"There are no bad programs..."

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AmoryBlaine

AmoryBlaine

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I hope even as an occasional poster I've been around long enough not to be blasted as a troll, just wanting to stir up some discussion amongst a group of people who seem to have interesting opinions.

Does anyone else find it intruiging that we are basically the only specialty that a) has not clearly defined exactly what "residency training" is and b) chafes violently against program stratification?

I am finding it increasingly odd that Emergency Medicine contains a debate as to how exactly to train itself, I am speaking here of the dreaded "1-3 vs 1-4 vs 2-4" debate. This is coupled with an almost violent denial of the possiblility that any program could be "better" than any other.

Witness the fact that if anyone tries to ask about "best programs" on SDN they are deluged with rumors of In-and-Out Burger. I realize that's all in good fun, but still...

"You're going to get great training anywhere you go" is something that is repeated as dogma to almost every applicant. Increasingly I find myself thinking, "really?"

Program X is a four-year high-powered academic center which demands that it's residents spend something like 6 months total in the ICU. Program Y is a family friendly 3-year community program with the minimum number of ICU months. Program A is at a hospital with an ED census of 90k, Program B's census is 40k. Program M has dedicated time at a tertiary Peds center, Program N takes what Peds it can get mixed in with regular ED time.

Yet all of these programs magically produce equivalent grads? I ain't buying it. Speaking as an applicant, I would like to ask some of the higer-ups to comment on this system. It seems to me to that a) this idea of "great training anywhere" almost has to be a myth and that b) applicants to EM are not served by its propagation.

I'll take my answer off the air, and hope that my flame-******ant suit can stay in the drawer.
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AmoryBlaine said:
I hope even as an occasional poster I've been around long enough not to be blasted as a troll, just wanting to stir up some discussion amongst a group of people who seem to have interesting opinions.

Does anyone else find it intruiging that we are basically the only specialty that a) has not clearly defined exactly what "residency training" is and b) chafes violently against program stratification?

I am finding it increasingly odd that Emergency Medicine contains a debate as to how exactly to train itself, I am speaking here of the dreaded "1-3 vs 1-4 vs 2-4" debate. This is coupled with an almost violent denial of the possiblility that any program could be "better" than any other.

Witness the fact that if anyone tries to ask about "best programs" on SDN they are deluged with rumors of In-and-Out Burger. I realize that's all in good fun, but still...

"You're going to get great training anywhere you go" is something that is repeated as dogma to almost every applicant. Increasingly I find myself thinking, "really?"

Program X is a four-year high-powered academic center which demands that it's residents spend something like 6 months total in the ICU. Program Y is a family friendly 3-year community program with the minimum number of ICU months. Program A is at a hospital with an ED census of 90k, Program B's census is 40k. Program M has dedicated time at a tertiary Peds center, Program N takes what Peds it can get mixed in with regular ED time.

Yet all of these programs magically produce equivalent grads? I ain't buying it. Speaking as an applicant, I would like to ask some of the higer-ups to comment on this system. It seems to me to that a) this idea of "great training anywhere" almost has to be a myth and that b) applicants to EM are not served by its propagation.

I'll take my answer off the air, and hope that my flame-******ant suit can stay in the drawer.
Click to expand...

Well, you are correct, to a point. We are the only specialty that was "born" in the age of modern medical education. As such, we do have a much stricter RRC that really does strive for parity (not equality) between programs. As no program predates the ACGME, and many of the traditional powerhouses in graduate medical education have only recently started EM programs, they have been able to achieve this in large measure.

Here is my take on this. Every program has many components - time in the department, ICU, EMS, toxicology, ortho, sometimes medicine, etc. Every program has achieved a decent baseline in all of these areas. Each program also excels at one or more of these areas. The trick is to find that program were the "excellent" areas meet with your interests. For example, the Mayo Clinic has lots of great components, all their "off" services are spent covering the ED, they have a decent EMS experience, but the emergency cardiology experience is amazing. With the number of STEMIs, the close relationship with cardiology, and exposure to some of the world's cardiology experts, I'm not sure that anyplace prepares you better for cards. I loved it. Another example is Indiana, which is probably the premiere place for special operations EM, with the availability of SWAT, DMAT, extensive helicopter and mass gathering medicine experience.

The other issue is that there are three types of emergency medicine 1. Urban, 2. Tertiary/Academic, and 3. Community. There is no question that certain residencies prepare you better for specific types of practices. A quick example - Resurrection Hospital in Chicago is an amazing place to train for community emergency medicine. Likewise, Hennepin would be an amazing place for an urban EP to train.

So, if we look at your example: "Program X is a four-year high-powered academic center which demands that it's residents spend something like 6 months total in the ICU. Program Y is a family friendly 3-year community program with the minimum number of ICU months. Program A is at a hospital with an ED census of 90k, Program B's census is 40k. Program M has dedicated time at a tertiary Peds center, Program N takes what Peds it can get mixed in with regular ED time." Program X would probably frustrate the heck out of the resident looking to return to rural Oregon to be a community EP. Program Y, on the other hand, is probably not the place for the applicant who wants to do a critical care fellowship and split his / her time between EM and critical care. Program A sounds like the place for you if you are looking to work in NYC or maybe at Cook County hospital, but if you are looking for a community practice, program B would suit you better. Program M might be overkill for someone looking to work in their hometown that has a large children's hospital drawing most of the peds EM patients in the area. Program N does have a minimum pediatric experience that has been independently verified by the RRC. It's graduates will be able to treat kids quite well.

It isn't that no program is better than another in a specific area or for a specific purpose, but rather that those areas and purposes are as diverse as the folks entering EM. No program can do it all for everyone - but everyone should be able to find a program that will work for them.

- H
 
No bashing here. I agree to an extent, but I think that one reason EM residencies are hard to 'rank' is because most of them give you more than your fair share of experience and procedures. Board-passage rates aren't even that important to me; 95% versus 97% doesn't really make me think that one program is better than another. It's comforting to know that you can choose the program at which you think you will be happiest, and that most U.S. programs will train you to be a great EM doc.
 
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breaker1919 said:
No bashing here. I agree to an extent, but I think that one reason EM residencies are hard to 'rank' is because most of them give you more than your fair share of experience and procedures. Board-passage rates aren't even that important to me; 95% versus 97% doesn't really make me think that one program is better than another. It's comforting to know that you can choose the program at which you think you will be happiest, and that most U.S. programs will train you to be a great EM doc.
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The whole point of this thread was my tepid challenge of that assertion. This is a statement about which I would argue we are entirely unsure.

Competent? Probably. Great? That is my question.
 
