Case Western Reserve University/MetroHealth/Cleveland Clinic Residency Reviews

[corpsmanUP]

I am basically at the point where I am going to go out on a limb and say that there is really no bad EM progam around. In fact, I am starting to believe that most of it is just how you get along with the people and whether you like the area. With the exception of a spaceage facility like Mayo, the constant sunny weather of El Paso, the Jeep experience at Pitt, or the flight experience at Case or Indy, there is really nothing that is a standout. I am just having a total blast coming the country and I have to admit that every place has its perks.

Today I interviewed in the coolest kept secret of a city, Pittsburgh. I think it is the San Fran of the east coast terrain wise. And it has just the right amount of winter to give you that Christmas feel. This place has turned out to be one of my favorites quite frankly because it has awesome people, and it has the Jeep experience. This is a unique experience where you do a couple of your assigned shifts per month in 2nd and 3rd year in a mini-SUV where you drive to the scenes of complicated medical and trauma patients and function as the on scene physician. This is not only incredible for teaching young docs how to be leaders, but it helps them learn EMS from a different vantage point. Pitt also has several star faculty like the other programs I am mentioned before. They like Indy, have a great mixture of county and private in UPMC Presby and Mercy Hospital. Residents were outstanding and a tight knit group that likes to eat, drink, and play together. This is one of the top 3 programs for EMS in the country in my opinion.

Case:
I showed up tonight a bit late driving in from Pittsburgh, but I still got to meet MikeCWRU and several other residents and applicants. They were on par with Pitt regarding hanging out and having fun. I laughed more with these guys than I did with any of the other groups. It was like an episode of the Drew Carey show where they hang at the Warsaw Pub. And why the hec has everyone been lying to me about these midwest cities telling me that they are all suffering from sprawl and depression? Pittsburgh was incredible, and driving into Cleveland tonight I felt the city was a really cool city. Its not too big or small, it has a great downtown stadium and a lakefront like Chicago. The drive to the Pizza parlor was lined with 1920's homes that were all gorgeous and lit up. I'll finish writing tomorrow about the Metrohealth/Cleveland Clinic program but I predict it will be be equally as impressive as Pitt was today. Its great to know that we are all entering a profession where everyone is laid back, where people all like to hang out together and where where the community of EM is still small enough so that we will all be able to get to know each other for decades to come.

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[EctopicFetus]

Corpsman,

My wife went to CWRU for one yr and I sadly had to go to cleveland too often. The city isnt all that terrible but comparing it to chicago is a big mistake. The Chicago Lakefront is awesome and clevelands is decent but nothing like Chicago.

 

[corpsmanUP]

Corpsman,

My wife went to CWRU for one yr and I sadly had to go to cleveland too often. The city isnt all that terrible but comparing it to chicago is a big mistake. The Chicago Lakefront is awesome and clevelands is decent but nothing like Chicago.

I disagree politely. Come visit Houston and then tell me Cleveland is the armpit of anything. If its the armit, Houston is the freaking crotch! It all depends on the stage of life you are in. Cleveland to me has everything I need and more. It has great sports, water access, 4 seasons, great fishing, small town flavor, and nice people. Its not Chicago but that to me means it has most of the same things a Chicago has without the traffic, and the cost.

Case/Cleveland Clinic has some extremely solid things as I found out today. I know this sounds like I am repeating all my same posts, but the residents were top knotch. The progam director gets an A, the facilities get the highest A possible, and the coordinator is as nice as everyone said she is. They area lot like Indy with the two hospital mix, but I would say the offservice rotations at Case exceed Indy's. The Cleveland Clinic is not Mayo Clinic, but quite frankly no place on earth in my opinion will give you Mayo off service rotations. I actually LOVED the city of Cleveland. Within 10 minutes in any direction you can find a nice cozy neighborhood with cheap housing and nice neighbors and schools.

When I say the facility at Metro is outstanding, I cannot emphasize it enough. You have to spend thousands of hours of your life in this place and why not go somewhere that the facilities are great? All private ED rooms with tons of space. The fishbowl is like an OCEAN with your pic of where to sit and write. The will be fully computerized in a few months as well, and already are most of the way there. Metro is the only county hospital I have seen with this nice of a facility. Their flight and EMS potential seems huge with the Cleveland EMS director being on faculty. And the 10 hour shifts are a bit more than most programs with 21-22 in a 28 day period.

If you are not geograhically limited and the midwest is desirable for you, then Case is a must see. It gets the award for the "surprise" program of the interview season for me and I am damn glad I kept that interview. If I were to list all my top programs as of now, they would all fit on one hand. This will definitely be one of them.

Lesson of the day boys and girls: It really pays to go see a program that you may only know limited amount of info on because it may very well surprise you.

 

[coldcoldworld]

Experience started out a bit rough with the obligatory night before dinner as I was one of only 2 applicants and 3 residents to show up. Needless to say, we didn't come close to eating the 8 pizzas they had ordered for us. They said it was really hit or miss on how many showed up but I would have hoped the residents would have cared a bit more about the recruiting process. Oh well, as that was really the only bad part of my story.

Going in, I always knew that Case had a great program but my only hangup was my preconceived notion that Cleveland wasn't a "cool" city. Boy was I wrong. After our tour of Cleveland Clinic, we took a little van tour in and around the city and I was pleasantly surprised. Just outside the city are tons of nice neighborhoods and the downtown seemed really nice. According to everyone there, the cost of living is very reasonable compared to other parts of the country. On to the interview experience....

Started by meeting their very pleasant residency coordinator and the PD. PD was going through his presentation and the chair, Dr. Emerman stopped by. Both were very impressive and really sold the program well.
Interviewed with three people -- Dr. Pennington (PD), 2 others that mainly work at the clinic, and one of the ultrasound coordinators. No big surprises, very laid back. Some had clearly read my file and had things they wanted to talk about whereas one said he never read them and just had some basic canned questions that he asked everyone.

PROS
*Facilities: Brand new ED at Metrohealth (2/3 of shifts) in 2004 with something like 74 beds each with own room and a 12 bed CDU. Very big and very nice. New ED @ Cleveland Clinic (1/3 of shifts) with plans to expand to meet growing census.
*Census: Seems very busy with about 100K/yr at Metro and 60K/yr at the Clinic. Roughly 20% peds. Also, they're one of the few hospitals in the country that are ACS level 1 in adults, peds and burns.
*Trauma: Seems like kind of the only show in town so they definitely get a lot...esp. with 3 level 1 certs.
*US: WOW!!! Tons of experience and research here. They have like 4 attendings that were fellowship trained.
*Flight: Claim to be 2nd busiest in the country with 4 choppers and a fixed wing making about 60,000 runs/year. Residents seem actively involved and can also moonlight.
*Off service: Sounds like really great experiences at both Metro and the Clinic
*Program Director: Seems very open to change and is constantly tweaking the schedules to better the resident experience.
CONS
*# of shifts: Sounds like they work about 20-21 tens with no overlap and those tens usually turn into elevens in order to finish up. Not a swamping workload but I've seen less.

I honestly think thats the only con I can think of. I was really blown away by how complete this program was. Nice mix of the "county" experience at Metro and the more community experience at Cleveland Clinic. Definitely very high on my list...may need to go take another look.

 

[goblue1]

Ok, time to stop being lazy. Here are a few of my reviews. As with everyone, these are very subjective....enjoy.

