Duke University Residency Reviews

Duke:

Pro's:
-Brand new ED opening in a few months
-Friendly & interesting young faculty
-Strong offservice rotations
-Nice, affordable place to live

Con's:
-More floor months than I personally desire
-Work more hours than most places I've looked (avg. 55hrs / week in the ED)
-12 hour shifts as intern
-Elective months may only be done at Duke
-Moonlighting allowed only in non-ED settings (a problem I think, as Duke doesn't provide a realistic glimpse of EM in the community outside of the Duke ivory towers, and doesn't allow away electives)
-Program director leaving, replacement not expected to be announced until after match day
-EMS opportunites are mostly observational (according to PD, "Duke flight patients are very sick" so residents are just supposed to observe)


Despite the long list of con's, I actually think Duke is a decent program and wouldn't mind training there.

Pretty much in agreement with the assessments of Duke and UNC. I believe there is a rotation at the VA hospital in durham that gives you the experience of being pretty much the lead person making decisions so that is a plus. The biggest problem seems to be the issue of the unknown PD replacement as that does affect decision making and impacts the class for this year the most. Wish they knew something. Duke is still in transition and probably will be a really good program in a few years. Less resident friendly than some but a great sim lab and a couple of really good teachers. It will take some time to get everything on track with the new PD and faculty changes. Good and bad like most programs. The academically strong, independent and motivated applicant would be happier here.

UNC actually seems to be fairly family oriented but you need to look around to see it and you can actually live in a small area on the bus line called Carrboro which is pretty close and affordable. I would say you could afford a place within 15 minutes if you look around. PD is great, nice guy and good advocate for residents. Great program, resident friendly and a great place to work and live. Parking is unfortunately not free.

ECU-hidden gem indeed. Great facilities, laid back residents, lots of pathology, plenty of perks. 10 hour shifts all around and residents have a say in how things are done. Very affordable living conditions and great recreational facilities nearby with a discount for residents. Good biking area and a couple of hours from the beach. Teaching is really good and I would say this place is on the way up. If you don't like small towns you may not like greenville but it really seems to be a nice place to live for 3 years and lets face it you will be working hard during your residency anyway. Staff is great and not much scut. Good sim lab as well. The new PD is well liked by everyone so no problems there. Gets a bad rap because of location but a great education is the tradeoff. Worth a really hard look IMO.

The new kid on the block... thought someone should give the scoop.

Residents: 8 residents for the upcoming year although PD looking to increase to 10 then 12 in near future. Residents take you out to Tyler's the night before for a casual dinner. All were nice, forthcoming of their opinions, and pleased with how their program was developing.

Faculty: The PD is Dr. Sara Stahmer, who came from cooper 5 mo ago. She is a self-described "jewish mother" who has even in those short months changed a lot which is impressive at a place like Duke where bureaucracy can halt good intentions. You CAN do away electives (one resident is doing his at Bellevue for tox). She has added a community experience at Durham Regional and Duke Raleigh. The list goes on and on. The faculty is young and really motivated to "take this program to the next level".

Hospital: The ED is brand new and really nice! I haven't been to many new EDs so I was loving it. Three bays with lots of computers, Peds Ed is right next store, the CT scan is right beside the four trauma rooms. Can you really ask for more?

Durham Regional is nice for a community hospital - 50,000/yr I believe. Separate attendings staff it so don't know how much teaching you get.

I know nothing about Duke Raleigh. Sorry

Ancillary Stuff: From what I heard, the nurses kick ass and do everything you need.

Admitting/Documentation: All electronic-based with the same computer program running at Durham Regional so you still have access. X-rays, labs, records all come up with the patient so there is no logging into three different system for everything which sounds pretty nice.

Curriculum: 3 year curriculum with 4mos? of the ED as an intern. During intern year you also rotate through duke's big guns like cards, neuro, and medicine. You do 10 hr shifts with 12 hrs on weekends. Upper levels do 8 hrs. Apparently, the number of shifts flucuate depending on the month anywhere from 14 - 21 or something like that. No one seemed to know how many they were supposed to be doing. Apparently, one attending makes the intern schedules while the chiefs make the upper levels.

Didactics/Research: Didactics are once a week and modular with a test at the end of each module. Blah blah this is all the same. The big thing they talk about is this "scholarly track" which is a niche they want you to develop during residency. No research requirement explicitly but they seem to want to foster an academic mindset whatever that means.