AmoryBlaine said:
The whole point of this thread was my tepid challenge of that assertion. This is a statement about which I would argue we are entirely unsure.

Competent? Probably. Great? That is my question.
Click to expand...

The question is what do you want to be great at? Look, the best academic docs would be awful in a community setting, the community guys would likely be overwhelmed at a 100K visit urban ED, and those urban EPs would be lost in the ivory tower.

If you ask a more direct question such as "I think I want to be an urban EP, what would be the best residency in the Chicago area or Ohio (because I've got family in those places)?" and you will get a better answer than in-and-out burger. But the question of "which residency is THE best?" is simply too variable to answer.

- H
 
AmoryBlaine said:
Witness the fact that if anyone tries to ask about "best programs" on SDN they are deluged with rumors of In-and-Out Burger. I realize that's all in good fun, but still...

"You're going to get great training anywhere you go" is something that is repeated as dogma to almost every applicant. Increasingly I find myself thinking, "really?"

It seems to me to that a) this idea of "great training anywhere" almost has to be a myth and that b) applicants to EM are not served by its propagation.
Click to expand...

I interviewed at 21 programs and have been intimately familiar with 4. I know of only three programs that I would describe as "bad." One of which has subsequently closed and the other two are inaccessible to the average applicant. The rest are much more similar than they are different and certainly adequate. Are some better than others? Probably, but not necessarily in ways that are important to every applicant. The more competitive programs tend to be those that excel in ways that are important to large numbers of applicants, and location is probably the most significant of these.
 
For specialties like medicine or general surgery, people often use subsequent fellowships and other positions to gauge how "good" a program is. Internal Medicine at an Ivy-League hospital will most likely get you the Cardiology or GI fellowship that many applicants are aiming for. Likewise, top surgery programs pump out residents who go into CT surg, etc. Whether this method is a valid assessment tool or not, you cannot judge EM programs by this criteria since fellowships are not as common and many residents don't want to enter post-postgrad training anyway.

Also, I think the learning in Emergency medicine is more patient based than hospital/faculty based. On medicine, you learn mostly from your attendings on those tortuosly long rounds. On surgery, you learn your skills and techniques from the faculty there. If your attendings and co-residents suck, then you won't learn much. This is not necessary true in the emergency department where you learn a hell of a lot just from the number and variety of patients who come in. That's why you can't just judge an EM program by how many papers the faculty has published or what the avg board score was for the entering residents. It just doesn't matter as much.

That being said, I think that there probably are certain programs that are "better" and "worse"... most of the time it's all in the eye of the beholder tho.
 
Someone mentioned the "bad" program that closed. It's true that the program was bad if you required structure and hand-holding. For those wanting to do Urban medicine, or who want to become a "pit doctor" I don't think a better experience could be found, since all of the patients were sick/dying, and there were tons of them to be seen.
 
This is a good discussion to have and I applaud Amory for being able to ask it in a way that resulted in a discussion rather than a firestorm. I'll throw in a few boluses of my 2 cents.
AmoryBlaine said:
I am finding it increasingly odd that Emergency Medicine contains a debate as to how exactly to train itself, I am speaking here of the dreaded "1-3 vs 1-4 vs 2-4" debate. This is coupled with an almost violent denial of the possiblility that any program could be "better" than any other..
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Other specialties have this too. Surgery programs are anywhere from 5 to 7 years depending on how much research they want you to do.
AmoryBlaine said:
Yet all of these programs magically produce equivalent grads? I ain't buying it. Speaking as an applicant, I would like to ask some of the higer-ups to comment on this system. It seems to me to that a) this idea of "great training anywhere" almost has to be a myth and that b) applicants to EM are not served by its propagation.
Click to expand...
I don't think every EM res grad is equal but I do think that the vast majority are competent. The problem is that when students ask which is the best residency it really is about fit. Like FoughtFyr alluded to, there are several different types of programs. The "best" urban program + a resident who is really suited for a rural program = pain.
 
missmod said:
For specialties like medicine or general surgery, people often use subsequent fellowships and other positions to gauge how "good" a program is. Internal Medicine at an Ivy-League hospital will most likely get you the Cardiology or GI fellowship that many applicants are aiming for. Likewise, top surgery programs pump out residents who go into CT surg, etc. Whether this method is a valid assessment tool or not, you cannot judge EM programs by this criteria since fellowships are not as common and many residents don't want to enter post-postgrad training anyway.
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I agree. There aren't enough EM physicians pursuing fellowships to make that a criteria for gauging how good a program is. The fellowships for emergency medicine usually aren't that competitive when compared to cardiology or other IM subspecialties. Exceptions are toxicology and pediatric emergency medicine.

Some people have advocated using the percentage of graduates from a program who take academic positions as a guide to how good a program is. However, this is flawed as well. Even though academic jobs are few, I wouldn't say they are more competitive than EM jobs. There aren't as many EM graduates who plan to enter academia when compared to those that plan to enter community practice.
 
AmoryBlaine said:
The whole point of this thread was my tepid challenge of that assertion. This is a statement about which I would argue we are entirely unsure.

Competent? Probably. Great? That is my question.
Click to expand...

After doing this for 30 years, training in the "big league" and training others in a small place, I don't think that becoming a great doctor is entirely up to the the resident. It seems a little obvious and trite to say this, but every place has some cream and some curds. The proportions vary.

The program just provides the patients and the teaching. Your efforts will make you great or otherwise.
 
FoughtFyr said:
The question is what do you want to be great at? Look, the best academic docs would be awful in a community setting, the community guys would likely be overwhelmed at a 100K visit urban ED, and those urban EPs would be lost in the ivory tower.

If you ask a more direct question such as "I think I want to be an urban EP, what would be the best residency in the Chicago area or Ohio (because I've got family in those places)?" and you will get a better answer than in-and-out burger. But the question of "which residency is THE best?" is simply too variable to answer.

- H
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I must admit, I am feeling Amory on this point. The more I look at programs, the more confused I feel about this whole equivalent grads thing. I totally agree that it really matters what type of doc you want to be, but even within that, what programs will make me a resident employers will salivate over?

For example, I would like to be fabulous EP 1st. Secondarily, an academic EP. What programs will best prepare me for this career in the NE and Cali area (following FoughtFyr's format)?

There are programs I have heard great things about clinically and others that are constantly lauded for research but I don't hear a peep about clinical training. I want a program that has great clinical and academic reputation, and serve as a relatively prestigious introduction to an illustrious career :)o). Which programs will get me there? The fact that the answer to this relatively specific question is unclear to someone who spends as much time on the internet as I do supports Amory's point that "a) this idea of "great training anywhere" almost has to be a myth and that b) applicants to EM are not served by its propagation"

OR, in briefer terms, BUMP! :D
 
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Hard24Get said:
I must admit, I am feeling Amory on this point. The more I look at programs, the more confused I feel about this whole equivalent grads thing. I totally agree that it really matters what type of doc you want to be, but even within that, what programs will make me a resident employers will salivate over?