University of Michigan:
Stats: 4yr program, 12 res/class, started 1992
General: 3 Hospitals: U of M (74K) – Tertiary care center, trauma, flight, Peds, majority of off-service rotations. St. Joes (85K) – Community “teaching” hospital, bread and butter, level 2 trauma. 15 min from main hospital. Hurly Medical Center (78K) – County hospital in Flint, significant trauma (penetrating and blunt); ~5 months total, 1 hr commute.
Separate and integrated Peds experience depending on location.
Pros: Very well run, impressive program with strong leadership and highly regarded faculty (i.e. - Dr. Barsan). Sold the 4 year program to me – significant ICU experience (9 months), extra elective time, teaching and administrative responsibilities for 4th year residents; overall a well rounded experience. Strong academic feel – relatively high percentage of residents go on to academic positions and fellowships. U of M is large and highly ranked hospital. Research is not required (“academic project” instead), but variety of projects readily accessible. Program director seems very well organized and passionate about program. Residents come from a variety of regions and are well marketed across country for future positions. Diversity of patients and experiences at different locations – plenty of pathology and trauma experience. Flight experience. Very nice facilities. Ann Arbor is a great town.
Cons: 5 months away in Flint which is a 1 hour commute each way. Resident classes didn’t seem as social and cohesive. Although a few ultrasound teaching attendings, ultrasound training not as well developed.


University of Pittsburgh:
Stats: 3yr program, 16 res/class, began in 1981
General: 4 Hospitals. UPMC – Tertiary care 50K, trauma, flight. Mercy 60K – community hospital downtown, bread and butter + trauma. Children’s Hospital. + 1-2 other community hospitals doing ED shifts and ICU. All hospitals within 15 min.
Pros: Residents seem very happy and all seem to get along – great camaraderie within classes. “Work hard, play hard” feeling. Residents raved about program. Strong, established, academic program with several fellowships (EMS, Tox, Peds, Research). Faculty approachable and good teaching. Great EMS program with “Jeep Shifts” – 2nd and 3rd year residents drive Jeep around town and are 1rst responders. Flight experience. Variety of clinical settings with separate pediatric emergency department. Pittsburgh is a surprisingly nice city which is very affordable.
Cons: 4-5 different hospitals with different charting systems. Most hospitals use paper charting. Average appearing facilities (from what I saw). Parking is apparently an issue for residents. Residents said Peds training “so/so”. Ultrasound training not emphasized.

Wash U:
Stats: 4yr program, 12 res/class, started 1997
General: Majority of time spent at Barnes-Jewish (main) ED – 80K as well as Children’s - 60 K; few community rotations scattered. Research required.
Pros: Heavy academic – required research (if that is your thing) and several months set aside for projects, frequent didactics and conferences (M&M, EKG, etc.), medical student teaching. Strong off service rotations at Barnes-Jewish/Wash U; emphasis on ICU rotations. Great pediatric experience at Children’s. Strong u/s program (looking to add fellowship). Great facilities – all computer charting. Well-organized program. Significant time for electives. St Louis very affordable (most residents had bought houses). 4wks vaca/year.
Cons: 4 year program – although many of the residents swear on it, many were talking about how they would only spend 30 hrs/wk during elective time (wonder if it is necessary??). Extra year allows more ICU, ent/optho, research months, elective time, etc. Required research project (if that is not your thing). The residents generally spoke well of the program, but many admitted that it was their 2nd, 3rd, 4th choice. Not its own department, for what it is worth. PD is very nice but “anal” and residents complain of “significant amount of paper work” . Although Central-West End is nice, none of the residents seemed thrilled with city.


Metrohealth/Cleveland Clinic:
Stats: 3yr program, 12-13 res/class, started 1991
General: 2/3 spent at Metrohealth – Large (90K+) county hospital with significant trauma, peds (integrated), and “bread & butter” ED cases. 1/3 spent at Cleveland Clinic – 40K+, less acuity, but are seeing unique CC pathology. Hospitals about 15min apart.
Pros: Nice balance b/w county and academic hospitals. Facilities generally very nice at both locations (CC ED brand new). Residents seem very happy and seem to get along. Residents are well prepared, although they admit to “working very hard” in their 3 years. Faculty are generally well-liked and lobby for residents. Excellent flight program with opportunities for residents. U/S training and fellowship available.
Cons: Seemed like a “local” program – most residents from upper Midwest and it seemed like many were planning to stay nearby. Cleveland is a livable, but mediocre setting (low cost of living, though). Was not an emphasis on non-ED rotations. Very little time for electives. No separate pediatric training (this did not seem to be an issue, however).

 

[goblue1]

Ok, time to stop being lazy. Here are a few of my reviews. As with everyone, these are very subjective....enjoy.

University of Michigan:
Stats: 4yr program, 12 res/class, started 1992
General: 3 Hospitals: U of M (74K) – Tertiary care center, trauma, flight, Peds, majority of off-service rotations. St. Joes (85K) – Community “teaching” hospital, bread and butter, level 2 trauma. 15 min from main hospital. Hurly Medical Center (78K) – County hospital in Flint, significant trauma (penetrating and blunt); ~5 months total, 1 hr commute.
Separate and integrated Peds experience depending on location.
Pros: Very well run, impressive program with strong leadership and highly regarded faculty (i.e. - Dr. Barsan). Sold the 4 year program to me – significant ICU experience (9 months), extra elective time, teaching and administrative responsibilities for 4th year residents; overall a well rounded experience. Strong academic feel – relatively high percentage of residents go on to academic positions and fellowships. U of M is large and highly ranked hospital. Research is not required (“academic project” instead), but variety of projects readily accessible. Program director seems very well organized and passionate about program. Residents come from a variety of regions and are well marketed across country for future positions. Diversity of patients and experiences at different locations – plenty of pathology and trauma experience. Flight experience. Very nice facilities. Ann Arbor is a great town.
Cons: 5 months away in Flint which is a 1 hour commute each way. Resident classes didn’t seem as social and cohesive. Although a few ultrasound teaching attendings, ultrasound training not as well developed.


University of Pittsburgh:
Stats: 3yr program, 16 res/class, began in 1981
General: 4 Hospitals. UPMC – Tertiary care 50K, trauma, flight. Mercy 60K – community hospital downtown, bread and butter + trauma. Children’s Hospital. + 1-2 other community hospitals doing ED shifts and ICU. All hospitals within 15 min.
Pros: Residents seem very happy and all seem to get along – great camaraderie within classes. “Work hard, play hard” feeling. Residents raved about program. Strong, established, academic program with several fellowships (EMS, Tox, Peds, Research). Faculty approachable and good teaching. Great EMS program with “Jeep Shifts” – 2nd and 3rd year residents drive Jeep around town and are 1rst responders. Flight experience. Variety of clinical settings with separate pediatric emergency department. Pittsburgh is a surprisingly nice city which is very affordable.
Cons: 4-5 different hospitals with different charting systems. Most hospitals use paper charting. Average appearing facilities (from what I saw). Parking is apparently an issue for residents. Residents said Peds training “so/so”. Ultrasound training not emphasized.

Wash U:
Stats: 4yr program, 12 res/class, started 1997
General: Majority of time spent at Barnes-Jewish (main) ED – 80K as well as Children’s - 60 K; few community rotations scattered. Research required.
Pros: Heavy academic – required research (if that is your thing) and several months set aside for projects, frequent didactics and conferences (M&M, EKG, etc.), medical student teaching. Strong off service rotations at Barnes-Jewish/Wash U; emphasis on ICU rotations. Great pediatric experience at Children’s. Strong u/s program (looking to add fellowship). Great facilities – all computer charting. Well-organized program. Significant time for electives. St Louis very affordable (most residents had bought houses). 4wks vaca/year.
Cons: 4 year program – although many of the residents swear on it, many were talking about how they would only spend 30 hrs/wk during elective time (wonder if it is necessary??). Extra year allows more ICU, ent/optho, research months, elective time, etc. Required research project (if that is not your thing). The residents generally spoke well of the program, but many admitted that it was their 2nd, 3rd, 4th choice. Not its own department, for what it is worth. PD is very nice but “anal” and residents complain of “significant amount of paper work” . Although Central-West End is nice, none of the residents seemed thrilled with city.


