UC San Fransisco (UCSF)/Fresno Residency Reviews

Anyone knows anything as to how this program is? What are the stregths of the program? Are residents happy and so on?

I don't know a lot of specifics about it. It has a decent rep academically. Fresno probably isn't the best for singles looking for a hot night life but it is close to Yosemite and the rest of the western Sierras.

I interviewed there last year, so from my memory:

Solid program. Location is a negative as far as being in Fresno. You are close to some cool stuff like Kings and Yosemite so that takes a bit of the sting out of it. If this program were in a more hip town, then it would get a lot more attention I'm sure because the program is so solid. The department is hopping - huge volume, lots of sick patients, lots of trauma, lots of people doing stupid things in Fresno which translates into good emergency medicine. Community feel - the residents there get to do a lot of procedures that other programs don't get to do because there aren't residency programs in all the sub-specialties. The department has a lot of autonomy within the institution. There's the Park Ranger thing which is a plus. Everyone in the program was really friendly. The one negative for me was that they split their shifts up so that they do half their shift in the high acuity side and half in the low acuity side. I prefer more of the pod style where you work with 1 or 2 attendings and the same group of nurses throughout the shift, but everyone there seemed to like it so I think that's a pretty minor complaint. People in EM seem to know that it's an intense place and that their graduates come out with a ton of experience. People there were very friendly, laid back, like the mountains, etc. Good curriculum with tracks, elective time. Hope that helps.

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strongboy2005 said:

The Fresno program is a PGY 1-4 program right? That's the only bad thing about the program from what I can see... why doesn't anyone ever mention this?

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Most people on the interview trail seem to either not care, or care strongly about wanting a 3 or 4 year program. Yes, it is a 4 year program. I ranked this program pretty high. It's amazing training, has great facilities, and is a solid program. You should check it out, fo sho.

I think Fresno is the most underrated program in the country...but this is from someone who believes in four years....and is only truly familiar with about five programs and partially familiar with 20-25 (beware when getting opinions from folks who have just interviewed or visited a program for a day or two)

HH

I absolutely loved the Fresno residents when I met them at ACEP. It's funny how after rotating around the tables and meeting people from so many programs that they stood out so much in my mind. Seemed like a great bunch of people who would be not only cool to work with but also to hang out with. Now I just need them to give me some interview love.

Hamhock said:

I think Fresno is the most underrated program in the country...

HH

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Agree. Great hospital, great pediatric medical center on the other side of town, pathology is top tier, faculty were smart and easy going.

Hi, since it's been a while since the last major update/review, can someone familiar with the program (preferably a current resident or recent grad) comment on the following?

• Average number and length of shifts per month for each PGY year. Is there enough time to pursue academic/professional/extracurricular interests?
• Are shifts stratified by acuity (e.g., “trauma” shift or “resuscitative” shift), or is the entire spectrum of pathology seen on each shift? In other words, is trauma only seen during concentrated blocks of training or throughout the entire residency experience in the ED?
• Which team runs the trauma? Is it an alternating schedule with the surgery residents? Who does the procedures (intubations, chest tubes, resuscitative thoracotomies, etc), is it shared with anesthesia/surgery residents based on odd/even days or MRN numbers? Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
• Are there any off-site locations other than CRMC, St. Agnes and Children's Hospital Central California? Is there frequent commuting between off-site locations (outside of the dedicated training blocks)?
• Is there an EMR? Is it Epic quality or a horrendous excuse for a computer program? Is there still paper charting?
• How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
• Is the environment family friendly? What percentage of the residents are married, have children?

Thanks so much for your help!

rocketfrog03 said:

Hi, since it's been a while since the last major update/review, can someone familiar with the program (preferably a current resident or recent grad) comment on the following?

• Average number and length of shifts per month for each PGY year. Is there enough time to pursue academic/professional/extracurricular interests?
• Are shifts stratified by acuity (e.g., “trauma” shift or “resuscitative” shift), or is the entire spectrum of pathology seen on each shift? In other words, is trauma only seen during concentrated blocks of training or throughout the entire residency experience in the ED?
• Which team runs the trauma? Is it an alternating schedule with the surgery residents? Who does the procedures (intubations, chest tubes, resuscitative thoracotomies, etc), is it shared with anesthesia/surgery residents based on odd/even days or MRN numbers? Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
• Are there any off-site locations other than CRMC, St. Agnes and Children's Hospital Central California? Is there frequent commuting between off-site locations (outside of the dedicated training blocks)?
• Is there an EMR? Is it Epic quality or a horrendous excuse for a computer program? Is there still paper charting?
• How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
• Is the environment family friendly? What percentage of the residents are married, have children?

Thanks so much for your help!

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Hey, current EM R2 at Fresno. I think I can answer most of your questions.

