[2015-2016] EM Rank Order List Thread

[TooMuchResearch]

The problem is that all those airway lectures you get during your conferences are essentially worthless until 3rd year because you have no grasp of what they are talking about until you are physically intubating a crashing patient with a difficult airway. Rather than having 3 years of instruction on how to better your technique, you only have one. Rather than having bad habits being caught and fixed 6 months into intern year regarding your technique, you are going several months into your 3rd year before they are fixed with only a few months left in residency. Not to mention I'd be upset that despite being completely capable of intubating, I'm not allowed to as a 1st and 2nd year due to a silly rule. That is just my opinion, however, and I am sure many will disagree.

They've been doing it that way for decades, seems to work for them.

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[Erek94]

No airways until PGY-3.

I interviewed here and I do remember the PD explaining why interns don't do airways but I thought they started doing airway sometime in the second year? Or at least that's what I remember our tour guide telling us.

 

[cbrons]

I interviewed here and I do remember the PD explaining why interns don't do airways but I thought they started doing airway sometime in the second year? Or at least that's what I remember our tour guide telling us.

Why would they do this? Are 1st years not as realiable as CRNA students? Or are there simply not enough to go around?

 

[holabuster]

Does anyone remember the shift schedule at Stanford or ACMC, ie. # of shifts per month or #hours per shift? Is there shift reduction each year? I really liked both of these programs, but I can't seem to remember the details about their schedules. Thanks.

My notes for Stanford say "20x8,10,12s/18x12/14x12/13x12." I had a tough time pinning down what the schedule is, and also no one was able to comment on how it will change with the 4 year curriculum, so the 13x12 is just a guess on my part. If anyone else got something different, please share!

 

[TooMuchResearch]

Why would they do this? Are 1st years not as realiable as CRNA students? Or are there simply not enough to go around?

Graduated responsibility.

 

[DrDrummer]

Thoughts on UCSF?

I am a current resident at UCSF, and am happy to talk to anyone thinking about where to rank UCSF or whether it might be a good fit for them.

This isn't a thread for resident reviews, so I won't say too much about it other than I am very happy here and think it's a great fit for anyone who is looking for a good balance of a resource-limited county department serving a very eclectic and often very sick/injured population and a large, research-heavy, specialist-filled academic center. Lots of smart non-EM residents here, too-- on off-service rotations, regression to the mean works in my favor.

 

[BrewS]

I am a little surprised I haven't read anything about University of Michigan. Only applied because of couples match and thought I'd hate it. But after visiting, I like Ann Arbor and the program seems outstanding. I've thought about ranking it among 4 year programs like Denver, Cincinnati, Emory and Penn. Am I missing something since my medical school is so far from the region?

 

[Jlaw]

Are people already certifying their ROL's? I'm basically set with mine and have just been flip flopping some of the middle programs, kinda feel like no good will come of waiting and being tempted to make last minute changes.

 

[gogodre]

I am a little surprised I haven't read anything about University of Michigan. Only applied because of couples match and thought I'd hate it. But after visiting, I like Ann Arbor and the program seems outstanding. I've thought about ranking it among 4 year programs like Denver, Cincinnati, Emory and Penn. Am I missing something since my medical school is so far from the region?

I'm from the area. I also really liked Michigan. My advisor at my home institution speaks very highly of the program. I really liked what they were selling too and would be happy to end up there. Only thing holding me back is while I like Ann Arbor itself I'm not so stoked on the surrounding area.

 

[wolf_of_the_sea]

Are people already certifying their ROL's? I'm basically set with mine and have just been flip flopping some of the middle programs, kinda feel like no good will come of waiting and being tempted to make last minute changes.

