Carolinas Medical Center (CMC) Residency Reviews

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I won't try to give you a comprehensive detailed assessment since you can get most of the facts online at the websites. More my impressions of the program.

I thought Carolinas was excellent. A very well rounded program with lots of opportunities. Perhaps the best asset is the people. The PD is amazing and very in touch with the residents. The chair is also very impressive and wrote an EM text.

The facilities of CMC are superb. They have a very nice ED, all the workings with PACS and everything you would expect in a high class ED. They will have a new Children's ED and facility completed in 2007. Peds is integrated into the curriculum.

The residents seemed very happy and they take care of a very county based indigent population mixed with everything up to the CEO of Wachovia. A very diverse population full of acuity in a very nice facility.

They also have very good research opportunities based out of a community setting, making it overall a very academic program.

Possible Downsides to this program is they have conference 5 days a week, if you don't like that. Also they don't have OMFS coverage and have to refer this out. They also don't have residencies in all specialties or fellows in some things like ICU.

Overall I think this is an excellent program and I would definitely think very highly of it.

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Carolinas

I thought this was a good program with many reasons to have the reputation that they have. The PD was good to talk to and the residents say that approaching the faculty is very easy. The residents got along very well with each other and a ton of them showed up to the pre-interview dinner, with their spouses and children too. The curriculum wasn't that appealing though. There are fewer ED months than most 3 year programs, and there is a medicine wards month and a general surgery month as an intern. I can't imagine that these would be as high of yield compared to having 2 more ED months added throughout the residency. The Orthopedics month also involves clinic duty from what I understand. I wanted to go into EM to get away from outpatient clinics. The facilities are nice, this is a private hospital after all but not as nice as Vandy, Indy, or UMass. But they are a high volume county receiving hospital that sees a good amount of variety and trauma. I was impressed but not as much as I thought I would have been because of the "word on the street" I heard beforehand. I will still be considering it though but I feel like there are some other programs that I've interviewed at will be a better fit for me and what I look to get out of my career in EM. PM me with questions. Thank you.
 
The curriculum wasn't that appealing though. There are fewer ED months than most 3 year programs, and there is a medicine wards month and a general surgery month as an intern.

This was one negative I did have about Carolinas because more than half of PGY1 and PGY2 is spent off service and it's hard to tell how strong the off service rotations are since this is a community program that may not have strong residencies in medicine or surgery. Ortho and OB/GYN are apparently strong however. The residents did not have any complaints though, but it's still hard to measure. High quality off services are important to me if there are going to be less ED months. I think we have enough representation from Carolinas interns here to give their thoughts about it....
 
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Residents: Seemed to be a cohesive group. The ratio of residents to applicants at the night-before dinner was 4:1. In terms of personality, the residents came across as a bit more intense than residents I've encountered at other programs. Several people I've talked to (other applicants, residents at other programs, and attendings) have been turned off by the arrogance they've perceived from the residents at Carolinas -- I didn't really get that feeling, but they do have plenty to be proud of in their program.

Shifts: They work more hours than most places I've been -- probably average around 55 hours a week while in the ED, but I might be overestimating this. PGY1: ~20 10's and 12's. PGY-2: ~21 10's. PGY3: ~20 8's, 10's, and 12's.

Facilities: All time is spent at Carolinas Medical Center. The ED sees a huge volume (>100,000) and is very nice, with large trauma bays, in-house radiology, an active hyperbaric chamber, etc. Nice computer system, and lab results are broadcast via the wireless network to your PDA if you choose to carry one. The ED is divided into 3 different zones based on acuity, plus a separate Peds ED, and residents have dedicated shifts in each of these zones each month. The hospital itself is sweet, and looks more like a fancy hotel than a hospital (for example: the carpets in the elevators are changed daily, so on Wednesday the floor says "Have a pleasant Wednesday" and so on).

Peds: Brand new beautiful children's hospital will be opening very soon. The residents I spoke to weren't sure, but thought that the pediatric ED would still stay in its old location despite the new hospital. Peds shifts are mixed in during ED months, plus one dedicated Pedi EM month. One month of general peds as a PGY2 and one month PICU as a PGY3. They are starting a new Peds EM fellowship next year. My sense was that peds exposure here was adequate, but not their biggest strength.

Trauma: I honestly don't remember who runs the traumas, who gets the airway, etc. I've heard that surgery-EM turf battles used to be a problem here, but I think they've outgrown that. They get plenty of blunt and penetrating trauma. One month is spent on the trauma team, and another month in the trauma ICU.

Faculty:
One of the greatest strengths of the program. Their PD seems down to earth and pleasant. Their chair is well-known and a resident advocate. They have some of the biggest names in academic EM, and all the faculty seemed to be quite approachable and friendly.

Curriculum: Herein lies both one of the biggest strengths and the biggest weakness at Carolinas.
Strength: Didactics are great and consist primarily of daily (M-F) one hour sessions at lunchtime. I think this is nice because it provides an opportunity to see your EM colleagues every day, to get follow-up from them on patients you saw (ie if they are on ICU and you admitted a patient to them), and so on. It also means free lunch every day of the week. This daily didactic time is protected even on off-service rotations.
Weakness: While the didactic curriculum is great, the breakdown of rotations is pretty terrible. This program has a ton of time devoted to off-service rotations (~14 months). The residents I spoke with didn't seem too thrilled with their general surgery month, IM floors, general peds, neuro, etc.

Patient Population: Good diversity in terms of both pathology and socioeconomics. After 3 years here I think you'd be comfortable with just about anything that might come through the door. Acuity seems a bit low with just a 14% admission rate -- however, that percentage includes the fast-track and peds patients which tend to have a low admission rate, and with over 100,000 patients I'm sure you'll see plenty of sick patients.

Location: Charlotte is a big city. The cost of living is incredibly cheap, and almost all the residents owned nice homes. Traffic was pretty bad both days I was in town. Despite being a big city, the cultural and dining opportunities seemed a little bit weaker than most cities this size. Just a couple hours to the mountains and a few hours to the beach.