1. Average number of shifts is 20 per month as an intern, and then 150 per year as R2-4. The 150 shifts is over 8 months as an R2 and 7 months as an R3, but you can do some of your shifts during off service months to decompress 3rd year a bit. I believe as an R4 you basically do your shifts year round, which translates to a pretty good schedule. Plenty of time to pursue other activities during residency.
2. Shifts are stratified by acuity. During intern year and 1st half of R2, you do all green and yellow zone (low to moderate acuity). For the rest of residency, you do mostly red and trauma (red is the high acuity medical patients). Some of the less critical trauma trickles its way into the other zones, leaving the trauma area for the moderate-to-high acuity patients.
3. EM resident is always head of the bed, in charge of the airway, and completing primary and secondary surveys. Anesthesia does not come to the ED except for very rare, extraneous circumstances (seen it twice in my 2 years). Other procedures are shared between the EM and surgery residents. Generally, these procedures go to the R2 or R3 currently on trauma surgery, which is usually an EM resident (just by virtue of the fact there are only 4 surgery residents). Technically, trauma activations are "run" by the surgery senior at the foot of the bed, who does not touch the patient and does not perform examination of the patient or procedures. Obviously, the decision to go to the OR is made by the surgery team, while the decision to intubate and perform other critical procedures in the ED are collaborative.
4. Off site locations are those you listed. One month at St. Agnes during R4 year, 2 months at Valley Children's Hospital as an R2. All the rest of the time is CRMC.
5. We use Epic EMR, which is quite nice. No paper charting.
6. Minimal to no scut work. Have never transported a patient.
7. Very family friendly program. probably half the residents are married, and most of those who are married have kids or are having kids in residency.

Really have enjoyed the residency so far. It's a great environment to train and I couldn't be happier. Let me know if you have any more questions.

FresnoEM said:

Hey, current EM R2 at Fresno. I think I can answer most of your questions.

1. Average number of shifts is 20 per month as an intern, and then 150 per year as R2-4. The 150 shifts is over 8 months as an R2 and 7 months as an R3, but you can do some of your shifts during off service months to decompress 3rd year a bit. I believe as an R4 you basically do your shifts year round, which translates to a pretty good schedule. Plenty of time to pursue other activities during residency.
2. Shifts are stratified by acuity. During intern year and 1st half of R2, you do all green and yellow zone (low to moderate acuity). For the rest of residency, you do mostly red and trauma (red is the high acuity medical patients). Some of the less critical trauma trickles its way into the other zones, leaving the trauma area for the moderate-to-high acuity patients.
3. EM resident is always head of the bed, in charge of the airway, and completing primary and secondary surveys. Anesthesia does not come to the ED except for very rare, extraneous circumstances (seen it twice in my 2 years). Other procedures are shared between the EM and surgery residents. Generally, these procedures go to the R2 or R3 currently on trauma surgery, which is usually an EM resident (just by virtue of the fact there are only 4 surgery residents). Technically, trauma activations are "run" by the surgery senior at the foot of the bed, who does not touch the patient and does not perform examination of the patient or procedures. Obviously, the decision to go to the OR is made by the surgery team, while the decision to intubate and perform other critical procedures in the ED are collaborative.
4. Off site locations are those you listed. One month at St. Agnes during R4 year, 2 months at Valley Children's Hospital as an R2. All the rest of the time is CRMC.
5. We use Epic EMR, which is quite nice. No paper charting.
6. Minimal to no scut work. Have never transported a patient.
7. Very family friendly program. probably half the residents are married, and most of those who are married have kids or are having kids in residency.

Really have enjoyed the residency so far. It's a great environment to train and I couldn't be happier. Let me know if you have any more questions.

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Thanks so much for your reply. It is very helpful.

Last question, how many hours on average are the shifts for each PGY year? Thank you for your time.

rocketfrog03 said:

Thanks so much for your reply. It is very helpful.

Last question, how many hours on average are the shifts for each PGY year? Thank you for your time.

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All shifts are 9 hours. With 3 shifts daily, leaves an hour of overlap at the end of your shift do get your stuff cleaned up to go home. Most people don't have to stay in the department excessive amounts of time after the shift to finish charting or whatever.

Does anyone know that's the average board scores for this program? Thank you!

coninuteremedia said:

Does anyone know that's the average board scores for this program? Thank you!

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Never understand questions like this one. Will it change how you study for boards? Then just take what you got and apply. Maybe they turn down your 265, maybe they like your 215. If you get an interview invite, your score is good enough. If you don't, you're out at most $10.

deleted.

Disclaimer: These are just my opinions

Okay!

Been a while since I’ve seen an update on UCSF-Fresno… with rank lists coming in I think it’s “safe” to gush on #1 and write my review. Full rank list to follow…

So first off, I rotated here. My interests are in county programs. I am slightly interested in academics as well. That being said I mostly interviewed at the big county places (midwest to west coast) with a few of the ivory tower types out of curiosity. I will say that after rotating and interviewing, lots of places throw around the word “county” and “safety-net” hospital pretty loosely. Fresno seems like the “most county” (aka: holy crap this place is crazy, high volume, ED autonomy, pathology, safety net) I’ve yet to see, hands down. As a rotator I got a couple central lines and intubations, paracentesis. I didn’t get any LP’s but a couple of my colleagues did.

