Residency Rankings Emergency - US News Best Hospitals

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There are dozens of amazing high quality EM programs out there. However, you will graduate exactly where you strive to be. In other words, deeply dedicated study, aggressively striving to absorb and retain factual details surrounding you at all times, and embracing all aspects of the system from administrative, interpersonal, academic, etc, will culminate in you becoming a highly competent ED physician. I trained at UCLA-Harbor which was an amazing honor and incredibly academic. The patient mix and volume was excellent. I have now been an attending for 15 years and still love my choice of field, love my job, and would do it again if I had to choose again.
Programs such as UCLA-Harbor, USC, San Diego, Denver, Emery, Cook County, only scratch the surface of good programs. The truth is that most programs that have matured for many years are excellent. You should instead decide where you want to live, consider family, your spouse, etc.
Best of success to you. You are asking good questions as an obviously enthusiastic premed.

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There are dozens of amazing high quality EM programs out there. However, you will graduate exactly where you strive to be. In other words, deeply dedicated study, aggressively striving to absorb and retain factual details surrounding you at all times, and embracing all aspects of the system from administrative, interpersonal, academic, etc, will culminate in you becoming a highly competent ED physician. I trained at UCLA-Harbor which was an amazing honor and incredibly academic. The patient mix and volume was excellent. I have now been an attending for 15 years and still love my choice of field, love my job, and would do it again if I had to choose again.
Programs such as UCLA-Harbor, USC, San Diego, Denver, Emery, Cook County, only scratch the surface of good programs. The truth is that most programs that have matured for many years are excellent. You should instead decide where you want to live, consider family, your spouse, etc.
Best of success to you. You are asking good questions as an obviously enthusiastic premed.
Thread is 8 months old?
 
How to pick the best Emergency Room Residency?
Easy question:

Look for a 4 year program with a flight program. It's usually laid out like this..1st year..general ER, rotating to other services..ie Trauma, ortho, etc

2nd year, more complex patient management, you become flight doc, and when you're not flying, you manage ESI level 3, maybe 2, patients, and for all med codes and traumas, you manage airway, and special procedures.

3rd year, you manage esi level 3 and 2 patients as well as all shock resuscitated patients, ie full arrests, traumas, both high speed, missile, blunt force, etc

4th year, you are managing the 1st years, and have oversight of all their work-ups, greatest autonomy.

As for Trauma level 1 vs level 2... Find out what criteria is keeping a level 2 from being a level 1... It could be something as simple as one required in-house service is not doing enough research, thus giving them a level 2 designation. If that's the case, ex: Highland...don't let being a level 2 dissuade you. Otherwise, go for ACS certified level 1 Trauma, and Tertiary care referral hospitals.

Pick an inner city, county facility that has a high volume in an under served population. A city with lots of expressways and a high violence rate will give you the best trauma experiences, as well as assault and other forensic cases. Under-served patients are sicker, and therefore more complex which give you the best med code experiences.

Look for a hospital that is a STEMI center, as well as a Stroke Center. This means you get to care for these patients instead of transferring. Other interesting populations are hospitals that have burn centers, psych emergency, with inpatient facilities, regional hospitals that are accepting complex patients from outlying counties, and pediatrics. Don't forget about birthing centers, to give yourself some exposure to complicated labor and delivery. A hospital that's affiliated with a justice center will give you exposure to caring for incarcerated patients which is important. In ER, you will always need a working relationship with the local police.

Some programs are training sites for docs deploying over-seas for military duty. These programs often have large grants with simulation laboratories that enhance learning.

Lastly, you want a program with a name respected enough that will get you your dream job, after residency.

And NO, the highest ranked in-patient hospitals are not necessarily the best for an ER residency. Emory for example..has no ED.

Ok, so here are some examples of Emergency programs that will get you the experience and respect to get your dream job. This list is by no means exhaustive. Merely a pointer toward the type of program you should be looking for...