For example, I would like to be fabulous EP 1st. Secondarily, an academic EP. What programs will best prepare me for this career in the NE and Cali area (following FoughtFyr's format)?

There are programs I have heard great things about clinically and others that are constantly lauded for research but I don't hear a peep about clinical training. I want a program that has great clinical and academic reputation, and serve as a relatively prestigious introduction to an illustrious career :)o). Which programs will get me there? The fact that the answer to this relatively specific question is unclear to someone who spends as much time on the internet as I do supports Amory's point that "a) this idea of "great training anywhere" almost has to be a myth and that b) applicants to EM are not served by its propagation"

OR, in briefer terms, BUMP! :D
Click to expand...

Let's address this FMFPants thread for what it is:

Every year a certain slice of the applicant pool wants a list of the "best" programs so the same pool members can apply to the list of "best" programs and make every effort to match at the "best" residency. It has nothing to do with quality of training, but the inherent bump in ego that goes with matching at a program that is perceived by others as prestigious.

This is not a scenario solely the realm of medicine. An article in the Economist this month talks recruiting the best and the brightest to be teachers in an effort to improve the "endpoint", where endpoint was performance of students on standardized tests. It turns out that the best way to recruit the best and brightest people to teach isn't to pay them more, or guarantee small class sizes. The best way is to make it more prestigious to get into teacher's training. You know how they do it? By raising the bar for admission standards. Ergo, a certain breed of over-achiever suddenly targets teaching as a desireable vocation. So the endpoint (students doing well on standardized testing) had nothing to do with quality of teacher training (they're likely broadly equal) but rather how tough it was for the classroom teacher to get into teacher's college. (Japan, Canada, and Finland were the leaders in case you're wondering.)

My point is, there is an inherent urge by some to strive for the most competitive place not because it is any better, but because it is, inherently, harder to get into. Prestige. Ego. Id.

And so, for those of you not motivated by the desire to know that you got into the most competitive residency, you will be happy to hear that you can feel free to choose based on geography, where your family lives, or how close you are to the beach or the sea and you're going to get training more than adequate. Good to great training, actually.

For those of you who just aren't satisfied with the "they're all broadly equal, so choose based on personal/lifestyle factors", I only sincerely hope that you are a little more chilled out by the time you actually finish residency.
 
I strive for mediocrity!
EM programs are all about where you feel you fit.
The "best" programs have been based on location and history.
 
bulgethetwine said:
My point is, there is an inherent urge by some to strive for the most competitive place not because it is any better, but because it is, inherently, harder to get into.
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and thats it right there. People are more interested in the prestige rather than the training, in a way then its the perception of a superior training that may or may not exist.

If an applicant was more interested in the training they would ask questions more along the lines of what has been recommended by previous posters, ie "what will prepare me best to work in a Midwest urban ED?", or what program has the best medical/surgical/cardiac exposure?

The fact is most applicants don't know EXACTLY what they want out of a residency (understandably so, not willing to "specialize", if one can do so in EM, within a specialty that is on the "general" side of the spectrum of scope of practice of medical specialties), and are searching for the program that will not only open the most doors later on, but just keep their options open. As such most are interested more in prestige, or as I stated "open doors down the line."

With a residency at Cincinnati or Bellevue, is there any realm of EM someone can't go? All doors are open. What about a residency in the middle of nowhere with the majority of training in a tertiary care ED? Certainly some are shut.

The best answer to a request for a ranking was given some years ago, (couldn't find it quick enough in a search and its getting late) where programs were ranked based upon national recognition (Cincinnati, Denver, Bellevue, Hennepin, Carolinas etc) and those with just regional recognition.

I agree with others that it seems the majority of programs put out competent EPs, each program with different strengths and weaknesses, its own pluses and minuses (and in the grand scheme of emergency medicine all thereby ending up on a relatively even playing field) However as most applicants don't seem to know what EXACTLY they want out of EM they/we will continue to look for the names that hold the most weight (for reasons right or wrong).
 
Chris Knight said:
and thats it right there. People are more interested in the prestige rather than the training, in a way then its the perception of a superior training that may or may not exist.

If an applicant was more interested in the training they would ask questions more along the lines of what has been recommended by previous posters, ie "what will prepare me best to work in a Midwest urban ED?", or what program has the best medical/surgical/cardiac exposure?

The fact is most applicants don't know EXACTLY what they want out of a residency (understandably so, not willing to "specialize", if one can do so in EM, within a specialty that is on the "general" side of the spectrum of scope of practice of medical specialties), and are searching for the program that will not only open the most doors later on, but just keep their options open. As such most are interested more in prestige, or as I stated "open doors down the line."

With a residency at Cincinnati or Bellevue, is there any realm of EM someone can't go? All doors are open. What about a residency in the middle of nowhere with the majority of training in a tertiary care ED? Certainly some are shut.

The best answer to a request for a ranking was given some years ago, (couldn't find it quick enough in a search and its getting late) where programs were ranked based upon national recognition (Cincinnati, Denver, Bellevue, Hennepin, Carolinas etc) and those with just regional recognition.

I agree with others that it seems the majority of programs put out competent EPs, each program with different strengths and weaknesses, its own pluses and minuses (and in the grand scheme of emergency medicine all thereby ending up on a relatively even playing field) However as most applicants don't seem to know what EXACTLY they want out of EM they/we will continue to look for the names that hold the most weight (for reasons right or wrong).
Click to expand...

Well, the last two posts have finally started to cut to the quick.

I will tell you that I'm an assistant program director in the Mid West. Full disclosure, I trained in a major Northeastern program, finishing in the early part of this decade. Below is my 'list', for better or for worse, of what I think are "top programs" by region.

It's based on what I know of the people who run them, the faculty (big emphasis on these first two points) the overall experience provided at the site (city, variety, acuity, etc), the quality of the parent institution, whether the program typically gets "top rated candidates" (ah! This is an enigma wrapped in an enigma!) and, where possible, takes into consideration what I know of their graduates. I will admit, some of my list will be a "surprise" compared with the usual suspects (at least their order, I think) but it reflects an ever-changing landscape and a certain degree of "diamond in the rough"-edness. I emphasize once again it is influenced heavily by the leadership at those institutions because they will not only steward you well during your 3 or 4 years, but are well poised to help you walk through many "open doors" (I liked that train of thought in one of the above posts) for the rest of your career.