Metrohealth/Cleveland Clinic:
Stats: 3yr program, 12-13 res/class, started 1991
General: 2/3 spent at Metrohealth – Large (90K+) county hospital with significant trauma, peds (integrated), and “bread & butter” ED cases. 1/3 spent at Cleveland Clinic – 40K+, less acuity, but are seeing unique CC pathology. Hospitals about 15min apart.
Pros: Nice balance b/w county and academic hospitals. Facilities generally very nice at both locations (CC ED brand new). Residents seem very happy and seem to get along. Residents are well prepared, although they admit to “working very hard” in their 3 years. Faculty are generally well-liked and lobby for residents. Excellent flight program with opportunities for residents. U/S training and fellowship available.
Cons: Seemed like a “local” program – most residents from upper Midwest and it seemed like many were planning to stay nearby. Cleveland is a livable, but mediocre setting (low cost of living, though). Was not an emphasis on non-ED rotations. Very little time for electives. No separate pediatric training (this did not seem to be an issue, however).

 

[ED crazy]

Interviewed at Resurrection: pretty decent program. Seems like the residents get a lot of procedures. The program directory is a funny guy, though pretty goofy. The residents looked laid back and seemed to be getting along pretty well. Chicago is awesome.

Interviewed at Case western-Metrohealth. Ok program. The residents seemed overworked and grumpy. The Chairman and program director from reports from local students and general impression is that they have a dictatorial style of running the program. One student mentioned that resident concerns during resident-faculty forums are shot down by the PD and chairman very quickly. Somebody mentioned that it's a penny pinching program.

Interviewed at Ohio state U. decent program. Residents love football (maybe because it's football season), some of the residents are over the top about OSU football and that's all they talk about; may not be a fun place if you are not an OSU alum. No other major issues. The PD seems pretty nice guy.

 

[edstir]

Case western- Metrohealth:
I have rotated here. Ok program. Large volume 90,000+, so you learn a lot from the patients. The faculty are more interested in moving patients than teaching residents or students. Their faculty-resident forums are famous for the word "No" from their Chairman to almost every request by the residents. Lot of focus on Trauma: repeatedly noticed that drunk guys falling down on the street in Cleveland is treated by Cleveland EMS and the ED as if it were a gun shot to the chest; practically the whole ED would rush to help this idiot, then a another person having an acute MI dying at the same time. Other EDs I have been too, drunk guys falling down are usually in the fast track, if they come to the ED at all. Unlike some other programs EM residents do not have their own resident lounge where they can chart, or read etc, heard, they had one last year then it was taken away for faculty offices. Residents get criticized in a way on shift that I wouldn't call constructive. Frankly, Cleveland is not the brightest spot in the country.

St. Lukes:
Good program. Dr. Lanoix as other people have noticed is hit or miss to students depending on your personality. Manhattan is obviously awesome.
Residents have a strong bond together. The ED itself is small compared to other EDs and looks old.Good toxicology research going on. There is oportunity for subsidized housing.

 

[mikecwru]

I let the first malicious post slide, but this seems identical to the prior review.
I am an attending at the program.

If you rotated as a student you attended a grand total of one residency-faculty forum. The resident requests are far from uniformly denied. In fact, I would say the majority are honored.

The majority of us are interested in teaching. There are approximately 35 faculty at MetroHealth (up to 50+ including the Cleveland Clinic). Some may not be great teachers, but that's sort of an unrealistic generalization you make.

Trauma is based on EMS activation. If EMS overcalls a trauma activation, then it can be downgraded. Triage systems are usually biased to OVER triage. I can assure you that the majority of drunk head injuries are not trauma activations. We do not ignore STEMIs for drunks getting hit in the head. By the way, since you have such a high clinical acumen, you would probably not want to ignore blood in the head for a patient with repeat visit chest pain and a normal ECG and troponin.

There was a small alcove with 3 computers that was converted into extra faculty offices. The area was underused by residents. The ED is fairly large, new, and nice. There is a large alcove of computers (the "fish bowl") to chart. There are also brand new call rooms with private baths and computers for residents.

"More concerned with moving the meat," sounds like the complaint of an early learner who is feeling overwhelmed. Part of emergency medicine is learning what needs to be done in the ED and doing it efficiently, without shutting the ED, and then the entire hospital down. To not do this is not teaching you emergency medicine.

I'm sorry you apparenty had a bad experience at MetroHealth and hope you find a place you are happy with. But you should be very careful of how you portray your opinions and limited observations as fact. Not doing so is kind of unprofessional. I trained at MetroHealth and feel more than comfortable performing there and at other hospitals I have worked at.

If you have a specific question or problem (you, or anyone) about the program, feel free to PM me.

Case western- Metrohealth:
I have rotated here. Ok program. Large volume 90,000+, so you learn a lot from the patients. The faculty are more interested in moving patients than teaching residents or students. Their faculty-resident forums are famous for the word "No" from their Chairman to almost every request by the residents. Lot of focus on Trauma: repeatedly noticed that drunk guys falling down on the street in Cleveland is treated by Cleveland EMS and the ED as if it were a gun shot to the chest; practically the whole ED would rush to help this idiot, then a another person having an acute MI dying at the same time. Other EDs I have been too, drunk guys falling down are usually in the fast track, if they come to the ED at all. Unlike some other programs EM residents do not have their own resident lounge where they can chart, or read etc, heard, they had one last year then it was taken away for faculty offices. Residents get criticized in a way on shift that I wouldn't call constructive. Frankly, Cleveland is not the brightest spot in the country.

St. Lukes:
Good program. Dr. Lanoix as other people have noticed is hit or miss to students depending on your personality. Manhattan is obviously awesome.
Residents have a strong bond together. The ED itself is small compared to other EDs and looks old.Good toxicology research going on. There is oportunity for subsidized housing.

 

[colicky]

University of Chicago: I enjoyed the interview there with the PD and faculty. PD was very approachable! Did not rotate here. one of the top tier programs in my opinion. You work a 3 places, hence, getting a variety in your experience. Heard great things about mt.sinai rotation. Residents get lots of procedure especially at Mt.sinai i have heard. Good CV research going on at UC. Hey it's Chicago!

Case-western/Metrohealth: Interviewed and rotated at this joint. Combined program with cleveland clinic. I rotated at the metrohealth side. My interview went well. I especially enjoyed my interview with some of the faculty from the Cleveland clinic as it was fun, and most of the faculty joke and very laid back; they do like to name drop that cleveland clinic as one of the best hospitals in the country. I enjoyed the faculty when we toured the cleveland clinic. My rotation at metrohealth was ok; faculty don't usually joke that much, and don't look like they are enjoying work. My ideal place would be where people are enjoying work and are having fun while being at work. After all it's EM, that's why we are going into this field instead of being surgical slaves. Watch out for the program director, from the shifts and teaching conferences, a total bully; usually threatening to residents, who look afraid of him and unhappy overall. The PD uses sarcasm to be judgmental about decision making of residents that is quite degrading. They do have nice teaching rounds everyday at 11 am during shifts for 10 mins. Busy ED, probably 90-100K at metrohealth side, and 60K at cleveland clinic side. Both sides have a very similar electronic record keeping so don't have to learn 2 completely separate systems. Lot's of trauma experience can be a plus or minus.