University of Cincinnati. (1st ER residency in the country....this program has every population listed above. Huge program, lots of research, and extremely respected. They also host the C-stars program for the air force trauma surgeons, very well funded, very competitive)

Highland Hospital, Oakland
San Francisco General, San Francisco
USC, Los Angeles
Cook County, Chicago
Boston Mass General
Parkland, Dallas Tx
Washington Hospital, D.C
George Washington D.C
Howard University D.C
Grady Memorial Atlanta
Univ of Maryland, Baltimore (shock trauma)

These are programs with which I have had personal experience. There are others with famous names, but they don't all have the violent inner city, edginess that makes for plentiful trauma cases...don't be seduced by a big name that only attracts a posh clientele. You want a packed, crowded, high volume all-teaching hospital...every service..teaching, not just ED and internal med.

A lot of posts, danced around the topic and didn't drop real names or rationale. I hope this helps.
 
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Double (or triple etc) post. Technical issues...
 
A lot of posts, danced around the topic and didn't drop real names or rationale. I hope this helps.
With all due respect Traumadok, your post is quite incorrect on several points.

1) If you're going to such a hot shot place with amazing experience, you simply don't NEED a fourth year. If your in-house population doesn't cut it, and you need some away rotations (or simply more time) to buff up your skills & experience, or, you wanna become the chair or PD of some big fancy program, yea, you probably need a 4 year program. Otherwise, it's overkill, and unnecessary. If you're THAT intent in becoming the best ER doc you can, even at the expense of an extra year, start your residency with a General Surgery internship. Yea, I said it. You'll learn SO MUCH (but in the MOST PAINFUL WAY) on post-op complications, and become MUCH more skilled & aggressive with procedures than your EM counterparts. The experience definitely carries on in the ED.

2) Some of the programs you list by name under "Huge program, lots of research, and extremely respected" have not only had their EM residency on probation, but have lost it altogether within this decade. And are frankly behind and inept when it comes to up-to-date equipment found in the modern ER, and the availability of all subspecialties.

3) Also on that list are some programs that may have a huge trauma program, but the ED itself sees NO significant trauma. Case & point: Shock Trauma. ALL serious traumas go to the TRU, which is run by Surgery ONLY. If you're not on Surgery, you don't see it, ALL RESIDENCY LONG. NO interaction at all, not even airway. And even IF you're on Surgery in the TRU, forget about seeing kids, cuz that subpopulation (that's critical for your education) is directed to Hopkins before it ever hits your door. So from the ED's perspective, you simply miss out. A lot. See my last point for more.

4) Just cuz you have a flight program doesn't mean you become flight doc. How do I know? I'm AT a program that has a flight program. We don't have that opportunity for residents, save for their EMS month. I know some programs actually allow you to moonlight as a flight doc (lesser pay, but still beats the daily grind in the ED), but not all flight programs are created equally. If you REALLY want good experience prehospitally, go to a program that has an established and active (read: physician field response) EMS Fellowship. That way, you likely have a chance at becoming an assistant medical director to one of their services when you're a 3rd year, and can get REAL hands-on administrative as well as clinical practice outside the hospital - which will not only improve & augment your existing EMS service, but it will also make you a better and more well-rounded (and well-respected) doc.

5) You failed to mention that many fancy schmancy big name places:
- Still make you do floor months. That's USELESS. You should look at the curriculum, and the more useless crap is on their curriculum, the less interested you should be. The program I went to had ZERO floor months. If you were off-service, if it wasn't Anesthesia, EMS, or Admin, it was an ICU month. Medical, surgical, tox, whatever. But no floors, no wasting time rounding. Show me how to treat the sickies. The not sick, we see those EVERY DAY from day ONE in the ED.

- Have big overbearing fellowship programs whose fellows swoop in and take your procedures. Your your program is simply lacks backbone, and consults for all procedures. If Ortho does all your reductions, and Pulm takes your lines and sometimes even airways, Surgery takes all your chest tubes, etc, look elsewhere, no matter HOW good the reputation. You're only as good as YOUR personal experience. And if it's being stolen from ya from other residents, that's not an ideal learning environment.

