Los Angeles County/Harbor/UCLA Residency Reviews

The closure of MLK's trauma will have some, but not a huge, effect on Harbor. The majority of that trauma volume will be going to California Hospital and USC/County downtown. More of an impact will come from the closure of nearby RFK, as they both serve similar population economically and geographically. In short, it's definitely a hard-working residency program but with excellent didactics as well. When I rotated there as a student many moons ago, there seemed to be more of an emphasis on "moving the meat" during day-to-day work than I found in my own program later.

UCLA-Harbor..

I initially cancelled this thing then begged back on..

So this is located in Torrance Cali, the residents all seemed real cool, as mentioned in a previous thread (I think the one comparing Harbor to Highland) they mentioned Chris Lampe who is their 4th yr chief this yr. He is a great guy with a ton of energy and is probably the nicest guy I met on the whole trail. So the day started with the 6 of us going to their morning rounds on Tuesday, Didactics were good, then they usually have an M&M conference but the day I was there it was Journal Club. To be honest it was the first one I had been to and I thought it was real good (with nothing to compare it to). Then we got a tour of the hospital, honestly it is a typical county place, nothing real nice or anything, the ED is a little older but they will be building a new addition but I dont think this will impact any M4s. LA/California has approved a ton of money to LAC+USC (1 Billion for a new hospital and ED of course), Harbor (~225Mil for a new ED) and MLk (Also ~225Mil for a new ED). We then ate outside In Jan where the weather was great. The residents eat free at the Doctors dining area. We met and talked to a ton of the residents including the interns. People were all very down to earth not pretentious A-holes. Everyone was very honest and willing to tell you what they liked and didnt. While the COL in LA is huge there are people who own there others rent (more on that later). Then we went for interviews 3 each, all were laid back, real nice little discussion about interesting things on my resume. The PD Burbulys is a nice guy. All my interviews were very pleasant. Then we went into a room and watched a movie that Dr Lampe put together, it was kinda funny but a real good video IMO. There is this place where I guess a lot of residents rent and it basically is right over the ocean AWESOME. Most residents tend to live by the water.

Details on academics.. Very strong in Peds, lots of Peds faculty, USC sends their residents to Harbor for Peds, they are unique in that they do a teaching signout thing twice a day so you can learn about patients who arent yours. I think they do this for like 30mins. Conferences now are Tues and Thurs, but thats about to change. They do a lot of ICU months in their 1st yr. and only have 1 call month 2nd yr.. and then no more call.

many residents go on to fellowships and we were told that if you want they will create a niche fellowship for you if you want. They have one in education, Peds, and a ton of others etc.. Lots of trauma as you might imagine in LA.. There is enough to go around.

Overall, impressive but strangely enough I expected more since I had heard so much about it, I liked USC better (I may be one of the few) but will rank harbor higher on my ROL. It will be behind my top 2 due to geography.

Honestly my favorite 3 programs were 1) Wash U, 2) USC, 3) Cook County (basically equal to cook county but in a nice location)..

It is weird cause they are all 4 yr programs! None of these will be in my top 3..

Wash U is AMAZING!!

There i hope that made up for the political mumbo jumbo!

Program: Harbor UCLA in sunny 'ol LA, Cali

Residents: 14 per year in a PGY1-3 format. There are plans to add 2 or 3 more residents when the new ED is completed (construction will begin in Jan/Feb, so 3-4 years from now). The residents are very friendly and all seem to be very happy with their choice. The location alone makes them happy and they have more than enough time to enjoy the beach and everything else LA offers. They are a happy bunch. There is one complaint about the program that I will address in the curriculum section. There is a great sense of camaraderie between the residents. They really do support each other and try to make each other's lives that much easier.

Faculty: There are some real leaders in the field that call Harbor home. All the faculty I met with were great and friendly, really willing to train the next generation of EM physicians. It is a very supportive environment. There is nothing but praise by the residents when talking about the factuly. The teaching is excellent, and they feel they get ample bedside teaching as well.

Facilities: Well, it's Harbor/UCLA, which is a county facility. Not the nicest or largest ED I've seen, but in my opinion, it's a minor issue. It's about 40 beds or so, with a seperate 12 bed peds ED across the hall. Also, there is very little scut work in the ED. Lines, draws and transport are taken care of for you. Just don't expect the same when you're rotating off-service.

Population: A great majority of patients are Hispanic, who everyone agrees are very grateful. They wait hours and hours for care and hardly complain. There has been an increase in volume due to the MLK closure, but it's been steadily increasing over the last year. Harbor says they do get more trauma as a result of the closure as well. They see very sick people here...such is county.

Curriculum: The curriculum is awesome. It's front loaded with off-service rotations, but all the departments, except for one, are great learning opportunities as they are all strong. The only one, and the biggest complaint by the residents, is the ortho month. It is heavily scut/floor intensive but we were told that they would be pulling out of it very soon and sending their PGY-2 residents to USC for their ortho experience. There is plenty of peds experience to be had, around 4-5 months total of the curriculum. The place has many fellowships, making them strong in many niches of EM, including Peds/EM, US, Research, etc. The only one they didn't seem to have was Tox. Shifts are usually 8 hours in length, which is pretty nice for a 3 year program. I'm not sure how many they work per month, however, as I don't think it was mentioned to me. There is a two tier trauma system, with the ED running tier 1 and trauma responding to tier 2. There are plenty of procedures to go around and many are alternated with the trauma team. Airway is the ED's domain. The didactics are strong as well, but they are currently split over two days. There is talk of combining them to one day. Only 2nd/3rd years attend. Interns have their own sets of lectures weekly. There is so much more to this program than I can touch on.

Location: LA. Most of the residents live in the redondo/hermosa beach areas, which are great areas to live. As I said earlier, they have more than enough time to enjoy their locations. While it isn't cheap to live in LA, it's doable and worth the "sunshine/beach" tax.

Overall: I really liked this program. Being able to work with such a great faculty is an awesome opportunity. The curriculum has a lot of what I would want from a 3 year program, including strong pediatric exposure. You can't really beat the location, probably one of the best locales to train in that's for sure. I will very likely rank this highly, top 3, barring any curve balls thrown to me by my remainder of interviews.