Other info:
-Numerous fellowships are available here including tox, EMS, ultrasound, research, and peds.
-Carolinas has a wonderful reputation (among the top few 3-year programs) that can open up doors
-Benefits here are better than most places, with a nice salary, hefty educational stipend, and generous meal allowance

Overall: Carolinas is a solid program with great faculty and an incredibly strong reputation. The opportunities are endless at this program, but you pay for it by working more hours and doing more off-service time than most other places. I haven't yet decided how I will rank this program -- it could end up as high #1 or as low as #5, I just have to decide whether I think the opportunities available here are worth the drawbacks.
 
Overall: Carolinas is a solid program with great faculty and an incredibly strong reputation. The opportunities are endless at this program, but you pay for it by working more hours and doing more off-service time than most other places. I haven't yet decided how I will rank this program -- it could end up as high #1 or as low as #5, I just have to decide whether I think the opportunities available here are worth the drawbacks.

Great review!!!!! This captures exactly how I felt about the program and I can't justify rehashing it all in a separate review. The curriculum is the only negative I have about this program, but I can see myself ranking it #1 or as low as #4 for me. Ranking it #4 would most likely guarantee not going there however. It almost seems like the hospital requests EM's help on services because they really need it because they lack some residency programs. They could fit the pictures of all the residents from all specialties for a class on a medium sized poster and still a have a lot of room for borders, etc. This obviously has something to do with it being a community teaching hospital. But the reputation they have has got to be there for a good reason, and there were a lot of other things I loved about the program.

By the way, AnonEMous, we must have interviewed on the same Wednesday when someone noticed the rug in the elevator and asked when it is changed. Thanks for the thorough review!
 
Hello:),
I've had 2pm's and above there was the question re: Carolinas Off Service Rotations. Here's my take on it and I'm sure that the other CMC'ers will weigh in.....

I think that while we do several off service months, including floor IM and Peds, it serves us well as EP's. Things change a LOT from your MSIV to your intern year (esp the last 6 months of fourth year). When you come to CMC, you are treated as a MD, not just an intern, which by and large is a GOOD thing to start easy by doing some floor months etc. It gives all a chance to learn the ropes, manage low acuity inpatient patients, and then move on to ICU level players, especially since we don't do a "orientation month".

While off service months are sometimes floor months, a lot of what we see here is going to be the "bread and butter" EM stuff, so it isn't too off of what we do on a day-to-day basis in the ED.

Things to think about when looking at our (or any programs) off service months...
1. If you are off service, what does that entail (i.e. clinic, home call, floor work w/in house call etc). A good example is our second year peds month. While is is classified as an "off service" month, we are exclusively in the ED doing ED shifts, Peds lectures, etc. Another example is our Ortho month in which we do NO floor work, no admits, no H+P's, its entirely ED specific either in the ED, or learning reductions/injections in clinic with attendings (not resident clinic). Once again, considered off service, but very much ED in the end.

2. What exactly is your concern in "off service months". Is it that you are concerned that you won't have enough time in the ED? Then you should look at # of ED months, # of shifts, and # of hours x years, rather than off service stuff.
If you are concerned that you don't "need" IM floor month etc then basically you are a fool (there is always something to learn, especially when you are going to manage the ICU's ALONE the next year). We graduate plenty of people that can manage any ED with our on service training.

3. At Carolinas, we train only at one facility, so you will still be in the ED a large portion of your off service months (learning from our attendings and cheifs etc when you are admitting a patient, seeing call ins, etc).

4. We are allowed to moonlight after your first ED month, so on my off-service months I still work 4-6 shifts in the ED, combine that with my "thank you bobs" (see below), I can work 4-8 ED shifts even on an off service month.

5. We have DAILY lecture, so even when you are on a off service month, you come to Emergency lecutures every day, not random surgery etc.

6. Lastly we do some extra shifts on several months to help out in the ED. This works out to be 2-3 shifts a month during SOME off service rotations allowing us to loosen the schedule and allow for some others to have time off etc. We call them "thank you bob" shifts and we do them second and third years.

Sorry for the long response, but as you can tell it's not as plain and simple as off/on service. It plays into what each rotation defines as duties, and when you are in the ED what #'s of shifts/hours you work. This goes for all programs, not just CMC.

Hope this helps, and good luck to all that are interviewing!!!!:thumbup:
 
I used this thread so much last year I would feel guilty if I didn't contribute this year. So here goes with a bunch.

Carolinas

Residents: Super friendly crew. The night before dinner was well attended, with plenty of good conversation and some pool played. I had the opportunity to meet the famous purple hippo :thumbup: and spent awhile talking to him. The residents seemed to be very good friends and had mentioned thinking of buying a class boat to take to the nearby lake.

Faculty: Very impressive. Dr Marx met with us and lectured during noon lecture and for being such a big name in EM it was great to see he didn’t have the big ego to go along with it. He was very interactive with the residents and seemed to know them all by name. Dr Hays is the PD and a great representative for the program. I honestly felt like Dr Hays could sell almost anything but I’m sure it helps when you have a great product to sell. Very dynamic guy and seemed extremely committed to the residency. The rest of the faculty I met with were all amazing, top in their fields and very easy to talk to.


Ancillary Staff: By all accounts they are great, I would imagine this is true just by looking around the hospital.

Curriculum: I know lots of people believe that CMC spends too much time out of the ED. I asked Dr Hays about this and he assured me that he didn’t feel like his residents waste any time outside the ED. I think the questionable rotations would be IM and Peds. The Neuro is gone. The rest of the rotations seem pretty high yield with lots of ICU months acting as the senior. But honestly its hard to argue with a curriculum that continues to turn out top notch physicians. And of course the didactics are awesome, one hour every day during lunch. Everyone gets together, eats and listens to a lecture.

Facilities: Carolinas medical center is a very nice hospital. It has the feel of a hotel in the lobby and elevators, but is the county hospital. It has a huge census (>100K). Everything appears to be top of the line. You spend all of your time at the same hospital. The Peds ED is located there as well.. Brand new beautiful children's hospital is very nice we visited the Panther floor(decorated by the Carolina Panthers).

Location: I really liked Charlotte. Very clean city, not too big and it seemed relatively easy to get around. The skyscrapers look like ice castles on top and the downtown (uptown as they call it) seemed very safe to walk around, I walked a mile to the dinner and felt safe the whole time. Cost of living is great and everyone either had a home or rented a nice home uptown.