City: Durham is ghetto in some areas but nice in others. There is always Chapel hill which is 20 min away which is more expensive but yuppier.

Extras: Salary is 43K+ or something with possibly a 2% increase next year. Parking is free! There is a gym that med students, residents can use somewhere. OF NOTE: Only medicine and surgery have to wear the dreaded short coat! EM residents do NOT have to do it. Just had to share...

Overall: Good program, needs a few more years to finesse some points ie the rotation schedule is still changing - only 1 elective month now with the addition of the community hospital experience. The program has fixed all the big holes to it and now just needs time to wrinkle out the details. This place def makes the best of what the Duke system has to offer which is fantastic.

Duke University Emergency Medicine

Residents: 8 interns per year. At the night before dinner these residents really impressed me. They were all very friendly, and engaging. They all seemed to get along wonderfully and have full lives outside of the residency. To a person, the residents were very excited about the direction the program is headed under the leadership of Dr. Stahmer, the new program director.

Faculty: The residents spoke very highly of the faculty. Dr. Stahmer, is newly arrived from Cooper where she was the PD. She is a dynamo and her vision and enthusiasm for this program is impressive. Dr. Broder, her assistant PD, is a nationally recognized teacher by ACEP and after meeting him this is not surprising. Research opportunities abound here. The EM faculty report strong relationships with other services suggesting that research outside the existing faculty expertise is possible.

Ancillary Stuff: Per the residents, the ancillary staff are terrific.

Curriculum: This is a PGY 1-3 program. Under the leadership of Dr. Stahmer it seems that she is evaluating every rotation and truly wishes to maximize the learning for the residents. On my interview day she told us that she had shadowed some of the residents on off-service rotations to determine the value of the rotation and made resultant changes to the PICU rotation for example. One of the more unique educational activities Duke has created is the “scholarly tracks.” Tracks included international medicine, ultrasound, sports medicine, research etc. The goal of these tracks is to help the resident to become an “expert” in the arena of their choice under the leadership of an existing faculty member.

Facilities: They have a brand new ED that I believe is built from the ground up. It’s beautiful. Everything is electronic from charting to orders.

Dr. Stahmer is currently working out details to increase the amount of community ED time at Durham Regional hospital.

Negatives: This program is relatively young but definitely feels like it is in the midst of an ascension. I particularly asked about the fact that EM is a division of Surgery and was told that it doesn’t affect day-to-day life of the residency at all; but, it was made clear that eventually, they want departmental status to have greater say in the budget. I wonder weather the residents see enough bread and butter EM in a quaternary care hospital like Duke. Durham is not for everybody--though it is affordable with a very pretty surrounding area.

Overall: I was really very surprised at how much I liked this program. Dr. Stahmer is the PD that I would want to work for. She seemed approachable, honest, direct, and enthusiastic. Her vision for the program is the best articulated of any place I’ve visited. I’d be happy to train here especially if there were significantly increased ED time at Durham Regional or another bread and butter facility.

Below are my biased short reviews:

Maine Med: +good residents, lots of camaraderie, cushy number of shifts, do lots of stuff in the ED (do not consult as much), lots of ED time as opposed to offservice, lots of outdoor opportunities in area
-not too much pen trauma, fair blunt, cold winters, small program, homogeneous population

U Mass: +good residents, very nice ED, well respected residents, good research, Hawaii elective, awesome helicopter experience, good reputation in area, great ultrasound
-hard to switch shifts, some unhappiness with residents, seemed like residents stay 1-3 hours after shifts for cleanup

Baystate: +work less than allmost anywhere else, good blunt trauma, good patient mix, very little offservice
-residents did not seem strong, faculty I interviewed with seemed disinterested, cramped department, city sucks and lots of residents live far away in nice town, bad ultrasound

OHSU: +very nice hospital, good research, cool city, residents were friendly
-small program, go to lots of different hospitals because primary does not see enough variety, residents did not seem strong

Carolinas: +great teaching, great research, awesome facilities, strong off service, good ICU experience, great reputation, strong residents
-lots of off service months, city not exactly what I expected

ECU:+strong residents, good teaching, nice department, great patient population, good reputation
-electronic records seem poorly implemented, city is very undesirable for some people

Wake Forest: +good teaching, good facilities, strong residents, good US
-Winston-Salem shuts down on Sundays

Christiana: +good residents, huge department, good records, good patient population, great benefits, nice facility, good teaching, very little off service, great ICU experience, great ultrasound
-area may not suit some

U Conn: +nice PD, nice facilities, good relationships with trauma
-area,

Duke: +New PD seems awesome, nice hospital, would be a good area to live in,good teaching
-not enough electives

Hey all - i'm an intern at duke and just thought i'd get some information out b/c i feel like this program is strong and flies under the radar b/c it's relatively new - 7th year. (I knew it was a big surprise for me last year once i interviewed) there were no new reviews i could find, so i wanted to chip in.