PM me with questions.

i went to my ucla/olive-view and harbor-ucla interviews and thought i'd share some stuff. i originally thought i'd like harbor better but i have changed my mind now. both are great places but i just got that gut-feeling about one more than the other...i LOVED ucla/olive-view. as background, i'm at harvard med so i'm stuck on the east coast right now...but my husband and i are dead-set on moving back to los angeles so i've really been trying to think carefully about which of the two hospitals i would rank first. here goes...

i'll start w/ my new favorite:

ucla/olive-view:
faculty: REALLY personable faculty...they were so enthusiastic and welcoming...well published and funded... Drs. Talan and Moran just received a $9million NIH grant for a new study. they are the kings of all things MRSA and you've probably already read their NEJM articles.
The program directors, Pam Dyne and Mark Morocco, are amazing. they're just the kind of people you want to spend time with...lots of fun, easy to talk to, very supportive of your own life and personal goals.
curriculum: this will be their first pgy 1-4 class. it's great to no longer have to do a separate prelim. as far as the patient populations: half of your time is spent in the westwood ivory tower (the new hospital building is FANTASTIC and will open this april). so you'll see all of the tertiary and rare pathology (transplant, neutropenic patients, etc)...you'll also have other awesome and world-renowned departments in the same hospital...this is a big plus as you can learn from them when you call your consults and learn from them when you rotate through the non-EM rotations.
additionally, the other half of your years are spent at the County hospital, Olive-view; there you can see the pathophys that comes with an indigent/poor and underserved population. Very rewarding working with that population...they seemed to be very appreciative of their docs since they don't have easy access to care. Residents also spend some time at Antalope Valley hospital where it's apparently Procedure Heaven and you get tons of practice.
Lifestyle: westwood is a great place to be because you have all the perks of being near a big university: football and basketball games, beautiful libraries and quads to lay out on during all the sunny days, etc. great beaches nearby (santa monica, pacific palisades, malibu). beverly hills and rodeo drive right there.
interview day itself: three interviews w/faculty, then an evening event at Dr. Morocco's house...the faculty and residents were all there and it was a blast. the faculty and residents have fun together as if they're more like equals...they really are a family and everybody parties. i'm all about being w/ people who really live up their free time.

Harbor-ucla
another awesome program...although it wasn't my personal favorite, i could see why other people would love it.
faculty: also another place w/ lots of big names like dr. hockberger. they also have some great research going on and they were very nice to us on interview day. unfortunately, they struck me as more old-school...less fun and less intertwined with the residents when not in the hospital. the residents and faculty seem as though they mesh together well and are a family on an academic/teaching level, but not as much on the after hours level (w/ the exception of maybe one or two faculty who seem to let loose).
curriculum: 1-3yr program so that's a big draw. similar to the olive-view portion of ucla/olive view in that harbor hospital serves an indigent/poor and underserved population. a plus is that they get lots of trauma (especially now that drew's closed). however, the downside is that the hospital doesn't have the bonus of being near the rest of UCLA medical center and having its $$, resources, or exposure to pathphys outside of the indigent population. the fewer resources also means that the other harbor departments are much slower and scut-filled when you're on your non-EM months (up until recently, on medicine you'd draw your own blood cultures, transport your own pt to CT if you wanted it done within a reasonable amount of time, etc...supposedly those things have recently improved but some residents say it hasn't). also, the entire ED and all charts run on PAPER!!! (w/ the exception of computerized lab results.) so i was really bummed to hear that. a big plus though is that the psych pt's go to a separate area of the ED and you rarely have to deal w/ them if they don't have a medical issue going on.
lifestyle: great beaches nearby (manhattan, hermosa, palos verdes estates). but no university around.
interview day itself: very similar: three interviews w/ faculty and then an evening event but it's just w/ residents, no faculty. the residents were really nice and all get along.

that's the end of my post but i'll add any edits if i think of anything. again, both are totally awesome programs and i'd be happy at either. but ucla/olive view just seems like my kind of place!! good luck everybody!

Residents: Expanding to 15 residents this year. Very close-knit, lots of post-shift get togethers, all seem sharp and personable, very diverse group.

Faculty: They’ve got the big names (Hockberger – editor of Rosen’s, Bessen – previous PD for 20 yrs) and we got to see some of them give presentations at conference. Humorous and educational at once! PD is down-to-earth, and always seeking input from residents. They seem to have a “Harbor Way” of doing things that has got their residents outstanding training for 30 years.

Interviews: 3 interviews, all with faculty, 20 minutes each. These interviews were a bit different in that they were more a place for you to ask questions about the program. They got 1000 apps this year, gave out 100 interviews for 15 positions … if you get an interview, they know you can cut it academically and so they’re just looking for a good fit.

Hospitals: Harbor is in Torrance, a predominantly Hispanic area south of LA and close to the beach communities (where the residents live). Patients here have the longest wait times I’ve ever seen (10-20 hrs with 24+ not that uncommon!) in the ED, but they are known to be grateful. Also, a very high patient acuity level (30% admit rate, with half of those going to the ICUs). Lots of community/hospital solidarity. Physical plant is nothing special, but that’s how county hospitals roll anyway. It’s really the people that make the place. All the services are “in this thing together” and have excellent inter-departmental relationships … medicine and EM seem to be very close-knit!

Ancillary: Didn’t really get a chance to meet them. The actual ED tour was very brief, but they looked like happy hard-workers.

Curriculum: 3 yrs, graduated responsibility (like all the good ones out there), Interns RUN all Pedi Traumas, PGY2s run Adult Traumas. Pedi EM seems to be outstanding here, and well-integrated into the curriculum with 5+ total months of that alone! Hard rotations are front-loaded with 4 ICU months in intern year, and 8 months of total call in first year. They have 1 month for OB, 1 for Neurology, and 1 Medicine Ward in 1st yr. Elective time is minimal (6 wks) but standard for 3 yr. program.

Didactics: Currently, split over 2 days but soon to be consolidated into one 5 hr day. Conferences are well-attended, more interactive sessions/procedure labs to occur.

City: The hospital is in an accessible part of an inaccessible city. LA is LA – you get the good (great cultural diversity) with the bad (ridiculous traffic). It’s in the South Bay, close to Redondo and Hermosa Beaches where most residents seem to live/play.

Negatives: The existence of a medicine ward month in 1st year seems odd since there are only 2 months in the Adult ED in the intern year. Traffic, traffic, and did I mention traffic? Get used to 2 hr commutes to travel 20 miles. Also, low-fidelity sims.

Overall: Clearly, Harbor has been doing something right for the past 30 yrs! Their patient population is a gift to EM – indigent and sick as hell, but grateful for care. The program has an easygoing feel, and resident camaraderie is high (lots of protected time for retreats … 1 week for interns, another for PGY2s, etc.). This is an excellent program, and it would be a pleasure to train here.

UCSF

I really enjoyed the interview day. it seems like it would be a great blend with the stuff at SFGH, Oakland (peds), UCSF, and Kaiser. The faculty seemed super excited and were keen to point out that while it was a new program, they have had lots of experience with stanford and highland residents rotating through SFGH in the past.
(+): amazing off services, SFGH only level 1 in SF, super dedicated faculty,
Minuses: while well organized, it seems that faculty are not super clear about how the shifts would work (how many 12H shifts, any 8H, etc). the residency director gave a very general statement that she was open to communication with the residents about the shift but was vague. this could be good but it could be brutal if we find out we signed up for 4 years of 20 12 hour shifts!!!


harbor:

(+) amazing history and variety....it was pretty cool walking into their chaotic ED and seeing the residents in action. amazing U/S training, interesting "college" section program that they will be putting into use for our class. residents seemed very happy
(-) some offsite services....some of the residents i spoke to were thought some of the offservice sites (like neuro) were pretty low yield. facilities are pretty old.

UCLA Harbor

A well-established 3yr program with an awesome reputation.