Maimonides: Did not rotate, did interview. Their chairman is one of the old school guys/founder of EM field. Pretty good EMS system that services the program. I think they have subsidized housing. Don't like Yankees. The hospital is in a nice neighborhood. Not much trauma. Not much else to say.

 

[edlife]

I am a resident at Case western-MetroHealth-Cleveland clinic. Not sure about the previous posts. However, I do enjoy the program. We have many perks at this program. We get extra money in our education account for documenting. I haven't heard of other residencies doing this. I Like our trauma set up as we rotate with trauma surgery for the trauma bay leader position every week, not many programs do that. Both at Metrohealth and Cleveland clinic we get meal allowances, that is more than enough even though we don't take that many call nights; especially at the Cleveland clinic we don't take any call months. The residency does appreciate us, they provide us with cool embroidered fleeces every year. Cleveland is a nice happening city, and has turned around a lot from it's hey days of crime especially the downtown area where the warehouse district is vibrant almost every day, has lots of bars, restaurants and clubs. Detroit and Madison ave in Lakewood are full bars and restaurant. Tremont district, where the new Iron chef from Cleveland has a restaurant and bunch of other swanky places. Then there is the steel yard in the city where a new shopping/restaurant plaza has opened up in the last 1-2 years. The legacy village and crocker park are unique shopping places of their own.
Cleveland is affordable in term or rent and buying a house.

 

[docB]

Note: Posted on behalf of a user wishing to remain anonymous. - DocB

Case Western Reserve University/Metrohealth/Cleveland Clinic

Disclosure: I am a fourth year medical student who has interviewed at this program

Residents: This program has 13 residents. During the intro lecture in the morning the program director stated he feels this is a good number and even though the program has been approved for more by the RRC he has no immediate plans to expand. On the whole the residents seemed happy even though several complained about the winters in Cleveland.

Curriculum: This is a three year program with a good mixture of ED time and ICU time. MICU, PICU, and CCU are all done in the second year. There is an orientation month meant to familiarize residents both with the system and with each other. There is one IM month (changed by program director to a MICU stepdown month) and one elective month.

Residency Leadership: The program director was one of the first resident graduates of the program and has been here ever since. He seems receptive to change and recently has changed how the aeromed shifts are allotted and shifted a peds wards month to basically a peds urgent care month at the residents’ request.

Facilities: Metrohealth Medical Center is a triple certified (Level 1 in adult trauma, peds trauma, and burns) and the only major trauma center in the city. This is a beautiful new 72 bed facility constructed in 2004. They have a patient census of just over 92,000. In a time of increasing crime there are plenty of resuscitations and procedures to go around. They see pediatrics mixed in with the rest of the patients (approx 23% of patients last year.) Residents spend approximately 2/3 of their ED shifts here. The Cleveland Clinic is a mammoth referral center for all kinds of zebras. Their ED sees approx 60,000 people and complaints range from bread and butter ED stuff to weird things you would rarely see other places. Residents said they saw transplant patients or patients with rare heart conditions much more frequently at this site. Residents do approximately 1/3 of their ED shifts here.

Benefits/Salary: Resident salary ranges from 42,910-46,612 PGY 1-3. There are 3 weeks of paid vacation per year. Life and Disability insurance is provided. Resident shares cost of medical, dental, or mental health insurance. EM residents also get 5 days of paid leave (on top of vacation) during either Christmas or New Years.

Moonlighting: One opportunity mentioned within the program was the ability to moonlight via their aeromedical program. This was just rolled back to start midway through the second year (formerly only third years had this option.) There is also an opportunity to moonlight teaching medical students 1:1 in the department.

Location: Cleveland is an industrial city that has been hit hard by the current economic downturn (and the preceding decrease in American industry.) As such there are some rough areas which keep the ED trauma service hopping. However, there are plenty of safe areas with inexpensive housing. Most of the residents live close to downtown Cleveland, although many live in the surrounding suburbs. The other big thing to remember is Cleveland winters can be rough with constant clouds and lake-effect snow.

Overall: This is a strong program in which the residents seem very pleased. To paraphrase what the program director stated during his wrap-up of our morning lecture, “The reasons why residents choose Metrohealth are high volume, diverse patient population, unique life flight experience, trauma, and ultrasound.” If these are important to you, make sure to give this program a good look.

 

[opb]

I hope you guys are finding these reviews helpful.

Overview: A 3 year program located in Cleveland, Ohio. It seems like a program that is strong in critical trauma, ultrasound (fellowship at Metro), and critical care. You do about 5 months of ICU, 1 month dedicated to Trauma Surgery, and 1 month of elective time in third year. You have the option of flying (with MetroHealth LifeFlight), but it is not mandatory. The combination of MetroHealth (county) and Cleveland Clinic (tertiary center) seem to give you a good mix of potential patient populations. There are 13 residents per year.

Residents: I went to the pre-interview social which was held at a pizza/bar place. Only 2 residents showed up for the social, which was kind of disappointing. I'm sure resident attendance to pre-interview socials is probably day dependent, but I would have liked to see a few more residents there. On the other hand, the pizza was awesome! I had this pizza there which had bacon and eggs on it... probably the best pizza I've ever had. If any of you 3rd years interview here next year, be sure to order a couple of these bad boys. Anyways, the residents that showed up were pretty cool and easy to talk to. More residents showed up for lunch during the interview day, and for the most part they seemed happy. They also seemed to get along well together.

Interview Day: Started at 7:30am with light breakfast and coffee followed by an overview of the program by the PD. During this time, the Chair joined us and talked a bit about the program for a couple minutes, then he left. I interviewed with a total of 5 faculty, one of which was a recent graduate and attending at the Cleveland Clinic. All were low-stress with the standard interview questions. Next was lunch with the residents followed by a tour of the ED at MetroHealth. We were also given a tour of the ED at the Cleveland Clinic, and a drive-by van tour of downtown Cleveland. The day ended at around 3:30pm.

Faculty: All of the faculty I met with seemed nice and friendly. The majority of faculty seem to be from the midwest, with a few from other regions of the country (NY, Florida, Northeast). Per the residents I spoke with, most of the faculty were good and interested in teaching.

Curriculum: 3 year program. The specifics of their curriculum can be found on their website. Some highlights: no medicine or pediatric floor months, 4 weeks of anesthesia at the Cleveland Clinic Foundation (CCF), 4 weeks ultrasound, 4 weeks ortho, 4 weeks tox, and 4 weeks of elective. ED months are spent at both MetroHealth and CCF, however I forgot the exact breakdown. I think the majority (60-70%) of shifts are spent at Metro with the remainder spend at CCF.

You have a dedicated Trauma Surgery month in the first year. Otherwise, your trauma experience is had during your ED shifts. Metro is a Level I adult and burn center. They are a Level II Peds center because they lost one of their peds urologists (this dropped them down from Level I to Level II). Metro is a major trauma center for the region, so you'll get plenty of trauma experience during your time here.

Peds experience seems to be pretty decent. You have 4 weeks of Ped-Urgent access during first year and 4 weeks of PICU during second year. Otherwise peds experience is integrated with your regular ED shifts.

Moonlighting is available starting the second half of your second year. One option which I found particularly appealing (because I like teaching) is 1 on 1 teaching with medical students during their shifts. You can also moonlight on LifeFlight once you are licensed.

EMS experience seems pretty strong here with one of the faculty being director of Cleveland EMS. Flight experience is available but not mandatory. Also, you can work shifts at Cleveland Browns' home games.

