This is my last review, I hope they've been as helpful as I found the previous reviews to be when I was considering EM programs. Now to sort out that whole ROL thing...
Johns Hopkins University
Residents: 12 residents per year. This will be the first class to enter the 4-year curriculum, so it will be years before there will be more than 36 total. The social event was well attended, and the residents appeared to get along well (some were doing shots; everyone was taking time to interact with the applicants). Interviewees attend a chairmans conference (sort of like an M&M with a presenting resident and Dr Kelen running the show), and there was a lot of joking and good nature in the crowd. I was a bit surprised by this, based on rumor about the program, but for my interview day at least everyone seemed to get along well. Residents are from all over the country, and live scattered throughout the Baltimore area. Im pretty sure SDNs shortbread9 did my tour
Faculty: I was extremely impressed by the faculty I met possibly more than anywhere else. Interviewees get a lot of face time with Dr. Kelen, and he even does a bunch of the interviews. Hes very down-to-earth and confident about the program. The PD, Dr. Chanmugam, is really nice even a bit goofy at times - a true resident advocate. He seems to have vision, albeit a little abstract, about leadership and teaching. Two other faculty members I interviewed with were wildly impressive and everyone repeatedly mentioned how amazing it was to be an academic in the fertile Hopkins environment. One of the assistant PDs took us on a bus tour of Baltimore and seemed really enthusiastic as well. Residents report a first-name basis with most attendings, although some did mention that there were a few that were tough to get along with. There is an incredible emphasis on international EM and policy/admin here seems like practically everyone on faculty has an additional MPH or MBA.
Hospital:
Time is split between Hopkins, Bayview Medical Center, and Howard County hospitals with most of the time at Hopkins. Additional rotations are spent at Shock Trauma. We did not tour Bayview, which is a community/academic site and Burn Center with a more bread and butter volume, or Howard County which is a pure community place in the Burbs.
Johns Hopkins University Hospital: When speaking of the ivory tower, one may as well be talking about the dome at Hopkins; 1000 bed quaternary referral center where the halls and teams are named after the famous folks who used to run them. The Hopkins brand is clearly on display in the lobby there is a wall will enlarged, framed copies of all 14 US News covers awarding them with #1 hospital status. The facility itself is not that impressive, but an enormous expansion is in construction that will make it the most state of the art hospital in the country (maybe the world). The ED is pretty basic (curtains, small rooms, crowds 30-ish beds for 60,000 plus volume) and its in the basement. The patient population is mostly county due to the location, plus some random crazy referrals. There are two teams, each with interns and senior residents. Level 1 pediatric trauma, and level 1 adult for the immediate area around the hospital (lots of penetrating), the rest of the region goes to STC but the residents rotate there too.
Ancillary Stuff: Supposed to be OK
Admitting/Documentation: Some residents said there was no problem with admitting, others reported occasional hassle, but ED has the last word on admission. Paper T-sheets are used in the ED, but they are going all computerized soon. Currently there are different documentation systems at each site, but I dont know the details.
Curriculum: Hopkins is trying to do something unique; the leadership decided that it takes 4 years to educate academic EM physicians, but also that all academic physicians need a true focus area. So they are attempting to essentially keep a 3-year curriculum and add year 1 of a fellowship. In theory, PGY4s will work the clinical schedule of a fellow (similar to an attending), and have protected time for research. They will be automatically accepted to finish their fellowship at Hopkins the following year, making this essentially a 5-year curriculum with an infolded fellowship. Sort of. Intern year is off-service heavy, including a floor month that sounds very intense (Hopkins internal medicine prides themselves on intensity), trauma (also intense), a couple critical care months, and that really cool trauma anesthesia month at STC the UMD residents do as PGY2s. The PGY2s sort of run one section of the ED at Hopkins, and see only critical patients at Bayview. PGY3 is similar with a larger section of the ED to run. They do Peds at both JHU and Howard county, as well as a PICU month and a Peds anesthesia rotation. It surprised me that they only really do 3mo of critical care over all 3 years. The PGY4 year is as above, the residents choose one of about 12 focus areas (ultrasound, research, admin, critical care, medical legal, special ops, etc), and essentially do year one of a fellowship. Its sounds like clinically they will act as attendings (but they still have to get their charts signed off, etc). I was told that in the unlikely scenario that too many people all wanted to focus in the same area, they would find a way to accommodate them. Residents do 12 and 8 hour shifts, I forget how many.
Didactics/Research: Didactics seem standard, except maybe for the fact that the faculty here is so strong. Dr. Kelen does his rounds weekly, and is obviously very involved. Research here is strong in almost everything (no real basic science). There is a major focus on international and policy, and they are planning a Tox program soon. The academic resources of JHU are out of this world, and youd be hard pressed to find a place more likely to embrace any specific professional interest you may have.
City: See above post on UMD for my opinion of Baltimore. Hopkins campus is in a particularly bad section of the city, although the new biotech campus and the new hospital are very likely to gentrify it substantially in the coming years. There are cool neighborhoods here, and as stated before Mrs. UE has connections to the city so its not a real negative to me.
Extras: Salary starts around $44,000, which is manageable in Baltimore. However, institutionally Hopkins does not allow Moonlighting (this may change) twisting the knife a little bit in that PGY4 year where there would definitely be time and opportunity to make some more money. You have to pay for parking, but its subsidized. Access to Hopkins benefits around town, which are good.
Negatives: Facility (at least at JHU) is lacking for the stature of the department. While everyone seemed great while I was there, there is a prevailing theory that folks here can be malignant. For what it's worth, I've been told this by someone who rotated there and someone who took a second look, so it's all second hand. Off service rotations are probably tough, but rewarding. The real issue here is that fourth (and essentially 5th - I cant imagine anyone would come to this program unless they plan on finishing the fellowship track they start on PGY4) year do you feel its necessary for you? I have no doubt I would get amazing training, and an unbelievable leg-up finding an academic job coming out of 3+2 Hopkins training, but Im not sure if its what Im really looking for. Im unsure why it seems all of the fellowships will now be 2 years in length why don't they have any 1-year fellowships so one could choose to complete residency plus fellowship in the 4 years. Additionally, the residents there now all chose to be at a 3-year program I wonder if the dynamic will change with the incoming classes.
Overall: The first program Ive been very hot and cold about there are things I absolutely love about it, and things Im not sure I could handle. As one who aspires to be in academics, the opportunities and resources here are simply unmatched but doing extra time with no chance of moonlighting seems to be a huge financial burden for someone with my level of debt. I was so impressed by the faculty I met, but the facility seemed depressing. If the new curriculum works the way they hope it will, Hopkins may set a completely new standard for academic EM once the new facility is open. This program is a wild card for me