Discussion in 'Emergency Medicine' started by maxpain, 05.28.07.
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Any thoughts on the program, atmosphere etc. ?
I've really enjoyed it here. PM me if you have any questions in particular, but in general:
The variety and acuity are amazing; people within the program are very laid back and helpful, almost without exception; other services within the hospital are overall extremely strong, making offservice rotations excellent- especially the pedi EM experience. That being said, Parkland is a county hospital and is characteristically busy. Expect to work extremely hard if you are here. Like I said, I've enjoyed my time here, and would come back if given another chance at match day...
The reason everyone is making jokes about wanting to watch this thread Maxpain is that the program's PD is an SDN EM regular. In short, it is a great program, and you will find very few (if any) within the profession of emergency medicine who would crititize the program to any significant degree. You will find even fewer critics of it here.
I graduated from the EM program at Parkland and cannot say enough good things about it. I would definitely choose the program again and recommend it to anyone interested in a busy county based program with alot of hands on experience (procedures etc). As far as the PD being a SDN regular, I don't believe that to be true, but would be happy if it were.
Maybe, then, we could use this thread to dispel rumors. I've heard it said by a few people that this is the most malignant program in Texas. Word on the street is that you have to stay 2+ hours after your shift alot to tie up loose ends and that the off-service rotations are unnecessarily grueling.
Please correct any false rumors. I'm very interested in this program and want the busy county based feel. I'll hopefully have time for a rotation there after my away in Chicago, but if I don't get to see it for myself I'd like more firsthand information.
When I did an away the residents stayed after for .5-1hr depending on how long check out/rounds took. I dont think I ever heard of anyone staying 2+ hours at UTSW. They do ~ 18 x 12 hr shifts (7p - 7a or 7a - 7p) which is pretty standard I think. I wouldn't say their schedule is malignant, at least during the EM months anyway. Off service is another issue. The IM and surgery departments at UTSW are very strong and respected and work their own residents very hard. Parkland delivers a lot of babys as well so ob-gyn is probably also intense. But, after the first year you don't go off service much and I haven't heard of too many EM programs with off service rotations that are easy.
I'm not sure how anyone can honestly say one program is "the most malignant," unless someone does a rotation or internship at every program in Texas? We work 18 12's as an inter, 16 as a 2nd year, and 14 as a third year. As an intern I stay ~30 minutes after a shift. A few times, I've stayed longer to do procedures or talk to consultants. I would guess that most residents at other programs have similar schedules. If not, I would guess that it is the norm to check out procedures or incomplete workups- which we try not to do.
Personally, I don't feel we have a malignant atmosphere. The offservice rotations can be gruelling (trauma especially), but as stated above, alot of these programs are top 5 or 10 in the country and therefor you get some excellent training while on them and get to work with some truly brilliant people. If your looking for a program where your hand is held and everyone tells you you're the smartest and best doctor in the hospital on a daily basis, this may not be the best place for you. Bottom line- every service in the hospital without exception is extremely busy and when an ER resident calls them with more work, they aren't always excited- but this is Emergency Medicine and that happens, especially in large county hospitals...
I recommend coming here and doing a rotation. You will quickly discover if it is the kind of atmosphere you will enjoy or not.
As I said before, I love it here and would come here again if I was given the choice. I feel I will be well prepared when I leave to pracitce in any setting.
I graduated from the program a few years back. It was my first choice and I've never regretted it. I saw a lot, did a lot, made some friends, and then took a pretty good community job in Austin. If you have any specific questions, feel free to PM me. Parkland'll work you hard and you'll be glad it did.
Anyone have any thoughts about UTSW? I hear that is an extremely strong clinical program, but am a little worried about it not being its own department - it's a division of surgery there. I'm not really sure what the implications of this is, but just wondering if any of you knew more.
Wow...wasn't expecting to see this thread again!
I'll be happy to answer any questions you may have. I liked Parkland...a lot, actually. You know, the program itself isn't malignant, but the place is just so freakin' busy that you'll end up working you a*s off!
I don't really know how to answer your question about not being our own department. Though it's true, from a resident standpoint, I'm not sure how big a difference it makes. I think I became pretty well-trained and had a great clinical experience. I think not being our own department is probably more evident on the administrative side of things - something I'm really not able to comment on since it never affected me. Maybe others who trained at a place where you were your own department can help out on that one.