Residents: 15 will be taken this year. The program is growing in anticipation of its new ED and bustling patient population, and is looking to go to 18 by the time the new ED opens. The residents I met were down to earth and fun - typical so-cal folks. Though they were from all over the country, the socal personality is easy to adapt . As explained to me by the PD and some residents, the program makes no bones about wanting the very best, and regional ties and diversity come second. Apparently, they only take about 100 people to interview out of 1000, so the residents are in a pretty elite group. They seem to be salivated over in the job market.

Faculty: Big names abound like Roger Lewis, James Niemann, Miek Peterson, Bob Hockberger (the chairman), and David Burbulys, the PD. They do amazing clinical and translational research and hold powerful leadership positions in EM. The PD is a pediatric EM trained doc who is as sweet as pie and clearly loves and cares for his residents.

Hospital:
UCLA-Harbor hospital is the jewel of the program, a county ED with crazy sick patients that often have to wait 12+ hours to be seen (so THIS is where people are dying in the waiting rooms-jk, this obviously the non-acute waiting time!). However, word is they are grateful and wonderful to work with. Many spanish-speaking patients in LA, of course. They are looking at well over 100K/year. For all this, the ED is embarrassingly tiny, featuring 24 curtain beds that appear woefully inadequate for the 50+ people in the waiting room at any given time. Though this is terrible for the patients, the residents get great training and there is never a dull moment. The new ED should open in 3 years and will be much bigger. Residents also visit St. Mary's (community), Long beach, and Santa Monica to round out their experience.

Ancillary Stuff: Pretty good relationship with nursing, who are usually pretty great, but you will have to put IVs in sometimes for your sickies. Rarely would you have to transport pts to radiology.

Admitting/Documentation: EM is a big-dog here and has no real admitting issues. However, other services, like medicine and surgery, are also strong here. Documentation is all paper at the primary site.

Curriculum: Interns do complain that they only spend 3 mos in the ED (one is pediatric), but there are 4mos of ICU and they throw in Neurology, Medicine, and Ob such that you are almost all ED for the rest of your time in the program. Residents need to be autonomous because there are so many people that need to be seen ASAP. 3rd years run the board, feel like they can handle anything, and can probably snag any job they want. There is a chief resident year PGY-4 that one person is selected for. It is a well paid position (1/2 the faculty (and you can do a mini-fellowship).

Didactics/Research: 5hrs per week, it is currently 2hrs on Thursdays and 3hrs on Fridays but it will be consolidated into one day and made more modular in the future. The didactics were excellent while I was there, a good number of faculty came and contributed nicely, residents presented the M&M.
There are rounds 2 times per day in the ED, and lots of US usage. The research program is run by one of the most respected EM researchers in the country (Dr. Lewis), and features translational research opportunities with Dr. Niemann. None of this is required, though a scholarly something is.

City: Ah, Los Angeles - as a So Cal girl, I know it pretty well. So much to do, the program is 15 mins from Redondo Beach which is just lovely . The traffic sucks and the cost of living is on the high side (though not NY or SF). Fortunately, residents can take the street way home to Redondo Beach or wherever they might live and avoid the horrendous traffic. I drove to the beach after my interview and just watched the waves roll in - this made it hard to remember the programs negatives.

Extras: Salary starts at 42K, no housing stipend. But all meals are free (you just show your badge at the cafeteria) and the food is decent, all benefits are provided. There are also maternity and paternity benefits. They have tons of women faculty!

Negatives: The interview day could be better organized! It begins at conference without an intro, then you tour and go to lunch, then you interview after you might have gotten something on your clothes, then you get the "intro to UCLA-Harbor" talk AT THE END. There is no packet or schedule given out, so you are always a bit confused. The residents made a cool video that is outstanding and really gets you excited about the program.

Other negatives include the tiny curtain-divided ED and the COL in LA relative to the stipend.

Overall: A well-established academic county program in sunny California that will seriously open doors for you and train you to be a monster in EM like many graduates have become. They drive a hard bargain! This program will be at or near the top of my ROL (and if I go there we'll work on the interview day)

UCLA-Harbor
[+] Excellent reputation for training doctors who are desired in the job market, good trauma exposure, good peds exposure, busy ED, great location (you can live near the beach), good ICU exposure
[-] First year is very heavy in off-service months, with only 2 months in the ED. (The resident leading the tour said you're like a general pre-lim intern your first year) The residents seem happy with this and say that it helps them know other residents and the hospital better. Not great OB exposure (low volume of deliveries) but this may be changing. Some of the residents told me that they learn more on a "trial by fire" method than with upper level supervision. Patient population is mostly hispanic, and thus not very diverse. Technically not allowed to do international electives, but I think there are loop-holes to this.

Mt. Sinai
[+] Great academic institution, outstanding research $, happy residents, opportunity to participate in unique projects, like documenting injuries of torture victems to support their asylum application, support for international electives, good exposure to both an indigent/county-type population and to a tertiary facility population, amazing diversity in patients
[-] Upper east side isn't the most exciting place to live, commuting between two hospitals sounds like a bit of a pain, trauma-light (like all new york programs) although this one apparently sees a bit more at it's elmhurst location

This is a couples' match list...if it were just me, my list would likely look pretty different. Some programs would have been higher on the list (especially Cinci), but Vandy definitely would still have been my #1.

I interviewed at 18 programs, and ranked all 18. This ROL is obviously just my (and my fiance's) opinion- no offense to anyone is intended. It was really helpful for me to look through ROLs from past years, so I thought I should reciprocate by posting mine.

I felt so fortunate to get to interview at these programs and honestly thought each of them had notable strengths. The couples match certainly complicates things (and requires LOTS of negotiation) but luckily I feel like I would be happy at a lot of these places.

Let me know if you have any questions about my list or the programs I visited. I'm happy to give my advice/thoughts to next year's applicants too- just message me!

1) Vandy: I am absolutely in love with this program. Love the faculty, love the Chair and PD, love the residents. It's one of the most resident-centric programs I have seen, with the best teaching in the country. Very busy ED with so many critical care patients. Tons of trauma because of huge cachement area; great relationship with trauma surg. Curriculum extremely well thought-out, including no floor months. Residents are very close and are amazing people. Very diverse patient population (tertiary care, uninsured/underinsured, bread and butter EM, peds, immigrants). Nashville is a really fun city, great COL, easy to live right by the hospital. Grads go anywhere in the country they want. This program has everything I want.

2) UCLA-Olive View: Truly amazing PD who has the residents over to his incredible house (and he was the medical director for the show ER- I thought that was pretty cool), and distinguished faculty. Well thought-out integration of county and tertiary care experience. Ronald Reagan is an incredible facility, and Olive View is a nice little hospital that has a new ED opening this April. Program curriculum is "front-heavy" (easier 3rd and 4th years), which I liked. Intern year is getting much better every year- there will be 6 months of EM during intern year 2011-2012 and fewer medicine/surgery ward months. PD described the program as a "liberal arts EM program," which I thought was an apt description and a pretty neat concept. Amazing international opportunities and a lot of elective time. My Spanish is mediocre at best, and that seems pretty essential (especially at Olive View). Trauma not as extensive as at other LA area programs. COL high and lots of commuting in nasty LA traffic.