- Catch up with the times. If you can't use Propofol (its restricted to Anesthesia only), look elsewhere. I cannot STRESS just how important being VERY skilled & comfortable with Propofol sedations is to the flow of your Dept, as well as its safety and ease of use in experienced hands. Children & adults alike

- If you REALLY wanna be a good ED doc, you wanna be a whiz with the population we are the most hesitant with: Peds. So don't waste your time going to a residency with a HUGE population, only to find out it's got a separate Peds ED you only rotate through for 3-5 months out of your entire 36 month residency. Yea, then there's a reason why you're uncomfortable with Peds. Cuz you barely did any of it. You want a high volume OPEN ED that sees peds and adults in the same setting, so its a linear - and constant - progression throughout your education. And you get experience doing their reductions & sedations as mentioned above as well. At my program, I logged over 60 Propofol sedations on children 1 year and BELOW. Yep, the population no one wants to touch.

Anyway, I think that's enough. I appreciate you taking the time to make your post, but I don't think you did a lot of first-hand research and fact-checking before posting it. Or perhaps it was merely your opinion, which we all have, but shouldn't necessarily readily share...
 
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So, I interviewed mainly in the Midwest and tried to limit myself to 3 yr programs. Here's my two cents. And I'll go ahead and use names....even though it doesnt seem like the hot thing to do. And again this is just what I was told from advisors and other residents I spoke to. First off, I was told that the Midwest was pretty much the birth place of EM so, for that reason it's hard to go wrong with a program from this area. Another big point to look at is job placement, a solid program can place a resident anywhere.
So, here it is, in short.

Illinois: Really can't go wrong with any program in Chicago, the big ones obviously being Cook County and Christ. Considered the top 2 programs in Chicago by many. Both have lots of trauma and lots of sick people and often considered the stronger residents in the hospital. Cook county tends to be a slower moving program, in the sense that the pt turnaround is incredibly slow due to an overwhelmed system. Next would be UIC and Resurrection. UIC being a very well rounded program with exposure to many different hospitals, trauma at Christ. Resurrection, tucked up in north Chicago. Smaller ED, with a more suburban demographic, not the typical inner city poverty patient population. Then, you have U of C and Northwestern. U of C at this time is struggling a bit more. Lost their Level 1 trauma designation a couple years ago, however, are still Level 1 for Pediatrics. The name still has a big draw outside of Chicago, but as a Chicagoan myself, no one ever really would talk about it. And then you have Northwestern, a 4 yr strongly academic center. Also, Level 1 trauma, however not the typical gun and knife club like Cook or Christ. Traumas are mainly MVA from Lake Shore. Again, a hospital with a good name however, tend to be stronger with other residency programs such as Internal Medicine, Surgery etc. That's a quick on the Chicago programs. Again, all have good placement and given the big urban environment, all have good training. I mentioned them in order of how much hype they got with all my time living there.

Indiana: Only one. IU. Amazing program. Inner city patient population, strong emphasis on CC, great placement. Indianapolis becoming a pretty hip city.

Wisconsin: MCW was told this was the birth place of trauma. Got to witness a few trauma resuscitation. Dead silent, can literally hear a pin drop. One person talking, everyone else listening and waiting. Also, very strong emphasis on Peds and EMS. Also, with good job placement. Milwaukee really chilled laid back city. UW, lots of flying. Very happy program. Being in Madison, may lack a bit in trauma exposure and census.

Michigan: Another state with many top programs. The best of which being in Detroit, Henry Ford, Detroit Receiving, and Sinai Grace. Henry Ford, told this was one of the top programs in the area. Strong emphasis on CC, US, research, lots of trauma and very sick patients. Considered strongest residents in the hospital with very good placement. Same can be said for Detroit Receiving. Considered to be the more county hospital of the area. Also, very good placement. Sinai Grace, located in north Detroit, away from Henry Ford and Receiving. For that reason they get loads and loads of trauma. Facility is a bit run down. Opening a new ED next year. Hands down strongest residents in the hospital given intense management of severely ill patients. All 3 of these with very good placement and very similar strengths. With Henry Ford being the nicest hospital with the most funding, a good mix of uninsured and insured patients. Receiving being the more county program. And Sinai Grace being the bare bones hospital caring for the most uninsured population. Sticking on the East side of the state next you have U of M. 4 year program, slowly adding a strong emphasis on CC. Big tertiary academic center, see lots of zebras passing through the ED, much less trauma than the Detroit programs, patients also much more insured and not as sick. But, great hospital with a great name and lots of research. Now, the West side of the state. The two big ones being Grand Rapids and Kalamazoo. Similar programs, very old with great placement and great training. Grand Rapids having the best scores on the boards for the past couple of years in a row. Large patient census with large catchment, in both programs. Kalamazoo having a very strong emphasis on EMS, stronger than most other programs. Both with very happy residents and considered top residents within the hospitals. All in all Michigan is a great state for EM, with top programs being in Detroit and also on the west side of the state.

