Albert Einstein College of Medicine (Jacobi/Montefiore) Residency Reviews

I have heard mixed things about Jacobi...just wonder what you guys think.

hello23 said:

I have heard mixed things about Jacobi...just wonder what you guys think.

Click to expand...

I rotated through Jacobi this summer...here's the scoop:

Yes, they are a 2-4 program but by getting that intern year out of the way they allow you to focus on Emergency Medicine for the rest of the three years. Unlike other programs their residents don't have to do Medicine on the floors, they are only required to attend rounds and not carry patients on other services such as ICU and CCU. Their thinking is that you do most of the necessary and evil scutwork during your intern year.

Great training too...I had my interview during the last grand rounds and they presented a case of a 32 yo cab driver who chased after a fare beater...was shot multiple times in the thigh and scrotum. On top of that to escape the shooter he jumped out of a two story building. These kinds of things happen on the regular at Jacobi...you see at least one crazy case a week.

That area of the Bronx is a great and very safe place to live!
The pay is really high for residency programs, the benefits including meal card are amazing!

They run traumas. I mean truly run traumas, they make the decisions on whether or not they should call trauma down.
Trauma complained that their residents weren't getting enouhg chest tubes so the ED ran a study and concluded that surgery residents got enough chest tubes on the other services.

The biggest plus!! A new building was just erected and will be fully functional by February. It is supposed to be state of the art.

The negatives: Not as academic as some other programs but they're trying to improve that. Not enough ancillary staff, so you will have to do some transporting, bloods, and IV's. But I think it's a part of training...who do the nurses go to after they're unsuccessful....US!!

hope this helps somewhat....

I am an EM-2 (PGY-3) at the Jacobi/Montefiore combined emergency medicine
residency. It is a 2-4 program affiliated with Albert Einstein College of
Medicine. The two clinical sites provide a good mix of patient populations
and pathologies. Each site has over 100k visits/year. As one of the oldest
EM residencies in the country (over 25 years old) and as a separate
department within the College, we enjoy a lot of autonomy. Jacobi is the
quintessential "county" level one trauma center that receives every major
trauma in the northern Bronx and lower Westchester. The ED is entirely
resident run. As a PGY-2 (EM-1) the residents are responsible for the
minute-to-minute aspects of patient care. The PGY-2 (EM-2) acts as the
"chief" of either the medical or the surgical side of the department and is
responsible for triage, patient flow, and assigning the more complex cases
to the lower level residents. The PGY-3 (EM-3) functions as the attending,
making all dispo decisions with the help of the attending. Cases are
presented to either the attending or the PGY-4 depending on the day and the
side of the department, It is this "graduated" responsibility that is unique
to our program and makes the transition to attending upon graduation from
the program a very smooth one.

Traumas are run entirely by the EM residents. The in-house trauma team is
called by us only after the patients are stabilized or if they are going
right to the OR. We have lots of experiences putting in chest tubes, lines,
etc. The airways are also entirely run by us as there are no anesthesiology
residents in-house. We have four ultrasound machines owned by our department
and an ultrasound fellowship program that will be starting this spring. We
have our own CT scanner and four radiology rooms. Montefiore is the academic
center of the medical school and is a major referral center. There is an
equal mix of private versus service cases. The ED is run like a more
traditional department with all cases presented directly to the attending no
matter what level of training. The medicine experience tends to be more
complex here with transplant patients, referral patients, and more "zebras"
than are seen at Jacobi.

As a 2-4 program we have very few off service rotations. We are not "farmed"
out to the other services as cheap labor. You'll get enough experience in a
well-rounded preliminary or transitional year so that repeating those
rotations as an upper-level resident would not be productive. Our
relationships with the other services are great and as a well-established
independent department, many of the "battles" have been fought and won by
those who came before us. We have full admitting privileges to every service
in the hospital. As for scholarly pursuits, there are plenty of attendings
who are involved in research. There is also a research fellow at the Jacobi
site. Our chairman, Dr. Gallagher, is an editor of the Annals, and is very
supportive of the residents.

Jacobi is also home to one of the busiest multi-person hyperbaric chambers
in the country and the snakebite referral center for the entire Northeast.
Graduates from the program (there are over two hundred out there) are
everywhere in academia and in the community. Once a year we have an alumni
event that is great for networking. The attendings and departmental
leadership at both sites are excellent and their main job is teaching the
residents. We have a very active attending-resident advisor program.
Half of the residents live in the Bronx (Montefiore offers very inexpensive
housing) and about half live in Manhattan. Both sites are 20 minutes away
from the upper east side of Manhattan (by car or subway). Half of the
clinical experience is done during the first year, with the EM-1 residents
working 10 twelve-hour shifts in 14 days at both sites. As an EM-2 the
schedule decreases to 8-9 shifts in 14 days (Jacobi shifts decrease to
8-hour shifts) and the EM-3's work 7-8 shifts in 14 days.

