I am a resident at VCU that regrets not writing this during my interview season. There were a couple of requests for reviews of the program last year. I wanted to give a taste to this year's candidates.
I interviewed at 12 spots in the southeast, northeast, and midwest. This place got ranked tops. I hope this conveys why. PM me with any questions.
Overview
3 year program. Very busy with tons of procedures. For my money, it is the strongest mix of trauma and medicine with a large contingent of critical care players. Heavy research and EMS experience located in a unique urban/rural interface.
Residents
8 per class. There are 10 people in the current intern class with 2 absorbed from slots left over after the folding of other programs. These extra slots may become permanent.
These are great people with diverse backgrounds. There are a lot of former EMSers and a few with previous experience in the military or other specialty training. Most are married and several have kids. Given these demographics, we do not get together to pound shots or go clubbing. However, there is the frequent post-shift get together. Ahh beer and omelets.
Faculty
Wicked strong teaching with a large contingent of young, enthusiastic attendings. New faculty include recruits from the hybrid Cardiology and research fellowships offered by the institution. Several of the staff are active in the Virginia DMAT. Critical Care is emphasized with 6 dual trained EM/CC attendings. The Peds ED has a combination of EM Peds boarded physicians and straight Peds training with decades of experience. Our observation unit is headed by an EM/IM boarded team that covers shifts in the department as well as time on the IM wards.
The VCURES research consortium is working on all kinds of neat stuff including rapid coagulation dressings for the military, and hgb substitutes.
Ancillary staff
Nursing is super competent. If you are asked to help with access, you will be getting a procedure either with U/S guided peripherals or a line. You are not asked to help unless there have been multiple attempts. Staff is vested in the training of residents and will seek you out for interesting cases or procedures. The institution supports the militarys Special Forces medic teams. This is where they get experience with penetrating trauma and learn how to suture, dress wounds, splint, intubate, and place chest tubes. Residents get first refusal for every procedure. These guys are enthusiastic students and are really fun to supervise once you are comfortable enough to give something away.
Curriculum
Comprised of 4 week blocks, there are 13 rotations in the year.
PGY1-EM orientation and merit badges one month, EM 4 months, then one month each of MRICU, Peds, IM, Orthopaedics, Trauma, Anesthesia, OB, EMS
PGY2-EM 6 months at MCV and one in the community, Peds EM, Tox, STICU, CSICU, Clinical Decision Unit, Radiology
PGY3-EM 10 months with one in the community, Peds EM, PICU, Head and Neck
Starting second year you manage the department. You assume responsibility for the majority of patients in your respective section for the shift. You are typically paired with an EM intern or a couple of off service folks. Third years take on more responsibility with oversight of med students and more departmental control.
After PGY1 you can participate in extra course offerings called longitudinal tracts offered in Cardiology, Ultrasound, Tox, Peds and Admin. Selecting one of these can fulfill your research requirement, set a foundation for fellowship and give a more in depth experience in each of the subspecialties.
We are developing the first interactive web-based EM "library" with an ongoing literature discussion to augment our monthly journal clubs. Journal clubs occur once a month at an off-site restaurant. We have strong faculty turn out with good discussion on pertinent literature. Our conferences are dedicated time. We are exempt from any patient care on any service for 5 hours in the afternoon every Wednesday. Several of these didactic sessions are combination conferences with other departments E.G. IM, Neuro or Trauma.
Our EMS experience is diverse with medical direction for the city's ambulance authority centered at the facility. Medical direction for the air medical program is provided by our faculty. There is not a "flight requirement", but there are plenty of opportunities to participate in air transport.
Our chair is Joe Ornato (Autopulse, chain-of survival, therapeutic hypothermia). Cardiology is a big deal with a unique system of leveling chest pain, 24/7 MIBI access and EM powered cath lab activation. The urban setting in a largely rural state at the intersection of two major freeways gives a giant trauma exposure. There are good relations with surgery with shared procedures and teaching. ED owns the airways on every trauma with anesthesia standing by. The population is sick! You will leave a guru of metabolic syndrome and all of its horrifying sequelae.
Facilities
The MCV campus is one part of the much larger VCU system. The medical center proper is actually 5 hospitals joined by a series of crosswalks. The department sees 80,000+ visits a year. 20% of these are pediatric. There has been a hospital on the site since the early 1800s. It is the 4th largest teaching hospital in the country. Our community center sees ~60,000 pts. a year and is the real community deal with attendings part of a democratic group that has a heavy billing and throughput elements of EM education.
The VCU ED is composed of Green (major medical/psych), Yellow (trauma, surgical/abdominal pain), Blue (fast track), Orange (observation unit) and Purple (Peds ED). Each section has between 14 and 20 beds.
The department proper was designed for a different era of medicine. Computer access has been an issue, but that has recently been addressed with resident dedicated computers soon to be offered. The good news is that big change is coming in the immediate future.
There is a brand new enormous critical care tower scheduled to open in 2009 with a new ED being constructed on the ground floor.
Charting
Using t-sheets for documentation, but computer entry for orders. EMR is being aggressively developed with a lot of input from the department as the EDs system intersects with the rest of the system.
Location
Richmond is a very livable city. Most residents own their homes. It has an urban feel with access to countryside very near. DC is a two hour drive. The beach is 90 minutes , and good size mountains are an hour away. The city has excellent historical offerings if thats your thing. Canals built by G. Washington run past iron works used by the Confederacy.
Excellent restaurants, good bars, tons of museums and a lot of parks make it a great place to live. There is world class mtn biking that goes 1 mile from the hospital. The only urban class V rapid in the east is right downtown. There are climbing crags within the downtown perimeter. There is a large emphasis on fitness and endurance racing. The Xterra games holds the East Championship here. The residency put up two teams for this race this past summer.
Negatives
As described above, the physical plant needs improvement. The city is not a metropolis, nor is it on the beach or at altitude. The patient population at MCV is largely indigent.
Positives
The department will get a new home very soon. The PD and faculty are aggressive advocates for the program. While less than a decade old, the department has a big footprint in a well developed center. The training here is excellent. Speaking with graduates, they tell me the program prepared them for their careers whether academic or community based. Graduating from this program will prepare you for any career in EM.