3) UNC: Residents were very happy and welcoming. I really liked the dual hospital system. I went back to do a second look and shadowed at both hospitals, which only served to increase my enthusiasm about their way of training. Of course, it does result in a lot of commuting but the traffic isn't bad so that didn't bother me. Amazing PD who is an outstanding teacher and very supportive of the residents. Program produces very well-trained EPs who also have satisfying personal lives. I love the location and the COL. Great moonlighting opportunities. Medicine and surgery ward months intern year (but at WakeMed so relatively laid-back). Not as much trauma as some other programs. Duke is obviously nearby so there is some division of patient populations, but I felt that was made up for by the WakeMed experience.

4) Highland: This is a well-known program that I felt lived up to its strong reputation. Faculty and residents are all very laid-back and fun. Strong family feel. A lot of the faculty trained at Highland (which may be a negative), but of course they stayed on faculty because they love it so much there. GI rounds TID seem like a great idea. Not an "official" Level 1 trauma center but there is none in the county, so serves as the de facto trauma center and see a lot of trauma. Not a stroke center, so do a month of neuro at UCSF. Amazing U/S experience. Peds is not integrated (no peds beds in HGH). Highest salary I saw on the trail (because they are unionized). Tahoe ski cabin sounds like fun. Sounds like they have everything worked out in regard to UCSF's EM program, but still made me a tiny tiny bit nervous.

5) BIDMC: The 3+1 (Junior attending year) is an amazing opportunity that I was very excited about. The curriculum is very well thought-out with a clear graduated responsibility. Rotate through 5 "affiliate" hospitals (community sites), which seems like a good experience to see how different systems work. Amazing EMR. Peds not integrated. Trauma pretty good but obviously there are a lot of hospitals (including four Level 1 trauma centers) in Boston. Relatively new program (10ish years) but has established itself extremely well. Had a great feeling about this program on the interview day and it was initially higher on my list; in the end, I decided that Boston is not at all ideal for me and that's what pushed it down the list a bit.

6) LA County: Another program that was initially much higher on my list. I was in awe of this program during the entire interview day. Very sick patients and a lot of trauma, in which EM has a huge role (they do essentially all procedures). EM also manages airways during codes on the floors (which at most other places is done by anesthesia or MICU)- I thought that was cool. Residents were really fun people and amazingly impressive. Work 12s all four years (except on peds). Facilities are amazing but very much divided up into pods. Not as many academic opportunities as a lot of other programs I looked at. This place, in my opinion, provides the best clinical training in the county but wasn't the best fit for my career aspirations and personal life once I got over the "sexiness" of the amazing clinical experience. Location also not ideal for me personally.

7) Wake Forest: I love this place. PD and Chair were both very enthusiastic. Very well-established (30 years old) program with a long history of producing great EPs. Residents were very family-oriented. Very busy ED, which pleasantly surprised me. Loved the city (can get an amazing house for very little money) but it did feel a bit isolated.

8) Emory: So many faculty, and a lot of them are really well known in EM. Increasing focus on research- get a lot of NIH funding. Grady is Grady- tons of trauma (only Level 1 in Atlanta). Hugely busy, exciting ED. Patient population at Grady not very diverse- primarily African American. ED divided into red (surgery/trauma) and blue (medical) pods. Residents were very diverse and most were single. Atlanta is amazing but of course the traffic sucks and it's relatively expensive. I expected to like the program more than I did, but I got a weird vibe on interview day. It was probably just me, though!

9) Indianapolis: LOVED this program but in the end the location just wasn't going to work well. Residents were incredible- really sociable, welcoming, and proud of their program. Outstanding clinical experience, with time split between Wishard (county) and Methodist (tertiary care). Residents have a huge role in their program (49% ownership) which I thought was amazing. Very much a team attitude. In ICUs, work one-on-one with CC-trained EM faculty- so a great experience. Residents were more regional than I had expected for a nationally well-known program.

10) BWH/MGH: Strong academic program. Well-known faculty and lots of research opportunities. Felt like this was a great place to jump-start a career in academics. Lots of elective time. Program grads are highly recruited and go wherever they want after training. From talking to the residents, seems like they do fewer procedures than most other programs I looked at. Also, medicine and surgery ward months. Residents said they felt a bit "looked down on" by other residency programs at the hospitals, for what that's worth. I'm not a fan of Boston.

11) UAB: Their PD is awesome. Very responsive program leadership. The residents are pretty Southern and a lot of them have kids. Great lifestyle. Do LOTS of moonlighting. 10-year old program but feels like it's been around longer (that's a good thing). Birmingham was a very pleasant surprise. Great physical set-up of the ED. Very impressed by the program but realized as interview season progressed that I wanted a place that produces more academicians.

12) Wash U: Very busy ED. Great elective opportunities. Strong off-service rotations, but lots of ward stuff 1st year. Division status (I asked about this and the program leadership said it's not an issue). Didn't really care for St. Louis.

13) Cincinnati: LOVED this program- would have been among my top few programs, but my fiancé really disliked it for his specialty. Oh well.

14) UVA: Very nice program leadership, good reputation. Relatively low volume (although also smaller class so it works out.) Not much trauma. I didn't really click with the residents. City was too small and isolated for me. Great program but not a good fit for me.

15) Michigan: Awesome program. Love the PD. Survival Flight sounds great, as does the trauma experience in Flint. I didn't really click with the residents. The main problem for me was the location. I just don't think I could tolerate those winters- I almost crashed my car about 5 times just while I was up there interviewing.

16) Duke: I thought the PD was incredible and the faculty were very impressive. Residents were nice but seemed pretty guy-dominated. The program seems to be still fighting some battles. Wasn't a good fit for me.

17) Louisville: Had a really weird interview day, in my opinion. I found the group interviews to be awkward. Relatively low volume ED but lots of trauma. Not what I was looking for, but it had a lot to offer.

18) Harbor: This one was a surprise. Very well known program with great pathology and amazing faculty, but not a good fit for me. I personally don't want to have to deal with the transition from 3 to 4 years and the move to a new physical ED. I greatly preferred USC-LAC, but that's obviously just me and it's good that not everyone loves the same program!

Previous years' ROL threads were a great help to me when I decided where to interview, so here's my part this year.

My list would also be much different were it not for 1) a spouse in the picture and 2) my interest in international EM, so take it with a grain of salt and to echo SuziQ, feel free to PM me with questions regarding any of the programs I interviewed at. Honestly, I'd be thrilled to land anywhere on my list.

1. Vandy Pros: INCREDIBLE faculty, residents, unparalleled teaching, the PD and chair are a dynamic duo that are very involved in resident education. Busy, busy university ED where you see ALL the trauma in a large catchment area, plus all the weird tertiary stuff, and your bread and butter. Great international opportunities with the Guyana residency, New Zealand, ect. Off service rotations are great, peds shifts are mixed into your regular ED months, residents are happy, 10 hr shifts with 1 hr built-in overlap, COL is incredibly low, Nashville has a great live music scene. Cons: Less diversity (in both staff and patient population), you're in a smaller southern city (+/-). Caveat: I rotated here, so I'm bias in that I'd already spent a month getting to know and love the people. But honestly, couldn't find a better program on the interview trail.