Didactics a per required 5 hours a week. These include formal lectures, simulation training, skills labs.

Shifts: 21 10 hour shifts first year, 20 10 hour shifts second year, 18 10 hour shifts third year.

Facilities: MetroHealth Medical Center is the home base. It is a county institution, a Level I adult trauma and burn center, and a Level II peds trauma center. It's the only Level I trauma center in the region. It's a new facility which opened in 2004 with electronic medical records and paperless orders. The ED was big with about 70 beds, 6 resus rooms, and a 14 bed CDU. The annual census is >100,000 with about 25% of them peds.

The Cleveland Clinic Foundation obviously needs no real description - one of the country's best hospitals with every specialty imaginable. You'll get your complex medical experience here with transplant patients on a regular basis. While the main Cleveland Clinic facility was other-worldly, the ED was smallish (30-40 beds) and not as nice and modern as Metro's ED. They see about 50,000 patients a year at the CCF ED with 1/3 of them peds.

Location: Cleveland, Ohio. See my review on University Hospitals regarding the city.

opb's final thoughts: Overall, I think MetroHealth is a very strong program. I think the two training sites are very different and will provide you with a nice breadth of experience (Metro - county; CCF - tertiary/super complex medical cases). So if you're looking for a program with a good combination of county/tertiary/academic, you should definitely keep this program in mind. Also, I think this program is very strong in trauma, ultrasound, and EMS. No medicine or peds floor months will appeal to a lot of people. You will work hard here, but I think when you finish the program you'll be ready for anything.

 

[rustycabin]

I recently completed a rotation in the ED at metro and here are some brief thoughts....

The most common theme that is echoed over and over again at this place is that if you go there for residency, you will work hard but you will be well prepared. I heard this from nearly ever single resident and faculty member. They work hard and they are rewarded for it. This place sees so much trauma and are exposed to endless procedural experience that residents are without a doubt ready to treat anything that comes in the door once they leave. The faculty was very nice and goes out of their way to make sure the students rotating there have a good experience. That being said, this month was the busiest ED month I have had yet. We had sim labs, lectures, mock boards, procedure days, EMS ride along, fire academy training, flying with the CCF etc....They treated the students as if they were interns. It gave the students a good idea of what it would be like to do residency there.

Overall if you are looking for a three year program that will prepare you well, you should consider this place. A lot of people give Cleveland a bad name but I actually found Cleveland to be a great place to live. Downtown is safe and is filled with young professionals, nightlife and plenty of nice restaurants. There are a bunch of other communities like Ohio City, Tremont and the flats that offer unique living and have their own unique cuisines. Cleveland has really good food. If you are not willing to work hard and you know that you will not want to work at a hospital that sees trauma, then maybe considering another place would be best.

I read the reviews previously posted and found them to be misleading. The program director is a very smart and nice guy. The residents told me that the faculty and administration are willing to make changes if they request them and they had no complaints about the faculty. All the residents seemed happy, but slightly overworked.

One negative is the amount of charting these residents do. They have 10 hours shifts, however most spend about 1-3 hours of charting after their shift. I think that the program should restrict the resident and not allow them to see patients after their 9th hour so that they could leave at a decent time. The residents, however, did not seem to mind that much. Hope this helped!

 

[EMPD]

Reviews can often be misleading! I loved Metrohealth when I interviewed there. I would have been very happy to train there years ago.

 

[haroldandkumar]

I thought I'd add my two cents since I've found these reviews pretty helpful. I rotated at Metro during 2012. All of the following are my opinions, so take them with a grain of salt. Feel free to PM if you have further questions.

Definite Positives:
- Amazing Trauma: as the only Level 1 center in Cleveland, you see a LOT of trauma; moreover, the relationship with trauma surgery is pretty good, and the EM residents play a central role

- Great Pathology: you also see a lot of variety beyond trauma, again, due to the indigent population. The patients are also pretty diverse, as Cleveland has large Puerto Ricans, Eastern European, and Middle-eastern populations

- Politically strong EM department: because the ED brings in a lot of revenue to the hospital, it carries a lot of weight

- Facilities: they have relatively new facilities which are very nice to work in. They use Epic btw

- CCF ED experience: a nice counterbalance to the county ED at Metro; you'll see very complicated patients (e.g. transplant or post-CABG)

- DO friendly: every resident class has several DOs



Definite Negatives:
- Charting: because Metro is a county facility, they rely on solid documentation to help generate revenues, so no dictation. Residents I worked with on average reported 2-3 hours of time for documentation after their shifts (which are 10 hours btw)

- Didactics: generally, they were decent, but I noticed there was very little interactivity outside of the Journal club sessions. Not bad by any means, just somewhat boring compared to other places I rotated



Things to consider in terms of fit:
- Stress/Resident well-being: Metro is by no means a malignant program, nor is the PD, as implied by earlier posts. However, I will say that the residents generally seemed less "happy" than at other places I rotated, the attendings were slightly less personable, and the PD is a little more "old-school." Ultimately, I think the residents seemed more stressed due to high work load (shifts are busy, and Metro has a heavy-ish schedule), and the program is a little more hierarchical than other places. Some people will really like the overall intensity. However, if you like more of a laid-back, friendly environment, it might turn you off (of all the students I rotated with or have spoke to, I'd say 50% liked the culture of the department, 25% were indifferent, and 25% actively did not like it). I will reiterate, this is NOT a malignant program by any stretch, but culturally, it won't be a good fit for everyone

- Cleveland: it's a decaying, blue collar industrial city that can seem pretty dead at times. If you like cosmopolitan places with large populations of urban professionals and a vibrant nightlife, such as NYC, Chicago, LA, Boston, DC etc. you will probably NOT like Cleveland (even this isn't a hard and fast rule; I know several people in my class who came from places like San Francisco who love it here, I think they're nuts...) However, if you like mid-sized cities and/or you have a family, it's an acceptable place to live with very low cost of living.



Overall:
Metro is an excellent place to train, and anyone coming out of this program would be well-prepared for community or academic practice.

The biggest things to consider in terms of fit are the workload, residency culture, and life in Cleveland. If you don't mind or like the latter qualities, than you should definitely rank Metro highly.

 

[Option]

1) General: 3 year program with 13 residents per year. Program is based out of two hospitals, metrohealth, 105k ED visits per year is a huge county hospital. Level 1 trauma/burn and level 2 ped trauma. You spend about 70% of ED shifts here and will get crazy trauma exposure and lots of high acuity patients. ED is huge here, 72 beds or so, very impressive facilities built in 2004. For a county hospital things are very well run, well kept, and they appear to have a lot of resources e.g. have 4-5 ultrasound machines in ED. No boarding of patients and patients get moved along or admitted as needed in quick fashion. This place is busy, there is no shortage of patients or activity here. Cleveland clinic is sub specialty paradise, ranked #4 in the county according to last years report. The clinic is located 15 minutes from metrohealth and is a massive multi block campus that is very impressive. The lobby of this place was ridiculously nice and over the top. There is no shortage of money at this place. The ED here sees about 50k per year and you spend 30% of shifts here. Amazing opportunity to learn from world renown specialist and consultants and see crazy complex pathology. Facility is smaller than metrohealth, but very well stocked. People here were incredibly nice and pumped to be working for the clinic.