Negatives: I guess the off service months but like I said, its hard to argue with a curriculum that continues to turn out great docs.

Other points: They claim to give you the true county experience of patient population and pathology and the experience of a great private hospital serving the wealthy, all under the same roof.
Great benefits, tons of educational money to go along with the free books and PDA.

Overall: I had very high expectations of the Carolinas program and I felt as if they were all surpassed. Very strong clinical experience, great faculty, good city to live in, great benefits, and very happy residents. I will be ranking them very highly and would be extremely excited to match there.
 
This program has a ton of time devoted to off-service rotations (~14 months). The residents I spoke with didn't seem too thrilled with their general surgery month, IM floors, general peds, neuro, etc.
I'm currently an intern at Carolinas, and I wanted to address this question since it comes up frequently. As I interviewed, I tried to come up with ways to differentiate between residency programs. We are clearly asked to make a major decision with very little information. I didn't like my IM month in med school (I think few EM types do) so I was initially down on having to do floor months in residency, it seemed a lot cooler to just have MICU months. Having now finished both my MICU and floor months, I am beginning to see why Parker (our PD) feels so strongly about having them.

In the MICU there are lots of fun procedures and interesting patients, but the fact is that these people are reallllly sick, and as an intern your opportunity to independently manage them in going to to be somewhat limit. You might start fluids on your hypertensive patient, but I personally am hesitant to go starting pressors on a vented patient in multisystem organ failure without talking to an upper level. Contrast that with say a surgical floor month when at night you are primary cross cover on 70 patients you've never seen before. You have to be able to rapidly asses and manage them. In our institution there is always an upper level if you need them, but they have a lot of other responsibilities and your are expected to manage the patients you cover in most cases. This definitely pushes your development as a physician.

Every year the second and third year residents review the rotations, and every year they have decided to keep these rotations in place.

In the end I decided that Carolinas has been producing excellent EM docs for decades, and that they probably knew what they were doing. I'm glad I did, it's been an excellent experience so far.

BTW, a number of those "off-service" months you are actually in the ED a lot of the time. I.e. on ortho you do all the reductions and splints, on U/S you do all the ED U/S, etc...
 
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I'm also an intern at CMC (Carolinas) and just wanted to add my $.02 to what djkammer said above... also, feeling guilty that I used these forums extensively last year without ever giving back. I'll try to stick to the format as much as possible. Apologies in advance for being so positive, but I love working here and can't say enough good things about the place, the people, and the training. Feel free to PM/email me with questions.

Carolinas Medical Center

Residents: Like a huge family. If you're interviewing here, make sure to attend the dinner the night before; routinely 20+ residents show up (anybody who isn't working that night) and have a great time. Obviously I'm biased, but everyone here has quickly become my closest friends. Our 14 person intern class comes from 14 different cities and is quite diverse.

Faculty: Others have commented on the quality of our faculty already, so I won't rehash it. What I can attest to is that personality-wise, it's a group that is extremely dedicated to resident education and fun to be around both in and out of hospital. There's something awesome to be said for working shoulder-to-shoulder with John Marx and then heading out for post-shift pizza at Brixx.

Non-Physician Staff: Everyone here is on a first-name basis and works together well. Our nurses are very capable and great to work with, as are techs, security staff, etc. There is one cafeteria guy that works at the Sbarro that I don't care for much, but I suppose you can't win 'em all. He looks vaguely irritated every time I order a calzone...

Curriculum: As mentioned in other reviews, we do spend a fair amount of time off-service, but I think this is where you truly grow as an EM physician. I worked up a complicated cholecystitis days after I got off general surgery - knew what to do and how to package the patient without a second thought. The same can be said for gaining familiarity with who should be hospitalized on peds etc. Personally, I think it's a huge mistake to remove IM/Surg/Peds months as some programs have done. They are our primary interface for the rest of our careers, and there is a lot to be learned spending time on the other side.

As a side note, we sit down with the chiefs as a group once a month, and one-on-one twice a year to review any problems or changes we think should be made in the curriculum. Nobody yet has argued to remove any of our off-service months, which I think speaks us feeling they are valuable.

Facilities: CMC is an interesting dichotomy, both functioning as Charlotte's county hospital/major regional referral center and also as the "best" hospital in the city. As such we see an extremely diverse range of pathology, from homeless guys to CEO's. Make no mistake, you'll be busy here as this is the regional hospital. Anybody too sick to be treated at an outside hospital gets flown here, so we tend to see more interesting cases as a result. The facility itself is beautiful, and the ED is currently undergoing renovations, to be finished next month. CMC does very well financially which shows. Food perks include Boars Head Deli, Chick-Fil-A, Sbarro, and a Starbucks all in the hospital.

Location: Weather's great, Charlotte is affordable. I bought a house when I moved here and have easily made it work with our salary.

Negatives: The Sbarro guy. Seriously, though, you will work hard here... but then again, all residencies are hard - you know this already. Better to work hard with a supportive environment around you than get thrown to the wolves with no backup. As an example, a particularly busy day on general surgery I hadn't eaten anything for 13 hours; I got a page to the ED for a "consult" only to find that 5 of the ED interns had brought me food from a dinner party.

Other points: There is so much to be said... tons of CME money, free medical/dental, moonlighting as of your 2nd month of intern year with very good pay, fellowship opportunities if you want. 25% discount on my iPhone/AT&T service through CMC.

Overall: We're very happy here, and I can say that to a person my intern class feels fortunate to have matched. I'd make the same decision in a heartbeat.
 

dwgs

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Hey all,

Here goes a description of the busiest week of my life (4 interviews in 5 days on the road:

Palmetto- WOW. A real shocker. This program was not high on my list prior to interviewing and now I think I'm going to rank them #1. PD (Dr. Cook) is AMAZING!!!!!!!! Education is solid and very much like the typical curiculum of other programs. Ultrasound is a definite strength as two attendings at this program travel to other programs to teach them how to do it. Facility itself was old but extremely well maintained. Benefits are beyond belief... I almost stroked out when I was told that all medical/dental insurance is 100% paid for you and your family. Also, food is free 365 days/yr, 3 meals/day. Free parking, lots of money for conferences, books, etc. 1st year salary 40K. I swear that I actually blushed while the benefits were detailed.

