top EM programs

discussed to death in MANY other threads. Look it up in a search...I will delete this thread tomorrow...
Mark

Cliff Notes:

1. Eye of the beholder
2. EM has very uniform training standards across the country
3. Main question is academic vs community career
4. Fellowship will be little problem regardless of where trained
5. Four vs three: Do search. Most are three.

A) Read edin's post above.
B) Unstuck thread now.

Q, DO

Im matching into it this week. Keep you posted.

I matched into it 2 yrs ago...it rules

I scrambled into it last year. It is awesome.

i asked this same question about a year ago as well and got the same random answers.......i think it is a legitimate question that deserves a real answer. big name programs allow you more options after finishing residency (just as big name medical schools allow you more options when it comes to securing residency) and if you find one of these programs that feels right for you, go for it. after looking into this topic quite a bit and talking to residents and attendings, i've come up with a list of my own......i think many will agree that the following programs (in no particular order.....actually to make it fun, we'll go from west coast-->midwest-->east coast) are indeed the most well respected in the nation.

highland
usc
ucla-harbor
uc davis
denver
charity
hennepin
pitt
indiana
cinnci
cook
carolinas
bellvue
jacobi

that being said, i honestly think the most important factor for me was gut feeling......the program i choose had everything i was looking for and when i left after my interview i knew it was right. the residents were great, the attendings were great, great location, amazing clinical experience etc......so as far as i'm concerned, i'm going to best program in the country next year.

There really is no finite answer...ask the residents and you will find out. I have heard dirt from many of the residencies listed above, and it really comes down to where you feel comfortable and those that have had a long term committment to EM and professional development. The RRC makes sure that the standards are met.

i think that the whole "well, the RRC oversees all the programs, so they must be equal" argument that i heard from many program directors and i see used by posters on this site is total BS. i interviewed at several programs and rotated at one program where the overall clinical experience was obviously far inferior to many of the above programs i had the opportunity to check out. i didn't feel like i'd be ready to call myself an attending if i trained at one of these institutions. my point above is that, yes there are programs that are considered top notch, yes they are more competitive to get into, yes their names and their alumni will carry weight across the nation when it comes time to get a job, and yes this issue of "what are the top EM programs?" is a legitimate question that gets asked every month or so and should not simply be answered with "whatever program you like, is the top EM program"......after spending at least a year rotating, interviewing and talking with people in the field i think we all know which programs in the country are the "big names" and i don't think there is anything wrong with sharing that info with M3's who are curious about this. bottom line is that you shouldn't base your decision solely on rankings. location, your fit into the program, gut feeling etc..are all very important factors. but i think if all those things come together at a top notch program and you are given the chance to train at such a place, good for you.

after spending at least a year rotating, interviewing and talking with people in the field i think we all know which programs in the country are the "big names"

Click to expand...

I think the point is that although you seem to think we all agree with your list, we don't. Your list is arbitrary. Some people in the world of academic EM would disagree. I personally would argue that there is little you can get at one of these programs that you can't get at another. The RRC IS more strict. Programs are much more consistent than you will find in the world of FP, IM, Surg, etc. I personally would knock a bunch of programs off your list and add some others based on what I've heard (heresay) from attendings and on the interview trail. That's why we never answer this question straight out, because there isn't a straight answer (as much as you want there to be one). I'm spent.

Of course, this is just my opinion--but you knew that.

C

Originally posted by bobdobaleena
i think many will agree that the following programs (in no particular order.....actually to make it fun, we'll go from west coast-->midwest-->east coast) are indeed the most well respected in the nation.

highland
usc
ucla-harbor
uc davis
denver
charity
hennepin
pitt
indiana
cinnci
cook
carolinas
bellvue
jacobi

Click to expand...

Don't count me in the "many" who agree with you. While many of the programs on your list are fine, at least one (Cook) routinely has difficulty filling, they scrambled three spots in '03.