So - very happy i came here, the facility is brand new w/ eighty-something beds:
18 bed peds ED
3 different adult treating areas
8 bed psych holding area
14 bed observation area (cardiac R/O, etc.)
2 fully-equipped x-ray rooms and CT scanner

Each patient room is private w/ computers - everything is electronic - helps prepare us for life after residency.

Before I came here all I heard about was, "Duke is malignant, duke is a "medicine" hospital, blah blah blah." I can tell you that the ER has some wonderful attendings - very friendly and knowledgeable - never do i feel belittled or in a "malignant" environment. and yes, duke is a very strong "medicine" hospital - but that only makes this program stronger in my opinion. I've already done my month of general medicine on the floor and thought it was great. the pathology you see at this hospital is very complex and if you can handle this, you are ready for anything.

on top of it all, i think the residents we have now are awesome - we get along well and have developed strong relationships w/ the other services. more of us are married than not, but there is a group of people always going out

i'd be happy to answer any questions - feel free to PM me.

Do you guys have to wear the short white coats like the surgery interns?

haha, that sucks for them doesnt it. nah, we get the standard long coats, but truthfully i just do scrubs most of the time. You'll wear the long coat on off-service rotations. Medicine interns used to wear shortcoats as well, but they've made a change this year and are now wearing longcoats.

Does Duke still have division status?

yeah we do have division status, but frankly - i don't know how that changes anything we do. We still get a fair allocation of money from the department of surgery (as you will see if you come interview and see our facilities). another program i considered very strong last year - utsw - also under the division status, but they have a great EM program as well. bottom line is that it doesn't affect the quality of resident education you will receive or detract from the procedures/traumas you want to run.

I don't think the division status will change by the way, b/c the Duke Way is to have limited departments. For example, neurology is under the "department' of medicine

I know that surgery is traditionally strong at Duke. Do they run the traumas or does EM get input? Also, who does the intubations?

I have definitely heard the rumors that Duke EM is second fiddle to the other programs there.

Thanks

so we do all airways in the department. just like most other programs, we alternate days w/ trauma surgery in terms of who runs the trauma. whichever team is not "running" the trauma ends up with procedures. dont really know what to say about your other comment, but i think we're well respected among colleagues and other residents.

In No particular Order

1. Scott and White - Excellent overall, best fit if you're married, wonderful people. Well-established program in a small town with a huge catchment area. Hospital is a "Texas Mayo Clinic" and very well respected both in the community and the state. The ED is new (finished <2 years ago IIRC) with all private rooms, excellent nursing staff, and lots of space. You don't feel crowded like many EDs that I've seen. The place sees a lot of different things on each shift (peds/adult/trauma, etc). Don't send a ton of people to fellowship though there is talk that this is changing - one recent grad is going to Peds-EM. Faculty are pretty well published, which surprised me, especially in sepsis. My vote for best overall program in the state.

2. Duke - Newish program (I would be in their sixth intern class) but it seems to have most of the kinks worked out. LOVED the PD Sarah Stahmer. Top-notch facilities, smart and personable faculty, and residents that I would most definitely enjoy being friends with. Very livable city. Curriculum suits me: they try and launch their grads into the world with awesome CVs. In short, I *heart* Duke. Currently my personal #1 but will have to convince the wife that it's okay to move there.

3. U Cincinnati - My other EM crush. Take what Duke has in terms of academics and square it. Highest quality EM program, possibly the funniest PD in the business (imagine Kevin Spacey doing standup), and the fact that I know the folks more than from an interview and they rock. However, Cincinnati is, well, Cincinnati. Which means that it isn't a bad school, per se, but it's in the middle of the Midwest. There's no family in the area, it's a four year program (not necessarily a deal breaker for me), and it would be hard for the wife to find a job there as Ohio is pretty much shedding jobs left and right. Would be a hard sell.