East Carolina- PD is great (Charlie Brown is his name). Dedicated to education and very appreciative of your time. No introduction to the program was given... you go right into interviews. Residents all very happy. Very "family friendly" environment. Attendings all very enthusiastic about the program. Nice town for quiet living. Currently moving into a gorgeous, brand new ED.

Carolinas- Good introduction to the program. All attendings very warm and inviting. PD is extrodinarily enthusiastic about the program and makes is known that he appreciates your energy and time in getting there. Program is very strong in ultrasound and research. There is a dedicated research building if that's any indication. Research, research, research...

EVMS- Solid program. Good education. Interview day is well organized. Residents seem happy. Attendings are kind and respectful. No hard questions. Residents work at 4 different hospitals that span all socioeconomic levels (poor and uninsured, blue collar insured, white collar demanding yuppies etc). Benefits are okay, not stellar. Location is perfect for the water oriented individual... Chesapeake bay, Atlantic Ocean. 8 hour shifts.

Dwgs
 
Below are my biased short reviews:

Maine Med: +good residents, lots of camaraderie, cushy number of shifts, do lots of stuff in the ED (do not consult as much), lots of ED time as opposed to offservice, lots of outdoor opportunities in area
-not too much pen trauma, fair blunt, cold winters, small program, homogeneous population

U Mass: +good residents, very nice ED, well respected residents, good research, Hawaii elective, awesome helicopter experience, good reputation in area, great ultrasound
-hard to switch shifts, some unhappiness with residents, seemed like residents stay 1-3 hours after shifts for cleanup

Baystate: +work less than allmost anywhere else, good blunt trauma, good patient mix, very little offservice
-residents did not seem strong, faculty I interviewed with seemed disinterested, cramped department, city sucks and lots of residents live far away in nice town, bad ultrasound

OHSU: +very nice hospital, good research, cool city, residents were friendly
-small program, go to lots of different hospitals because primary does not see enough variety, residents did not seem strong

Carolinas: +great teaching, great research, awesome facilities, strong off service, good ICU experience, great reputation, strong residents
-lots of off service months, city not exactly what I expected

ECU:+strong residents, good teaching, nice department, great patient population, good reputation
-electronic records seem poorly implemented, city is very undesirable for some people

Wake Forest: +good teaching, good facilities, strong residents, good US
-Winston-Salem shuts down on Sundays

Christiana: +good residents, huge department, good records, good patient population, great benefits, nice facility, good teaching, very little off service, great ICU experience, great ultrasound
-area may not suit some

U Conn: +nice PD, nice facilities, good relationships with trauma
-area,

Duke: +New PD seems awesome, nice hospital, would be a good area to live in,good teaching
-not enough electives
 
Here are some quick facts about programs from last year of interviewing. I tried to be non-biased as possible, but sometimes I threw in some subjective comments. Hope this helps.

FYI, some things may have changed at programs so be sure to ask.

Christiana - 3 years, 12 EM residents/year (+3 EM/IM and 2 EM/FM), 9 hr shifts with 1 hr overlap, 40 hr/wk as intern, 1 mo of night shifts with minimal night shifts on other ED months, >110k volume at main hospital with 72 beds, ~200k combined volume, 5 hrs lecture/week, daily morning conference, monthly animal lab, 1 month orientation, dedicated CT and radiology dept, OR in the ER, $200 mil expansion of Wilmington hospital by 2011, EM gets airway AND procedures in trauma, no anesthesia residents to intubate, no ortho/ENT/NS/optho residents either, fellowships in admin/EMS/US, 6 U/S machines with great U/S faculty, $49k as R1, 6 mo of ICU rotations over 1st two years, interns work >1/2 shifts at Wilmington, no floor months, no state sales tax, 30-45 min to Philly, 1 hr to Baltimore, 2 hours to DC/NY, 90 min to Atlantic City, moonlighting available

Hennepin - 3 years, 11 residents (+2 EM/IM)/yr, 9 hr shifts, >100k volume, very little floor months but surgery heavy, 2 mo neurosurgery as R2, believer in "graduated responsibility" (AKA delayed gratification) so that as R1 you don't have many duties but by R3 you are running the dept, "pitboss" as R3 with no note responsibility, free food, 4 stabilization rooms with U/S mounted on each bay, airways only as R3, 12 U/S machines total which are directly linked to PACS, U/S tech hired to teach residents, EM on ALL traumas and surgery as consult, 1 mo community experience, OB/gyn involves inpt and outpt care, EMR (Epic), sim lab integrated into curriculum, great EMS relationship, 1 wk hospital orientation and 2 wk EM orientation, hyperbaric chamber

Brown – 4 years, 12 residents/yr, >100k volume, brand new ED with cath lab, 2 CT scanners, 72 beds with 6 crit care beds, awesome sim lab 1 day/mo, no boarding in the ED (is that possible?), strong peds EM program, large amount of trauma since they are the only show in town from New Haven to Boston, strong U/S program with fellowship available, 4.5 mo electives, trauma surg without scut work, conferences supposed to have more small group discussion this upcoming year, 20-22 shifts/mo, 9 hr shifts with 1 hr overlap, great international EM, 75 full-time facult, $50k salary as intern

Yale – 4 years, 12 residents/yr, 1 full month orientation, stong U/S program, 12 hour shifts, 18-20/mo as intern, 6 mo crticial care over residency, tox month at NYU Bellvue, 2 hours sim lab per month, 6 mo elective time, $51k as intern

USC – 4 years, 17 residents/yr, 12 hour shifts, 20? shift/mo, top-notch U/S program with over 20 machines, 12 resus bays, tons of procedures, EM has ALL hospital codes, work in the underground jail ED, excellent teaching with tons of videos uploaded every month, attendings doen’t write notes so that have more time to teach, observation unit run by attendings and NPs, new hospital with good facilities, no EMR using all paper notes but plans to upgrade