You can still change your list after you certify: http://www.nrmp.org/faq-questions/can-i-make-changes-to-my-rank-order-list-rol-after-i-certify-it/

 

[medicsb]

A lot of programs don't have interns doing intubations. Part of it is so that come 2nd year everyone has done an anesthesia rotation as an introduction to airway management and everyone is on the same page. And generally there are certain procedures that you do in different years. Intern = central lines. PGY2= medical intubations. PGY3=trauma intubations. Trauma tubes are almost invariably PGY3 at my institution (the head of trauma demands a good explanation for any nonPGY3 intubating a trauma - last years explanation was a large MCI, thus strained resources). PGY2s will do CVCs, but less than an intern, and interns will get some intubations, but much less than the PGY-2s. While not dictated by policy, interns tend to do most LPs, lac repairs, and reductions under guidance of an upper year. I was a little disappointed to not intubate as an intern, but it wasn't a big deal and I still got a number of tubes. I would NOT let this be a deterrent to ranking a program highly.

Keep in mind some 4 year programs don't routinely have interns doing CVCs. When talking to a friend at "prestigious" west coast program, he had only a fraction of the lines I had at this point last year when we were both interns. NBD. He'll get plenty of lines and tubes, it just that they didn't start intubating til PGY-2 and didn't start placing lines frequently til PGY-2.

 

[TBoneKoko]

Hypothetical question. If one sends a "ranking you #1" email to a program and never gets a response, how grim is the prognosis?

 

[TooMuchResearch]

Some won't respond regardless of how much they like you, so it depends.

 

[HoosierdaddyO]

I could see how that would be a little disheartening regardless lol!

 

[Jlaw]

Hypothetical question. If one sends a "ranking you #1" email to a program and never gets a response, how grim is the prognosis?

Don't sweat it, some don't communicate or will just send a canned response. If you look back at old threads plenty of people report getting no replies but matching anyway. Or getting love from a program and not matching there.

 

[Jlaw]

You can still change your list after you certify: http://www.nrmp.org/faq-questions/can-i-make-changes-to-my-rank-order-list-rol-after-i-certify-it/

I'm gonna certify it and forget it. I'm very sure of my top 3 and bottom 3. I would be equally happy at any of my middle ranked programs so trying to nitpick between them is just going to drive me nuts.

 

[Cinematographer]

Submitted via Google Forms

Main Considerations in Creating this ROL: Proximity to family, location, EMS

1) Vandy: Nashville was awesome. Really tight knit group of residents. Education here seemed great w/ Slovis. Strong peds.

2) AGH: Close to family and friends. Lots of EMS and flight activities. Definitely had more of a community hospital feel to it.

3) Wake Forest: Really loved my interview day. Old established program. Tons of opportunities in EMS, wilderness medicine, and ultrasound. Winston-Salem was a great little city. Really cool group of residents, with low COL.

4) WVU: close to family. Nice group of residents. See a lot of peds. PD was super nice.

5) Temple: lots of trauma/procedures. All the people I interviewed with seemed like really cool people.

 

[Cinematographer]

Submitted via Google Forms

Main Considerations in Creating this ROL: Overall gut feeling on interview day, happiness of residents, quality of relationship between residents and nurses, quality of clinical training (for me = high acuity, high volume, good autonomy), geography/SO's job prospects, and alumni employment/fellowship match.

1) Advocate Christ: (+) felt like I fit in there during interview day, cool/smart/happy residents who get along really well, residents and nurses reportedly get along well too, outstanding clinical training with essentially no graduated responsibility in the ED, one clinical site makes life easier/better, and reasonable ED schedule that allows good work/life balance (but still produces graduates known to be truly excellent clinically). (-) 1:1 with attending all three years potentially could mean you are less comfortable supervising residents when you first start out as an attending post-residency.

2) Denver: (+) amazing clinical training, by the end of residency will have had tons of experience running the ED (both adult and pediatric) at attending level, job placement and reputation of graduates second to none, Denver is amazing place to live. (-) residents here work significantly harder than anywhere else I interviewed at, to me it felt like the residents were slightly less tight-knit than I've seen at other places (but that was just my experience on one day, so take that with a grain of salt).