For those of you who are going to be silly enough to choose based on someone else's list, you might just as well use mine.

Northeast:

1. BIDMC
2. Christiana
3. Bellevue
4. North Shore
5. Geisinger

Southeast:

1. Carolinas (UNC - Charlotte)
2. Duke
3. Wake Forest
4. UNC - Chapel Hill
5. ECU

Midwest:

1. Iowa
2. Cincinnati
3. Akron
4. Univ Illinois at Chicago
5. Cook County
6. Ohio State
7. Henry Ford
8. UIC (Peoria)
9. U of Michigan
10. Kansas City/Truman (U Missouri)

West and Southwest:

1. Oregon
2. Maricopa
3. UC Irvine
4. Denver
5. U New Mexico
6. LAC + HSC
7. Harbor/UCLA
8. Scott and White
9. Loma Linda
10. Southwestern
 
Itscoldinohio said:
Well, the last two posts have finally started to cut to the quick.

I will tell you that I'm an assistant program director in the Mid West. Full disclosure, I trained in a major Northeastern program, finishing in the early part of this decade. Below is my 'list', for better or for worse, of what I think are "top programs" by region.

It's based on what I know of the people who run them, the faculty (big emphasis on these first two points) the overall experience provided at the site (city, variety, acuity, etc), the quality of the parent institution, whether the program typically gets "top rated candidates" (ah! This is an enigma wrapped in an enigma!) and, where possible, takes into consideration what I know of their graduates. I will admit, some of my list will be a "surprise" compared with the usual suspects (at least their order, I think) but it reflects an ever-changing landscape and a certain degree of "diamond in the rough"-edness. I emphasize once again it is influenced heavily by the leadership at those institutions because they will not only steward you well during your 3 or 4 years, but are well poised to help you walk through many "open doors" (I liked that train of thought in one of the above posts) for the rest of your career.

For those of you who are going to be silly enough to choose based on someone else's list, you might just as well use mine.
....
Click to expand...

You know that the "Southeast" includes more than the state of North Carolina, right?
 
I'm still trying to figure out exactly what part of the South Oregon is in. I mean, I guess it is south of Washington and Alaska.
I too like that North Carolina is well represented.
 
That's a ridiculous list. C'mon, no Vanderbilt or Emory? Have you been anywhere in the south other than North Carolina? UVA isn't a great program? Louisville not on the list? But 'other' programs made the cut? :rolleyes:
 
Chris Knight said:
If an applicant was more interested in the training they would ask questions more along the lines of what has been recommended by previous posters, ie "what will prepare me best to work in a Midwest urban ED?", or what program has the best medical/surgical/cardiac exposure?
Click to expand...

This is pretty much what I was looking for, which programs would best prepare me for academic EM (and help me get a job). I respectfully disagree with bulgethetwine. Applicants that talk about reputation are for the most part interested because of the achievements of the faculty members who have graduated from their programs. It used to be said over and over again that you should look at the graduates of a program to know which ones offer the best training for what you're interested in. And if you can get a helping hand, why not? Why should it be so hard to find out which programs are those described below...

itscoldinOhio said:
...they will not only steward you well during your 3 or 4 years, but are well poised to help you walk through many "open doors" (I liked that train of thought in one of the above posts) for the rest of your career
Click to expand...

And I don't think Amory was looking for a list, but rather to discuss the issue of whether you can really get "great training everywhere".

BKN probably said it best when he said it is primarily up to the applicant, but a little door opening never hurts. Why are people so afraid to talk about this? "what programs have the best US", "which programs have the best EMS", "which programs are best at shepherding their grads to great jobs in X" - are similar questions.
 
I don't think Amory was looking for a list, so much as a discussion about whether or not it helps the specialty as a whole to propagate the belief that all programs are created equal. I feel like the real question is, if this is true, do all graduates of accredited EM programs end up getting the exact type of job they were hoping for? As in, if one was to train at a lesser-known facility but still excel, are they considered just as qualified for a great job as someone who excelled at one of those programs people keep mentioning (say, Cincinnati)? I realize this should be broken down into "great community job" vs "great academic job", So lets make it even tougher, if someone excels at a lesser known program and decides he/she really wants to work in academics, if all else is equal, are they on equal footing as someone who went to one of the academic powerhouses?

It would be amazing if this were true, and I'd say it would be good for the specialty as a whole. But I do wonder...There was a thread a long time ago where Roja and Niner and some of the other statesman of SDN discussed how it seemed like everyone in their class was getting great job offers, and whether or not the name of their institution mattered....I certainly hope this is the case, because I plan on going where I feel is the best fit, regardless of reputation, and then working my butt off
:)
 
I think I would add a few things to this discussion. Those of you looking for academic jobs out of residency I would have to tell you that in my experience the job market for that is getting tight. Most places that I have spoken with are either looking for some community experience first or fellowship training. Likewise for desirable private jobs - these are going word of mouth to people with job experience who are preferred over fresh grads. If you are just looking for a big paycheck then you can find it, but it won't be in NYC or LA.
 
bulgethetwine said:
Let's address this FMFPants thread for what it is:

Every year a certain slice of the applicant pool wants a list of the "best" programs so the same pool members can apply to the list of "best" programs and make every effort to match at the "best" residency. It has nothing to do with quality of training, but the inherent bump in ego that goes with matching at a program that is perceived by others as prestigious.

This is not a scenario solely the realm of medicine. An article in the Economist this month talks recruiting the best and the brightest to be teachers in an effort to improve the "endpoint", where endpoint was performance of students on standardized tests. It turns out that the best way to recruit the best and brightest people to teach isn't to pay them more, or guarantee small class sizes. The best way is to make it more prestigious to get into teacher's training. You know how they do it? By raising the bar for admission standards. Ergo, a certain breed of over-achiever suddenly targets teaching as a desireable vocation. So the endpoint (students doing well on standardized testing) had nothing to do with quality of teacher training (they're likely broadly equal) but rather how tough it was for the classroom teacher to get into teacher's college. (Japan, Canada, and Finland were the leaders in case you're wondering.)

My point is, there is an inherent urge by some to strive for the most competitive place not because it is any better, but because it is, inherently, harder to get into. Prestige. Ego. Id.

And so, for those of you not motivated by the desire to know that you got into the most competitive residency, you will be happy to hear that you can feel free to choose based on geography, where your family lives, or how close you are to the beach or the sea and you're going to get training more than adequate. Good to great training, actually.

For those of you who just aren't satisfied with the "they're all broadly equal, so choose based on personal/lifestyle factors", I only sincerely hope that you are a little more chilled out by the time you actually finish residency.
Click to expand...