Upon graduation we definitely can handle any type of emergency that rolls
through the doors because we have seen and done it all. Jacobi has built a
new ED that will be opening in the spring of 2005. Residents have had a lot
of input into the design and flow of the new department and we are all eager
for it to open.

-Jason

Rotated there, interviewed there. Probably one of the better county-style programs in the country, IMHO. The residents truly run the ED. Worked with a few Jacobi grads and they all have a very no-nonsense approach to EM.

Tough place, rough schedule, very poor ancillary staff at Jacobi especially, having to do a year of medicine/surgery and not too much community experience would be the downsides. Supposedly have a new ED soon, which should be nice.

Interview day started at 8am with breakfast and a case conference. Make sure you park in the right lot - lot #3 is NOT the visitor one where you pay! There's no gate or anything, it's on the right just past the visitor parking and right by the ED.

8 applicants were present. Conf. wasn't heavily attended by residents b/c it wasn't the main dept conference - only for those working at Jacobi that day shift. The Jacobi chair was there, however, along w/ several faculty.

Half then did interviews w/ 4 faculty (NONE of the PD's!) while the other half did tours of both Jacobi and Monte. They take you in a bus over to Monte which is 5-10 min away w/ traffic. Interviews were pretty short and tended to center around the program a lot since they did the slide show about the program after the interviews. All were on the younger side, under 50 I'd say. i thought there wasn't enough time for the interviews. I can't remember any pointed questions or even much specific. As usual some mentioned my interest in sports.

Then lunch w/ residents, probably 6-8 showed up. Mostly from northeastern med schools, unfortunately no one representing from the south was there that day...

I then did an interview w/ the IM prelim year at Jacobi. Then observed in the ED for almost 3 hrs, making it a LONG day for me but worth it I thought.

+++ Tremendous variety of patients. They see a large # of various Hispanic groups, mostly Dominicans, Puerto Ricans, and an increasing # of Mexicans at Jacobi. Mostly indigent sorts of pts at Jacobi, more insured/tertiary care stuff at Monte.

+++ Peds at both places, have fellowships too.

+++ lots of trauma, run by EM at Jacobi until they want to call surgery

++ Housing available at Monte, under $800 including utilities. Not at all fancy but it's across the street w/ an attached parking garage. Also free food at Monte cafeteria.

++ Graduated responsibility - EM1's get first crack at procedures, work hard.... so that you can basically run 1 side of the Jacobi ED as an EM2 and be a "preattending" as an EM3. This is pretty unique, only a couple of other places do this at all.

+ I really liked the Bronx - still a borough w/ activity but helluva lot cheaper than Manhattan. Express bus to Man. is 20-30 min. Lots of trees in the area, can keep a car in the Bronx.

+/- Not sure which -- Jacobi is divided into "med" and "surg" sides... unclear whether this will persist in new ED (see next).

+/- New Jacobi ED isn't finished even for a tour, so hard to gauge what it will be like once it opens (early 2005 they say, running behind). For class matching this year there will be a good year plus for the kinks to be worked out!

+/- PGY 2-4. [Haven't fully made up my mind about this or the whole 4 year thing in general. I think i'm hopelessly neutral and will not consider it a factor unless as a tiebreaker.] *** Note to future applicants: Program is going to 1-4 format in 2006 match.

- Didn't get to talk to a whole lot of residents given the size of the program. Probably due to the fact that....

-- EM2's work 20 12's a month while in the ED... that is a tough year there and necessary to do the graduated responsibility thing. There are some lighter blocks like peds, gyn booth where it's just 5 8's a week.

--- No interviews w/ any PD and the PD was sick that day! I'll be going back to meet w/ her since I really liked the program overall. Meets most if not all of my personal and professional needs/wants.

Feel free to PM me w/ questions. Keep in mind i'm not one of those lookin for a coosh place so my opinions are to be taken as such!