3) Harbor-UCLA (I rotated here): (+) happy residents who get along and hang out alot, friendly/helpful/skilled nurses, inspiring faculty, amazing patients, great reputation for job placement, LA is amazing place to live. (-) next year will be the first year that there are PGY-4s and growing pains may (or may not) happen, had a surprisingly negative interview experience where I felt the applicants were mostly ignored by residents and faculty during the lunch etc (and this feeling was confirmed to have been shared by the majority of other applicants that day).

4) Johns Hopkins: (+) really well-thought out curriculum with great variety of clinical sites that are not that far from each other geographically (including 2 months at Shock Trauma, one of which is the highly-rated trauma airway month), outstanding departmental and institutional resources, strong off-service rotations, one of the few programs to use the 4th year in a way that made sense to me (ie you get alot of elective time and work as a pre-attending in the ED). (-) residents admit they use the consultants more than they need to at Hopkins, the program's reputation is not yet reflective of the high quality of its training, the fact that like 1/4 of the residents and faculty wore ties with Hopkins logos on them during conference made me a little queasy.

5) University of Maryland: (+) great reputation, nice/cool/happy residents who get along, reportedly good relationship with nursing, good didactics, all kinds of cool things going on here academically (aka research powerhouse). (-) I felt a little unsure about the clinical training despite its reputation of being excellent (for example, many residents said their favorite site was a community affiliate where the patients are "much sicker", and they seemed to indicate their role was often unclear at Shock Trauma, except when the surgeons were in the OR and the EM residents had to step up to the plate in their absence).

 

[Cinematographer]

Submitted via Google Forms

Main Considerations in Creating this ROL: Location, Reputation, Residents, Leadership

1) NYU: Great reputation, love the residents, love NYC, love Bellevue. Cons: Trauma.

2) Sinai: Same as above but also don't love the commute to Elmhurst.

3) Northwestern: Chicago is beautiful, great reputation, 2 months at Cook County, research I'm interested in, cool residents.

4) Temple: Loved this program, PD is awesome, social was the best of the trail, residents are so much fun and seem super competent. Would be higher than 5 but I prefer 4 year.

5) BMC: Great reputation, awesome county feel, "county with resources", residents seem down-to-earth.

6) Penn
7) Hopkins
8) Jacobi/Montefiore
9) U of Chicago
10) Yale

Others: Downstate/Kings County, Georgetown, Brown, Maryland, GW

 

[swamprat]

Lol at people who "prefer" 4 year programs .. Don't do it, especially if you have loans.

 

[exsanguination]

Lol at people who "prefer" 4 year programs .. Don't do it, especially if you have loans.

Three years is too short and four years is too long

 

[deleted547339]

Three years is too short and four years is too long

People say that, but I don't feel like 3 years is too short if you're at the right program.

 

[swamprat]

Yeah I don't think 3 years is too short. You need to cut the cord at some point IMO.

 

[exsanguination]

People say that, but I don't feel like 3 years is too short if you're at the right program.

As a person at a four year program I probably should have picked the "right" three year program. As a second year I already feel like that last year will be a huge drag. Come on attending, do I really gotta wait for you to approve my dispo on this 23 year old pelvic pain?

 

[StephBee]

Are people sending love letters to more than just their #1? (Some of my friends in other specialties told like their top 3)

 

[Cinematographer]

Ugh... All this negative talk about 4-year programs is making me doubt my current ROL.

@StephBee planning on only contacting my true #1 with a "you my bae" email.

 

[deleted547339]

As a person at a four year program I probably should have picked the "right" three year program. As a second year I already feel like that last year will be a huge drag. Come on attending, do I really gotta wait for you to approve my dispo on this 23 year old pelvic pain?