2) Curriculum: Less off service rotations than most other places I interviewed at. Really focused on ED experiences in metrohealth and Cleveland clinic. 21 ten hour shifts as intern, 20 as second year, and 18 or somas third year. New simulator center just opened in late 2012 and will be incorporated into curriculum more but that is still be worked out. Didactics weekly on wednesday mornings that seemed to be well liked. Trauma experience at metrohealth will be one of the best around, very busy and EM residents are very involved. EM has all airways and shares procedures with trauma. Supposedly good relationship with trauma and all residents confirmed they get silly amount of procedures. Peds is integrated in every shift and will allow great exposure and continuity throughout training. I view this as a positive aspect. Having Cleveland clinic, one of the premier hospitals in the country to train at is clearly a bonus as well. Provides a nice balance to crazy and wild county exposure you get at metrohealth. Tremendous opportunity to learn from some great physicians during consults etc.

3) Per-interview diner: I wasn't able to attend but heard it was well attended by residents.

4) Interview: Started at 7:30 at metrohealth campus. Program coordinator is amazing, very organized and very friendly. The day went smoothly because of her which was great. Orientation with assistant PD to highlight program was followed up with grand rounds for 1 hour. Sorry but this was painful. It was an interesting topic, but I think I speak for most applicants when saying I'm not going to base my decision for residency based off of a hour of didactic lectures. Interview followed this. Three 20 minutes interviews with faculty that were very laid back and conversational. One 10 minute interview with PD that was friendly but more of rapid fire easy questions to get to know you. Overall it was a relaxed process. Lunch with residents was next and then ban tour of city of Cleveland. We finished up day by heading to Cleveland clinic and touring facilities and ED there.

5) Summary: The best program I interview at, there I said it.

Great learning from both sides of the spectrum at this program. Tons of trauma and crazy county experience which I have always wanted at metrohealth yet balanced with an academic world renown powerhouse of Cleveland clinic. Basically the best of both worlds. I will say that you will work hard at this place. You will likely work more shifts and harder than most other residency programs so make sure you are aware of that. However, some of the horror stories I've heard bout charting for 2-4 hours after every shift seem to be totally exaggerated. Most residents say they chart 45-60, minutes after every shift which seems reasonable. Literally every resident and faculty member I talked with seemed super happy and glad to be there. They all seemed to have fun on their shifts and have good relationships with one another. Lots of laughing and joking around happening.

Cleveland is actually a really cool city, I spent a few days to check it out post interview. It's the Midwest so it's cold and gray in the winter, that is a given. However the downtown is sweet, lots of restaurants and bars. I will say that it is very clean and safe downtown as well. I had a blast checking the city out and since I have lived in the Midwest would totally be fine doing it again. A much cooler city than people realize unless you have been there recently.

An incredible program and I seriously think the best one I saw on the interview trail. With that being said I don't think it will be my top choice simply because I want to be close to family. Likely top 3 but family ultimately is more important to me and my S.O.

 

[pointblank44mag]

Pro:

Good mix of patient pathology, though not a lot of sick kids (they are are hard no matter where you train)
You'll like 90% of your attendings, they wanted you succeed, smart and amicable
Great residents, great espirit de corps
Off-service rotations are great, very ED-specific/applicable, and you are treated well and learn lots
In terms of cirrculum, the administrations are fairly open minded
Cleveland gets a bad rap its actually a fun town, its very nice in the summer but the winters are a miserable as you think they are; Given you work so much and the cost of living is so low, you can live pretty well as a resident (nice downtown apartment/lakeside high rise, et cetera)
Sweet helicopter based flight program, lots of internal moonlighting opportunities
Lots of UltraSound machines, and the program is trying to make every attending highly ultrasound credentialed. The RDS/US coordinator is a nervous nelly/OCD/anxiety type and tends to restrict one's autonomy in US and overall makes the US more painful than they have too. But if you want to get crazy with ultrasound, the opportunity is there.

Admitting rights -- for the most part, not alot of fighting with the inpatient units, they are coming upstairs if you think they need to be there.
I feel prepared after three years to take on what life throws ahead of me

Con

The nurses are above average in terms of fund of knowledge, but there is a corp of 8-10 nurses who hate their job and seem to do everything in their power to make sure you hate yours too. You are always treated as a subordinate despite being the one writing the orders. The charge nurse is the most important person in the ED and the nursing supervisor is the most important person in the hospital. Many of the nurses prefer to communicate by hissy-fit when they do not like your plan of care.

SEE MORE PATIENTS. Attendings at metro are RVU based, so when you aren't seeing patients you are costing them money. So you always feel pressured to see more patients no matter how far behind you are on your documentation or you have a really interesting case they you need to know more about for. This relates in most residents staying 90-120 minutes after their shift, making the 10 hour shift effectively 12 hour shifts

We work alot. If you are a hands on learner, this is good. If you can study on your day off (like me), this is bad as you'll be too tired to be productive.

We tend to brutilize the ortho residents, there are some closed reductions that are defintely within the ED scope of practice that we turf to ortho. This is because the ortho attendings are OCD and this will allow you to see more medical patients for the ED attendings.

40-60% of the metrohealth patients have a primary psychiatric/substance abuse disorder, some days you feel more like a social worker than a physician. It also makes neurologic compliants quite troublesome.

Adminstration is "old school" with regards to compliants/disclipnary manners. Any patient, faculty or support staff compliant is automatically true and they really aren't interested in your point of view on the manner. In the class of 2013 there were three suspensions and one person decided to be an internist after not progressing from pgy2 to pgy3. This (suspensions) has profound implications on your employment as an attending. In the class of 2012, one person quit to join the navy and the person who came in to replace this resident had a history of tardiness one week and was suspended and drug tested. The administration would prefer to be punitive than rehabilitate their residents in my opinion, the average age of administrators/program directors is mid-50's, and their attitude toward resident disclipine is reflective of this era.

 

[BJJVP]

Pro:

Good mix of patient pathology, though not a lot of sick kids (they are are hard no matter where you train)
You'll like 90% of your attendings, they wanted you succeed, smart and amicable
Great residents, great espirit de corps
Off-service rotations are great, very ED-specific/applicable, and you are treated well and learn lots
In terms of cirrculum, the administrations are fairly open minded
Cleveland gets a bad rap its actually a fun town, its very nice in the summer but the winters are a miserable as you think they are; Given you work so much and the cost of living is so low, you can live pretty well as a resident (nice downtown apartment/lakeside high rise, et cetera)
Sweet helicopter based flight program, lots of internal moonlighting opportunities
Lots of UltraSound machines, and the program is trying to make every attending highly ultrasound credentialed. The RDS/US coordinator is a nervous nelly/OCD/anxiety type and tends to restrict one's autonomy in US and overall makes the US more painful than they have too. But if you want to get crazy with ultrasound, the opportunity is there.

Admitting rights -- for the most part, not alot of fighting with the inpatient units, they are coming upstairs if you think they need to be there.
I feel prepared after three years to take on what life throws ahead of me

Con

The nurses are above average in terms of fund of knowledge, but there is a corp of 8-10 nurses who hate their job and seem to do everything in their power to make sure you hate yours too. You are always treated as a subordinate despite being the one writing the orders. The charge nurse is the most important person in the ED and the nursing supervisor is the most important person in the hospital. Many of the nurses prefer to communicate by hissy-fit when they do not like your plan of care.

SEE MORE PATIENTS. Attendings at metro are RVU based, so when you aren't seeing patients you are costing them money. So you always feel pressured to see more patients no matter how far behind you are on your documentation or you have a really interesting case they you need to know more about for. This relates in most residents staying 90-120 minutes after their shift, making the 10 hour shift effectively 12 hour shifts

We work alot. If you are a hands on learner, this is good. If you can study on your day off (like me), this is bad as you'll be too tired to be productive.

