Brigham and Women's Hospital/Harvard Residency Reviews

Glad to help with any questions - I'm currently an intern in the program. To address your specific issues:

1) Regarding moving from hospital to hospital, we spend the vast majority of our EM time either at Mass General or at the Brigham. These are large tertiary care Level 1 Trauma centers, both teaching hospitals in Boston affiliated with HMS. You learn fairly quickly to feel at home both at MGH and at BWH. Although there are a lot of similarities between the two (several other residencies are combined between these hospitals, like Ortho and Neurology, and they both are "managed" by the same umbrella organization, called Partners), each has their own unique culture, patient populations and clinical practice differences that adds value to spending time in each place. For example, the Brigham is next door to Dana Farber, so we see a lot of sick cancer patients in the Brigham ED. We see more trauma at Mass General, especially penetrating, etc. The two other hospitals that we spend time in include Mount Auburn Hospital (a community hospital in Cambridge with an annual census of about 30k, not a level 1 trauma center) and Children's Hospital of Boston (big tertiary care teaching hospital). We only spend about a month in each of these two places each year for the first three years. I really like experiencing these additional places because 1. the community ED practice (i.e., calling consultants at home, transferring patients) can be quite different than the experience in the big academic hospitals, and it's great to see this during residency and 2. we all need more experience with kids and it's very convenient having such a great children's hospital next door. All of these hospitals are within a 15-20 minute driving/T radius, so getting around is not really a big deal.

2) My experience with faculty has been great. They are very supportive of residents; there are more research opportunities here than residents available to help, and I've been happy with the teaching that goes on during my shifts. There are also 4th years supervising in addition to addendings, and they often enjoy teaching and giving interns/junior residents procedures (I have often been pulled aside and told an intubation, joint tap, central line or other procedure is going to happen in some room and I should introduce myself and get prepped, and then they walk me through it). I get a sense that the faculty is very interested in international emergency medicine, airway management (the Chairman at the Brigham, Ron Walls is an airway guru), CAD, PE, and many other big EM topics.

3) HAEMR being "worth" 4 years is a completely individualized determination. There are 5 months of elective time built into the residency, and many take advantage of this to pursue interests during residency that would be unavailable in a three year program. Deciding a worthy use for this time is a personal task. For myself, I have interests in health care management (have an MBA), and I plan on using this time to establish more experience so that when I am looking for an attending job I have already proven myself a capable leader and manager, so for me, it makes sense. Could I have accomplished this with a fellowship in addition to a 3-year program? Absolutely. I am not going to get into the 3 versus 4 year debate here (search threads for lots of opinions), but if you feel that a 4 year format appeals to you, we do it pretty well.

Let me know if you have more questions, I'd be happy to help.
Good luck with your search!

I am happy to elaborate more about the places I interviewed...
--------------------------------------------------------------------------

1) Denver: (+): amazing program, amazing location, 4th years blew me away managing ED. (-): almost no elective time
2) Hennepin: (+): very surgery-based program, Pitbosses run the ED 3rd year, critical care emphasis. (-): Minnesota.
3) Highland: (+): autonomous training, great group of people, nice location, self-sufficient residents. (-): unsure about strength of off-service rotations.
4) MGH/BWH: (+): great city, great resources, phenomenal international health program. (-) young program, 1 million potential consultants to be called
5) New Mexico: (+): great program, super nice people, SICK patients, nice outdoor recreation nearby, critical care strong. (-): location seemed a little ghost-townish for me, issues with movement of pts through department & flow
6) UMichigan: (+): huge critical care, no medicine wards, diverse training sites. (-): not a huge fan of the location/weather, worried about the # of consultants that could be called.
7) Bellevue: (+): big time autonomy, self-sufficient residents, reputation. (-) I am a little intimidated about the idea of living in Manhattan .
8) Maine: (+): the most friendly people ever, location. (-) seemed a little cushy for me
9) BMC: (+): location, underserved patient population, lots of trauma. (-): 2-4, PGY2s do ALL procedures in dept.
10) OHSU: (+): location. (-): didn't gel with the people
11) UC Davis: (+): sick pts. (-): nothing really set them apart, location
12) UCSF Fresno: (+): Yosemite, nice people. (-): couldn't really see value of 4th year, living in Fresno.
13) Stanford: (+): Paul Auerbach, lots of resources, bay area. (-): pts not sick enough, a little too academically snooty for me
14) BIDMC: (+): location. (-): unfriendly, extremely academically snooty people
15) Indiana: (+): fantastic program. (-): location

I also interviewed for the UVM Preliminary Medicine Year and the Transitional year at UC San Diego, so feel free to ask me about those...

Please note: the (+) and (-) are only my opinion. I'm sure there are several other people who had totally different experiences and therefore completely opposite opinions (which is why the match works!)