Respectfully, you are way off base. This is not a FMFP thread, nor is it a solicitation for for a "List." It was an attempt (I think somewhat successful) to address an issue that appears unique to emergency medicine.

This concept that "all programs are essentially equal" is not found in any other field of medicine. If it is indeed true for EM then that is freaking awesome, but I don't think that a little healthy skepticism is indicative of the fact that I (and to a lesser extent my girl Hard24Get) need to "chill out."

I respect that alot of you are residents, attendings, and PDs and the world must look totally different than it does for us M4s. But, as I said before, it makes things very difficult for an applicant because of the difficulty of getting any substantive opinions on residency programs. Everything is described in varying shades of "stellar" with maybe the admission that the Peds exposure is only "great."
 
When it comes to how 'great' a program is outside of EM, it seems that most people go with:

1. Reputation
2. Leadership
3. Research or advancement of their respective field

In those respects, you can name a few EM programs off the top your head. Aside from these characteristics, you can look at location, facilities, pass rates on boards, and whatever else you want to look at.

Fortunately, EM for the most part is a field with great training programs all over. The field is still young enough to continually have new leadership and new input; I haven't heard of any 'malignant' programs yet, unlike surgery or medicine.

In terms of 'bad' programs, we all hear things that raise our eyebrows about certain programs on rare occasions. But I don't think that isolated events are enough to judge a program by.

I'm just looking forward to interviews; they should tell me a lot about which program is the right fit for me.
 
AmoryBlaine said:
This concept that "all programs are essentially equal" is not found in any other field of medicine. If it is indeed true for EM then that is freaking awesome, but I don't think that a little healthy skepticism is indicative of the fact that I (and to a lesser extent my girl Hard24Get) need to "chill out."
Click to expand...

Well, there's never anything wrong with skepticism. ;)

AmoryBlaine said:
I respect that alot of you are residents, attendings, and PDs and the world must look totally different than it does for us M4s. But, as I said before, it makes things very difficult for an applicant because of the difficulty of getting any substantive opinions on residency programs. Everything is described in varying shades of "stellar" with maybe the admission that the Peds exposure is only "great."
Click to expand...

But you see, this is what happens every year - a certain breed of applicant is incapable of accepting the fact that you get great training everywhere (that is the statement that you disagreed with in your initial post).

Year after year, applicants brush aside the carefully articulated explanations about how EM is the only specialty that evolved after the RRC was started, that there are far fewer EM residencies then, say, IM. They continue to seek the holy grail of "best" residency program. It's like the fact that the leaders in EM strived to MAKE the system so uniform -- so rigourously uniform in terms of good training -- is an insult to you MS4s, and you think that we're trying to pull the wool over someone's eyes.

The ones who designed it to be so uniform weren't a bunch of rubes, you know. It isn't a myth to be propagated rightly or wrongly -- it's the design, silly.

And seriously, do you really think it is difficult to get any substantive opinion on residency programs? It certainly isn't difficult if you asked specific questions. But you're asking the wrong ones. As alluded to earlier in this
thread, ask goal-directed questions:

1) Which program(s) has the best ultraosund
2) Which program(s) has the best urban knife-and-gun-club training
3) Which program has the best mix of community/academic
4) Which program has the best patient of mix of inner city beside the rich aristocracy?

Plus, if you do a search on a specific program or start a thread that specifically requests the pros/cons of a program in question, you'll get great information.

But if your general assertion is that all programs couldn't possibly give adequate (good to great) general training in emergency medicine because your MS4-level understanding of the landscape precludes you from accepting what others have tried to point out, well, then I imagine, in your most honest moments, you would admit come Februrary that your ranklist reflects some ill-defined notion of what the best "perceived" programs are and you, Sir, will have missed the forest for the trees. Of course, the good news is, you'll still get great training :) You just might not end up getting some of the lifestyle, geographic, or other important (to you) factors that you could have otherwise got.

Good luck, Amory.
 
I think that the biggest problem with making lists for the best programs in EM is that there is so much disagreement within the specialty. The list changes dramatically depending on who is doing the ranking, what region they are from, where they trained, who the know or collaborate with and so on.

I think that this is because we still have a situation where the academic leadership in the country was a part of or one generation removed from the original EM diaspora. Back when many of the leaders of the field trained there were only a few programs. They look favorably on their programs and programs spawned by people they knew and among the elders the community at that level is pretty small. I will be interested to see if the inabiliby of EM to agree on what the best program is.
 
bulgethetwine said:
But if your general assertion is that all programs couldn't possibly give adequate (good to great) general training in emergency medicine because your MS4-level understanding of the landscape precludes you from accepting what others have tried to point out, well, then I imagine, in your most honest moments, you would admit come Februrary that your ranklist reflects some ill-defined notion of what the best "perceived" programs are and you, Sir, will have missed the forest for the trees. Of course, the good news is, you'll still get great training :) You just might not end up getting some of the lifestyle, geographic, or other important (to you) factors that you could have otherwise got.

Good luck, Amory.
Click to expand...

Where is all the hostility coming from? When did Amory even ask for "the best" programs? If that was all he wanted he could pick from the hodge-podge of oft-mentioned programs and have done with it. He simply wanted to clarify that we can truly choose any residency we would like within our interests (ie community, academic) and get trained just as well in each and every arena. He acknowledged that probably all programs would be adequate, but was asking about why there is no distinction between good and great for the various areas of EM. As he said, if true that everyone gets great training (no difference between academic A and academic B grads), it would be freaking awesome, and he specifically posted this thread to get a perspective beyond the MS-4 landscape.

These questions are not unreasonable. For instance, Seaglass and others have pointed out EM jobs are more and more competitive, and docB mentioned comfort of EPs with programs they are familiar with. Do those doing the hiring then, really not consider your residency program at all? If that is true, again, freaking awesome, but we are just asking for discussion and clarification of these issues, not a list. Why does that seem to anger you so? :confused: This is our career - are we not allowed to plan for it and make informed decisions? Are we insubordinate to even ask if RRC requirements really make everyone exactly the same (beyond adequacy)? Maybe you need to chill out, too. :)

EDIT: If you scroll back you will see it was other posters bringing up "the best" programs, not Amory. I will admit that even I mentioned it - I am trying to do something that is relatively rare and will need all the stepping stones I can get. I also think it's funny how everyone immediately attacked the list that got put up there for leaving programs out rather than dismissing the idea of a list altogether. Who cares, right?
 
The "best program" comes down to what you want to get out of it. Some people are interested in academics, some interested in urban gun/knife club, some in community EM. Each program has strengths in one of the general areas.

The problem with the whole match system is that someone may really want to do academic medicine, but due to board scores, etc may end up in a community setting. Likewise the person who loves gun/knife medicine may not get the big urban E.D. experience like at LAC-USC or Cook.