We tend to brutilize the ortho residents, there are some closed reductions that are defintely within the ED scope of practice that we turf to ortho. This is because the ortho attendings are OCD and this will allow you to see more medical patients for the ED attendings.

40-60% of the metrohealth patients have a primary psychiatric/substance abuse disorder, some days you feel more like a social worker than a physician. It also makes neurologic compliants quite troublesome.

Adminstration is "old school" with regards to compliants/disclipnary manners. Any patient, faculty or support staff compliant is automatically true and they really aren't interested in your point of view on the manner. In the class of 2013 there were three suspensions and one person decided to be an internist after not progressing from pgy2 to pgy3. This (suspensions) has profound implications on your employment as an attending. In the class of 2012, one person quit to join the navy and the person who came in to replace this resident had a history of tardiness one week and was suspended and drug tested. The administration would prefer to be punitive than rehabilitate their residents in my opinion, the average age of administrators/program directors is mid-50's, and their attitude toward resident disclipine is reflective of this era.

I graduated from Metro a while ago and I have to say that unless things have changed significantly, I find your con list misleading. I realize, however, that this is your opinion and you are simply stating your experience.

I found the program director to be very supportive and no real punitive type disciplinary actions were taken towards any of the residents as far as I know. I agree ortho could've been better but after I graduated, the residents requested more ortho and I believe they made changes in the curriculum to reflect this. I don't know how the attendings are paid but I NEVER felt any pressure to move pts other than pressure I put on myself.

US was a great experience for me. I don't know if Jones is still the US guy there but if he is, I do not think he was excessively overbearing. In fact, because in some ways, it is a turf war, and for that reason, a higher risk area, I would be glad for someone to watch over me closely as I learned the basics of US. I see a lot of new grads who say they like US with poor fundamentals (using the wrong probe, etc). I felt I received a good US experience, enough to identify pathology but also enough to teach me not to be overconfident.

The nurses at the program were like any other nurses I have worked with....some really good, some not so good. They were no better or worse than anywhere else I have worked.

Finally, I need to say that I felt I received top notch training and exposure to pathology and procedures. I have now worked in at least 4 different settings since residency and speed, procedures, experience with various pathology has never been an issue. I am not one of those people that loves everything about everywhere I go either. I hated my medical school and thought it was the worst educational experience.

Please PM me with questions regarding the residency program.

 

[EM 216]

CWRU/MetroHealth/Cleveland Clinic EM

I read the above and have to completely disagree. I'm a current resident. I ranked this program #1 over all other competitive regional and non-regional 3 and 4 year programs I looked at, and I would do so again today after being here for 3 years.

MetroHealth/Cleveland Clinic is a strong 3 year program with a balanced mix of both County experiences at a bust Level 1 Trauma Center (MetroHealth Medical Center) combined with quaternary care experience at a top 4 US hospital (The Cleveland Clinic). We split time 65% at Metro/ 35%at CleveClinic.

There are few programs like it in the country. To my knowledge there are No - 3 year programs like it. It is well established, first class 1991 from which the current PD (Pennington) was part of. The experience is vast, and the exposure is excellent to both sick trauma/surgical and medical patients. Take a look at MetroHealth/Cleveland Clinic. Please read below:

OUR EDs
We work in 2 large major medical centers with newly build significantly resourced EDs:

MetroHealth Medical Center ED: Level 1 Trauma and Burn Center. Volume 110K. 80 bed ED. 6 dedicated trauma bays. 5 Heli Pads. 12 bed Observation Unit in ed. Dedicated CT scanner and ED radiology dept. Radiologists in ED including 24 hr ED and Rads U/s. 2 dedicated optho rooms. EPIC EMR. Digital radiology. In ED Radiologist. Cleveland EMS med command site. NE Ohio Trauma System (NOTS) command center. ED built in 2004.

Cleveland Clinic ED: 44 + bed ED. 60K+ Volume. 12 bed obs unit in ED. Dedicated CT scanner and Radiologist in ED including 24 hr ED and Rads U/s. EPIC EMR. Digital radiology.

MetroHealth Medical Center 770 in patient beds
Cleveland Clinic 1300+ in patient beds

WORKLOAD:
If you are going to train in a 3 year program, you need to see a decent amount of patients in those 3 years. We work a bit more than average, but WE ARE NOT overworked. During an ED month we work shifts at both clinical sites (~65% at MetroHealth and ~35% at Cleveland Clinic).
Number of shifts in the ED per EM block (per 4 weeks) per clinical year:
PGY 1s: 21-10hr shifts
PGY 2s: 20-10 hr shifts
PGY 3s: 18-10hr shifts

~25% of ACGME programs are 4 years. All AOA programs are 4 years. Around ~ 40%+ of all graduating EM residents each year come from 4 year programs. Clearly I choose a 3 year and would again. The caveat is in choosing a 3 year programs you want somewhere you see enough in your time there. Our hours (as above) are enough, they are NOT too much, and I am not sure you would want less (in order to gain enough experience in 3 years). My advice would be, if you are going to choose a 3 year program, choose one where you get enough exposure/training in those 3 years. The Metro/CCF EM program does so easily.

CHARTING/VOLUME
Do SOME residents stay over their shift to chart? Yes (~30-60 min)… but not all do and this IS NOT the majority. The faculty actively try to alleviate this as much as they can. We use EPIC at both sites. We have resident offices at both sites to chart in after shifts as needed. My guess is that at most programs; there are always some residents that chart longer than others, and you have random busy nights where you get behind on charts. I doubt this is unique to Metro.

While there are a lot of patients to see (110,000 + at metro:: 60K + at Cleve Clinic) the pressure to see them does NOT come from attending's due to monetary/RVU motivation. It comes from that we are a county hospital. Ask residents at USC, Hennepin, Cook County, UT-SouthWestern, Grady, ect if they feel pressured at times to see patients when their EDs are busy? My guess is they do too. If you like the county setting, then you will enjoy it here. You will also be an extremely efficient EM physician after 3 years here.

In my opinion, EM is learned best in an ED, not at a desk. You will get that hands on clinical experience in our program. And...it works; as we consistently average high scores on the in service each year.

BENEFITS // LOCATION
Our benefits are great: salary $50k / 51,500K / 53K pgy 1-2-3 yr. FULL medical/dental/vision plans and a fully funded 403B that you're vested in at 1 year (OPERS – same as OSU or Cinci): at the end of 3 yrs it will exceed 20K in retirement funds you can walk with and resembles a std 401K. Large food stipend.

Cleveland is not southern California (similar though => ): but it is a nice large (3 mil + metropolitan area) mid-western city located on a large body of water (Lake Erie) with culture/arts/museums/great food/sports/music/tradition/ an amazing park system (Cleveland Metroparks)/4 seasons….AND, it's extremely affordable!!! Rent a house in the suburbs for 1K/month or a loft downtown for $750/month.. Can't beat it.

ADMINISTRATION
The Administration are supportive and protective of our EM residents. The Vice Chair (Cydulka) is a lead author of Tintinalli, and works shifts with residents. The chair (Emerman) gives each resident an EXTRA 5 days off around Xmas OR NYE for time with family during our "holiday block", essentially giving each of us an extra week of vacation each year (on top of the 3 weeks the hospital provides). The department funds this on top of our CMS funds. Each resident is pulled off non EM services to protect them from being the resident on call in the MICU over Christmas. That's hardly old school.

The range of PDs and admins is 30s-50s y/o and they are vastly experienced including presidents of ABEM/ACEP/Ohio ACEP. I see no reason why this is a bad. Personally I am a fan of being taught/mentored by those that were pioneers in the field or have been practicing EM for some years.