Highland – 4 years, 10 residents/yr, one month EM orientation, awesome U/S training with 2 U/S fellows, county program, great salary, uses EMR, ski cabin in Tahoe that residents share, one month off per year, 3 informal teaching session in the ED per day, free food all the time, no OBS unit so you must admit all low risk chest pain, rotate though many hospitals (Kaiser, UCSF, Children’s, SFGH), ortho rotation includes time in OR, great tox month at SFGH, weaker IM program can be frustrating

Carolinas - 3 years, 14 residents/yr, >100k volume, very nice hospital, only 1 hospital to rotate through, labs results broadcast to free PDA, didactics daily with free lunch and protected on off-service rotations, fellowships in tox/EMS/US/peds/research, large amount of off-service rotations but I was reassured that they are important, $45k/yr as intern, no EMR but orders by computer coming soon, no orientation month, 4.5 resus bays, no direct medical school affiliation, residents go to SAEM 2nd year and ACEP 3rd year

UMass - 3 years, 12 residents/yr, no medicine floor months but lots of ICU, 10 hr shifts, 20-22 shifts/mo, 5 u/s trained attendings and 8 toxicologists, volume 80-90K and growing, 200+ million dollar ED, new CT scanner, located in worcester (pronounced wooster), helicopter medicine - one month in PGY1 with a 2 or 3 running the show (the bird never flies without a resident) but can be grounded often in winter, every U/S is recorded and Q/A'd by U/S doc, likely elimination of PGY3 elective to Hawaii with free housing/car, 45-60 min from boston, plenty of trauma with all procedures/airway being done by EM residents, residents can moonlight in the ICU starting 2nd yr, 5 hours weekly of didactics, computer tracking system with labs/rads results but orders/vitals/nursing notes/MD notes are all paper and then scanned into computer that you can pull up later if needed.

Vanderbilt – 3 years, 12 residents/yr (increased by 1 this year), no floor months, 1 hr lecture each morning by PD or chair of EM, 1 month orientation with reduced ED shifts and great teaching, awesome EMR, >100,000 combined volume of main hospital and children’s, teaching by U/S fellowship trained EM physician, >3k level 1 traumas/yr, video review for each trauma, 2 BS toxicologists, ED radiology 24 hrs/day, emergency cardiologist in ED, 6 wks community ED, moonlighting allowed, 2 CT scanner, 4 active trauma bays, 10 hr shifts as R1, great sim lab with 1 day/mo, Keeping Up! (EBM review website) run by attendings, $49k as R1, fellowships for EMS/international health/peds, no anesthesia residents/attg necessary for PSA, tons of airway devices, evals p every shift/month/6mo, great EMS relationship
 
Just a note, as of this week the interns at Carolinas no longer do a general surgery rotation. I still think off-service rotations are important for the reasons I outlined above, but I think that our leadership had done a good job of responding to resident question about the best use of our time. I have to say that this is very typical here, I feel like our concerns and questions are definitely taken seriously.

Also, my $0.02 on how to choose a residency. To quote Ron Walls, "Choose a place where you know you will get excellent training, and because of how it makes you feel and what you think of the people." Picking a place because it has an extra month of elective will make you happy for exactly a month. Pick a place where you are proud to show up everyday and you will be happy (most days) for all of residency.

Other stuff:
I've gotten a bunch of questions by PM, so I thought I would post the answers here

EMR: We do have an EMR. Notes in the ED are still paper based (which I like since you can get them 90% done while you are in the room), the are then scanned into the EMR the following day.

Trauma: The trauma service responds to all priority 1 and 2 trauma codes (priority 3 codes are just the ED). Codes are run on an alternating basis, on even nights the ED resident runs the codes, on odd nights it's the trauma resident. The resident who isn't running the code does all of the procedure (chest tubes, lines, etc), except for airway which always belongs to the ED. Interesting, since we do trauma rotations, the "Trauma resident" is often actually an ED resident as well.

Airways: The ED residents handle all emergent airways in the department. The only time an anesthesiologist is called is for elective procedure requiring deep sedation (and thus an airway) in the department. This is relatively rare (I've seen it one in 18 months), and is usually for hip reductions in patients who did not otherwise need an airway.

Admitting: I've had several people ask if we have "admitting privileges" from the ED. This is kind of an odd question since technically "admitting privileges" means that you have the right to bring a patient in to the hospital on your service (most ED folks wouldn't want that since it means you'd then have to take care of the patient on the floor). The more relevant ED questions are:
1) Can a consultant or admitting service refuse your request to see a patient? The answer here (and hopefully most places you're looking) is 'no'. Now it's important to be reasonable with your consultants, and if they say "I think we can send this patient home with medication X and see them in clinic tomorrow for a re-eval" that may be a good alternative to admission. But it's also important that you have the power to say "I don't feel like that's safe for reason X" and know that you can make sure the patient will get brought in (which is also the case for use fortunately).
2) Can you get patients out of the ED if the admitting team is not immediately available? I don't know hoe this works at other places, but we have the ability to write quick "holding orders" (affectionately called "bunny hops") to get patients out of the ED if the admitting team can't come see them immediately. These get the patient taken up to the floor, and the admitting team can evaluate them and admit them from there. Obviously you only want to do this with stable patients who you are sure require admission, but its a great tool to keep your department moving.
3) Do you have an ED obs unit where you can put folks who just need to be watched without admitting them? These are pretty common now days, and we, like most big hospitals have an obs unit that we run ourselves.
4) Do you often have long boarding times? Having lots of boardes in the ED means your not getting to see as many new patients as you otherwise could, which I think is bad for your educational experience. It can be hard pinning people down on boarding tie, so one way to ask the question is "how often do you end up signing out a patient at the end of your shift who was signed out to you by the person on the previous shift?" In 18 months at Carolinas I've only had to do this once

Vacation: Do you really only get 2 weeks off a year? No. We get 4-5 weeks off each year. 1 week a Christmas or New Years, 1 week of conference time (interns pick their conference, pgy2's go to SAEM, 3' go to ACEP), plus two weeks of pick-your-days-off for 1's and 2's, 3 weeks for R3's

Shifts: In general we work about 18-20 10 hr shifts a month. As a upper level shifts in the Peds ED are only 8 hrs, and the senors' shifts have an hour of overlap where the person coming off stops seeing new patients and just tidies up loose ends.