I think your list is more histoical than real and current. Much of the current EM leadership is found in programs not on your list. Are you saying that as the head of the RRC Dr. Overton (Kalamazoo) has difficulty finding his residents jobs? (Of course his program had some openings in the recent past.) To say nothing of Dr. Hamilton (Wright State). The current head of ACEP (Dr. J. Brian Hancock) is on faculty at Saginaw. Both Duke and Mayo (powerhouses in most other residency programs) have new EM programs which are just coming into their own. Akron General has a long standing program (oldest community based program in the country? - per them) with a wide network of graduates. One of their D.O. grads is now a tox fellow at UIC (hurts the whole four years and strong academic residency needed for fellowship argument). I think that there are "names" in EM, but I think it is far too young a specialty to speak in absolutes as to the best programs.

Without question the number one factor is still fit. If you like a program and fit in there, you will likely do well.

Originally posted by bobdobaleena
i think that the whole "well, the RRC oversees all the programs, so they must be equal" argument that i heard from many program directors and i see used by posters on this site is total BS. i interviewed at several programs and rotated at one program where the overall clinical experience was obviously far inferior to many of the above programs i had the opportunity to check out. i didn't feel like i'd be ready to call myself an attending if i trained at one of these institutions.

Click to expand...

That is a gutsy statement. I find it hard to believe that an MS4 can evaluate a program more completely than the RRC. If you are speaking personally (i.e., you wouldn't be prepared coming from a specific program), that's fair - but others would likely disagree. You are right in that if you want to be an EP in a fast-paced, 100K+ visit/yr, urban ED you should probably not train at a slower, 40K visit/yr community EM residency (and vice-versa), but would it leave you unprepared? No! Would there be a steep learning curve at your first job? Yes! But any of the accredited programs leave you eligible to take the EM boards, and that is what matters.

Anyway, if you want my $0.02 worth (actual cash value $0.005), I would worry more about how you mesh with a program than on what its reputation is. If you are happy, you will excel, and that will be of far more benefit than graduating miserable from a "top program".

- H

Unfortunately, the reason that everyone tries to kill a thread like this is because we all think that the program we are in is the best in the country. It just ends up being an arguement that goes around in a circle...I mean, who's actually going to admit that they're in a crappy program...hence the whole "RRC being strict and all programs being awesome" talk. Just a thought

elfman

Just to beat a dead horse. The concept of 'best program' is BS, in general. Just like in medical school, the quality of training is incredibly dependent on the person. I have seen HORRENDOUS doctors from 'top tier' medical schools. And AMAZING MD's from 'bad' schools (or carribean).

Same for residency. Perhaps some larger named schools could perhaps make it easier to get an academic position. but if you are goign private, you pretty much have to be an ax murderer not to get a decent job.

And as far as academia goes, fellowship can help. And more importantly, publishing can help.

and then there is nothing to say for simply going to meetins and ending up drinking with important people (that maybe you don't even know are important. )

Originally posted by roja

and then there is nothing to say for simply going to meetins and ending up drinking with important people (that maybe you don't even know are important. )

Click to expand...

This is exactly why I try to get drunk with as many random people as possible every year at ACEP and SAEM.

Well I for one do appreciate a good list of top programs. Yes a list like this only really tells us who bobdobaleena thinks are the best programs. But even as a lowly medical student, I've heard many of these programs mentioned over and over as being the best by attentings and residents at both my institution and others. I think I would question the motives of anyone who would argue that Cinci, Bellevue, Denver, Harbor, etc are NOT the leaders of EM.

I think your list is more histoical than real and current. Much of the current EM leadership is found in programs not on your list.

Click to expand...

Any reasonable list of this nature will definately take historical performance into account. A program that has produced leaders in the past will continue to in the future. I'm not saying that these other up-and-coming programs won't become great in the future, but there is no guarentee that they will either. This is my career, the rest of my scholarly life, I'm not taking any chances. I'd rather go somewhere that has proven itself already.

I definately want to train at one of the "top" programs. Call me shallow, but if I can match at the best, then I will damn well try to be there. But if I dont match that well, then I'll probably be back on this forum saying how all programs are equal. Funny how that happens.