2. Brown Pros: this was the program that snuck up on me. I even considered canceling the interview. Like Vandy, a university program with a large single hospital program with a huge catchment area, very busy ED. Happy residents, warm faculty, great peds experience, strong support for international work and opportunities (currently setting up a training program in Nicaragua), 9 hrs shifts all 4 years, Providence has surprisingly low COL for the northeast and is a great little town with amazing food and recreational opportunities. Cons: It's in Rhode Island, 4 yrs > 3yrs.

3. New Mexico Pros: another single-hospital system with a huge catchment area (which I like for the reasons above), incredibly nice PD, down to earth faculty, happy happy residents, strong commitment to underserved care with a large indigent community, great international/wilderness opportunities, one of the best programs for critical care exposure, great reputation, large Spanish-speaking population, only 4 months of call all 3 yrs of residency, 9 hr shifts with 1 hr built-in overlap, you have skiing and hiking less than an hour away. Cons: the city's economy somewhat depressed, less job opportunities for spouse (this program would be my #1 or #2 if not for this), less ethnically diverse.

4. Highland Pros: well-respected program, hard-core county training, in a beautiful part of the country. Great service commitment, residents are happy, strong pedi exposure at CHO, tox at SFGH, 8 hr shifts. Cons: the faculty are quirky (+/-) and somewhat inbred, very weird interviews, draw your own labs as PGY1, ED itself felt a little small, not a Level 1, the cafeteria food (yes, that's picky).

5. OHSU Pros: old, well-respected program with happy residents in a beautiful part of the country, diverse hospital exposure (university, VA, community), faculty very supportive of residents, 1:1 with attending as PGY2.10 hr shifts PGY1, 8 hr shifts PGY 2-3. Cons: low-volume primary ED, only 1 mo elective time, have to drive a lot.

6. Stanford Pros: Dynamic faculty, content residents, 3 hospital system with exposure to university (Stanford), community (Kaiser) and county (Valley), an AMAZING amount of resources for anything you could possibly be interested in, great fellowships, great international and wilderness opportunities, beautiful part of the country to live,time for research/scholarly project built into rotation schedule. Cons: COL (highest of anywhere I interviewed-this was huge for me), low-volume at primary ED (Stanford) which is where you spend 1/3-1/2 of your time, intern year spent with a lot of off-service rotations (including medicine and surgery wards and NICU time), 12 hr shifts, "country club" feel (the catered lunch comes to mind).

7. Carolinas Pros: incredible community program with great training, I loved the PD and faculty I met, residents are very tight and social, 1 hr conferences daily instead of a 5 hr block, single-hospital system, great U/S experience, starting an international fellowship, great COL. Cons: I thought Vandy was a better fit for me when it comes to Southern programs, their int'l focus is in Tanzania (my interest is Latin America), medicine and peds wards months, Charlotte, a very "proud" program.

8. USC Pros: Incredible faculty and residents who obviously enjoy working at LAC, probably the most amazing county training out there (certainly busiest ED in the country). Great diversity in both staff and patients, huge volume ED that probably sees some of the craziest trauma and pathology, residents run their own "pods" and jail ED, commitment to indigent care, in SoCal. Cons: 12 hr shifts all 4 years, maybe a little too autonomous for my taste, can only do international rotations on your vacation time, LA is not my favorite city.

9. BWH Pros: amazing resources for international EM, great U/S program, friendly, well-connected faculty, great opportunities for research and an interesting mix of pathology, shifts are a mix of 8,9, and 12 hrs. Cons: residents were the geekiest bunch of the trail (but seemed very happy!), greater focus on research, Mass Gen's ED felt very cramped, COL in Boston, 4>3 yrs.

10. Emory Pros: great service commitment, huge county program that is also academic, diverse residents and patients, busy ED. Cons: the number of patients I saw in hallway beds!, not as much international support, very county feeling, strange interview.

11. Harbor UCLA Pros: amazing country program in LA, great training, well-respected, good autonomy. Cons: not much international support, LA.

12. Baylor Pros: amazing county hospital with incredible pathology and young, enthusiastic faculty. Shifts 8's on weekdays, 12's on weekends. Cons: too new of a residency program.

13. Duke Pros: Dynamic PD, good mix of faculty, happy residents, time for scholarly track, COL. Cons: not very diverse, Durham, still young residency program, hard PGY1 year with lots of off service rotations, not as many intl opportunities.

Would be thrilled at any of my top 5, especially top 3. Kind of wondering if I should have ranked Vanderbilt higher in retrospect. I was extremely impressed by that place (they pretty much have it all!) but just didn't feel like I could legitimately pick Nashville over LA or Boston...oh well, too late now! And I really do love LA, not so sure about the south. Why can't Vanderbilt be in a bigger city?!? Anyway, we will see what happens on Match Day.

1- LAC/USC: +top-notch clinical experience, +tons of procedures, +very hands-on, +autonomy, +work in jail ED, +residents a lot of fun, +EM is top program in hospital, +brand new enormous ED, +/-tons of Spanish speaking patients, +intern year months alternate ED and offservice, -pods isolated (i.e. in one shift, only work in resuscitation area), +ED residents get all ED procedures except thoracotomies, -all 12 hour shifts all 4 years, -attendings are reportedly hit or miss in terms of availability, +love LA (and family in area), -not that many opportunities for research

2- BWH/MGH: +tons of amazing, cutting-edge research (affiliation w/ MIT, so tons of biomedical technology), +supportive environment, +big names in EM, +/-two pretty diverse clinical sites (trauma, more county-style at MGH and lots of cancer/gyn/superspecialized stuff at BWH), +great didactics, +strong reputation, +other top residency programs at the hospitals, -floor months, -Boston is a little oversaturated in terms of hospitals so not your "typical" EM experience, +Boston, -tons of PAs in the EDs, -not nearly as much trauma as my #1 and #3, +spouse prefers Boston

3- Vanderbilt: -NOT a county program but +they get all the trauma in Nashville (lots of penetrating), +outstanding program leadership, +incredible didactics, +residents exceptionally happy, +great reputation, +really really sick patients in busy ED, +no floor months and lots of ICU experience, +/- nearly all at one site (exception- community EM months), +get tons of procedures, +trauma time is ICU only, +/- Nashville (seems like very nice city, good COL and weather, but not as exciting as LA or Boston), +strong and integrated peds EM experience, strong EMS

4- UCLA/Harbor: +getting a nice new ED in 2013ish, +residents live by the beach, +plenty of autonomy but attendings are available and involved, +county experience but big name, +great reputation, +very appreciative patients, -transitioning from 3 to 4 years, +trauma, +LA (lived there before- love it), +changing/improving didactics, -not as intense a clinical experience as USC.