If you have any other questions, please feel free to drop me a message.
 
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Thought I should chip in since I know I read these threads incessantly last year. I added in a bit about my overall thoughts on each program, in case anyone finds that helpful. Feel free to PM me if you have questions and I'll try to at least give my personal insight (which was mostly gleaned from a 1 day interview so it for what it is!).I didn't go to all the interviews I was offered, but I ranked all the places I interviewed and honestly feel I'd be happy at any of them. Yay for EM. :)

1. Vanderbilt:
Loved this program. Had everything I was looking for in terms of having great people, tremendous leadership, great academic/research opportunities, nice city with good COL. Overall the hospital is super supportive of resident education, good benefits, etc. SO liked it too, so it was a fairly easy choice.

2. U of AZ: This was a strong #1 for me until I went to Vandy (which was my last interview). Totally loved the residents, wanted to go out for drinks with the rockin' PD, and Tucson in December was awesome. Great research and terrific curriculum, too. In the end, though, it's far from family and didn't outshine anything Vandy could offer so being a direct flight from family won out.

3. Maine: Totally loved this program, too. Fantastic residents, great hospital, fabulous location. I've spent a lot of time in Maine so this place felt great to me. Thing is, they have no NIH funded research, and since it's important to me to have mentors with NIH grants, etc, I decided I had to pass this one up. I do hope to get back there later in my career, though, and if Match Day brings me there now I'll still be really happy.

4. Carolinas: Great, well established program that has been turning out fantastic EPs for a long time. I liked the new PD a lot on a personal level, although it felt like she's still working out her vision for the direction of the program from here. I don't think that really takes away how great the program is, necessarily, but the leadership at other programs pushed them above this one for me. Again, I think I could be very happy here.

5. UMass: Again, another very well established, very strong program where I could be very happy. I absolutely loved the PD here and it's clear that he puts the education/health/happiness of his residents at the top of his to-do list every day. Worcester is really a drab, post-industrial city with horrendous winter weather, though, and SO was pretty dead set against moving there. So down it went.

6. Utah: I rotated here and really enjoyed my month. Really fun people, good focus on education, could not really be in a nicer location. In the end it was also far from family, and it's a young program that still seemed to be finding its place in the overall hospital scene. I know some residents in other departments at the U and it seems from their experiences that there's an overtone of 'residents are here to work' instead of 'residents are here to learn.' I figured out on the interview trail that this distinction was important to me. I don't think that was true in EM there at all, but you do have to do your off-service rotations. This could be off, it just seemed that some of the other programs I saw had a bit more to offer me in the end. Despite that, I would be more than happy to train there, and I'm sure I'd get a great education, if that's how things go.

7. Georgetown: Dr. Love (the PD here) was actually the one who drew my attention to the point mentioned above, that you want to go somewhere that you're not just a cog in the wheel of the hospital but that your education is primary. He has such a well-defined, clear vision for his program. It was really inspiring. I'd be really happy to train here, in theory, but the logistics were just not going to work for me. COL was way too high, you have to drive to locations that aren't near one another in crazy DC traffic, etc. I was kind of bummed I couldn't easily make this one work for us. We'll figure it out if match brings us there, but it'll be a challenge.

8. UVA: I definitely loved Charlottesville and the residents I met. I went here after I was at G'town and I wanted to take that program and move it to Charlottesville. The PD here is new and just wasn't a great salesman. I don't doubt they have a great program, but he did a lot of handwaving and literally saying 'blah blah blah' during his PPT and I felt like I didn't get a sense at all of what he was offering. That said, I'm sure I would be happy here and I certainly loved the scribes program.

9. Rochester: Definitely a strong program, nice people, good COL, strong research, but SO wouldn't budge on location.

That's all she wrote. ;) Bring on 3/17!!
 
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...
 
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.
 
Posted anonymously on behalf of a student who interviewed there:

*****

I applied in the south east area. Top quarter of my class, 254 step 2, Honors in EM x3, 2 away 1 home, Couple of publications. Sent out like30 apps. Only interviewed at 3 year programs.

My top 4 programs (in alphabetical order):

UAB
Pros: Outstanding program, outstanding reputation. The guys that write harrison’s internal medicine txt are from UAB. Great research support. Used to be a 4 year program, only been a 3 year program for a few years. The program director is a huge highlight. Resident advocate. My favorite interview on the trail. Resident centered program. Best moonlighting opportunities I encountered. They have internal moonlight at an urgent care type facility for so-so pay. Also have external moonlighting where you are paired up with more experienced physician and cover 2 physician EDs. A majority of the residents moonlight at least some. ED is brand new and state of the art. New children’s hospital/ED opening this year. 10 residents.
Pros/Cons: Birmingham.

Carolinas-
Pros: Outstanding program. Long history and great reputation in the field. Top of the top researchers in EM. Jeff Klein for instance is THE pulmonary embolism guy. Program directory is absolutely awesome. One of my favorite interviews of the trail. I just read one of her chapters in Rosen’s actually. They treat their residents amazingly. Great benefits. One of the best cities to live in period. Cool patient population, you get both underserved and the private type patients in the same ED. 12 residents per year.
Cons: No external moonlighting, although they do have internal moonlighting that pays so-so. No medical school affiliation (although I think they are working on this). I wasn’t a big fan of the ER, Kind of seemed cramped and older.

Emory
Pros: Again, outstanding program, great reputation in the field. Tons of top people have trained at emory. New trauma area is super nice. Lots of freedom as a resident. High patient volume. High acuity. Clinically, arguably the #1 program in the southeast. The research here is on another level. The CDC is located there in Atl and has large ties with the EM department.
Pro/con: Giant program 21 residents. Grady. I think it would be awesome to work there. Tons of action. Lower socioeconomic patient population. Atlanta is a pro/con, either you like it or you don’t .
Cons: No one moonlights there. Apparently it is allowed, but just no one does it for some reason. I asked about it and they had maybe 1-2 third years that do any moonlighting at all. They don’t do integrated Peds shifts, this is the only program on the list that does full Peds months exclusively with no year round type of experience. I felt that the program was less resident centered and more research/attending centered.