Jacobi/Monetefiore – Jacobi is located in a fairly nice middle-class section of the Bronx on a tree lined parkway, surprising location for the amount of inner city pathology/trauma seen there. The day began with breakfast and attending the morning report lecture given by one of the faculty and was followed by a brief presentation by the PD and interviews with the PD, two faculty members, and a senior resident. The interviews were pretty laid back. The program will be 1-4 starting this year with most of the off service intern rotations at Jacobi. There was a tour of the new state of the art ED building which is a mind blowing improvement over what they are in currently. Although the move in date has been pushed back for nearly a year, the PD promises that it will ready by Jan 2006. More than half the residents seem to live on the upper east side in Manhattan and commute 30 minutes via subway or driving, while the other half are scattered in other sections of the Bronx. There’s housing offered at the Montefiore site for cheap. We were then taken to the Montefiore site in the afternoon, which sees a slightly older population than Jacobi with more medically acute patients. The volume there is ridiculous for an academic center, pushing over 85,000 adult visits making it one of the busiest in the east coast. While the program prides itself on being very resident run, it is pushing to be more supportive of academics with a new research fellowship. The only complaints heard from the residents had to do with having to work so hard and the current crappy ED facility at Jacobi, but otherwise they seemed to be happy to be there.

New York Presbyterian. – The morning began at Cornell with a presentation from the PD. Cornell is located in the well-to-do upper east side of Manhattan and is physically a very nice hospital. Dr. Carter, the PD, is awesome and super supportive of the residents. He let a couple of residents take off from their shift duties to go down to Katrina, and they ended up running the ED public health surveillance for Baton Rouge. The Cornell site does see level one trauma has one of the highest trauma severity index (a measure of # and severity) for New York. We then had interviews with the PD, assistant PD, and a nursing supervisor (which I thought was very cool). The residents in the program are among the most well rounded I’ve met. A couple of them have already gone on to take leadership positions in EMRA and one was elected best houseofficer overall at Cornell. We had a tour of the ED and critical care units at Cornell which are very state of the art. Then we were shuttled off to Columbia which is about a 20 minute ride uptown. The Columbia medical center is in the heart of Washington Heights, which has a vibrant inner city feel in a Dominican community. We attended noon conference which they have 4 days a week there in which one of the faculty members presents a case over lunch. The Columbia ED facility is somewhat cramped and divided into three sections with acute and non acute patients mixed into each section. There are ton of stretchers in the hallways and almost has a county feel to it. The only complaints from the residents were that they were working there asses off and wished they had more residents in the program. This program is great and has the potential to be one of the best academic EM programs in the country. The faculty will have to become more academically productive in terms of research, though, for this to happen. This is not the place to go if you want to go into the community. You must want something more than just practicing clinical EM to be happy here.

NYU:
-great didactics, morning report every day
-faculty mindful of other programs within the city, (lots of we got this much of this and they only have that much of that)
-good orientation month
-less exposure to trauma, but they do run them (as opposed to surgery-run)
-smart residents, friendly residents
-faculty are hit or miss, some are intense
-less peds (universal in NYC)
-less u/s (only one machine for the whole department)
-hours okay (12,12,10,8)
-less cards, but more neuro experience than at other programs

Jacobi:
-new ED coming (current one is tiny, but new one is phenomonal - have they moved into it yet? any day now, last i heard)
-good orientation month
-GREAT faculty resident relationships
-peds + or -
-GREAT trauma (all run by EPs!!!)
-good U/S
-less didactics, most is at the bedside (and beside teaching is done)
-tons of ED time and shifts (less off service)!!!
-graded responsibility (dept. flow and management during upper years)
-really really hard first year (huge time commitment) - all residents though happy were vocal about how "damn hard" the first year is
-friendly and down-to-earth faculty (VERY approachable)
-less ego-trips than other NYC programs
-more academically focused than other trauma-intense EM programs in the burrows

Mount Sinai:
-strong didactics (daily sign out, guest lecturers)
-good orientation month
-good ultrasound teaching
-half of ED months spent at Elmhurst – good staff, good ancillary support, less drunks, great trauma (peds mixed in) THIS IS THE TRUE PEARL OF SINAI!!!
-lacking peds (universal around the city)
-good residents - outgoing and friendly and smart
-faculty: some are intense, but most are benign
-commute to queens is ****ty
-ed shifts = all 12’s is bad, but only 18/month is good, not too tough, residents say they have a life outside the hospital
-mt. Sinai patients = mix between Spanish harlem and upper east side, medically complex and transplant patients
-learn 1) good clinician 2) good ED management
-nursing off-service isn’t malignant, but isn’t great, push you around some, and not the brightest
-trauma = 50% by EM vs Surgery, and most of the time primary command is EM

Good:
-Elmhurst in Queens is a great experience with bizarre differentials, and great faculty and great teaching. Sinai is filled with medically complex patients. Residents are fun to hang out with. Attending coverage is great. Peds not great (but electives available).