If you get a chance to interview (even better, a rotation there), go for it! I think you'll have a good experience!
I did a student rotation there this year, and I LOVED it. If you are looking for a place where you will be busy for your entire 12 hour shift, this is it. There was always something interesting to see, or something going on that you could help with. The student rotation gave me alot of opportunities to do procedures. There are even a couple of shifts were you are assigned to the "teaching resident", and it is a great time to ask ANY questions you want. Plus you get to walk around the different sections of the ER and look for procedures to do! The residents and attendings are all extremely friendly and happy to teach. And another plus, the nurses were great!
You should definitely look into doing an away rotation here. I highly recommend it (obviously).
I just finished a rotation at UTSW. Here are my thoughts on the program:
Faculty: Excellent! Very into teaching and give residents room to make their own decissions
Residents: Very laid back group! The ED is very busy but they still maintain a calm. These people love their patients more than they love doing procedures. They truely care about their patients and love being at a "inner city" county hospital.
Ancillary: Few excellent, Too many bad. I think the biggest problem is understaffing but most were cranky and not helpful. However, all were nice to patients (guess that is what really counts). One example is I waited 6 hours for an UA. After calling the lab, I found out it was never sent. Turns out the nurse was carrying it around in her pocket. To her defense she had 15 patients! This happened numerous times. They seem very unhappy!
Pathology: Lots of everything. Everyday you have numerous high acuity patients i.e. codes, strokes (including SAH), MI's, etc. They have a huge population of dialysis patients. Hyperkalemia all day, everyday.
Charting: just started epic (I love epic, the other 2 places I rotated also used it); paper charts for meds and IV orders
Overview: I have rotated at 2 other places that have the same number of patients or more per year. Something seems to be very wrong with how the place is ran because it feels much busier than the other places. It could be the ancillary staff or the high acuity of the patient population; I'm not sure. I loved being busy but most of the time it felt chaotic. Pt are every where, in the halls, in assessement chairs. I hated the chairs. Pt sit there all day, you interview them with someone sitting right next to them (no privacy), you move them into an examining room (if one is available) for the PE (a room that is not cleaned btw patients). The chairs seem very wrong! Patient turn around is slow (back to the UTI who waited 12hrs).
Note: Posted on behalf of a user wishing to remain anonymous. - DocB
UT Southwestern/Parkland Hospital
Disclosure: I am a fourth year medical student who has both interviewed at this program and done a 4 week rotation earlier this year.
Residents: This is one of the largest programs in the country with 19 residents per class. The residents seem like a good mix of married and single and come from all over the country. They seem uniformly academically strong. The residents also seem to get along well together and most seem very happy. I would say 12-15 residents and the division chief showed up for our pre-interview social.
Curriculum: This is a three year program with a heavy emphasis on time in the ED. The schedule has undergone some changes in the last couple of years at the request of the residents. A pediatric ward month was dropped in favor of another peds ED month, and several community EM months were added when the residents voiced concern they were missing out on community experience. A burn ICU rotation was also added to take advantage of the outstanding burn center at Parkland.
Residency Leadership: The program director seems genuinely interested in making sure the residents are as well supported as possible. There are three associate program directors who are all young and enthusiastic. They seem to pour a huge amount of energy into the residency and their hard work shows. They seem to be very receptive to change (see Curriculum above.) They have HUGE Tox and EMS programs with many double boarded attendings.
Facilities: Parkland is a large county ED that triages >100,000 people/year and the patients are SICK. The pathology is really one of the strong points of this program. The ED is compartmentalized into east and west sides and there is a separate Gyn ICC and Psych ER. I will echo what was said in a recent review that Parkland often seems more chaotic than some of the other major hospitals in which I have worked. I brought this up at interview and the faculty stated they are continually trying to find ways to improve the efficiency but they still have a way to go. There was a bond passed this year that is supposed to allow the building of a new Parkland that is set to open around 2011. Childrens is the major peds hospital and is the only level 1 pediatric trauma center in the state. Childrens triages up to 100,000 kids/year and the residents see the 50,000 or so who are triaged as needing acute care.
Benefits/Salary: Resident salary ranges from 45,075-48,460 PGY 1-3. There are 3 weeks of paid vacation per year. Disability insurance is provided. Resident shares cost of medical, dental, or mental health insurance (sorry couldnt find the details of cost.) Also, just as FYI, Texas has no state or local income tax so thats a nice little bonus.