Not surprisingly I believe Fresno to be the best pathology and training in the country. Of course my opinions are all based my couple rotations and interview day(s). I get that. Ranking is no easy task, as you all know.

Either way, It’s one of the busiest ED’s in the state (and growing) -- and the busiest level 1 trauma center in California. I don’t know if it’s true, but one of the R2’s said Fresno is the largest patient-resident ratio compared to other Cali programs... Maybe BS, but seemed reasonable. There is a huge physician shortage in the central valley, and very few specialists around. This translates to the ED having to manage a lot and being exposed to experiences just not offered elsewhere. Additionally it’s the #1 receiving hospital for all of the other ED’s and residency’s in the area. That being said, I think one of the things that is good and likely helps to alleviate patient burden, are the fact that attendings take clinical (non-teaching) shifts. There are also midlevels who see lower acuity folks as well. The senior residents also get these floating shifts where they basically go where needed.

Program Type: 4 Year county/academic. Level 1/STEMI/Stroke/Burns/Tox center. Graduated responsibility. The R2’s run green zone, which is technically low acuity but it’s the size of most ED’s in itself. Green patients range from not very sick to needing to be transferred to resuscitation bays. There are 10 strictly medical resuscitation bays not including the trauma side. There are more beds in high acuity but not all are resus bays. Junior residents also get to keep their patients and procedures if the patients get upgraded.

Atmosphere: Exploding at the seems. I don’t know how many beds they have, but it’s a ton. Divided into zones based off acuity. Green, yellow, red, trauma. Also there is a locked psych unit, small peds zone, and “blue zone” which is sorta like urgent care. There was a patient on one of my red zone procedure shifts that came from the blue area

Boarding: There are lots of hallway beds. Some of the patients (dunno what %) are admitted and waiting for upstairs beds. The nice thing is in addition to having UCSF teams admitting patients there is a private hospitalist group. You only have to deal with boarders if someone acutely decompensates, so I don’t think it’s a big of problem here as other places.

Trauma: I didn’t get a lot of exposure while rotating, but it’s the busiest level 1 trauma center in california. So I’m sure the exposure isn’t lacking. The EM program is much larger than surgery so they end up helping to run the service. They said there is about a 50% chance the “trauma resident” is EM. The residents all seem to agree that procedures are not an issue. The number of procedures listed on the recruitment powerpoint was well above the national averages, including more of the exotic procedures (crics, thoracotomies). The interns manage an insane amount of patients while covering the trauma floors overnight. Heard a few cool stories about having to resus/send floor patients back to ICU.

Hours: I never really understood the #shifts/month here. It seems like 20’ish? It’s based on shifts/year dispersed over however many months you’re in the ED. Most shifts are ~9 hours. One hour overlap between shifts. Sign-out usually includes teaching points/pearls from the day. Also if it’s a morning shift all residents/students go to “morning report” and work through an interesting case on the whiteboard for about 30 minutes.

Moonlighting: Internally as an R2, externally I think as R4 (maybe R3’s?). Either way there are opportunities pretty early!

Research: Definitely not the research powerhouse as main campus and some of the other quaternary center cali programs. You can tell they’re trying to step up their game though. Also I can only imagine the research potential at this program given the acuity and random-ass pathology that seems to frequent the central valley. Research is something I’m on the fence about but if that’s your gig there seems to be a lot of support there.

I guess on the topic of research I can mention my education interests… I really strongly considered main campus (my #4). Such a powerhouse name on the west coast. Problem is, I honestly just don’t think the clinical training comes close to Fresno. I could be wrong here, that’s a judgement call and I’m comfortable living with the consequences. I think it’s interesting to note that all of the UCSF students from last year matched at Fresno, none stayed at main campus. I don’t really know what that means (if anything) but it’s another variable.

In the same breath as my mention of education, I have to mention the EMRAP connection (which admittedly exists at other great programs). It was pretty sweet driving in listening to C3 and then having shifts with some of the same badass residents/faculty. It’s a super cool opportunity they get.

Other Perks:
-Parkmedic program. Fresno’s proximity to Yosemite/Sequoia/Kings Canyon is not only a social perk -- but they train all of the park rangers both locally and nationally. Residents work as the base-hospital physicians and answer radio calls both for EMS in the valley and in the national parks.
-Free Food/Parking
-Old, very well respected department. Lots of autonomy.
-Cheap COL but still with SF salary (minus housing stipend).

Note: Just wanted to mention that on my green zone shifts I got to talking with a couple of the attendings from brand name non-UCSF/Fresno grads. They (n=2) were very forward about being grateful for their training, but if could have done it all over would have trained in Fresno. I think that really spoke to me.

#fingerscrossed. I really love my top 5-6-ish choices.