The program also fully funds EVERY PGY-3 to attend ACEP each year for the entire week and EVERY PGY-2 to attend Ohio ACEP (only program in the state to do so) as well as the chiefs to SAEM each year. I also like working for a non-corporate group of Docs (both groups are staff physicians to the respective hospitals – Metro and Cleveland Clinic).

RESIDENTS
While we had a resident change to medicine a year ago, that was at the resident's own choosing as they did not feel EM was right for them. It was the resident's choice, the program was supportive of doing so, and our program helped secured this resident a medicine residency to allow for ease of transfer between the programs. Not bad. We had another resident graduate early as they had completed an IM/ped residency prior to ED, and had been awarded credit (by Metro!) for doing so. Simply said, supportive.

We have a strong group of residents from a variety of states and medical schools. Its cordial social laid back and supportive.

ROTATIONS
Our off services are great. We have eliminated ALL floor months. We have 5 ICU months (SICU/PICU/MICU/CICU/Medicine Step Down). We do anesthesia at the Cleveland Clinic which has over 100 ORs (lots of tubes to be had). I delivered 16 babies on OB. We also partake in some Free standing/community ED work at a Cleveland Clinic satellite during our dedicated ortho month. To add to this, 3rd year we have an elective month, a dedicated Aeromedical month flying on Life Flight, and a combined administrative and tox month.

EM Year 1: 24 weeks Emergency Medicine, Medical Step Down (4 weeks), Anesthesia 4 weeks, Pediatric Urgent Care (4 weeks), EM Ultrasound (4 weeks), bstetrics - L&D (4 weeks), Surgical Intensive Care Unit 4 weeks, Trauma Surgery 4 weeks
EM Year 2: 36 weeks of Emergency Medicine, PICU (4 weeks), MICU (4 weeks), Cardiac ICU (4 weeks), Orthopedics and Community EM (4 weeks)
EM Year 3: 40 weeks Emergency Medicine, Aeromedical Medicine (Life Flight) 4 weeks, Elective (4 weeks), Tox/Administration (4 weeks)


FLIGHT
We fly Metro Life Flight during our 3rd year. It is a Physician-RN flight service. You are the primary provider (not an observer) on the flights. We fly EC-145s with 2 engines and 2 pilots that are blinded for each mission. The service has a perfect flight record. There are many scene runs. It is one of the busiest flight services in the nation. If you want to fly, Metro will suit you well.

TRAUMA
Trauma is an everyday part of EM at MetroHealth. MetroHealth is the ONLY level 1 trauma center in Cleveland, which means everything comes to our ED. We see a good mix of penetrating and blunt trauma. Almost all penetrating trauma in the city comes to Metro. There are two Level 2 trauma centers, both in the suburbs. The bulk of the cities trauma comes to Metro.

The consolidation of trauma in Cleveland makes our trauma experience second to none. All major regional trauma comes to the MetroHealth ED. Multiple regional EM and surgery programs send their residents and fellows to Metro for trauma each month, given our acuity and volume, and the education experience that provides. As an EM resident here, you will be part of this everyday.

Category 3 traumas are cared for by the ED only, Category 1 and 2 involve the ED and the trauma team (surgical service). It is a collaborative effort. The ED resident ALWAYS manages the airway and head of the bed. ED PGY-1s also partake in a dedicated month on the trauma service. You will take part in trauma every shift as the ED resident at Metro.

ED STAFF
Our RNs/paramedics/clerks/etc. are awesome, truly awesome. Is it posh community work? No. The people that work at Metro chose to do so because of the mission and care we provide to our community, especially trauma victims. And they are experienced. Are there a few disgruntle RNs, sure, there are a few. But every ED will have this. I do not see how this is relevant in regards to the program or that it is unique to metro.

Our faculty are diverse. There is little for malignancy. Personally, I've had NO issues over 3 years. It's laid back, especially for an academic program. First names are common. And there a good mix between the 2 sites, allowing for unique mentor-ship opportunities in EM and all its sub specialties (tox/academics/flight/admin/EM critical care/EM-peds/informatics/observation medicine/legal/and beyond).

PATIENT POPULATION
We work with an urban population that come with a set of social issues similar to any urban population. I chose to work in this environment and value doing so. It's probably similar to those in LA, Chicago, Brooklyn, Cincinnati or wherever else an inner city ED exists. RE psych patients, yes we have psych patients, every large ED does. Psych placement is an issue at times in NE Ohio, not always, and this is more a reflection of community psych resources, not metro. No - 60% of our pts are not psych (5% are). I doubt this is unique to Cleveland/metro either and would guess it's actually better than most.

FALSE: """40-60% of the metrohealth patients have a primary psychiatric/substance abuse disorder"""....This is just not true. Are there drug seekers or drug abusers in our ED? Yes. Are there in most EDs? Yes. Our hospital has a program that flags the patient's chart with a statement from risk management (which is beneficial from a risk management stand point there to protect the MD). I have never seen such proactive measures in any other ED I have worked in.

Re Ortho: Metro is a level 1 trauma center. Ortho is busy. I expect it is at most Level 1 centers as people have trauma and break things, often times bones. We do not brutalize these residents; trauma pts have broken bones often. Personally I reduce shoulders/hips/digits/radius ulnar fractures and more w/out ortho when clinically indicated.
To add to this, Metro and Cleveland Clinic are major referral centers for the regions ortho care, from the smaller community hospitals, hence lots of transfers in for fractures/ect. This means lots of reductions and procedural sedation in the ED for ED residents.

SUMMARY
MetroHealth is a solid EM program. It is unique especially given it is a 3 year program. Our program is not perfect; however the above issues raised by "point blank" are not unique to MetroHealth, nor do I feel they actively reflect what our under-rated top notch 3-year EM program has to offer.

If you want a high yield county experience (Metro) with added experience at a world renowned quaternary care hospital (Cleveland Clinic): where you will come away a confident well trained EM physician, than the MetroHealth/Cleveland Clinic EM program is for you. If you want to place central lines, chest tubes, intubate patients and see ED thoracotomies in your first month of PGY-1 year (I did), the MetroHealth/Cleveland Clinic EM program may be for you. If you want a well-established 3 year county EM program with a strong flight program, great trauma exposure, with a supportive administration: the MetroHealth/Cleveland Clinic EM program may be for you.

Take a look for yourself, I think you'll agree: The CWRU/MetroHealth/Cleveland Clinic is a hidden gem among ALL EM programs in the country.

Here's a link to our site: http://www.metrohealth.org/body.cfm?id=690

Feel free to msg me with any other questions/concerns. I apologize for any spelling errors in advance.

 

[imddr16]

Long time lurker, posting on alternate account in order to remain anonymous. These threads greatly helped me and as such I am paying it forward. Good luck for future medical students. I won't go into the curriculum details or specifics since those are mostly readily available on their websites, but rather I made a long pro/con detail list along my interview trail and I will highlight my thoughts from that list.

Pro: Awesome program, great facilities and resources, huge tie to CCF, affordable, family friendly, fun stuff to do in Cleveland surprisingly, great moonlighting, matching 403b, great PC, established, tons of sick pathology, opportunities for research, train you to work anywhere, integrated curriculum

Con: Cleveland, cold winters, long interview day, busier than most programs, cold, only 2 residents at dinner, meat movers, older ED, didn't realize how county this is (would've been nice to see CCF since it is so integral into the day)

Overall impressions
Gut feeling:7/10
Facilities/resources: 8/10
Location: 4/10
Didactics: can't comment
Prestige: 7/10
Research: 6/10
Shift/hours/wellness: 4/10