Moonlighting: There is no internal moonlighting but there are many opportunities in the area. The program has no problems with residents moonlighting as long as it doesnt interfere with
Location: Dallas is well
Dallas. The DFW metroplex now holds roughly 5 million people. As such it has all the benefits and drawbacks of such a large city. There seems to be lots to do and there is ample affordable housing. As with any major city there are problems with traffic. That being said, I found Dallas surprisingly livable while I was there for my rotation.
Overall: This is a strong program with continual willingness to improve. I was really impressed with the number of opportunities available to residents here. I enjoyed my experiences and will be ranking this program highly.
I hope there is no particular reason no one has posted on yet...like being blackballed from all EM residencies...so here goes...
Overall: Relatively new program (est. 1997) at a well-respected institution at a county hospital with a lot of strong residency programs.
Residents: Large class with 19 residents per year up from 17 two years ago with a good representation of TX overall, but that depends on the class as well. I think the PGY1s are 50/50, but the PGY2s are more like 75/25. Laid-back group that seemed happy with their choice, and there was a good showing at the pre-interview dinner. Program seems to have a family slant, but singles are still welcomed.
Faculty: The chairman, Dr. Pepe is enthusiastic and really advocates for the *Division/Department and works closely with the CEO of Parkland to get all the necessary funding to the ED. Dr. Wainscott is extremely nice and is constantly working on ways to improve the residency. The rest of the faculty have very strong clinical backgrounds and diverse interests. My faculty interviewers were very conversational and down-to-earth, which the residents said is reflective of the faculty as a whole. Good teaching.
*Dr. Pepe actually discussed the whole division vs. department controversy and in short stated that they choose to be a division of surgery as it affords them more funding by being a part of a such a strong department. If they broke off and became their own department, it would be similar to starting from scratch.
Ancillary Staff: Mixed bag, Ive heard that the nurses are great from some and terrible from others. Dont know what to make of it.
Curriculum: 3 year program with 2 elective blocks in year 3. I say blocks because their schedule is divided into 4 week blocks, rather than months, so you have 13 blocks in one year. Highlights include integrated Peds ED shifts in PGY2-3, a short orientation at the start of intern year, and 2 weeks each with the neonatal resuscitation team and the Burn unit in lieu of the SICU. You do a block of trauma each year, with the last year being at a community hospital where I heard you get to do pretty much all the procedures. You also do 1 block of L&D and 1 block of Gyn Urgent Care in PGY1. There are a lot of opportunities to get involved in EM fellowships/areas of specialization including Peds EM, Practice Management, International Med (all expense paid rotation in New Zealand), and Disaster/Tactical medicine through the awesome EMS/GEMMS fellowship. Also, there is a chance to participate in event medicine and go on the sidelines, yes sidelines, of the Cowboys and Mavericks games covering the athletes. There is the typical progression of responsibilities from learning the basics to mastering critical care to gaining an understanding of administration and patient flow. Very strong/intense off-service rotations due the reputation of UTSWs IM, Surgery, and OB residencies. Most residents said that you have to be willing to jump in and bust your butt to get respect on the off-services. Also, there is plenty of teaching on almost all your consults about what more you could/should have done.
Facilities: Parkland is a huge county hospital with ~100K ED visits a year. Its a fairly new facility, but a recent bond was passed allowing for the construction of a new hospital to be completed within the next 3-4 years. The ED was recently renovated and has 80 beds and either 4 or 6 trauma bays, cant remember exactly. Right now only 2 US machines (one dedicated to the trauma rooms), but they are in the process of getting 2 more. All EMR using Epic. The Childrens Hospital ED is just through a set of sliding doors and sees ~90K kids a year and is a Level 1 center. Other rotations are at community hospitals around the city that have the perks of private facilities.
Location: Its Dallas, its Texas
some absolutely love it and others hate it. The city is very spread out and residents live all over depending on family status. You can definitely rent in the more bohemian, nearer to downtown places or buy out in the burbs. Dallas has all the major sports, lots of restaurants, bars, lounges, clubs, arts, shopping as well as traffic, pollution, crime (though not as bad as the other big cities). The weather is hot and dry in the summer and winter can bring anything, including a few icy days, but overall mild. The landscape is flat, there are a few surrounding lakes, but not a huge outdoorsy city. Mostly conservative, but with city life comes some degree of liberalism. Also a large Hispanic population with about every 1:4 patients Spanish-speaking only, this can really slow you up if you dont speak Spanish and cant find an interpreter.