5- Cincinnati: +Love the flight program, +/-pretty intense residency, +great reputation, +faculty are great, +1st/4th year mentorship, -not ideal place to live, +/- nearly all at one site (exception- community EM months), -might kind of suck to get pulled out of your shifts to fly

6- Maryland: +Shock Trauma is incredible (but -separate trauma months), great program leadership, residents happy and friendly, +no floor months, -Baltimore, -Hopkins interaction seems a little odd

7- Indiana: +great county and academic experience, +Methodist and Wishard very close together, +friendly residents, +well-known program, +huge patient volumes at the two hospitals combined, -Indianapolis is kind of blah, -ready to get out of Midwest, -liked Cinci a bit better when comparing Midwestern programs

8- Maricopa: +location (family in area), +autonomy, +residents very nice, +program leadership impressive, -facilities, - offservice rotations, -other residencies in the hospital

9- Carolinas: +great atmosphere, +great reputation, -floor months (medicine and peds, I think), -not as much trauma and medically sick patients as my top choices, -honestly thought Vanderbilt was a stronger program when comparing Southern programs

10- Bellevue: +autonomy, +great reputation, +lots of ICU time, -peds experience, -trauma experience, -cost of living (decided NYC is not for me)


Plus a few others...

Harbor comparison thread: http://forums.studentdoctor.net/showthread.php?t=788569

1. Harbor-UCLA
+sickest/highest acuity of patients especially now that MLK has closed, getting new ED in 2012, 3 years, ridiculously nice people (both residents and faculty) who are incredibly well respected in field, peds ED (usc residents used to rotate here for peds), great autonomy but not too much, procedures, procedures, lots of trauma (saw 6-911 gurneys lined up one friday night), R1-R3 participates in all codes (vs USC), great relationship with surgery/medicine, +research opportunities, +location near beach!, 3 meals a day free, Wilos!, spanish speaking population, amazing job prospects afterwards in both academics and community, cameraderie fellow residents both ED and other services, great community experience at 3 hospitals.

-going to 4 years soon, LA traffic, not a ton a support for international work, cost of living (sunshine tax)

2. UC Irvine
+small class, research opportunies, leaders in disaster medicine and other fields, new PD goes to bat for residents, 3 years, residents live in newport beach, new hospital, great ultrasound program, first name basis with faculty, close knit, international opportunities
- surgery runs the show on traumas, need to take shuttle to get to hospital, questionable relationship with other services

3. UCLA/OV
+awesome well rounded experience at 3 hospitals, 4th year focused on career and skill development, connections in So-Cal. probably some of the most supportive faculty and residents I have encountered,
truly a family, focused on helping obtain career goals, great international opportunites, fantastic location
-4 years, driving in LA to different sites

4. USC
+crazy trauma that is on par with Harbor, new ED, excellent didactics, mel herbert , research opportunities,
- 4 years, 4th year doesn't add value (vs UCLA/OV), too much autonomy would like more teaching on shifts, faculty presence in ED, some malignant faculty (not experienced personally but from prior rotators), Pod system doesn't allow for resident involvement in all codes (vs Harbor), no relationships with other services since ED is King

5. Highland

6. UC Davis
+excellent hybrid of county and academics with community exposure at kaiser, 3 years, super supportive faculty, location is great for foodies and outdoorsy folks, great trauma, brand new ED, relationship with other services
- location if you need to be in a more urban environment

Based on the above reviews, these are the bulleted points I've gained about UCLA-Harbor.

General info:
-4 year program
-16 residents/year
-40 adult beds, 12 ped beds @harbor (this was pre-renovation, so this is likely outdated info)
-salary starts around 45k, increases about 5k each year, stipends not used added to pay

Schedule:
-I read 8 and 10 hour shifts, not sure which is correct

Off-site Locations (based off Harbor website):
-St Mary’s ED (3 weeks, PGY-2, 9.8 mi away from Harbor)
-West LA VA MICU (3 weeks, PGY-2, 21 mi away)
-White Memorial ED (3 weeks, PGY-3, 20.1 mi away)
-Long Beach Memorial ED (3 weeks, PGY-3, 7.2 mi away)
-White Memorial NICU (3 weeks, PGY-4, 20.1 mi away)
-Long Beach Memorial ED (3 weeks, PGY-4, 7.2 mi away)

Perks
-3 free meals/day

Since it's been about 4 years since the last review, could someone please give an update with any information I post that is wrong or missing? Specifically, I would like to know the following:

-number and length of shifts per month for each PGY year
-who runs the trauma at Harbor? is it an alternating schedule with surgery? who does the procedures (EM or surgery)? who does the airway? does EM do RSIs, chest tubes, etc or is that handed off to surgery/anesthesia?
-it appears that most of the off-site locations are done PGY-2 through PGY-4. Are these weeks done all at once? Or are they spread throughout the year? Reason I ask is because commuting in LA is horrendous, and I would like to know if I have to deal with a bad commute in concentrated weeks or sporadically through the year. Also, can someone comment if I missed any other weeks at any off-site locations.
-is there any commuting between site locations (outside of the dedicated PGY2-4 weeks)? I'm looking for programs with minimal commuting.
-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? (transporting own pts to CT, etc)
-is the environment family friendly? What percentage of the residents are married, have children?
-another poster above mentioned 8 months of call in the first year. This is confusing, I thought EM as a specialty did shifts, not calls.

Harbor-UCLA resident here:

-number and length of shifts per month for each PGY year
Will be decreased with the 4-year program once we have PGY-4. Currently in the 3-year format it is around 21-22 shifts in 30 days, each shift around 9 hours.

-who runs the trauma at Harbor? is it an alternating schedule with surgery? who does the procedures (EM or surgery)? who does the airway? does EM do RSIs, chest tubes, etc or is that handed off to surgery/anesthesia?
The primary/secondary survey is always an Emergency Medicine resident. Airway is always a (senior) Emergency Medicine resident (junior residents can do medical airways, but our agreement with the trauma service is that the airway management in trauma is PGY-3+). We split the chest tubes and resuscitative thoracotomies with the Trauma Service depending on the medical record number (even is ED, odd is surgery) but nobody worries about that too much unless the patient is really stable. The rest of the resuscitation procedures are pretty much whoever is available (e.g., central lines, etc.). We have a very good working relationship with the Trauma Service.

-it appears that most of the off-site locations are done PGY-2 through PGY-4. Are these weeks done all at once? Or are they spread throughout the year? Reason I ask is because commuting in LA is horrendous, and I would like to know if I have to deal with a bad commute in concentrated weeks or sporadically through the year. Also, can someone comment if I missed any other weeks at any off-site locations.
I just finished updating the website today, so you can see the new schedule. The blocks are 3- or 4-week blocks where you would be rotating at outside places. Honestly the commute isn't that bad most of the time as long as you plan your trips accordingly. Most shifts are scheduled being cognizant of that and help to avoid the traffic, when possible.

-is there any commuting between site locations (outside of the dedicated PGY2-4 weeks)? I'm looking for programs with minimal commuting.
Other than the outside rotations you had mentioned, all other rotations are done at Harbor. Therefore, your commute >90% of the time would be dictated by your proximity to the hospital.