Vanderbilt
Pros: Outstanding program, outstanding reputation. Best resident education I encountered on the trail. Wrenn and Slovis are on a plane of their own. World renowned lecturers/educators. Resident centered program. Great moonlighting opportunities (external only I believe), most of the residents did some moonlighting. Ed and Childrens ED both have excellent layout and look nice. Great reputation in the area, with wide patient diversity and high acuity. Good relationship with trauma dept. Nashville is an awesome city with tons to do. 12 residents.
Pro/con: Medical record isn’t one of the big professional ones, it is one that was created in house. Seems good, with all the features you would expect/need.
Con: no real cons to the program.
 
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I worked with some of the EM residents at Carolinas not too long ago. Those guys were incredible! The program is top noch and so are what it produces.
 
Just completed my away month at Carolinas.

Overall, I was blown away by the program. I decided to do my away at Carolinas because of its stellar reputation. Yet, I can honestly say it lived up to my expectations.

Pros:
-Amazing facility, yet functions as the county in Charlotte. Only Level 1 trauma center in Charlotte. Saw a ton of acuity during my month.
-Faculty are laid back and easy to approach. Worked with multiple nationally recognized faculty.
-Residents are great, smart yet extremely social. Constantly organizing nights out and other activities.

Cons:
-Competitive program
-Concerned with amount of off service rotations during intern year.
-Not sure I want to live in the Southeast
 
Just completed my away month at Carolinas.

Overall, I was blown away by the program. I decided to do my away at Carolinas because of its stellar reputation. Yet, I can honestly say it lived up to my expectations.

Pros:
-Amazing facility, yet functions as the county in Charlotte. Only Level 1 trauma center in Charlotte. Saw a ton of acuity during my month.
-Faculty are laid back and easy to approach. Worked with multiple nationally recognized faculty.
-Residents are great, smart yet extremely social. Constantly organizing nights out and other activities.

Cons:
-Competitive program
-Concerned with amount of off service rotations during intern year.
-Not sure I want to live in the Southeast

Absolutely this. Seemed like the most fun and cohesive group of residents I encountered. Not to mention the city of Charlotte has a TON to offer.

Not sure I would count competitiveness as a con, and I absolutely love the southeast so that's out too.
 
Carolinas Medical Center (CMC)
Curriculum:
A lot of critical care for a three year program. PGY-2/3's are seniors in PICU, MICU, CICU and trauma ICU. Interns do a MICU month also. No burn unit or dedicated peds anesthesia time but you have three months elective time when you could do that. Strong ultrasound/tox/trauma experiences. Sim 9x/year as an intern, 5x as PGY2/PGY3 Decent EMS; Carolinas MED-1 is this HUGE tractor trailer that can basically be a mobile hospital. Not clear how often it really gets deployed though. Residents said ortho is their weakest rotation but didn't really get a clear answer on why this is.

Off service months were the big thing I was worried about going in to my interview but I felt a lot better about it afterwards; it seems like each one is there for a reason. Apparently the surg rotation is basically a emergency surgery consult service that was created specifically with the EM residents in mind. Peds floor month is just you and an attending. Medicine is the one that I still wasn't totally sold on.

They recently created a website that they call the "Compendium" where they have pulled landmark articles/textbook chapters and organized them by rotation to help residents know what to read each month.

ED:
Not the nicest, not the worst. 3 Adult areas plus Peds. Seems like the residents see a TON and have a lot of autonomy. When I shadowed there I saw a pediatric trauma, a code STEMI, a couple of medical resuscitations that needed to be intubated and then a lot of other "run of the mill" stuff. Didn't realize that this is the 6th busiest trauma center in the country. That's pretty cool. Patient population seemed genuinely really varied. Makes sense. Pretty much only game in town with huge catchment area plus referrals from 30+ CHS hospitals.

Residents: First thing that stood out is how cohesive and happy the residents seem to be. Great turn out at the interview dinner. Super relaxed, lots of kids. Seems really family friendly (although no moms that I met, all dads). Lots of different types of people but all social and seem to be proud of their program. Some people told me on the trail that they felt like the residents here can be "fratty" but I didn't find that to be the case. In fact, most people seemed really outdoorsy and very down to earth.

Charlotte: better weather than where I'm coming from. Got to check out the Whitewater Center that everybody talks about on my visit. That place is AMAZING. Pretty much an adult playground, 30 minutes from downtown/the hospital. Charlotte was surprisingly way more affordable than some of the other southeast cities I'm looking at (Nashville, Atlanta, Charleston). Asked some of the residents what they pay for housing, seems to be anywhere from $800-1200 per person depending on the set-up.

Faculty:
The PD and Chair both seemed very approachable. Dr. Gibbs is a nationally known airway guru. Brings the advanced airway course that people usually pay $$$ for directly to the residents. Another faculty member won the big ACEP teaching award last year. Faculty and residents seem to get along well. Lots of faculty at most of the weekly block conference sessions, not just M&M.

Benefits: Free parking; lots of meal money (I think they said $3000?); $1900 in CME; free iPad. 2nd years go to SAEM, 3rd years go to ACEP. Apparently the Interns go on an annual ski trip where the upper levels cover their shifts so that everyone can go? Sign me up!
 
The last major detailed review was in 2010, can someone familiar with the program (preferably a current resident or recent grad) comment on the following?
  • What are the average number and length of shifts (in hours) 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/trauma seen on each shift?

  • Do EM and trauma still alternate days on running trauma?

  • Do EM and trauma still share procedures based on alternating days? Are all airways still done by EM?

  • Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?

  • How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
Thanks so much for your time and contribution.
 
The last major detailed review was in 2010, can someone familiar with the program (preferably a current resident or recent grad) comment on the following?
  • What are the average number and length of shifts (in hours) 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/trauma seen on each shift?

  • Do EM and trauma still alternate days on running trauma?

  • Do EM and trauma still share procedures based on alternating days? Are all airways still done by EM?

  • Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?

  • How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
Thanks so much for your time and contribution.

10 hours/shift intern year. 8s when you work in peds after 1st year. 9 with an hour overlap when you work major as a third year. You have time during EM months to do whatever you want.