Negatives: Busy county with never-ending patients to see type of environment if thats not your cup of tea, intense off-service rotations, UTSW is reputed to be malignant at all levels of training, but I didnt get a real feel for that with the EM program
Overall: Impressive 3 year program that is now jockeying at the top of my list.
Residents: 19 residents/yr plus absorbing some of UTMB; I think the second year class has 21 residents in it. All the residents love being there and learning at Parkland. Residents seem to get along together and have monthly poker nights. Off-service residents are strong and relations with other services are good. No residents have left recently. Feedback is given qshift via the standard note cards rating you on 6 objectives. Graduates seem to stay in Texas, with the people who come from out of state reportedly not wanting to leave because of cost of living and high salaries. Lots of graduates end up staying in Dallas specifically.
Faculty: Faculty are well accomplished and generally well known. The Chair is triple boarded in EM, IM, and Pulm/Critical Care and is pretty much internationally known. He gives a presentation about the faculty and basically said theyre the best thing since sliced bread. They are great teachers but not much time for bedside teaching due to mass quantities of patients. This is definitely a self-starter program where you learn mostly from your patients and books. PD is nice and a big resident advocate. PD works ~6 shifts/mo with chair not really working much he is more of an administrative chair although he does a ton of other really cool things (e.g. medical director for Dallas police and fire). When asked what the faculty will do for you to help find a job, the big plug was that there are people on the staff that work for each of the big Dallas EM companies who will try to recruit you and will help get you a job. There was no mention of the Chair and PD calling around for you if you want to go out of Dallas, but Im sure they would and I know they are well connected. Practically no faculty turnover with everyone wanting to stick around. Most faculty are on first name basis.
Ancillary Staff: Nursing staff is standard nursing staff. You wont have to do IVs, etc unless it is really busy in a trauma or something.
Curriculum: Three year program with all the standards. One floor medicine month, no MICU month but instead has a great CCU month at the VA, recent addition of Burn ICU has replaced SICU. Really awesome 2 wk block of neonatal resuscitation team was just added. This is a typical busy county hospital so most of learning is done from seeing tons of patients. Active tox program with tons of tox staff on faculty. US program seems to be the weakest point with residency just acquiring 1 US trained attending who will spearhead US program. Plenty of trauma. All airways are done by EM. Procedures are up for whoever wants them really surgery does fair share in traumas and in non-trauma patients it is the residents procedure. 40/60 do academics:community. 5 Fellowships already active with talks of starting up international fellowship over next 2 years. There is an all-expenses-paid elective in R3 yr to New Zealand for up to 8 wks. Simulations are done ~three times/yr with belief being that you learn from your patients more and that by the time you do the simulations you have probably already seen the real thing in Parkland already. There are two teams on each side, Medicine and Surgery (both run by EM), with one team on each side being run by R2 and other being run by R3. There is an intern and nurses on each team as well. R2 or R3 manages all ambulance calls. Traditionally you work 18, 16, or 15 12-hour shifts, respectively, but this year the R2 class has decided to start doing overlapping 10s. The schedule is left up to the residents to decide, and the R2s have decided to continue this next year but doing 12s on the weekends to allow for more weekends off. Officially nothing has changed, but unofficially I have been told bey some residents that there isnt a chance anyone is going to go back to 12s. Im still not sure if the interns will also be doing 10s next year though. One resident mentioned that they were so beat down after a 12 hour shift and staying to dispo afterwards, that they could only go home and pass out. This also kept people from taking advantage of all the possible things to do at Southwestern. Administrative training is weaved into curriculum. 8 weeks of elective time. R3s are encouraged to moonlight to gain community experience with autonomy.
Peds: Great peds experience at Childrens Hospital, with Childrens ED being attached to adult ED. Residents say peds fellows are great and allow you to do a lot. You do 2 months of peds EM in R1 yr and then integrated shifts in R2-3 yr. PICU rotation and rotation on Neonatal Resuscitation Unit also present.
Didactics: 5 hours weekly; protected. No problem with board passage rates and all residents do great on in-service exam. Mock oral boards.
Research: Scholarly project required with research available if interested. There is a ton of research grants and NIH money.