If someone is really set on a certain type of EM, and only ranks those types of programs they risk not matching.

I really wanted to do academic EM, but ended up in the gun/knife club residency, and am finishing at a community EM residency. I still want to do academics.

As far as "general" EM goes, I think that the smaller community programs prepare people just as well as the big academic or urban residencies. Obviously a small community hospital can't offer the same specialized experience, however I know a lot of people in academics who've come out of non-academic programs.
 
Hard24Get said:
Where is all the hostility coming from? When did Amory even ask for "the best" programs? If that was all he wanted he could pick from the hodge-podge of oft-mentioned programs and have done with it. He simply wanted to clarify that we can truly choose any residency we would like within our interests (ie community, academic) and get trained just as well in each and every arena. He acknowledged that probably all programs would be adequate, but was asking about why there is no distinction between good and great for the various areas of EM. As he said, if true that everyone gets great training (no difference between academic A and academic B grads), it would be freaking awesome, and he specifically posted this thread to get a perspective beyond the MS-4 landscape.

These questions are not unreasonable. For instance, Seaglass and others have pointed out EM jobs are more and more competitive, and docB mentioned comfort of EPs with programs they are familiar with. Do those doing the hiring then, really not consider your residency program at all? If that is true, again, freaking awesome, but we are just asking for discussion and clarification of these issues, not a list. Why does that seem to anger you so? :confused: This is our career - are we not allowed to plan for it and make informed decisions? Are we insubordinate to even ask if RRC requirements really make everyone exactly the same (beyond adequacy)? Maybe you need to chill out, too. :)

EDIT: If you scroll back you will see it was other posters bringing up "the best" programs, not Amory. I will admit that even I mentioned it - I am trying to do something that is relatively rare and will need all the stepping stones I can get. I also think it's funny how everyone immediately attacked the list that got put up there for leaving programs out rather than dismissing the idea of a list altogether. Who cares, right?
Click to expand...

<shrug>

I'm not angry. I don't have a stake in where any of you match. Frankly, I don't object to the questioning. It's the smart thing to do and we all did it when we went through the same thing you're going through now.

But thanks for the offer to chill. Think I'll grab a beer and watch the ball game! :thumbup:
 
bulgethetwine said:
Well, there's never anything wrong with skepticism. ;)

But you see, this is what happens every year - a certain breed of applicant is incapable of accepting the fact that you get great training everywhere (that is the statement that you disagreed with in your initial post).

Year after year, applicants brush aside the carefully articulated explanations about how EM is the only specialty that evolved after the RRC was started, that there are far fewer EM residencies then, say, IM. They continue to seek the holy grail of "best" residency program. It's like the fact that the leaders in EM strived to MAKE the system so uniform -- so rigourously uniform in terms of good training -- is an insult to you MS4s, and you think that we're trying to pull the wool over someone's eyes.

The ones who designed it to be so uniform weren't a bunch of rubes, you know. It isn't a myth to be propagated rightly or wrongly -- it's the design, silly.

And seriously, do you really think it is difficult to get any substantive opinion on residency programs? It certainly isn't difficult if you asked specific questions. But you're asking the wrong ones. As alluded to earlier in this
thread, ask goal-directed questions:

1) Which program(s) has the best ultraosund
2) Which program(s) has the best urban knife-and-gun-club training
3) Which program has the best mix of community/academic
4) Which program has the best patient of mix of inner city beside the rich aristocracy?

Plus, if you do a search on a specific program or start a thread that specifically requests the pros/cons of a program in question, you'll get great information.

But if your general assertion is that all programs couldn't possibly give adequate (good to great) general training in emergency medicine because your MS4-level understanding of the landscape precludes you from accepting what others have tried to point out, well, then I imagine, in your most honest moments, you would admit come Februrary that your ranklist reflects some ill-defined notion of what the best "perceived" programs are and you, Sir, will have missed the forest for the trees. Of course, the good news is, you'll still get great training :) You just might not end up getting some of the lifestyle, geographic, or other important (to you) factors that you could have otherwise got.

Good luck, Amory.
Click to expand...

1. I would submit to you that asking these questions does not unequivocally mark me as a "certain kind of applicant."

2. I would also submit to you that as an applicant it is difficult to get substantive opinions on programs for the exact reasons I am trying to bring up. If you ask "which program has the best Peds exposure" you will get a list of 40 places, but every other place will tell you that their Peds is "still great."

3. I don't think my ranklist is going to represent any ill-defined notions. Quite frankly I think that you are unfairly categorizing me as a name-seeker and therefore addressing me in a condescending manner. I believe that if you refer to prior posts you will note that I admit that I am asking these questions with a limited perspective, so I do genuinely appreciate the good-faith opinions of my superiors.

4. You alluded to some of my more "honest moments," the whole point of the thread was to wonder if among the group of residents/attendings on SDN there might be "honest moments" where they doubt the maxim in question.
 
Here's my blah-blah-blah on the subject:

There are zillions of types of injury and affliction we can see in the E.D. At my program we have attendings that will hold your hand, give you nuance at every turn of every patient. We have attendings that will leave you to your own devices, giving you just enough rope to hang yourself, while stealthily sneeking into the rooms of your patients and knowing exactly what needs to be done, then saving you from yourself at the last moment. We have attendings that will pimp you. We have attendings that will push you to be more efficient, while also pushing you to be more direct in your management plan.

We are the third oldest EM residency in the country. EM was basically started here, as was ABEM, and The Society for Acedemic Emergency Medicine and ACEP. We have a great research director, with 6 poster presentations at ACEP this year by our residents. We have 5 oral board examiners, and 2 who write questions for the written EM Boards. We have a faculty memeber who lectures nationally and who writes a chapter in Tintanelli. We are affiliated with a big 10 university, with access to all those resources, including their research statisticians.

We are a level I trauma center, with GSW's, nasty blunt trauma, and drunk college kids. We see close to 100K/year and are opening a brand new E.D. in two months.

As a third year resident I'm beginning to feel as a quarterback who can finally slow down the action and see all events on the field in front of me, allowing me to use my skills and my creativity. Was it this particular residency? Or would this be my fate at any program I had attended? I can't make that judgment, nor do I care to.

There are programs that make a lot of noise, and there are programs that make none. There are programs that emphasize knowing every last new article written, and there are those that emphasize broad based knowledge so you can run an efficient shop. And there are programs everywhere in between.