Lists lists lists...opinions opinions opinions!

How bout the list of residents who are 4th year cincy residents that regret they chose a 1-4 residency? They don't exactly wear t-shirts that say "I should've..." But the stories are out there.
Blah blah blah

And to say that if you don't match onto someone elses "top 10" then you didn't match well is pure bull****. How friggin ******ed and arrogant to say.

Top programs are a BS theory, bottom programs are VALID. The ABEM identifies problem programs...this is the more worthwhile list, not someones "i heard it from this guy who heard from this guy who heard from this guy" list.

I remember when I matched, U of Chicago, UT Southwestern, Michigan, Maricopa, Sparrow...blah blah blah were on those lists.

How can you NOT include Harvard with Friggin Dr. Peter Rosen or Dr. Ron Walls?? How can't you include Temple with Dr. MacNamera, Toledo with hard core flight programs or Wagners program with Dr. Hamilton?

Top 10's are subjective, bottom 10 can have objective data. But, I beg of you, don't list any bottom 10s you crazy list makers.

Originally posted by OhioInTheWest
I definately want to train at one of the "top" programs. Call me shallow, but if I can match at the best, then I will damn well try to be there. But if I dont match that well, then I'll probably be back on this forum saying how all programs are equal. Funny how that happens.

Click to expand...

Actually, I matched at my #1, and had strong feedback to indicate that I might well have matched into any of my top five (including places on that list) had I ranked them #1. I felt I "fit" best at Mayo, and I'll take my chances that the program will develop to be of equal reputation to the rest of their residencies.

Good luck with the match Ohio...

- H

It takes more than a few "names" to make a program good. BTW Sparrow???

Originally posted by OhioInTheWest
Well I for one do appreciate a good list of top programs. Yes a list like this only really tells us who bobdobaleena thinks are the best programs. But even as a lowly medical student, I've heard many of these programs mentioned over and over as being the best by attentings and residents at both my institution and others. I think I would question the motives of anyone who would argue that Cinci, Bellevue, Denver, Harbor, etc are NOT the leaders of EM.




Any reasonable list of this nature will definately take historical performance into account. A program that has produced leaders in the past will continue to in the future. I'm not saying that these other up-and-coming programs won't become great in the future, but there is no guarentee that they will either. This is my career, the rest of my scholarly life, I'm not taking any chances. I'd rather go somewhere that has proven itself already.

I definately want to train at one of the "top" programs. Call me shallow, but if I can match at the best, then I will damn well try to be there. But if I dont match that well, then I'll probably be back on this forum saying how all programs are equal. Funny how that happens.

Click to expand...

Ohio,
Dude, you are thinking about this all wrong. You shouldn't be trying so hard to match at the most prestigious program, instead, you gotta really look for a good fit. 2 reasons. First, there really ARE a lot of great programs out there. One of the blessings of our specialty is the variety of training format and structures. All the programs listed in the posts by bob and foughfyr are good. Many of these places will help you to become a great EM doc. Of course I'm gonna be partial to where I matched, but I'm not gonna compare my program to any other for you...thats for you to decide. Second, the people who will be rotating with and interviewing you, you know the ones that make the rank list, will probably pick up on the fact that you are more interested in the name of a place and less concerned about finding out about the personality of the program.

By the way, don't forget that we are all in this together. We need each program to become strong and well respected, thats very important in such a young field. Many of the EM programs have strong connections and intertwined heritages. Denver graduates, for example, have gone on to head programs throughout the country. It is probably in Denver's best interest that all of these programs become great.

Good luck for next year.

my whole point in bringing this issue back to life was to stimulate a bit of discussion....it looks like that happened. the list i posted above was a list of programs that i found to be mentioned over and over again thoughout the past couple years....these were the programs people often mentioned when asked what they felt were the top programs. yes, i agree there are many other excellent EM residencies out there and that is why i think this post is important.......to bring out those places that don't normally get mentioned...there are 120+ places out there to train and we don't hear about many of them unless they happen to be our home institution or we get lucky and rotate though one of these "hidden gems" or a friend mentions something about a program or quinn talks about his program or someone posts some real info on a forum.....etc.....so by all means, lets get some discussion going about the programs on the above list and more programs that are up and coming and give people an idea of what to expect next year....places they should check out etc......seacrrrrest out!