Facilities: Split into Medicine and Surgery side, a throwback to when Medicine and Surgery actually ran the ED. Each side is set up in a circle with nursing/doctor station in middle. There is also a 6 person asthma room with its own RT, eye room, CP room, psych area, and an ortho room with fluoro. This is the epitome of county hospital so most of beds are separated by curtains. Being a county hospital, the funding isnt as great as some programs you will see and so therefore the physical plant is going to look older. This is not bad, just different. A bond was just passed to build a new hospital, but it wont be done for another 3 years or so. CT in ED. Separate fast track and psych area.
Charting: All orders, results, and records are on new EMR.
Location: Dallas, Tx. Cheap cost of living with 1/3 owning, 1/3 renting apt, and 1/3 renting a house. There are tons of things to do in Dallas, but doesnt have mountains or ocean. Of course, as the PD points out, both are short flights away.  You have typical Texas weather of being hot in the summer with mild winters, but you do get an occasional snow being in North Texas. Its the only residency around, so no competition
. but considering this is a county hospital there really isnt a competition for these patients. Great schools and good jobs abound. Parking is cheap and right next to ED.
Extras: 24hr PharmD in the ED to check over prescriptions and help teach. Event medicine at Stars, Mavs, Cowboys, Concerts, etc. Vacation is in 1 wk blocks that are scheduled at beginning of year. Accreditation status is fine. Break room between the two EDs. Has one of nations NIH resuscitation centers. Disaster med is big with opportunity to do SWAT stuff. Critical care in every shift. EM decides whether or not to admit to medicine. 1 of alumni started a residency in Costa Rica. They will pay for any meeting you present at. Since EM is a division of Surg Dept, they get a lot of benefits from the big brother.
Interview: Hour long presentation by chair (complete with Robot Chicken clip), another hour presentation by PD, 5 20-minute interviews, lunch, tour, and done.
Posted anonymously on behalf of a student who interviewed there.
Pre-Interview Social: The pre-interview dinner was at Mannys Uptown Tex Mex. There was a large turnout of residents and a few significant others. The residents seemed to be a fairly cohesive bunch considering how large the classes are at UTSW (19 residents per class).
Interview Day: The interview day started at 7:30 AM with breakfast and a talk by the chairman. It was one of the odder interview day talks I sat through. First he went around and asked each of us where were from and why we were interested in UTSW. As each person gave an answer, hed use it as a springboard to talk about the strengths of UTSW, as well as emphasizing all of the famous people who are there. This went on for over an hour, and then he gave a brief powerpoint about common questions asked to the chairman, which included does he support the residency, financial stability, what he plans to change, and whats for lunch? Next the PD gave his slideshow, which was more the typical thing you expect that went over the curriculum, didactics, benefits, etc. This was followed by interviews, lunch, and a tour.
I had four interviews with the assistant PD, two other faculty, and a resident, and I also spoke briefly with the PD. The interviews were 20 minutes each, plus two 20 minute breaks. All of the interviews were pretty relaxed. I was asked why EM, what do I see myself doing ten years from now, why UTSW, and to talk about one of the experiences I had listed on ERAS. Everyone also asked me what questions I had, so make sure youre prepared to ask questions!
Curriculum: UTSW is a three year program. The main hospitals are Parkland (county type hospital on the UTSW campus that is also a tertiary referral center) and Childrens Medical Center (also on the UTSW campus). In addition, there is one rotation each at the VA, Methodist (community site), and one other community hospital. For shifts, PGY1s do a combination of 9s and 11s (not overlapping), while PGY2s/3s do overlapping 10s where they see patients for the first eight hours and then spend the last two hours cleaning up. Childrens shifts are 12s. Im not sure how many shifts they do now that theyre on this new schedule instead of all 12s. There are two peds EM months in PGY1, and then peds shifts mixed in with the EM months for PGY2s and PGY3s. Total EM time is 25 months, including the community EM blocks and the teaching block. There are three ICU months.
There is no orientation block, but interns can practice procedures like putting in IVs and foleys during their first EM block if they want. The PD stressed that off-service rotations are very strong. Ortho consists of ED consults. OB is on labor and delivery. There is also a month of gyn urgent care. There is one medicine ward month. They do a lot of anesthesia: three weeks of adult and two weeks of peds. There are two elective blocks, one of which can be an all expense-paid month in New Zealand. Both electives are scheduled for PGY3 year, but residents can rearrange their blocks to have elective time during PGY2.