It gets WAY worse once you start doing external moonlighting.....I started moonlighting at the beginning of my PGY-3 year (this year). It was very humbling. It made me go back and read a ton, start running through patients I've had moonlighting with attendings I trust, etc. It also made me much more cognizant of my limitations. But I've slowly gotten more comfortable with my own practice. I've developed my own personal practice patterns. I tend to be fairly close to the middle of the road, but slightly more towards less testing. When I end up working with the super conservative, over-testers or the super-cowboy don't test anyone people, it makes me crazy.

 

[HoosierdaddyO]

I feel like tho for every person that says don't do a 4 year, there's another that says they enjoy the 4 year program. Plus you also have to ask yourselves what are these people who are saying no to 4 years doing after residency whether it be academics, community. I'm sure those that are choosing academics aren't singing the same "4 years suck compared to 3 years" tune, or are they lol?!

 

[winkleweizen]

My experience is almost identical to timesnewromans

 

[namethatsmell]

I feel like tho for every person that says don't do a 4 year, there's another that says they enjoy the 4 year program. Plus you also have to ask yourselves what are these people who are saying no to 4 years doing after residency whether it be academics, community. I'm sure those that are choosing academics aren't singing the same "4 years suck compared to 3 years" tune, or are they lol?!

I'll stand by my earlier comment: do what you think will make you happiest. If a 4 year program is truly at the top of your list and and your #2 is well below it than just rank it there. Recognize that there's a trade-off and move on.

FWIW I'm in my last year at a 3 year program and like the others have mentioned I couldn't imagine doing another year of residency. Also do NOT let anybody tell you that you need to do a 4 year program if you want to go academic. It just ain't true.

 

[Zebra Hunter]

I am one of those that loves my four year program. You have to make sure that the 4th year is worth something. If the 4th year is simply an extra month of elective, or you are expected to "see more patients" then hell no. But if it provides something for your career that you want (mini fellowships/focuses, research time, ways to pursue other policy/admin/ems intersts, etc.) then go for it.

Of course it is possible to go to academic places after a 3year program. However, you can not deny the trend that you need to bring something more to the table to get into academics. Whether that's a fellowship or a developed niche interest, you need to show what you offer. I don't think you can get a good academic job just because "you like teaching residents." A 4 year program allows you to develop these niche interests. The majority of the graduating 4th years in my program are going into either pure academic jobs, fellowships, or community/academic hybrid jobs. They all have jobs that I look at and say to myself "that's what I want." They aren't just community workhorses.

Watching the 4th years from the beginning of their year to the end, that's what makes me glad I am in a 4 year program. The growth and development that year is astounding. Sure, that happens as an attending during your first year after a 3-yr program as well. But I'd rather come out of residency as a more competent physician than have to struggle my 1st year on my own.

Also, there is a trend of programs choosing to become 4 year programs and adding an additional year. I don't see many programs going the other way. There are many ways to interpret that, but I think those in charge of running programs are realizing 3 years might be a bit rushed. Just my opinion.

Serious question, do you truly believe people coming out of 4 year programs compared to 3 are immediately more prepared for their first attending job? If so, I'd have to question that, as I think the learning curve for the first year out is probably about the same. No matter what sort of training you got at your 4 year program, it's completely different when you have absolutely no back up.

 

[HumerusBaker]

Are people sending love letters to more than just their #1? (Some of my friends in other specialties told like their top 3)

Emailing my top 3 or 4 per my advisor and what people did last year at my school
Emailed my #1 saying, you my number 1 Bae
Emailing the others just more generically like top of my list or very highly or some nonsense.

 

[TooMuchResearch]

I feel like tho for every person that says don't do a 4 year, there's another that says they enjoy the 4 year program. Plus you also have to ask yourselves what are these people who are saying no to 4 years doing after residency whether it be academics, community. I'm sure those that are choosing academics aren't singing the same "4 years suck compared to 3 years" tune, or are they lol?!

The 4th year doesn't replace the requisite fellowship needed for academics.

 

[carbonizedeyesockets]

I get a little suspicious when I see that a program produces mostly academic docs., whether it is a 3 or 4 year program. I immediately wonder if they're so uncomfortable with the idea of community practice that they stay in academics for comfort.