Minnesota: Only familiar with Hennepin. So, a bit biased. But, as someone not from the area this is the only one I was told to apply to. That being said, very solid program, with great placement. Good research, lots of well organized trauma. Considered strongest residents in the hospital. Good blend of poverty stricken patients and well insured. Also, really cool chill city

Iowa: UI. Newer program. Really up and coming, within a couple years can see it becoming an EM powerhouse. Good flight experience, slowing started up strong CC emphasis, rural patient population, less knife and gun for trauma, more farming accidents etc. Very happy people. Also, very small town, lots of college students.

So, that's the short of it. Tried my best to not actually rank them, but gave a fairly unbiased opinion on what I heard and saw. Again, limited to the Midwest for this was my main emphasis. Let the blasphemy begin!!!!
 
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...3) Also on that list are some programs that may have a huge trauma program, but the ED itself sees NO significant trauma. Case & point: Shock Trauma. ALL serious traumas go to the TRU, which is run by Surgery ONLY. If you're not on Surgery, you don't see it, ALL RESIDENCY LONG. NO interaction at all, not even airway. And even IF you're on Surgery in the TRU, forget about seeing kids, cuz that subpopulation (that's critical for your education) is directed to Hopkins before it ever hits your door. So from the ED's perspective, you simply miss out. A lot. See my last point for more...I appreciate you taking the time to make your post, but I don't think you did a lot of first-hand research and fact-checking before posting it. Or perhaps it was merely your opinion, which we all have, but shouldn't necessarily readily share...
While I agree with some of the criticisms you made on TraumaDok's post, I'd like to offer my own first-hand research.

The UMD EM residents rotate at STC more than any program (moreso than even the GS residents), so those trauma patients mentioned above are really just seen by us. There's at least one UMD EM resident in the TRU 24/7. We run the TRU as seniors. Simply put, the TRU IS our ED. Contrary to the above, we also see trauma patients throughout our residency at our other clinical sites. It's just that, when at STC, we see the ones that make the evening news.

We control the trauma airway during our anesthesiology rotation. Instead of offering OR airways under controlled conditions, our anesthesia month focuses on obtaining the emergent airway. Some of my colleagues have racked up triple digits of emergent tubes. This is over and above the airways we get through all of our ED rotations. We're also the home of Levitan's difficult airway course, and we have quarterly cadaver labs to practice critical procedures like intubations, crics, chest tubes, thorachotomies and the like.

With regards to pediatric experience, we rotate through our peds ED and DC Children's, where we will see a senator's daughter in one room, a West African emigre in the next, and then a hypoplastic left heart kid in the third. We do everything - sedations, intubations, trauma resus, etc. at both of these locations.

For the M4's - Peds Trauma is such a rare beast that I'd argue nobody feels 100% comfortable with these patients. That being said, the miracle of our RRC is that all programs provide at least adequate experience in each area of training. Each program has their strengths above and beyond the minimum - at UMD, we get world-class training in resuscitating critically ill medical and trauma patients. We have a longitudinal ultrasound experience and monthly sim labs. Our faculty are renown in medical education, international EM, EMS, and research.

At this anxiety-provoking time of your career, I would suggest reading a lot about programs, but be careful about where you get your information. I encourage anyone with questions about UMD to message me. If you're like me, you'll end up chucking all of this and make your ROL using a combination of gut and geographical constraints. That's OK, and believe me when I say that it all works out in the end. Good luck, and congratulations on making it this far.
 
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[QUOTE="...You should spend some time shadowing in the ER when you get to med school. It will give you some idea of what goes on in there. Don't just go during the day, do some evenings and weekends and nights too. It will give you a better idea. Personally, I love night shifts, especially on weekends. There tends to be more excitement, and plus, there are less people around, so you get to see and do more, even as a student.[/QUOTE]

<--- I scribe in the ER and I thoroughly agree. Weekend nights are the best, especially if you get the right mix of nursing staff
 
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