All major EM subspecialties are covered. I already mentioned peds and ICU. There is no EMS block, but they offer optional flying, and the PGY2s and PGY3s provide radio EMS medical control. There is a tox block at the North Texas PCC, and one combined block of U/S and rads. The residents can all get U/S credentialed. They have one block of trauma and a two week neonatal resuscitation block, although the PD said that the residents end up doing resuscitations on every shift because of Parkland being such a busy receiving hospital. EM does the airway and leads the resuscitations. PGY3s have a teaching block. PGY2s and 3s also run four of the five pods, each having 12 beds (80 beds total including asthma and eye rooms, OB/gyn area, psych area). One pod is for urgent care and open 16 hours per day. Each pod has its own faculty plus a resident and maybe an intern. The PD said the pods have made patient flow more efficient. They have an emergency pharmacist in the ED 24 hours per day.
Didactics: They have your standard five hours per week of didactics. This is protected time even on off-service rotations. Interns have their own conference series for two hours each week, and they do sixty hours of procedures in Ft. Worth. This is the kind of program where you are responsible for your own learning, and there are no assigned readings or quizzes. Also, they do what they call asynchronous learning, where there are various optional didactics like journal club, board review, etc. The residents have to attend a certain number of hours of these didactics, but they get to choose which ones they want to attend.
Benefits: UTSW has decent benefits. There are three weeks of vacation and two weeks of sick leave per year. The salary is very reasonable for the COL in the area. Residents have to pay for parking, but its pretty cheap ($15/mo). They can moonlight as PGY2s and PGY3s after passing Step 3. They have a retirement plan and flexible spending account, get funded to go present research at conferences, etc.
Administration: The chairman told us that the fact that he spends so much time talking to applicants should be taken as a sign of his commitment and support for the program. He wants this program to be the best (however you define that). I got the impression that the UTSW culture in general is kind of intense, both on-service and off-service. Residents select a faculty mentor during their PGY1 year.
Dallas: Its your typical large city with hot, dry summers and relatively mild winters. We didnt hear too much about things to do during the interview day, but they have all of the regular cultural amenities like sports teams, museums, art, and so on. Residents can afford to buy homes in the suburbs if they want.
Summary: I left my interview day feeling like Id be prepared for just about anything after going through this program. Parkland is one of those hospitals where you are going to see a huge variety of pathology, and as a public hospital, you will also be the safety net for the indigent population in Dallas. Its also a hospital where all of the departments are very strong, not just EM, so the off-service teaching is top notch. I liked the residents I met, and they went out of their way to make sure that we had a good visit. Most of the EM subspecialties are very strong. Their tox department is enormous, with around a dozen toxicologists. U/S has been greatly improved to the point where the residents can get credentialed now. No one has any problem getting enough procedures. The New Zealand elective sounds awesome. There is graduated responsibility, and the residents get a lot of administrative experience by running the pods and teaching the medical students. They have longitudinal peds shifts, which gives them good seasonal variety. The new overlapping shift schedule has helped a lot with getting people out on time since they have two hours of cleanup time built in. Also, now the shifts are only ten hours total instead of twelve hours plus cleanup time like they used to be. That seems to have made a big difference in terms of resident wellness. The institution as a whole is very research-oriented, so if you want to do research here, you can. But its not expected, and more than half of the residents end up going into community practice.
The biggest negative to me was that the chairman kept emphasizing how he is working to make UTSW be the best EM program in the country, to the point that it makes me wonder just how high the pressure to be the best is ratcheted up. Considering how stressful working in this kind of high pressure environment can get in and of itself, Im not sure that all of this extra pressure to reach some undefined level of good reputation is really necessary! Id also like to have an orientation block, which they dont have. Finally, doing a ward month is bad enough, but the idea of doing a gyn urgent care block is beyond unappealing.
Overall, I think Id get great training at UTSW, but the culture there might be a little too intense for me.
I used past posts about people's thought on the programs on their rank order list to help formulate my own preferences in the programs I interviewed at so I thought I would pass my thoughts along about the programs on my ROL, now that all interviews are said and done. Be forewarned: I'm not very picky about where I do my training, so I ended up making a lot of decisions based on gut feeling and eccentric preferences.
1. JPS, Ft Worth: Really clicked with the faculty and residents. Hospital and program is very well funded and the EM program has a lot of pull and respect within the hospital. Really like the city for its size, low cost of living, and reasonable traffic volume. Almost all the training (except three months) is at their hospital.
