.

We call them to wake them up and let them know that the fun part is over and it's time to organize consults, start tube feeds, and watch the cultures grow. Nothing is funnier to me, than watching a med or surg resident that I worked circles around while rotating through their team, who failed ACLS, and has trouble with simple management issues, complain about how the ED sucks. Then as a resident that person will rotate through our department and function at the level of a 4th year med student.

Part of it can be pure jealousy. EM is competive and gets strong candidates, and also has it somewhat easy as far as scheduling goes. That can make a lot of miserable people even worse.

The other part can be depth vs breath of knowledge. People with large egos go into fields of depth (opthalmology with subspecialization in the 1st branch of the retinal artery) and they will always "know" more than you. You will know a little about everything and will always be consulting "experts." You will have the same amout of knowledge as them, just organized for broadness and not depth, but they will "feel" smarter.

Part of bieng in EM is realizing that you will be critisized often, and often by people that simply don't even have the ability to do what you do. But it's best to just smile alot and have fun with it all, b/c it's alot better than having to do what they do. ...But I'm still working on that.

I dont know much about UKMC, but certainly don't base your decision on a couple of IM resident opinions of EM. (sorry for all the ranting)

the above answers are absolutely right on. One must deal with their attitude virtually constantly...but when you are on IM, all of a sudden they look toward YOU to help them during codes and procedures.
I have seen it time and time again, a first or second year EM resident running a code on the floor AHEAD of the 3rd year IM resident. Or helping IM doing LP's or starting EJ lines or putting in a chest tube... let the fleas talk and mentally masturbate for 20 minutes over what dose of lasix is appropriate for the patient with decompensated heart failure...that is what they do best.

Ah yes... The fine art of ER bashing... It's not just IM that bashes ER residents. EVERYONE bashes the ER. Some reasons for this...

1. Whenever you get a page from the ER it means that you have to go to the ER and see another patient... which means more work! You start to associate ER pages negatively because of this.

2. Most of the time the consults are warranted. Unfortunately I can only recall the few ER visits where the ER docs goofed. E.g. - consulting the service I was on for a possible GI bleed but no one had bothered to do a rectal. Or the consult for a possible SBO and after 6 hours of sitting in the ER the patient did not have an NG tube...

3. ER docs typically know less about subspecialties so they might look "dumb". We forget that the whole reason that they are consulting a service is because they aren't sure about something and they want our opinion/service.

4. ER docs might get defensive when a consulted physician makes a dig at them. It's natural, but it only adds fuel to the fire.

I agree with the above poster that if you go in to ER, you better just be prepared to take some bashing. Personally, I never engage in ER bashing. It's unprofessional, and adds nothing to patient care. And it's not like the ER is the only place mistakes are made...

Anyways, enough pity-parties about EM:

Back to the original question...3 friends of mine interviewed at UMKC for EM last fall and the overall report of the program is as follows:

1. Amazingly arrogant interviewers
2. Exceedingly poor facilities
3. Considerably more hours than other programs (but UMKC is a 3-yr program)
4. Good training in terms of volume and pathology.
5. None of the 3 ranked the program above #10.

Hope this helps.

UMKC/Truman Medical Center doesn't dominate the Kansas City health care scene like many large, county hospitals. For example, Parkland, Charity, Grady, etc are all huge hospitals that are "the place to go" in their city. They are well respected, major trauma centers that dominate the market. UMKC is one of three level 1 trauma centers in KC, along with several level 2 trauma centers, and KC has only 1 1/2 million people. Compare that to New Orleans - only Charity Hosp for 1 1/2 million, Parkland is one of two Level 1's in Dallas (for 4 million people, and it dominates the market) and you'll see why Truman/UMKC isn't dominant in KC. Plus, KU Med Center is by far the more respected of the 2 medical centers in Kansas City and that's the hospital where the locals go for their tertiary care. Truman is a busier inner city hospital, but again, compare it to others around the country like Charity, Parkland, Grady, Cook County, etc and it doesn't even come close.

As a medical student I witnessed service bashing by some attendings and residents, and I vowed I'd never do that. Hopefully we all went into medicine with the goal of providing the best care possible to our patients. In order to do this I believe we must effectively work and communicate with our colleagues.

When selecting an institution for my residency I considered the other training programs at the institution and the strength of other departments. Considerations in this were how these departments/ programs affected my educational opportunities and my ability to provide quality patient care.

The institution I am at has a strong EM program. Unfortunately like all programs at all institutions it does have a few residents who seem to miss the mark; perhaps they are procedurally inept, lacking a sufficient fund of knowledge, or unprofessional in their dealing with colleagues and patients. In general they are a strong group of physicians and I think we recognize that we all have a role in providing quality patient care.

In closing I'd like to address the following post by DocWagner

"I have seen it time and time again, a first or second year EM resident running a code on the floor AHEAD of the 3rd year IM resident. Or helping IM doing LP's or starting EJ lines or putting in a chest tube... let the fleas talk and mentally masturbate for 20 minutes over what dose of lasix is appropriate for the patient with decompensated heart failure...that is what they do best."

Obviously I can not comment on the strengths and weaknesses of the IM and EM residencies at your institution as I am not there (and from the way you describe the situation I am glad of that). I can tell you that in our system our IM residents are competent with procedures. (I and some of my colleagues have gotten LPs that the EM resident and ED staff were unsuccessful with, we put in our own lines (albeit more true central lines than EJs--something I actually learned how to do from an ED nurse as a medical student. It's come in handy at times) and chest tubes. In our system the EM residents rotate on a ward team as interns (and they do not run codes!) when they do their PICU and ICU months as upper levels they may run codes if there is not an upper level resident from the medicine or pediatrics program present. At our institution the EM residents learn a lot on their offservice months and we learn a lot from them. However none of us approach the month determined to prove and flaunt our superiority. We all strive to provide quality patient care. Perhaps that is why it works here? Hmmm.

Perhaps the IM residents at your institution really are as you describe, or perhaps you are retaliating against the abuse you receive (or perceive) from other departments. Does your attitude affect your dealings with them? Does that detract from patient care? I suppose only you can answer those questions.