-is there an EMR? Is it Epic quality or a horrendous excuse for a computer program? Is there still paper charting?
We have Cerner, which is what the rest of the DHS facilities (USC, Olive-View) will be using. It's not quite as good as EPIC, but it is very efficient and easy to learn to use.

-how is the scut work for EM and non-EM months? (transporting own pts to CT, etc)
The scut work is there, as it is in all programs with off-service intern years, but the other services have a very good relationship with us and so usually it is kept to a minimum when applicable. That said, paperwork needs to get done and notes need to get written on patients when you are in the ICU, on the wards, etc. and the intern is the person that typically does those jobs in all hospitals with residency programs.

-is the environment family friendly? What percentage of the residents are married, have children?
There's many married people in each class, and at least a few with children each year as well.

-another poster above mentioned 8 months of call in the first year. This is confusing, I thought EM as a specialty did shifts, not calls.
We do not take call, except on the VA ICU rotation, when we are the ICU senior and do take call q4 for that month.

Please feel free to ask any questions you may have and I am more than happy to answer them.

Wow, thank you so much! That was the most helpful and direct response I've received in a while. You addressed every question I had. Thanks again. If your helpfulness is a reflection of your colleagues at Harbor, it must be a great place.

RPedigo said:

-number and length of shifts per month for each PGY year
Will be decreased with the 4-year program once we have PGY-4. Currently in the 3-year format it is around 21-22 shifts in 30 days, each shift around 9 hours.

Click to expand...

Couple more questions RPedigo,

What year did the 4 year program begin? Based on 2011 posts, it seems like it started in 2012. If that is correct, then the first year that Harbor will have PGY-4's is 2015.

Also, I'm assuming the 21-22 shifts per month you mentioned is just for interns. If PGY-2+ have decreased number of shifts, can you comment on how many shifts per month a typical PGY-2 and 3 have? (There aren't any PGY-4's yet so I imagine you can't comment on that).

Can you comment on the size of the ED? Last quoted number I have is 40 adult and 12 peds beds, but this is pre-renovation. Thanks!

rocketfrog03 said:

Couple more questions RPedigo,

What year did the 4 year program begin? Based on 2011 posts, it seems like it started in 2012. If that is correct, then the first year that Harbor will have PGY-4's is 2015.

Also, I'm assuming the 21-22 shifts per month you mentioned is just for interns. If PGY-2+ have decreased number of shifts, can you comment on how many shifts per month a typical PGY-2 and 3 have? (There aren't any PGY-4's yet so I imagine you can't comment on that).

Can you comment on the size of the ED? Last quoted number I have is 40 adult and 12 peds beds, but this is pre-renovation. Thanks!

Click to expand...

The 4-year program began with the class behind me (I am class of 2015). Therefore, the current PGY-1 and PGY-2 are in the 4-year program. So the PGY-2 will be PGY-3 during the 2015-2016 academic year, and PGY-4 starting the 2016-2017 academic year.

The shift structure will be less shifts by the time anyone here who is considering applying would start, since there will be PGY-4 in the ED as well (meaning each resident needs to do less shifts for identical coverage). Therefore, any comments I make would not be applicable to anyone interested. But the answer is "less", but I can't really give you a number that I could guarantee accuracy on, to be honest. The schedule is very good though; I always feel like I have ample time off even on the days that I do work. The schedule when there is a full PGY 1-4 class will be even better.

The new ED opened 4/2014 and the new layout is as such:
- Pediatric ED pod: 2 resuscitation bays, and about 22 or so normal pediatric ED beds (can still do conscious sedation, etc. in about 3-4 of the other beds and do resuscitation if required) including an ENT/dental room and a room for delivering babies should it occur (I've delivered babies in our peds ED before)
- There are two adult pods, each with roughly 20 beds, plus a trauma pod with 5 resuscitation bays. We are changing the team layout and the plan is to have one "team" of residents (e.g., a junior and senior resident, plus usually an intern or off-service senior resident, plus an attending) per pod and manage that pod plus half of the resuscitation bays. The other pod would be identically set up as well. A few of the beds in each pod will be fast track-type beds and the NPs will screen the sicker patients to be put back in the beds for us and also will see and dispo the lower acuity patients for us, so it optimizes your exposure to high acuity patients. By the time anyone who is applying starts here, that is almost certainly the way that the pods will run. We do not have our shifts stratified by acuity (e.g., no "trauma" or "resuscitation" shifts), so you see the whole spectrum of pathology each shift.

The training here is phenomenal, the patients are grateful and are a pleasure to see (even though sometimes they wait 12-24 hours or longer to be seen because our waiting room is often 100+), and the pathology you see here is remarkable. Every disease imaginable comes through the ED at Harbor, and it's really nice to be able to actively manage those diseases instead of reading about them. When people talk about the differential diagnosis for chest pain, I feel much more comfortable managing those patients because I have personally diagnosed and managed bunches of aortic dissections, tension pneumothorax, tamponade, etc. Also, a large portion of Rosen Emergency Medicine is written by our faculty, and it's nice to get teaching by the people who "wrote the book" on Emergency Medicine, so to speak. Even though they are incredibly accomplished, they are also very humble and approachable. It's really a great working environment and an amazing place to be. There has not been a day where I have second-guessed my decision to rank Harbor #1.

We also have sit-down rounds twice a shift (beginning and end) which includes protected time for teaching from the senior residents and attendings. We also do teaching on each case as it is signed out, when applicable. I really like that because each shift you know there will be two opportunities to get really good dedicated teaching that is relevant to the patients you just talked about (and therefore more memorable).

Thanks again RPedigo for answering my questions and commenting on the training at Harbor. This sounds like a fantastic place. I'm pumped to do an away here, hopefully it isn't too late to get an application in.

RPedigo said:

We do not have our shifts stratified by acuity (e.g., no "trauma" or "resuscitation" shifts), so you see the whole spectrum of pathology each shift.

Click to expand...

Not that I have any personal experience what the alternative would be, but this sounds like such a better way to train. I would ideally like to see the spectrum of pathology throughout my years, rather than concentrated blocks of "trauma" and "resuscitation." Thanks for pointing this out.

Hi all. Harbor intern here. I used these forums a ton last year so am paying it back. I’m very happy with the clinical training here thus far.

What I am also happy to speak about is the social medicine and public health work being done here for anyone who is curious and for whom this is a differentiating factor between programs given their interests and desire to be involved in this type of work during residency and/or after they graduate.

Feel free to message me.

Recently interviewed here, here's what I thought/found:

Harbor-UCLA: incredible location by the beach. Decently high volume, high acuity. Highly autonomous in most procedures, split trauma procedures with trauma surgery but ED has all airways and I think always runs it. Most ortho reductions are within the ED scope, but not all. PGY3 and PGY4s are on airway call inpatient for half the week. They do have TEE and an enthusiastic ultrasound division. Their EM-CCM faculty are growing, very excited to get EM residents into CCM. Integrated Peds shifts starting PGY2. 4-year program with shift reduction, minimum 4 night shifts per month. Average amount of elective. Academic rounds first hour and last hour of shift (brief didactic session by resident/faculty; management and disposal discussion of every patient). Very social EM/patient-driven, more time to get involved with projects. Emphasis on professional/academic development. Moonlighting as early as PGY2 but usually start at PGY3. Tons of construction happening the next few years unfortunately but for anyone who reads in the future it’ll probably be done by the time I would be done! 2028ish?