2. Christiana, Delaware: Very well respected program that's been around a long time. I did a rotation there and its clear that many of their residents are very strong. Has many of the same qualities I liked about JPS (strong and respected program within the hospital), but I grew up in the area and am hesitant to move back. Has two training sites that are 20 minutes apart.
3. Ohio State, Columbus, OH: Really liked a lot of the residents I met. Had trouble clicking with some of the faculty, but did get to sit in on a small group session with one of their younger faculty members leading who was a phenomenal educator. Columbus seems like an awesome town. Just a little hesitant about the separate training sites.
4. Summa, Akron, OH: The nicest cafeteria I've ever been to. New YMCA connected to the hospital. Maybe that shouldn't have influenced me so much, but it did.
5. York, PA: I was really into the program director's pride in having a strong sense of community in the program. I also thought their simulation and other educational programs sounded really engaging.
6. Baylor, Houston, TX: Assistant residency director (Tyson Pillow) was the most personable, fun, and candid person I met the entire interview trail. Would love to work under him.
7. Jefferson, Philadelphia, PA: Three different training sites, some of which appeared to be long commutes. Really cool neighborhood for the university hospital, but pricey. Awesome airway course included with the education.
8. Little Rock, Arkansas
9. CHRISTUS Spohn, Corpus Christi, TX: Program director seemed a bit awkward and not very personable, but the assistant program director and a lot of the other faculty seemed cool. Didn't really click with any of the residents. Seemed like they have a cool simulation experience.
10. St. John's, Detroit, MI
11. UTSW: Very cool residents. Did get the impression that their training experience was a bit skewed to free labor taking priority over education side of things. Clerkship director was very arrogant. Very insistent on his excellent clinical and educational abilities.
12. Metro/Clevland Clinic: Great reputation, but many of their residents seemed burnt out and dissatisfied. They were also the only place where the residents didn't seem to hold their program director in especially high regard.
13. New York Hospital Queens: The fact that this is one of the most ethnically diverse areas in the US makes me think I'm going to have to use a translator way too much.
Pre-Interview Social: It was at a local Pizza joint in Uptown Dallas which is a really great area if you’ve never been. They had the biggest turn out of any residency social event I attended with about 20 or so residents there. Everyone was very enthusiastic about the program at the social, they all seemed like a really close group (despite the large residency size), and were all very honest about the residency.
Residents: Best group on the trail, mostly married or engaged but a few singles. They all liked to party. It’s UTSW so everyone is very, very smart—heard that the interns average Step was 240 (not sure if this was Step 2 or Step 1). Most are allopathic MDs but they do have DOs as well. Many were from Texas but people were from all over the country. Big Residency: 19ish per class.
Interview Day: It’s a pretty standard interview day with about 4-5 interviewers plus a presentation by the Chairman and the Program Director. It was a great tour and lunch too (not too long and didn't show us the ICU thank goodness). Program Director and Assistant Program Director were both awesome. They’d be excellent people to work for and definitely seemed like they always have your back.
Curriculum: A lot of this stuff can be found on the EMRA Match App but they are a 3 year EM program with 2 months of Electives total over the course of the three years. Integrated Peds after the first year, tons of critical care exposure and probably the best thought out Intern Year. They have this really cool thing—ICU/Anesthesia/Ultrasound /Tox super block that’s 2-3 months I believe. No floor months, but they do have two Trauma Months (one intern and one second year) which sound pretty difficult. Trauma intern year sounded like scutwork but as an R2 you are the upper level on the team. Incredible Ultrasound and Critical Care Exposure. Sim is once a month. Lots of attending teaching on shifts with great attending backup when needed. Tons of procedures and autonomy.
Fellowships: These guys have literally every Emergency Medicine fellowship you can think of outside of Pain and Palliative Care: Administration,Critical Care/Trauma,EMS,International Medicine,Pediatric Emergency Medicine,Toxicology,Ultrasound. It is one of the only places that currently has a Surgery Critical Care Fellowship where EM docs can get boarded (have a few that have already done it too).
Shifts: Great system. Shifts are all Circadian.
Intern Year: 17-21 11 hr shifts with 1 hr overlap so residents are out of there basically right on time.
R2-R3: 17-21 10 hr shifts with 2 hr overlap, so you stop seeing patients at hour 8 and have 2 hrs to wrap up. Residents said they usually leave right on time if not a little before the shift is officially over.