Brigham & Women's / MGH

Residents: 15 residents in the intern class. Tons of residents showed up to Boston beer works for great food and blueberry beer. Everyone was laid back, intelligent, and happy. The program was the first choice of most I talked to. Though there was a leaning towards the NE, residents were from lots of places and there was a mix of married and single. I went to their mid-day conference and was impressed by how the residents carried themselves and how faculty acted with them. Everyone gets cute little jackets

Faculty: Many faculty I met were from this residency or BIDMC, though there was a smattering of a few other places represented. They have Ron Walls as their chair, who is awesome and makes sure they have plenty of airway toys. Dr. Arbelaez is a leader on diversity, and they have several up and coming faculty members. I really liked the PD, Eric Nadel. He seemed really down to earth and was fun to talk to. Residents during the night out said he would do anything for them and they feel very supported in terms of their individual goals.

Hospital: Training occurs at two primary hospitals, Brigham & Women's and MGH. You tour both on your interview day. To be honest, I don't remember which ED was which, but they were both packed with folks waiting to be seen and are both level I traumas with great off-service consultants. I think it was MGH that had patients packed up to the clerk's desk! However, they are supposed to be getting a new, bigger ED. They were about 20 minutes or so apart from one another. Mt Auburn is a bit further but offers a community ED experience.

Ancillary Stuff: Great ancillary services, you won't have to do any wheeling people around, starting IVs, or making your own phone calls.

Admitting: I think admitting privileges are only to medicine, but I always forget to ask these kinds of things.

Curriculum: Four year program with a traditional focus - General surgery and medicine floor months, MICU as an intern, and visit many other services in the hospital during the 4th year. This is for better or for worse since the off service rotations are great but many don't like to be off-service so much. You will do EMS ride alongs as well. The PD pushed the idea that you can't learn real autonomy without doing a 4 year program because you never have time to run the whole ED as a 3rd year in 3 year programs, so you won't really be ready to be an attending without the extra investment. This rubbed me a bit the wrong way, since many 3yr programs featured a "pit boss" opportunity, although admittedly not all do and f you are going to do 4 yrs you BETTER be running part of the ED. You can moonlight within the Harvard health care system.

Didactics: Very innovative! Something like 3hrs a week of the didactics is hands on simulation rather than just sitting in lecture. The simulation center is state of the art and seems to offer great training.

City: Boston is a relatively big city with a small town feel. The food is good and there are lots of things to do. However, it is not very diverse racially or ethnically. It is pretty much black and white and mainly white, with a few latinos. It is also cold...

Negatives: Still a relatively new program in a powerhouse institution. Unsure how much they have earned the respect of the rest of the hospital. With only 2 blocks of elective time and a good amount of off service rotations, I wasn't completely sold on the four years, actually.

Overall: This is a solid EM program that seems to be putting a great docs in a number of places. It would be much higher on my ROL if it wasn't in Boston.

Overall: combined emergency medicine program utilizing many of harvard’s “crown jewel” hospitals: MGH, Brigham, Children’s, as well as community experience at mt auburn

Residents: 15 per class. all over the country; many from the top med schools in the country. The residents I met at the pre-interview day (dinner at some place near fenway park) were all really interesting and down to earth. What amazed me the most about them was the outstanding interests that many of them had (i.e. started international medicine programs, former national ski patrol, former Olympian, military folks, etc). the group as a whole exuded confidence but not arrogance and this was reflected on how positively and kindly they spoke about *other* programs….classy.

Faculty: the faculty seemed like a nice collection of all star attendings from airway guru Walls, to Simulator guy (pozner), to international EM peeps. Residents said most attendings were really nice and enjoyed teaching. My interviewers seemed cool. But can’t say much more than that

Ancillary Staff: seemed good according to the interns I spoke to; apparently nurses will do the IVs, draws but you are more than welcome to do them as you wish (many interns did them for the first few months, then stopped once they felt more comfortable). Also have some clinical assistant backup that does lots of the patient transport, getting paperwork from other hospitals. SWEET!!

Curriculum: 4 years. 1st year seems pretty standard…bunch of off-service rotations, about 6 months in the ED (brigham/mgh has about 2 months each, then 1 at the community site and 1 at Childrens). Have a picu month and micu month your first year; a sicu month your second. Two months of elective time your third and fourth years. pretty standard. i think their shifts are a mix of 9 and 10 at brigham and 12s and 10s at MGH your intern year, then supposedly it gets to mostly 8s as you advance with occasional 12H shifts during weekends to give you two weekends off a month!

Facilities: MGH/brigham/Children’s. well, three of the most famous hospitals in the country. I was expecting to see white gloved stuff that might be too out of touch with the down and dirty of emergency medicine. but what was surprised me the most was how “community” MGH felt….it was packed with patients, seemed kind of old and was like a small city. It was pretty crazy… Talking to residents they said they got their share of penetrating and blunt trauma. Brigham seemed more what I thought Harvard med would be like….supposedly very complicated medical patients….very sick; a mix of both bread and butter as well as zebras.

Location: boston seems like a great young city to hang out for a few years; great restaurants, vibrant night life, good music. Real expensive though. And Cold. Let me repeat: COLD. It was like 20 when I went to visit. Very tough change coming from the west coast.