I'm not one of those walking encyclopedias of EM knowledge. I still have to sneak a peak at one of my little pocket reference books, and often. I think I can intubate anyone, and if not, I've done a couple of cric's and am therefor unafraid of a difficult or messy airway. I can do a central line under US guidance, or I'm just as comfortable doing one without if need be. I've done enough chest tubes, and floated enough pacers. I've seen and managed 3 day olds that were blue, and I've delivered babies. I've had positive FAST exams on what first appeared to be minor traumas that went straight to the O.R. I've cracked a chest, I've counseled new mothers on how to deal with their 10 day old's oral thrush. I've had my hand in more vaginas than an Italian gigalo, and I can manage a vaginal bleed in a 9 week pregnant woman with my eyes closed. I can make good decisions on who's sick and who's not, albeit this is still a wider gray area than I would like. I can read an artilcle with enough of a critical eye to make a decent judgment on it's merit. (Note: I don't debate which treatment modality is better based on conflicting literature, that's intellectual masturbation and I'm too busy for that. You brainy types can sort it out and tell me what you've decided. But it doesn't make you a better doc than me.)

Yet my program is practically invisible to this forum. I read these posts all the time. I see the same programs mentioned again and again. It just kind of makes me chuckle. I lived in New York City my entire adult life (25 years), having grown up in the midwest. What always struck me was how funny it was that New Yorkers always referred to NYC as "the greatest city in the world". And I would think; you mean that urine smell that permeates the city from June through September, or that screaming idiot in the cab? Better than Paris in May? Better than London? Tokyo? Of course, it just takes 11 million people saying it to make other people believe it, whether it has any truth or not.

You feel you need to be coached by the best, seek them out. If you feel you need a lot of room and less interference by the staff, seek out that. But you're always going to be only as good as what you've got inside of you, no matter what kind of program you attend.
 
AmoryBlaine said:
1. I would submit to you that asking these questions does not unequivocally mark me as a "certain kind of applicant."

2. I would also submit to you that as an applicant it is difficult to get substantive opinions on programs for the exact reasons I am trying to bring up. If you ask "which program has the best Peds exposure" you will get a list of 40 places, but every other place will tell you that their Peds is "still great."

3. I don't think my ranklist is going to represent any ill-defined notions. Quite frankly I think that you are unfairly categorizing me as a name-seeker and therefore addressing me in a condescending manner. I believe that if you refer to prior posts you will note that I admit that I am asking these questions with a limited perspective, so I do genuinely appreciate the good-faith opinions of my superiors.

4. You alluded to some of my more "honest moments," the whole point of the thread was to wonder if among the group of residents/attendings on SDN there might be "honest moments" where they doubt the maxim in question.
Click to expand...

I didn't categorize you. Nothing personal. I've commented, where appropriate, on the line of questioning that comes about every year from certain types of applicants. It's up to you decide if you fit that mold, and even if you do, it wouldn't be too late to change! :rolleyes:

It sounds like you have your head on straight -- you're really trying to get some clairvoyant answers, and for that, I applaud you. Just remember that what might seem anethma to you, what you question as being not "honest", might just actually be the "truth in the universe". Our honest responses have been, well, honest. It really is that level of a playing field in this specialty, for the reasons that have been re-hashed, repeated, and re-hashed again. At some point, the patient, repeated urging of medical students to just accept this as valid in the face of constant prodding from the same medical students for us attendings to "more honest" wears thin.

Whatever your rank list, I hope you get "your" #1! The trick is to make it *YOURS*.

And if in doubt, follow ER-ER-Oh's advice above. It's sound as a pound.

Good luck, AB
 
bulgethetwine said:
You know that the "Southeast" includes more than the state of North Carolina, right?
Click to expand...

I'm surprised Vandy didn't make his list. This goes to show that it's only one person's opinion, and that opinion only matters to that one person.

Each should evaluate his or her own criteria and determine which programs they would rank best, not programs someone else will rank best.
 
ER-ER-Oh said:
Here's my blah-blah-blah on the subject:

There are zillions of types of injury and affliction we can see in the E.D. At my program we have attendings that will hold your hand, give you nuance at every turn of every patient. We have attendings that will leave you to your own devices, giving you just enough rope to hang yourself, while stealthily sneeking into the rooms of your patients and knowing exactly what needs to be done, then saving you from yourself at the last moment. We have attendings that will pimp you. We have attendings that will push you to be more efficient, while also pushing you to be more direct in your management plan.

We are the third oldest EM residency in the country. EM was basically started here, as was ABEM, and The Society for Acedemic Emergency Medicine and ACEP. We have a great research director, with 6 poster presentations at ACEP this year by our residents. We have 5 oral board examiners, and 2 who write questions for the written EM Boards. We have a faculty memeber who lectures nationally and who writes a chapter in Tintanelli. We are affiliated with a big 10 university, with access to all those resources, including their research statisticians.

We are a level I trauma center, with GSW's, nasty blunt trauma, and drunk college kids. We see close to 100K/year and are opening a brand new E.D. in two months.

As a third year resident I'm beginning to feel as a quarterback who can finally slow down the action and see all events on the field in front of me, allowing me to use my skills and my creativity. Was it this particular residency? Or would this be my fate at any program I had attended? I can't make that judgment, nor do I care to.

There are programs that make a lot of noise, and there are programs that make none. There are programs that emphasize knowing every last new article written, and there are those that emphasize broad based knowledge so you can run an efficient shop. And there are programs everywhere in between.

I'm not one of those walking encyclopedias of EM knowledge. I still have to sneak a peak at one of my little pocket reference books, and often. I think I can intubate anyone, and if not, I've done a couple of cric's and am therefor unafraid of a difficult or messy airway. I can do a central line under US guidance, or I'm just as comfortable doing one without if need be. I've done enough chest tubes, and floated enough pacers. I've seen and managed 3 day olds that were blue, and I've delivered babies. I've had positive FAST exams on what first appeared to be minor traumas that went straight to the O.R. I've cracked a chest, I've counseled new mothers on how to deal with their 10 day old's oral thrush. I've had my hand in more vaginas than an Italian gigalo, and I can manage a vaginal bleed in a 9 week pregnant woman with my eyes closed. I can make good decisions on who's sick and who's not, albeit this is still a wider gray area than I would like. I can read an artilcle with enough of a critical eye to make a decent judgment on it's merit. (Note: I don't debate which treatment modality is better based on conflicting literature, that's intellectual masturbation and I'm too busy for that. You brainy types can sort it out and tell me what you've decided. But it doesn't make you a better doc than me.)

Yet my program is practically invisible to this forum. I read these posts all the time. I see the same programs mentioned again and again. It just kind of makes me chuckle. I lived in New York City my entire adult life (25 years), having grown up in the midwest. What always struck me was how funny it was that New Yorkers always referred to NYC as "the greatest city in the world". And I would think; you mean that urine smell that permeates the city from June through September, or that screaming idiot in the cab? Better than Paris in May? Better than London? Tokyo? Of course, it just takes 11 million people saying it to make other people believe it, whether it has any truth or not.