Bad:
-I've heard a few people say that Sinai is a second tier EM program, but I don't know why, this was one of the places I liked the most in NYC. Mt. Sinai is a trauma level 2 hospital, but 50% is ED time is at Elmhurst which is level 1 and sees more trauma than other trauma levels in the city
-commute to Queens isn’t that bad apparently (20 minutes by car? 45 min by subway), but still annoying

Hey everyone. I'm an m3 that's pretty much decided on going into EM. It's time to start thinking about where to do externships. I was wondering if there is anyone who did a rotation at Jacobi, or interviewed there this past year. All insight into this program is welcome. Thanks!

BTW...I did do a search on the program and read some of the older posts. I'm interested in also hearing about their new ED.

Jacobi is the oldest, most established program in New York City. The ER itself is crazy, blunt-trauma-heavy, with some great pathology. Plus, it has amazing faculty and great residents. Montefiore (the other half of the program) is the busiest ER in New York City, and it has many of the advantages of a private hospital. It is definitely worth taking a look at.

As far as the fourth year rotation, it is a very good one. You will not get a lot of the dedicated classroom didactics or high-tech sim labs that some other top programs will provide, but you will get incredible bedside teaching and lots of hands-on experience. In general, it's a mini introduction to what your life would be like in a top county program. It's hard, you learn a lot, and you get to hang out with some amazing residents.

PM me if you have questions about other county rotations in New York.

About the new ER - it hasn't opened yet. The new hospital now has inpatient medicine and peds patients, and they are going to move over the ORs and the ER soon. Don't let that be a deciding factor for rotating there. The building is not what the Jacobi experience is all about.

Dr. Will said:

Hey everyone. I'm an m3 that's pretty much decided on going into EM. It's time to start thinking about where to do externships. I was wondering if there is anyone who did a rotation at Jacobi, or interviewed there this past year. All insight into this program is welcome. Thanks!

BTW...I did do a search on the program and read some of the older posts. I'm interested in also hearing about their new ED.

Click to expand...

I interviewed at Jacobi in November and am seriously considering the program. If you are coming outside of new york and are thinking of focusing on new york for residency, some (not all) of the choices are: Jacobi, Sinai, Bellevue, St. Lukes, Downstate, cornell/columbia. There are others (lincoln, methodist, NYP/Queens, etc.), but I feel like those names I listed jump out at me, probably because they are names that will more likely jump out on the application/interview then a smaller community program. I think you are wise to be thinking about Jacobi. As every region has at least a little geographic preference, doing a rotation at jacobi will open some doors for you to other programs in new york when you apply. I would suspect downstate, st. lukes, cornell/columbia, and sinai would do the same.

Jacobi and Downstate are both big time county programs. Relative to each other only, I'd say between teaching and clinical exposure, I'd say Jacobi lean more towards teaching relative to downstate, and downstate lean more towards clinical exposure. Jacobi has been around longer as noted above. Both have physically finished building the new ER and when I interviewed they took us on tours of both of them. The are very similar and both will be impress, especially their size (downstate's has 10 trauma bays; that should give you an idea of their exposure to trauma, penetrating and blunt).

I think it will definitely help you to do a rotation at a big county program. You learn a ton and get to do procedures others won't get to do. Both translate to confidence when you interview. When you interview with other county programs, they'll feel like you're less of a risk relative to someone who didn't seem to get any "hardcore" experience. Having said that, it's good to get exposure at a community hosp also, I just don't know if it's more beneficial.

Anyway, Jacobi is nice. Monte has high volume and physically it's pretty nice. And you get perks like parking and I think lunch. Jacobi is your typical county (neutral connotation).

The only thing is I don't know about the living situation. Presumaby if you're not from new york, not really been to new york, and you'll be coming to new york for rotations, you might want to check out the night life. I'd say that's easier from the manhattan programs (st. lukes, bellevue, sinai, columbia/cornell). Even downstate has brooklyn's park slope and brooklyn heights, and when traveling to manhattan downstate will hit the downtown spots, whereas from the bronx you'll have to traverse all of uptown to get down. of course that all depends on where you can get housing; maybe you have family/friends.

good luck and go for it.

Thanks for the replies guys. I'm already going to be doing a rotation at Cook County. I wanted to do one out east, and possible out west in cali where I'm from. Although I wouldn't mind going back to Cali, it's not my highest priority. I want to keep my options open. In cali, I was considering USC and UC Davis. If I ended up doing Cook, Jacobi, and USC, it would be all county programs. Don't really think that's ideal. If you have any other suggestions, I'm all ears.

The great thing about doing any rotation in NYC is that it is a *very* small community. All the PD's know each other well. So if you get a good letter of rec, it will carry you through any/all of the NYC programs.