My chair has pointed out many times, even to the faces of chairs and PDs of 4 year programs, that there is no evidence that graduates of 4 year programs demonstrate a higher level of competence upon graduation than the 3 yr grads. The pressure on programs to go to 4 years is largely political, with direct or indirect pressure from other specialties within the institution. Anyways, as a resident of a 3 year program, I do sometimes wonder if 4 years is better. It may be if done "right", but I'm not sure what "right" would be.

 

[fahimaz7]

FWIW I'm in my last year at a 3 year program and like the others have mentioned I couldn't imagine doing another year of residency. Also do NOT let anybody tell you that you need to do a 4 year program if you want to go academic. It just ain't true.

Thumbs up here. I'm 5 months from graduating from as a PGY3 and couldn't imaging having another 18 months of being chaperoned. Don't get me wrong, I love the attendings that I work with and the comfort of being a resident, but at the same time I realize that I need to start getting out on my own to progress. Another year in training would just slow down the progression and cost me $250k in the process.

 

[deleted547339]

Thumbs up here. I'm 5 months from graduating from as a PGY3 and couldn't imaging having another 18 months of being chaperoned. Don't get me wrong, I love the attendings that I work with and the comfort of being a resident, but at the same time I realize that I need to start getting out on my own to progress. Another year in training would just slow down the progression and cost me $250k in the process.

To be fair, it would only be 17 months.

 

[erasthrowaway328382382]

I think it really depends on what you want out of residency. If you simply want to work especially in the community 3 yrs is fine. But if you are looking to do something more in residency such as developing your own niche it's helpful to have 4 yrs. Especially if the 4th year is well thought out (ie pre attending and light shift load).

If only more programs were 3+1 like BIDMC, it seems like the best of both worlds.

 

[winkleweizen]

If you want academics....three year and fellowship is the way to go. I can tell you the new hires at my residency programs aren't 4 year grads, they are grads with a fellowship.

 

[MackandBlues]

Stupid Michigan osteopathic rule that eats up ALL of your elective time if you want to moonlight in MI (DO residents get around this by moonlighting in Indiana instead).

can someone explain the Michigan and DO rules? Thank you.

 

[Fox800]

can someone explain the Michigan and DO rules? Thank you.

AOA Resolution 42

 

[airball]

Emailing my top 3 or 4 per my advisor and what people did last year at my school
Emailed my #1 saying, you my number 1 Bae
Emailing the others just more generically like top of my list or very highly or some nonsense.

I dont understand how this goes well for your chances at those programs that you're sending a generic email to... doesn't it just sound like fluff and what would they even send back to you? Seems like it would end up being more of a turn off for programs

 

[mmich369]

I dont understand how this goes well for your chances at those programs that you're sending a generic email to... doesn't it just sound like fluff and what would they even send back to you? Seems like it would end up being more of a turn off for programs

I emailed my top three and got pretty reassuring responses. So who knows. It's all a game!

 

[HumerusBaker]

I dont understand how this goes well for your chances at those programs that you're sending a generic email to... doesn't it just sound like fluff and what would they even send back to you? Seems like it would end up being more of a turn off for programs

I mean I personalized them, and it wasn't just a one sentence email. I meant generic in the sense that I didnt specify what number I am ranking the program. I don't believe these notes really change how people get ranked but my advisor encouraged them and she's been doing this pretty successfully for years (no unmatched EM applicants that I know of).

 

[TheBlueBlazer]

having seen how they make the sausage/chicken nuggets, I can assure you that while these don't really hurt you unless you try get too clever in your wording and come off like a jerk, they amount of benefit they do ranges from zero to minimal with the former being MUCH more common than the later.

 

[b-real]

If you want academics....three year and fellowship is the way to go. I can tell you the new hires at my residency programs aren't 4 year grads, they are grads with a fellowship.