You feel you need to be coached by the best, seek them out. If you feel you need a lot of room and less interference by the staff, seek out that. But you're always going to be only as good as what you've got inside of you, no matter what kind of program you attend.
Click to expand...

Thanks for the advice. As an OMS-I who has been thinking ER for a while, I have had and still have the anxious thoughts expressed above. I appreciate the insight, and perhaps the calmness you speak of will appear before I start to apply.
 
er-er-oh, where are you training?
 
I know! We're all wondering where you're training now and whether it's too late to apply there! Very nice endorsement for your program. Your post is one of the best I've read in a while; it inspires me to be a better EP and excites me about residency.
 
ER-ER-Oh said:
Here's my blah-blah-blah on the subject:

There are zillions of types of injury and affliction we can see in the E.D. At my program we have attendings that will hold your hand, give you nuance at every turn of every patient. We have attendings that will leave you to your own devices, giving you just enough rope to hang yourself, while stealthily sneeking into the rooms of your patients and knowing exactly what needs to be done, then saving you from yourself at the last moment. We have attendings that will pimp you. We have attendings that will push you to be more efficient, while also pushing you to be more direct in your management plan.

We are the third oldest EM residency in the country. EM was basically started here, as was ABEM, and The Society for Acedemic Emergency Medicine and ACEP. We have a great research director, with 6 poster presentations at ACEP this year by our residents. We have 5 oral board examiners, and 2 who write questions for the written EM Boards. We have a faculty memeber who lectures nationally and who writes a chapter in Tintanelli. We are affiliated with a big 10 university, with access to all those resources, including their research statisticians.

We are a level I trauma center, with GSW's, nasty blunt trauma, and drunk college kids. We see close to 100K/year and are opening a brand new E.D. in two months.

As a third year resident I'm beginning to feel as a quarterback who can finally slow down the action and see all events on the field in front of me, allowing me to use my skills and my creativity. Was it this particular residency? Or would this be my fate at any program I had attended? I can't make that judgment, nor do I care to.

There are programs that make a lot of noise, and there are programs that make none. There are programs that emphasize knowing every last new article written, and there are those that emphasize broad based knowledge so you can run an efficient shop. And there are programs everywhere in between.

I'm not one of those walking encyclopedias of EM knowledge. I still have to sneak a peak at one of my little pocket reference books, and often. I think I can intubate anyone, and if not, I've done a couple of cric's and am therefor unafraid of a difficult or messy airway. I can do a central line under US guidance, or I'm just as comfortable doing one without if need be. I've done enough chest tubes, and floated enough pacers. I've seen and managed 3 day olds that were blue, and I've delivered babies. I've had positive FAST exams on what first appeared to be minor traumas that went straight to the O.R. I've cracked a chest, I've counseled new mothers on how to deal with their 10 day old's oral thrush. I've had my hand in more vaginas than an Italian gigalo, and I can manage a vaginal bleed in a 9 week pregnant woman with my eyes closed. I can make good decisions on who's sick and who's not, albeit this is still a wider gray area than I would like. I can read an artilcle with enough of a critical eye to make a decent judgment on it's merit. (Note: I don't debate which treatment modality is better based on conflicting literature, that's intellectual masturbation and I'm too busy for that. You brainy types can sort it out and tell me what you've decided. But it doesn't make you a better doc than me.)

Yet my program is practically invisible to this forum. I read these posts all the time. I see the same programs mentioned again and again. It just kind of makes me chuckle. I lived in New York City my entire adult life (25 years), having grown up in the midwest. What always struck me was how funny it was that New Yorkers always referred to NYC as "the greatest city in the world". And I would think; you mean that urine smell that permeates the city from June through September, or that screaming idiot in the cab? Better than Paris in May? Better than London? Tokyo? Of course, it just takes 11 million people saying it to make other people believe it, whether it has any truth or not.

You feel you need to be coached by the best, seek them out. If you feel you need a lot of room and less interference by the staff, seek out that. But you're always going to be only as good as what you've got inside of you, no matter what kind of program you attend.
Click to expand...

:thumbup: I don't know where you came from or how you got here, but WELCOME!
 
breaker1919 said:
I know! We're all wondering where you're training now and whether it's too late to apply there! Very nice endorsement for your program. Your post is one of the best I've read in a while; it inspires me to be a better EP and excites me about residency.
Click to expand...

I'm nearly positive he's at MSU Lansing, but it would appear after a quick search he was mistaken about it being the 3rd EM residency as it was actually the 2nd...

http://www.emlansing.org/program_information.html
 
Yeah, I'm at EM Lansing. I came to medicine late in life, after running a business repairing ships. I'm 49 years old (oh god). I came out here from NYC after spending 25-26 years there, and I'll be staying on as an attending next year.

What I've found, not just in EM or any part of medicine for that matter, and in life, is that finding a place you're in tune with, a place in which you can reside (physically and mentally), is difficult at best and yet so gratifying when you feel it click.

I chose EM because it's a lot like repairing ships in a way...the deadlines are brutal, fast paced to an almost absurd degree. The circumstances which create obstacles are often hard to believe, never mind over come, and the reward is often that your client is not impressed, content only that you didn't f**k it up too much. And confidence only begins to emerge as you realize you'll never completely master any of this stuff, and noticing that one day you're driving home feeling this incredible power after having floated a pacer blindly in a crumping patient, tubed a guy, dx'd a nice little lingular pneumonia from your own read of the CXR, and maybe had some time to joke with a patient or two, and crack up some of your attendings and fellow residents, only to return the next day and fall all over yourself, making mental mistakes, feeling as you're dragging a huge anchor of 'the not so sick' around through mud. SMACK.

I was burnt out with New York, and Lansing, particularly East Lansing, was just what I needed. It's busier (that word just doesn't look right) than NY Methodist where I was doing med school rotations, and the attendings are all to some level great characters. I love it here, not because of the teaching, not because of the research, not because Lansing is a goofy little city, but because it clicks with me for some weird reason. And because of that I'm inspired to learn and to be as good as I can be. It's so stupidly simple really.

Any way, I really wish all you 4th year med students good luck. And I hope you all find a way to match somewhere that will lend you the same degree of inspiration, fun, and confidence that EM Lansing has afforded me. Good luck
 
southerndoc said:
No. It wastes bandwidth and requires additional scrolling. I had to burn an extra Calorie to scroll through your post.
Click to expand...

If I buy you a beer (to replenish the calorie), will you get off my case?
 
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