Dr. Will said:

Thanks for the replies guys. I'm already going to be doing a rotation at Cook County. I wanted to do one out east, and possible out west in cali where I'm from. Although I wouldn't mind going back to Cali, it's not my highest priority. I want to keep my options open. In cali, I was considering USC and UC Davis. If I ended up doing Cook, Jacobi, and USC, it would be all county programs. Don't really think that's ideal. If you have any other suggestions, I'm all ears.

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roja said in more eloquent terms what I mentioned about "regional preferences".

I guess the only thing I would say about keeping your options open is that you just have to see what your comfortable putting up with. I approached "audition" rotations as what they were: I was aiming to impress, get letters, and opening doors. That takes a lot of effort--to bring your A-game all the time--and can be stressful. With that in mind, I did only two rotations, one at my home school and one at an away program, both well known programs. I didn't do more and I'm really glad I didn't. Are there places I didn't get an interview at when I might have been able to if I did a rotation in that geographic area? Maybe, but I guess I thought doing more than two was kind of a waste of my time. I figure I'd get two letters from my home program and at least one from the away program, and that's three from EM. If they are great letters you're pretty much good to go. Again, it's personal. For me doing a rotatation at three county programs would be overboard, but maybe it's right for you.

The choices you mentioned are all good. I'm not sure what you'll get out of doing three county rotations. USC is pretty hard core, but so is cook and jacobi. You might get sick of it. If Cook is your home program, definitely do that one. If New York is a region more preferred than Cali (yes, I understand you wouldn't mind being back in Cali, but just ask yourself where you would rather be), than do one in New York. If you'd rather end up in Cali, do one in Cali. Then call it a day and relax and enjoy your fourth year. Or do a more chill program in the third region. Hey, you can't cover the whole country.

Good luck.

I have to burst your bubble - sorry...

Jacobi is still, somehow, riding on it's previous reputation as a strong program. The truth is glaringly different.

To begin with, the administration does not support the residents in the least. There is a pervasive attitude that the residents are there only as cheap labor. The same issues regarding working conditions are brought up year after year and are swept under the table because the residents have no say in how the department functions. With notable exceptions, teaching is absent in the department. This is a "learn on your own" program and no-one is going to correct you if you do the wrong thing.

Your job as a resident involves being a tech or a nurse - rarely a doctor. You put in all your own IV's, give your own meds, push your patients to xray. In fact, the xray techs have more clout in the department than you will.

The outside rotations listed in the syllabus are a farce. 99% of residents would be hard-pressed to tell you where to even find the ICU or PICU, let alone show up for their rotations. You will have an enormous amount of free time. No-one will care or monitor whether you show up for these rotations, which is fine since even when you show up, your involvement is to walk around on rounds for a couple of hours and then go home.

Research is a joke. They have finally realized that research may bring them some money, so a few attendings are focusing on projects now. This is an academic program in name only. Draw a parallel between Jacobi and, say, UCLA. There's no comparison.

Monte is far closer to what ER training should be, but even it doesn't make up for the glaring failures at Jacobi.

There is no such thing as protected time. You will be scheduled to work during conferences. Remember, it costs much less to have a resident as a warm body in the ER than a nurse.

With regard to the living situation, you are completely on your own. You will find little to no help. There are a couple of over-priced apartments next to Monte, but a lot of residents live in the city and commute.

What is most frustrating about Jacobi is the potential. The volume and acuity could be a great learning experience but the administration refuses to take advantage of it.

Do yourself a favor - try USC, UCLA, Denver, Cleveland MetroHealth, or even Maricopa.

The problem with residency programs is that you're never quite sure what you've gotten into until you're already in. Be very careful of how programs present themselves.

MyAntonia said:

I interviewed at Jacobi in November and am seriously considering the program. If you are coming outside of new york and are thinking of focusing on new york for residency, some (not all) of the choices are: Jacobi, Sinai, Bellevue, St. Lukes, Downstate, cornell/columbia. There are others (lincoln, methodist, NYP/Queens, etc.), but I feel like those names I listed jump out at me, probably because they are names that will more likely jump out on the application/interview then a smaller community program. I think you are wise to be thinking about Jacobi. As every region has at least a little geographic preference, doing a rotation at jacobi will open some doors for you to other programs in new york when you apply. I would suspect downstate, st. lukes, cornell/columbia, and sinai would do the same.

Jacobi and Downstate are both big time county programs. Relative to each other only, I'd say between teaching and clinical exposure, I'd say Jacobi lean more towards teaching relative to downstate, and downstate lean more towards clinical exposure. Jacobi has been around longer as noted above. Both have physically finished building the new ER and when I interviewed they took us on tours of both of them. The are very similar and both will be impress, especially their size (downstate's has 10 trauma bays; that should give you an idea of their exposure to trauma, penetrating and blunt).