No Fast-Track Shifts (no additional indentured servitude).
Always staff patients with an attending even as intern so BC EM doc is teaching you and not an upper level resident (very important imo).
Upper Levels run each pod (obviously with attending backup). This isn’t a place where the attendings aren’t there, they sit right beside you while you work. Apparently intern year to running a pod was a big transition for residents in the past, now they’ve added a transition month or two to help ease you into covering all those patients.
Trauma: Trauma Shifts are integrated throughout the ED months like Peds shifts. When you aren’t on the Trauma Team as an intern or R2, it seemed like most of your Trauma duties were Airway and Primary Survey (HEENT). Trauma Team during Trauma Month as R2 you are the upper level and you do primary survey, procedures (outside airway), etc.
Facilities: Parkland is the busiest single center ED in the country with patient visits exceeding 160k+ according to the interview and after spending sometime down in the ED I definitely believe it. They have a Pod System. According to PD, they can flex the ED out to 200 or so patients at any given time with 40 or so per Pod at max capacity. A pod is typically run by an upper level resident, intern, and an attending to supervise so you’ll see ALOT. R2 told me she was up to 3pts/hr at times. Place makes Grady in Atlanta look calm. It is COUNTY. Patients are lined up in chairs across most of the hallways (you may think these are family members waiting…nope! These are the sick patients). Never really seen anything like it. Upper Levels can cover 20+ patients at a time because of this. Acuity isn’t triaged out so you have BS complaints and then super sick patients in the same pod. Recently opened up some lower acuity pods that are staffed only by PAs so residents see higher acuity stuff. New Parkland opens next Spring and looks very nice.
Didactics: I’ve heard excellent things from residents, attendings, and medical students that attended these. Seem to be a good mix. Didn’t get to see any during my stay. PD talked about all the great guest lecturers they get. Learning seems to be a priority at this place.
Research: UTSW has TONS of research/academic opportunities and it’s very easy to get involved with any project through the Department or outside. Lots and lots of funding.Research is required for everyone but there's a ton of stuff going on 21+ pubs by UTSW's ED according to EMRA.
Benefits:Highest paid salary of anywhere I saw in the South or Midwest. It’s actually pretty significant when you factor in COL. Standard 3 weeks vacation. Moonlighting starts as early as fall of 2nd Year. It seemed like everyone was moonlighting here.
Admin:Current Chairman was excellent. He gave a presentation during the interview day and then we just listened to Zeppelin while waiting for interviews. UTSW just became its own Department this year (it was originally under Surgery since 1997 I believe). I know they are currently searching for a new Chairman as of this post although I hope they just keep the current guy. He’s awesome. I’ve bragged about the PDs above. Regular faculty I met were just excellent--wanted to teach, loved their jobs, they were awesome!
Dallas: DFW is the 4th largest metro in the country with tons of stuff to do—>sports, arts, theatre, bars etc whatever you want it’s there to do. If you don't like a big city, this isn't for you. It’s also one of the fastest growing economies in the country like most of the big Texas cities too. Dallas is hot in the summers and can get cold in the winters. It has some great areas in the city to visit—Uptown, Knox-Henderson, Preston Hollow, White Rock Lake to name a few. Sounded like most residents owned their home. Dallas traffic isn’t too bad despite it’s massive size.
Cons: You’ve got to want COUNTY. Probably the most county of any program in the country. Probably need to know Spanish. You’ve got to want/love/thrive in the chaos. Every resident is worked hard at UTSW and heard from the EM residents that sometimes you really have to sell admissions and that other services are always upset when you call. They had some weird limitations put on them in the past that apparently have been alleviated since Departmental Status was given (consulting ortho on fxs, giving propofal without anesthesia present, etc). They might not be the most respected Department in the hospital--believe that honor goes to General Surgery or Medicine.
Overall: There are probably few residencies in the country that will give you the education, patient exposure, autonomy, craziness, resources, network and just awesome people to work with like UTSW will. This seems like one of those places that if you make it through you could literally go anywhere in the world and feel comfortable. I heard a PD from another program once say that every EM program will train you to be a great, competent EM physician. The RRC basically mandates it. But, the difference between a good and a great EM residency is the ones that teach you how to handle the "surge." The surge of patients, complaints, and craziness. Not all places can emulate this but Parkland certainly can. It might not be for everyone, but it’s the best place for EM in the country in my opinion.
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