Agree with this. Don't be fooled into thinking that a 4 year graduate has a leg up in academic hiring. The academic places I've seen value a fellowship-trained graduate over a 4 year graduate. Your "mini fellowship" or "pre-tending" experience during your 4th year means very little. If you're dead set on academics, why not go 3+1 (fellowship) over a 4 year program?

 

[Cinematographer]

Submitted via Google Forms

Main Considerations in Creating this ROL: Feel on interview day, access to ample procedures, good off service rotations, reputation, 3 year >>> 4 year

1) Temple: Incredible amount of procedures, great relationship with trauma, ICU experience seems perfect, the PD and apd were two of the most genuinely nice people I have ever met and seem truly committed to the program and are serious about having happy residents. With that in mind, they were the happiest residents I have seen. Slight Cons: Main ED is a bit too small for the volume, mostly homogenous population, not crazy about Philly as a city.

2) BIDMC: well thought out curriculum, world renowned faculty, seem to have really great didactics, really sick population, Harvard affiliation. Cons: some faculty seemed a bit uptight, fair amount of traveling to community sites, Boston is an awesome city but super expensive. Residents seemed really tired.

3) Emory: "war zone" style program at Grady with academic opportunity at Emory. Happy residents, committed to service, seem to see it all. Cons: kind of had a weird interview day, Run down facility, floor month.

4) Pitt: unbelievable Ems experience. If you want to be in EMS for life, go here. Great icu experience, lots of pathology with Zebra's at Presby. Cons: tough tough schedule, Pittsburgh didn't work well for SO, limited trauma experience.

5) UIC- I thought the faculty here were incredibly invested in the program and care so much about their residents. Lots of pathology, I thought Chicago was a cool city, great opportunity to pursue niche. Cons: Chicago traffic sucks and there is a lot of travel between sites, four unique systems means four sets of faculty, ancillary staff, etc which I thought wasn't ideal.

6 and beyond: Hennepin (great program, wasn't crazy about graduated responsibility), Cooper (fun program with super sick patients and very busy ER. Fairly new program, limited trauma experience as major trauma goes to surgical side of department), Christiana (great PD, lots of procedures, hated the location), Detroit Receiving (lots of pathology, incredibly busy. Tough location for SO, limited resources at hospital), GW (liked the program but it's 4 yrs, DC is expensive, chair was not friendly at all on interview day), Hopkins (again, great program but 4 year), Cleveland Clinic/ Metro Health (didn't really feel great about this program. Very busy and lots of pathology, but residents were overworked and not friendly on interview day, and Cleveland is not ideal for me or my SO.

 

[airball]

am i the only one that thinks EMS blocks in residency is a waste of time? is riding around in an ambulance valuable once you're an attending? on the trail it seemed like residents just liked it cuz it was an easier rotation but then if that's the case i rather have 2 more weeks of US

 

[Modafinil]

Anyone with last minute questions/concerns/reservations about Charlotte, NC feel free to shoot me a PM.

Good luck with the match everyone. You'll all be amazed how it all works out.

 

[Brigade4Radiant]

I feel like tho for every person that says don't do a 4 year, there's another that says they enjoy the 4 year program. Plus you also have to ask yourselves what are these people who are saying no to 4 years doing after residency whether it be academics, community. I'm sure those that are choosing academics aren't singing the same "4 years suck compared to 3 years" tune, or are they lol?!

Honestly if you want to do academics you would be better off doing a fellowship after your 3 year program somewhere

 

[RPedigo]

Honestly if you want to do academics you would be better off doing a fellowship after your 3 year program somewhere

Just remember if you're geographically limited that it may be problematic to find a fellowship your first year out. When I graduated from Harbor (3 years at the time - 4 years now) and was looking for fellowships in LA area, both UCLA and LAC+USC would have had me doing non-teaching attending shifts in satellite emergency departments for the first year because I couldn't be a "PGY-4 attending" supervising a PGY-4 resident. Many other places have similar policies and will limit you your very first year out, for whatever that is worth.