I think it will definitely help you to do a rotation at a big county program. You learn a ton and get to do procedures others won't get to do. Both translate to confidence when you interview. When you interview with other county programs, they'll feel like you're less of a risk relative to someone who didn't seem to get any "hardcore" experience. Having said that, it's good to get exposure at a community hosp also, I just don't know if it's more beneficial.

Anyway, Jacobi is nice. Monte has high volume and physically it's pretty nice. And you get perks like parking and I think lunch. Jacobi is your typical county (neutral connotation).

The only thing is I don't know about the living situation. Presumaby if you're not from new york, not really been to new york, and you'll be coming to new york for rotations, you might want to check out the night life. I'd say that's easier from the manhattan programs (st. lukes, bellevue, sinai, columbia/cornell). Even downstate has brooklyn's park slope and brooklyn heights, and when traveling to manhattan downstate will hit the downtown spots, whereas from the bronx you'll have to traverse all of uptown to get down. of course that all depends on where you can get housing; maybe you have family/friends.

good luck and go for it.

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Someone bitter? Are you currently a resident there? When I rotated at Cook one of the newer young attendings there (2nd yr attending I believe) Was a great teacher, incredibly knowledgeable and a great guy to be around. Now maybe thats his personality but I have to believe at least some of that came from his training. Oh and BTW he was strongest on the ICU-type patients that got wheeled into the ED..

Disclaimer: I did NOT rotate nor interview at Jacobi..

Bitter, no... irritated, yes. I would have liked to have had the complete picture before going into residency. I expected Jacobi to be a better teaching program and it simply wasn't. It's a very self-driven, self-taught atmosphere and that can be dangerous. Now, that said, the sheer volume and acuity there was such that you couldn't help but learn. Besides, patients are held there in the ER for hours to days on end, so you end up getting VERY good at managing ICU patients.

I can only imagine that you're talking about Jordan - the red-headed wild child. I'm sure he is a great teacher - he's just a great guy all around. He is also extremely self-driven. I'd say he learned what he learned because of exposure, not training. There's a difference.

Listen, what it boils down to is that you need to know what you're getting yourself into and make sure that is what you want.

EctopicFetus said:

Someone bitter? Are you currently a resident there? When I rotated at Cook one of the newer young attendings there (2nd yr attending I believe) Was a great teacher, incredibly knowledgeable and a great guy to be around. Now maybe thats his personality but I have to believe at least some of that came from his training. Oh and BTW he was strongest on the ICU-type patients that got wheeled into the ED..

Disclaimer: I did NOT rotate nor interview at Jacobi..

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I have to completely disagree with jaydoc... I can only say that this is an individual with clear motive to smite the Jacobi/Montefiore program! Beware advice as purposely negative as Jaydocs!!
I am a past graduate of the Jacobi/Montefiore Program and have to say that J/M has been and continues to be one of the top programs in the area / country. I had rotated as a medical student through various other ED's in the area before ranking Jacobi/Monte #1, did my internship year at another area hospital with an academic EM program and now work at a major academic center. I can tell you 100% that the mis-statements about exposure vs. training, zero faculty input, no protected time... etc. is completely false!
True, you are allowed to make independent clinical decisions as a resident in your more senior years, but this should not be mistaken for a "learn on your own" program. This is one of the few programs I have encountered with a clear and progressive graduation of responsibilities as you move from one year to the next. The faculty is highly involved in daily bedside and didactic teaching as is the chairman of the department, EJ Gallagher, a major academic force in EM, and a resource for the program not to be overlooked. There are times that you feel that you are in over your head, there are times where you are going to read during a shift to teach yourself about a topic and yes, there are attendings that do not teach a hell of alot, but you are not left on your own to make uneducated decisions about patients or to teach yourself about topics. The faculty, is overwhelmingly involved in patient management, bedside teaching and didactics, as are more senior residents who are involved/comitted to teaching as well.
True you do push stretchers around and put in IV's as a resident on a semi-regular basis in order to get the job done, but your job is not reduced to that of a tech. As an attending I continue to push stretchers, put in IV's, dispense meds, get patients cups of water, give patients bedpans, etc. You know why? To get the job done, to be a team player and to be a thoughtful and respectful doc to my patients and others I work with.
As for off service rotations (ICU, PICU) true you do not have direct patient care responsibilities in most cases of off service rotations so your involvement is limited. Some residents do skip out early or do not go at all and why should this be blamed on the program? We're adults folks... we should not have to have big brother looking over us at all times. Don't be misled! The residents are not getting shortchanged... As Jdoc does mention, our graduates know how to take care of realllly sick patients while multi-tasking incredibly high volume... this is a virtue of both training and exposure!
And as for J/M not being a progressive program: how about the fact that in the past five years they have started up two research fellowships (one at each training site) and an emergency ultrasound fellowship (not for cheap labor as Jaydoc may reply, but to further the academics endeavors of the program), hired two directors of research and published numerous articles in major peer reviewed journals (again, not as Jdoc infers for $$- research in general, is not a lucrative endeavor). Residents are also involved in research and present posters/orals at national conferences and are regular co-authors of articles. The program has also moved to a 1-4 format to better standardize the teaching of the residents and to expose them to what J/M feel are key to the practice of EM.