I just couldn't stop myself from putting my foot into this ring.

As a recently matched 4th year (yes, my #1......no, not on "the list") I can see all of your points. I too was interested in what the "top" EM programs were because, let's face it, it does make a difference where one trains. I ended up matching at a program that doesn't have the name recognition of some of the programs listed on the previous post. I was restricted to a certain area of the country due to my significant other's job, and had to choose between some very prestigeous institutions with mediocere EM programs and several lesser known institutions with what appeared to be great EM departments. What I ended up doing was judging these programs based on objective data (volume, pt. population/demographics, faculty #'s, shift length, curriculum) and my own personal feelings (people, place, gestalt, etc.).

Questions that were at the top of my mind while I interviewed were (in no particular order):
1. Do I like these people?
2. Do I like the location?
3. Do I like the facilities?
4. What is the reputation of this institution?
5. What is the reputation of this EM program?
6. What is the pt. volume?
7. What is the patient population like (inner-city vs country)?
8. Will I have to compete with other departments for ANYTHING (airways, chest tubes, reductions, central lines, resources, politics, etc)?
9. How is the ED percieved by other departments?
10. Most importantly, will I get the training that I need in order to walk into my first job without filling up my shorts?

In the end, what I ended up with was a pretty well thought out ROL that took the whole picture into account.

So what is my point? I'm not sure, but I think that each of you would have slighlty different answers for a lot of the above questions, and I'm sure that we all weight them in different orders. I guess I agree with the idea that there are programs that are a good "fit" for some, while not for others, regardless of reputation. That does NOT mean that reputation is not important. Oh contrare, it is very important. What is more important though is the quality of training that you will end up getting, and your sanity while doing it. That being said I will offer up my very short list of the unlisted that I feel merit mention.

1. Maine Medical Center - fantastic location, great people, very strong EM dept despite a slightly anemic pt. volume.
2. Baystate (Tuft's program) - Area surrounding Springfield is very nice (Springfield itself is questionable), happiest residents I've seen, Busiest ED I've ever heard of (130,000+ including Peds), Nicest PD in the business.
3. Christiana - Huge volume, tons of resources, happy happy residents, overall fantastic training.
4. UPenn - Great PD, friendly residents, truly amazing institution.
5. UMass- flight program second to none, great training, new ED on the horizon, this should be one to watch.

I'm sure I've only stirred to pot a bit more, but I hope that this helps some.

I'm glad this discussion is up and running. A few of my thoughts...

1. The importance of your "fitting in" with a program seems obvious to me. If you are actually ordering your rank list based on reputation alone, without paying attention to what your life would be like there, you have seriously missed the smart boat.

2. Data doesn't hurt. As an early MS4, whenever I asked residents, attendings etc., "What are the best EM programs?," everyone kind of clammed up and gave the whole "Well, they're all good..." line, which was absolutely no help to me. Finally, I made friends with a few residents who then told me what they REALLY thought. I may have chosen to ignore some of them entirely, but at least they told me SOMETHING. Saying that all EM programs are good is not helpful to MS4s - saying which ones you think are best and which suck, even if you're totally wrong, is.

3. An argument about one EM program being better than another will obviously be heavily drenched in subjective opinion, but there are two statistics that are usually not mentioned (or available to an applying MS4 for that matter) which are very important and grounded in fact, not opinion: competitiveness and reputation. COMPETITIVENESS: One of the most frustrating things as an MS4 is not knowing what your chances are at various programs. If you have low board scores or are a mediocre student who didn't do an away elective, you can pretty much forget about Highland, for example. Unfortunately, schools don't like to release how far they go on their rank list to fill, which would be proabably the best indicator of this. REPUTATION: Whether deserving or not, some programs have excellent reputations, and this will help in finding a job afterwards, especially in academic EM.