Negatives: the weather….seriously…if this place was in warmer climates, I would definitely put it #1. while residents at the program were saying how cool it was to be with other outstanding residents from other departments, I don’t know if being at such a historical place as mgh/brigh with their strong medicine/surgery departments…how much EM has pull there…

Overall: my adviser at my med school told me that the face of emergency medicine is changing…..whereas 20 years ago the “best” places to train were places like Denver, Cleveland…exciting places that took chances on a new specialty, now that EM has “grown up” in many ways….the big dogg places are now looking to build the strongest departments…and you are seeing a shift of the best applicants going to train at institutions such as MGH/brigham, UCSF, etc. places that have both outstanding overall reputations as well as high volume and diverse patient populations that encourage rigorous training. I don’t know how true this is or not, but I walked away with a excellent impression of this program and think that many doors would be opened by being trained at such a busy and prestigious hospital network.

I heard that anesthesia does the trauma airways at the Brigham. Can anyone who has interviewed there confirm/refute? Thanks.

ItsTimein2009 said:

I heard that anesthesia does the trauma airways at the Brigham. Can anyone who has interviewed there confirm/refute? Thanks.

Click to expand...

brigham resident here - this is absolutely not true. the airway is EM's unless you, as the senior resident, actively choose to give it up (ie if the pt coding and you are actively running the trauma and there's nobody else to run the code while you intubate.) but by and large, traumas are tubed by EM.

ItsTimein2009 said:

I heard that anesthesia does the trauma airways at the Brigham. Can anyone who has interviewed there confirm/refute? Thanks.

Click to expand...

That's actually pretty funny. Whoever told you this was totally pulling your chain since the chair at the Brigham is Ron Walls - the guy whose NEAR databases are the reason we were able to take ED airways from anesthesia in the first place.

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...

1. Brigham/MGH: POS: Two amazing institutions, The Name (Partners) which helps if you want to do something in addition to medicine, faculty, resources, admitting powers, off-service education, true SIM-lab along with true integration into curriculum, fellowship in US (not that i'm interested in doing US fellowship, but having a fellowship makes it more likely that we will get a good ultrasound experience), getting an expanded ED at MGH, impressed with 4th years (they get experience running obs unit and getting presentation from PAs- say what you will about the importance of knowing how to run OBS unit and PAs, but all you need to do is look at the news and realize the possible future of EM), can use propofol, You get bread and butter at both hospitals (albeit, you're more likely to see zebras at these hospitals). NEG: Surgery floor rotation (I don't mind medicine floor), only 4 ICU months (I wish there was one more instead of surgery floor), slightly worried about admission pushback (but ED has admitting powers, so it's okay).
2. BMC: POS: "Boston City Hospital"- so many people have trained there, admitting powers, ED is powerful there, trauma is truly run by ED, largest ED visits in the New England area, largest number of trauma (penetrating) in Boston, sees the most number of patients in the New England area, Boston EMS medical control, great number of fellowships. NEG: Ortho experience is what you make of it, POTENTIALLY a weaker peds experience as it's a Level II peds center, limited propoful use, trauma is run sort of inefficiently (3rd year does tube AND leads the trauma, which is contrary to the principles of leadership)
3. UPenn: POS: this place has everything I want (perfect number of ICU rotations), true integration with trauma, residents can use propofol, admitting powers, great off-service rotations, great airway toys, Pharmacy is in the ED to help with codes (drug calculations) and drug questions. NEG: The number of ED visits they see seems a little low, weaker/building from scratch a SIM lab curriculum.
4. NYP (columbia and cornell): POS: Two great hospitals, best peds experience in NYC (which is tough in NYC), subsidized housing available, resources, admitting powers, can use propofol. NEG: relatively new (that being said, it's made a name for itself). High cost of living in NYC
5. Beth Israel Deaconess Medical Center: POS: Academic, 3+1 option, the name, the residents, the faculty. NEG: lower number of ED visits compared to other programs in Boston, many off-site rotations (which are worth it for this program, but driving can be a hassle)
6. UMass: POS: Great toys, helicopter- TRUE integration of residents and nurses as a team, residents, the BEST facilities of any program on my list, PD is AMAZING, busy level 1 adult/peds, great number of fellowships, ED is very powerful here. NEG: location in Worcester (but that being said, cost of living is great with it still being relatively close to Boston)
7. Brown: POS: Amazing number of fellowships in everything you could want to do in the future, VERY busy with large volumes of patients (second largest in New England), Large sim lab, has access to basic science research (if you're into that thing). NEG: location
8. Northwestern: POS: perfect number of ICU rotations, well known, great facilities, great location in Chicago, gets a lot of trauma from the South side of Chicago (since U. Chicago is not a level I trauma center). NEG: No fellowships, except a research fellowship (I'm worried I won't get a good US experience if there is no US fellowship)

Hi, it's been about 4 years since the last review, can someone familiar with the MGH/Brigham EM program give an update? Specifically 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)?
  
  
• Is there frequent commuting between site locations (outside of the dedicated training blocks)?
  
  
• 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 for your time and help!