So sorry to Jay doc if he felt that he wasn't spoon fed or hand held enough during his training, but the fact is whether he realizes it or not, is that he graduated from one of the better (not neccessarily the best) programs in the country. He may be surprised to find out that when he graduates, no one is going to push him to read, learn or keep current. Unfortunately for him, if he was not self-driven during his experience at J/M, he never will be as a practicing physician.
True not every resident is going to be happy with the training that they received, but that is not a reason to purposely and harshly condemn a program like he did.

jaydoc said:

Bitter, no... irritated, yes. I would have liked to have had the complete picture before going into residency. I expected Jacobi to be a better teaching program and it simply wasn't. It's a very self-driven, self-taught atmosphere and that can be dangerous. Now, that said, the sheer volume and acuity there was such that you couldn't help but learn. Besides, patients are held there in the ER for hours to days on end, so you end up getting VERY good at managing ICU patients.

I can only imagine that you're talking about Jordan - the red-headed wild child. I'm sure he is a great teacher - he's just a great guy all around. He is also extremely self-driven. I'd say he learned what he learned because of exposure, not training. There's a difference.

Listen, what it boils down to is that you need to know what you're getting yourself into and make sure that is what you want.

Click to expand...

Residents: 18 residents per class, largest I have seen so far. All seemed very laid back (Isn't this the trend, I have not gone to one program where everyone was uptight) and most seemed to have a) wanted to be in NY and b) ranked Jacobi first.

Faculty: Dr. Perera is the new program director, but was active in Albany prior to this. He has "more energy than a ferret on 2 espressos" as he described himself and he is definitely a talker! That energy will really psych you up as he gives you the talk in the beginning of the day. Faculty at Jacobi seem older, Monte seems to have the younger attendings, many of whom graduated from the program recently. They have trained huge amounts of Emergency Physicians who have gone on to academic jobs all over the country (but mostly in the tri-state area). They will give you a list of all their alums and it is impressive.

Interviews: 4 interviews, each very short 15-20 minutes, tightly regulated.

Hospitals: Jacobi is the county hospital in the Bronx and much time is spent up in this main hospital. The graduated responsibility roles take place here. It is newly renovated with brand new rooms, a very intuitive and spacious layout, stock carts in each room, and an overall comfortable feel with room to sit and chart. I honestly already forgot if charting/ordering was computerized or not, but they said that they don't have a good electronic whiteboard, which sometimes poses a problem. Most off service rotations are done here. Jacobi is not a cath center, but Monte is.

Monte is the "private" hospital, but it looks more like a county hospital with curtained rooms and patients who sometimes are in 3-4 deep. It was crazy by the time we were there and definitely "buzzing" with that typical ED noise. Monte sees 100,000+ patients per year and residents say that this place really tests you. Attendings here see patients on their own as well and there is no graduated responsiblity at this hospital -- everyone just presents to the attending.

Good trauma and pathology in the Bronx, sick patients abound. Jacobi has a younger subset of patients, Monte has a lot of geriatric patients who are all sick and septic and need lots of lines.

Ancillary: Apparently, they have hired twice the number of nurses they used to have, so ancillary services, which they admitted use to be a big downside to the program, no longer is an issue. Newer, younger nurses are more willing to do things and learn from residents and attendings. To be honest, I'm not sure if I believe that it's completely gone, but probably going in the right direction.

Curriculum: 4 year program with graduated responsibility at Jacobi only. Interns and PGY2 are juniors and are assigned patients by the PGY3. The PGY3 sees all the patients on one side and then gets the work up started, decides if they are really sick and assigns a junior (PGY1 or PGY2) to see the patient. Personally, this seems weird to me. Not sure if I would enjoy having all my patients screened by the third year before I see each patient. Feels a bit like med school. The PGY4 is the true "pre-attending"... he/she acts as the attending on that side, listens to presentations, decides on dispo, and just dispos. Legally, the attending on the other side is responsible for all patients but many times they do not even see the patient before the PGY4 dispo's them.