There's your TEE again. What's up with that?

I liked this program but didn't go there.

thegenius said:

There's your TEE again. What's up with that?

I liked this program but didn't go there.

Click to expand...

I guess you could do a TEE to make sure there wasn't a clot before you cardioverted or you could do a TEE if someone's kidneys are botched to rule out an aortic dissection.

I think I'd rather just admit and move on to the next patient rather than spending 30+ minutes sedating and performing a TEE to avoid an admission, and contrast loads in life or death situations are acceptable in patients with renal failure especially given the newer literature supporting CIN not being as much of a problem as the more hyperosmolar/iodinated contrasts.

southerndoc said:

I guess you could do a TEE to make sure there wasn't a clot before you cardioverted or you could do a TEE if someone's kidneys are botched to rule out an aortic dissection.

I think I'd rather just admit and move on to the next patient rather than spending 30+ minutes sedating and performing a TEE to avoid an admission, and contrast loads in life or death situations are acceptable in patients with renal failure especially given the newer literature supporting CIN not being as much of a problem as the more hyperosmolar/iodinated contrasts.

Click to expand...

Agreed. Who in this world has time to do a TEE in the ER? If someone needs a TEE, they get admitted.

Back when I was in academia, TEE's main draw for the ER was in optimizing chest compressions in CPR. You can do continuous CPR with a TEE in place, knowing you are hitting the right spot, and know if there is ROSC earlier. My Department was trying for a while to get it to be one of the first in the area. Whatever it takes for program marketing, right? Agree it's over the top and of very little real life utility.

GatorCHOMPions said:

Back when I was in academia, TEE's main draw for the ER was in optimizing chest compressions in CPR. You can do continuous CPR with a TEE in place, knowing you are hitting the right spot, and know if there is ROSC earlier. My Department was trying for a while to get it to be one of the first in the area. Whatever it takes for program marketing, right? Agree it's over the top and of very little real life utility.

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I mean why stop there? Let's do ECPR even though the research doesn't support it. TEE+ECPR FTW! In all seriousness, piston-based CPR (e.g., LUCAS device) provides far superior compressions.

I noticed this too.
"Wow, this guy thinks that things you never do in the ER are real selling points for the program!"

RustedFox said:

I noticed this too.
"Wow, this guy thinks that things you never do in the ER are real selling points for the program!"

Click to expand...

uh okay.

The TEE thing for me is two-fold. One, I just really enjoy ultrasound and thought it’d be a neat tool to learn about and be trained on. Second, I’m planning on working at an academic institution (not community practice) mainly because I enjoy teaching. About half the programs I interviewed at do resuscitative TEEs. The literature is minimal but growing, but like an above poster mentioned it is primarily used in cardiac arrests and undifferentiated shock and can potentially guide management.

There’s no telling what’s going to be big in 10-20 years, so I figured why not learn as much as possible in residency since it’s the one time in my life that I train.

Lastly, the TEE thing is a minute point that I don’t really factor into my ranking. My #1 ranked program doesn’t do TEE.

BenignBeignet said:

uh okay.

The TEE thing for me is two-fold. One, I just really enjoy ultrasound and thought it’d be a neat tool to learn about and be trained on. Second, I’m planning on working at an academic institution (not community practice) mainly because I enjoy teaching. About half the programs I interviewed at do resuscitative TEEs. The literature is minimal but growing, but like an above poster mentioned it is primarily used in cardiac arrests and undifferentiated shock and can potentially guide management.

Click to expand...

Yeah, all of us too when we were your age. We liked the shiny thing because it was shiny. And yeah; it potentially guides management until it doesn't. Most of us have been around long enough to see things that were myths become dogma, and then become heresy. (See: Renal dose dopamine, steroids and spinal injury, CDM rules for C-spines, etc).

Yeah, I thought I would go into academics too. Then I learned what academics was actually all about. Anyone else out there? I guarantee there's a sea of hands going up on the forum.

BenignBeignet said:

There’s no telling what’s going to be big in 10-20 years, so I figured why not learn as much as possible in residency since it’s the one time in my life that I train.

Click to expand...

It would be better if residencies taught the skills you actually need in practice, but they don't like to do that because eww.

BenignBeignet said:

Lastly, the TEE thing is a minute point that I don’t really factor into my ranking. My #1 ranked program doesn’t do TEE.

Click to expand...

Seemed big enough to mention it in your deluge of reviews. In real-life, we use ultrasound for exactly one thing: CVLs.... sometimes.

cyanide12345678 said:

Agreed. Who in this world has time to do a TEE in the ER? If someone needs a TEE, they get admitted.

Click to expand...

This is Pie in The Sky kind of stuff that is only done in residency at some fancy top 30 academic hospital.
Funny thing is Canadians just shock everybody, all the time, regardless of how long in afib.
Now we are not only doing < 2 days, now there is possible TEE? LOL

Oh my god..the thought of doing TEE in the ER makes me gag. How would I justify all that time suck to my colleages seeing 2.5/pt hr and the waiting room piling up and getting worse, all so the cardiologist who comes down to the ER says "Oh ok! nice TEE. i'll take him to the cath lab and do my own."

I have nothing against TEE itself, it's just so far away from commonplace ER practices. Like if academic institutions are doing this, I would never want to go to one as a patient.

As a cardiologist that purposefully doesn’t apply for TEE privileges because life is 100x easier when you say, sorry I don’t do TEEs (mostly to neurology and ID), I just can’t wrap my head around those fixated on wanting to do them in such meaningless situations.. especially when you’re in such a busy place like the ED

They’re perfect for anesthesia where they have time to dink around contouring their arms to see random stuff

Resuscitative TEE is a very different beast than doing TEE inpatient. Basically the algorithm is anyone who’s an arrest with ROSC or peri code/in shock gets a TEE probe dropped in as soon as they get tubed.

You’re not looking to get 20 views and doppler measurements. It’s a quick 4 view exam that basically says what their contractility is, how the RV looks, if they’re severely volume overloaded or depleted, and if you see an effusion or dissection flap.

The whole thing takes under a minute to perform and is part of doing a resus along with intubation, lines, etc. The pros are that TEE views are better/clearer, don’t rely on windows, and it’s actually much less operator dependent than trans thoracic.

Obviously this is something that’s happening at a handful of academic centers in the US and is on the cutting edge of resuscitation medicine - nowhere near the main stream. But then again so was transthoracic US 20+ years ago.

It’s a neat skill and an interesting thing to have in a residents education, but I wouldn’t put more than a penny’s stock in resus TEE when choosing a program. Both because the chances you’ll be using it as an attending are low and because it’s not particularly challenging to learn - the skill can easily be picked up as an attending on the off chance you end up working at one of the few shops doing this.