We have 4 areas in the ED. AEC - Fast track; Diag - you can have anything from a cold to a ruptured AAA; Major - all the traumas/medical resuscitations plus anyone who has the potential to be awful. That said, I have had multiple people who were triaged to AEC end up being septic or having an NSTEMI. You've gotta have your guard up everywhere.

Yes

Yes

No - our second years have done thoracotomies this year. One of our third years has done two (lucky bastard). We take care of all airways. I have yet to see anesthesia in our department, even for fiberoptic intubations. Crics are on the books for us as well.

You never transport anyone. You never have to take vitals. In the ED you even have a secretary to page out all of your consults. More time to focus on patient care rather than hunting for phone numbers/pagers.
 
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10 hours/shift intern year. 8s when you work in peds after 1st year. 9 with an hour overlap when you work major as a third year. You have time during EM months to do whatever you want.

We have 4 areas in the ED. AEC - Fast track; Diag - you can have anything from a cold to a ruptured AAA; Major - all the traumas/medical resuscitations plus anyone who has the potential to be awful. That said, I have had multiple people who were triaged to AEC end up being septic or having an NSTEMI. You've gotta have your guard up everywhere.

Yes

Yes

No - our second years have done thoracotomies this year. One of our third years has done two (lucky bastard). We take care of all airways. I have yet to see anesthesia in our department, even for fiberoptic intubations. Crics are on the books for us as well.

You never transport anyone. You never have to take vitals. In the ED you even have a secretary to page out all of your consults. More time to focus on patient care rather than hunting for phone numbers/pagers.

Thanks for the update Modafinil. What's the average # of shifts a PGY-1/2/3 does? I assume it decreases as you become more senior. Thanks.
 
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Thanks for the update Modafinil. What's the average # of shifts a PGY-1/2/3 does? I assume it decreases as you become more senior. Thanks.
A little late most likely given your question was back in April, but yes the average # of shifts is around 20-21/18-20/17-19. Shifts also get shorter for senior residents as was mentioned above.
I'm an intern here, so haven't been around for too long, but we all love it here. I think it strikes the perfect balance of being crazy busy enough that you're always working hard and seeing tons of awesome s**t, but not being overworked or stretched too thin. It's awesome here. Happy to answer any more questions if anyone wants to post here or message me.
 
Got these questions as a PM, so I figured I would share my thoughts:

Do you get a lot of the emergent airways?
Is there any involvement in the E.D. at all from nurse anesthetists or anesthesiology residents (i.e. do they steal any airways)?
How about traumas? Does surgery run all of them?
Do you work with PAs or NPs? Do PAs or NPs supervise residents?
How is the autonomy/graded responsibility for EM residents there?
How are the ICU blocks there?
--------------------------------------------------------
-Tons of airways. We also do an airway month combined with ultrasound in which we just tube people and ultrasound. It's awesome.
-Anesthesia never comes down unless we call them, which I have not seen happen. We do all airways. The chair of our department is Mike Gibbs, who is an airway master, so we get fantastic airway training.
-We split running traumas vs doing procedures every other day. We are the 6th busiest trauma center (by volume) in the nation, so we get plenty. We also rotate on trauma so we get to run traumas and do procedures while on their service as well. One thing I love about this program is that we have fantastic relationships with our consultants, including surgery and trauma surgery.
-There are PAs/NPs we work alongside on certain shifts. They are essentially treated as senior residents and work under our attendings. We don't work under them.
-2nd years take EMS and transfer calls, see trauma patients in triage and decide their alert/activation status, start running the show more. 3rd years basically run the department, are supposed to know more about the bed/flow status, etc. We (interns) present to 3rd years only in 1 of the 4 sections of the ED, which gives them practice as supervising docs. Otherwise we present to attendings, who are all super nice and approachable. Interns don't typically pick up the super sick resuscitations or major traumas, but the upper level residents are all very good about backing us up, allowing us to pick up resuscitations and know that we have backup available when/if we flail :)
-ICUs are great. We have slightly more crit care than the national average. MICU (tons of procedures) as intern; Shock Trauma ICU, Cardiac ICU, and MICU as 2nd years; and supervising role as 3rd years in PICU. We have some awesome intensivists who are crazy good and smart, but also very approachable and excellent educators.
Hope that helps! Hit me up if any other questions..
 
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How are the didactics at Carolinas? Are they fun and interactive or a drag? And how often are they??
 
How are the didactics at Carolinas? Are they fun and interactive or a drag? And how often are they??
I think they're fun. We have very approachable, smart, and funny faculty. Residents give talks as well, which are usually sprinkled with enough humor to keep us awake and smiling. Sim is awesome as well.
 
Are the SLOEs here graded more harshly than at other places? I heard and read on here that the bar tends to be much higher here vs. elsewhere. If so, does it make sense for me to do an away here for a good letter if I want to match here vs. a great letter from a lesser known institution?
 
Wanted to put in my own response after interviewing because I used these threads so much over the years and before interview season. Here’s my rank list with descriptions of the programs! PS, if I say things like “weak” or “meh”, its all relative to programs who have stronger experiences in something. I do not think any of the programs here are weak. I think you will come out incredibly trained at any of them! I’d be happy to match at any of these programs:

  1. Carolinas Medical Center: 3 year program. Integrated Peds shifts. Often block nights together. Robust (top-notch) ultrasound division, do TEEs, “feels like a mini-ultrasound fellowship”. Weak ortho experience because of strong ortho surgery program, no community rotations so only get reductions on ortho rotation as PGY1. High volume, high acuity. Not technically county but serves underserved population for years historically. Lots of community service opportunities available. EM-CCM faculty and lots of CCM research. Very strong Peds EM (PD and APD are PEM trained). Tons of trauma research, traumas split 50/50 even/odd days, but EM has all airways and FAST exams.Moonlighting as PGY2/3. Most medical airways in PGY2, trauma airways PGY3, PGY1s get airway on anesthesia and MICU. ICU months have no fellows, so resident-run (with attending supervision of Course). MICU director is EM-CCM.
MODERATOR NOTE: Because this lengthy post was copied in multiple threads, I have deleted the other program reviews.
 
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