Didactics: Typical rounds. They have a joint conference with the Trauma team during which there is some yelling back and forth, but pretty friendly.

Research: Did not ask what areas of research they typically focus on. Many residents have published or have ongoing projects.

City: It's New York, but not really. This area of the Bronx is relatively safe, nice and tree lined with lots of parks and close to the Bronx Zoo. Large hispanic population with recently influx of eastern european, asian immigrants. Many residents live on the Upper East Side and drive to work. Others live in the subsidized housing near Monte ($500/studio)

Negatives: Only thing that I can think about is the weird graduated responsibility. While great for the PGY4 and PGY3 who oversee the department, I don't know if you are independent enough as a PGY1 or PGY2.

Overall: Oldest EM residency in New York City with huge alumni base that will undoubtedly land you jobs after you graduate. Residents seem prepared after the volume and true pre-attending experience that they get. It is a tough residency as they work hard and see many patients, but everyone is proud to come out of this well respected institution. Great pathology, great patients, young faculty who are willing to teach and very motivated group of residents who all want to be there.

Jacobi's hours are various depending on year and which site.
In summary, while in the EDs it is as follows:

Jacobi PGY 1 (Junior yr 1, get assigned patients, close oversight of work up, decisions and procedures): 10 twelve-hour shifts in 14 days
Jacobi PGY 2 (Junior yr 2, get assigned patients, see the work up and dispo through with more independence): 9 twelve-hour shifts in 14 days
Jacobi PGY 3 (Chief year - eval, triage, assign and begin w/u of ALL patients): 6 eight-hour shifts and 3 twelve-hours shifts in 14 days, every other weekend off
Jacobi PGY 4 ("pre-Attending", you are in charge): 7 twelve-hours shifts in 14 days, every other three day weekend off (yeah, picture that!)

Monte PGY 1 - 4: no graduated responsibility, just you and the Attending, though much more independence each year (4th years are essentially just another Attending in the ED). PGYs 1s and 2 have 10 shifts in 14 days, 9 for the PGY3s, 8 for the PGY 4s (sweet indeed).

The Jacobi program is perhaps described as "informal", "self driven" (no hand-holding or strict enforcement of requirements prior to graduation day) with "amazing resources" in what it makes available inside and out of the ED, and "work hard/play hard". You will work hard and be rewarded well for it.

Feel free to send any other Jacobi/Montefiore questions my way.

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Any update? @BoardingDoc referred people here; no info on Jacobi in last 10 years. Would love to hear the unique aspects of this program. Appreciate any input

I interviewed at Jacobi this cycle. Overall, I really liked the program but it's definitely not for everyone. Has a reputation for being a very hard place to train, and less cushy compared to other programs. However, graduates of Jacobi do very well for themselves after residency - on interview day they gave us a long list of alumni who are now Deans, PDs, APDs, and chairs.

Training Sites:
- Jacobi - Level 1 trauma center, 14th busiest ED in the country, real county experience, less nursing/ancillary support
- Montefiore - 2nd busiest ED in the country, very sick patient population, mad house (ED at capacity with tons of hallway beds)
- Weiler - community site, lot of in-house consults, older and better insured patient population

Shifts:
- PGY1 - 12-hour shifts, 9 out of 14 days
- PGY2 - 12-hour shifts, 9 out of 14 days
- PGY3 - combination of 8s, 10s, and 12s, 8 out of 14 days
- PGY4 - 12-hour shifts, 6 or 7 out of 14 days

Pros:
- Very diverse patient population (large immigrant community)
- Best trauma experience in NYC - tons of penetrating and blunt trauma which you don't get in Manhattan
- As one of the oldest EM programs in the country, it has a huge alumni network and excellent job prospects
- New PD is awesome - very committed to the program (trained at Jacobi) and the residents seem to be very fond of him
- Instant street cred as a graduate of this program
- Competitive salary with decent COL (not NYC prices) - subsidized housing ~$900/month for 1 bd
- Only snakebite center in tristate area - per residents they treat 5-10 patients a year

Cons:
- Less of an academic center - less emphasis on didactics and research
- From my understanding, there is no protected conference time as a PGY2-4
- Only 4 resident dinners scheduled throughout the year - somewhat of a red flag as I didn't get to meet many residents during my interview day
- Chief residents seemed a bit intense
- Off service rotations may not be as strong, +medicine floor month

Thank you very much for writing this out @MrBrightside167