4. The Ohio State University, Columbus, OH - solid, friendly, and comfortable PGY1-3 program. Has just about anything that you'd want in a program but lacks a bit in the academic grooming department that other programs put front and center on interview day. Faculty were nice as were the residents. ED is good looking if not flashy (contrast to UCSF's Moffett-Long which was one of the prettiest out there). Program is on/near the campus of the undergrad campus and there is a lot to be said for having a University's resources available. Columbus seems like a really neat city to live in and the people that I met out and about were really nice. The airport is one of the more convenient, easy to maneuver, and nicest airports that I've ever experienced (free wi-fi too). The town is growing and adding jobs which is no mean feat in Ohio these days. Encouraged moonlighting, and you can do it in one of several OSU-affiliated hospitals (you won't have to get your OH license). Would be a tough sell for the wife but vastly easier than Cincinnati would be.

2. Eastern Carolina University, Greenville, NC - man, where to start about this program? I had a bad vibe from the beginning: the coordinator didn't provide the physical address of the hospital so it was hard to find the place as I'd never been to G'Vegas before and was driving in the morning of the interview. It was a painful, awkward day.

It was a foggy day outside and the grayness seemed to be unrelieved by the program offices (in stark contrast to Duke, which was all light, smiles, and holiday cheer). The presentation from the PD seemed a bit half-hearted compared to others that I've seen (for example, Cincinnati put some effort into spicing up the program overview, doing a "morning report" bit that was far more instructive in obvious and subtle ways than anything else). The faculty didn't really seem to do more than ask a few pro-forma questions and then ask if we had any questions. Now, I'm not saying that everyone has to ask me things, certainly not. But I've had really thoughtful questions and discussions at other places that made it clear that the interviewer had thoroughly reviewed my application....or at least followed up on things I had mentioned which indicated that they were interested. Maybe it was just me....

So anyway, the resident's didn't really impress me all that much. The pgy3 was aggressive in a weird way, and the two interns were a disaster. One was saying how happy she was that no one cared if they asked stupid questions and then told us what the dumb question was....The old saying "Better to to be suspected of stupidity than to open your mouth and remove all doubt" was definitely applicable. The other intern barely spoke and appeared catatonic, and when asked why he chose ECU, gave me the weirdest look that I've ever seen. And didn't answer the question. To be fair, we ran across another intern from CA who was working in the ED who seemed really excited and enthused about the program. Perhaps he should have been the one to come to lunch, eh?

Anyway, the ED is gorgeous, no doubt, and they have possibly one of the best designed layouts that I've yet seen. Very nice. The rescucitation bays are the best yet. I think that they are a solid clinical program that for some reason didn't put their best foot forward that day. It was kind of sad.

I originally posted this in the Unofficial 2009 ROL thread but I'm posting here so that folks down the line can get more hits when they search for various programs.

1. Texas A&M-Scott & White - Loved the facilities, great reputation in Texas and surrounding regions, LOVED the residents and faculty. Feels like home. Brought my wife back for a second look and it was a giant love-fest. Training is extremely good, great location, and extremely family friendly.

2. Duke Univ Med Ctr-NC - I loved the PD (Sarah Stahmer), the faculty, and the residents. I definitely felt as if I could spend three years with these guys. The feel-goodness started at the resident social and continued on. I was also impressed by the group of applicants who were there with me (one of my hidden indicators). Excellent training, though a bit too university hospital biased. Duke name and reputation, facilities, and Raleigh-Durham is gorgeous. Family in the area. Would be excited to end up here.

3. UC San Francisco-CA - One of those programs with that "X-factor" that's hard to describe; yet you know it when you see it. Really liked the PD and Assistant PD. Fantastic facilities, really top-notch faculty, residents were nice and very welcoming. New program and that brings with it problems; however, I've made something of a habit of helping to establish new organizations and I love a challenge. Though SF is hideously expensive, we think that we can make it happen. Plus it's SF! Gorgeous city and TONS to do when we're not working. Family (a well-traveled bunch) would be thrilled too and have already promised to visit all the time if we end up there.

4. University Hosp-Cincinnati-OH - My favorite program by far when considered in and of itself. However, when those "other factors" get thrown in, it was hard to rank them higher. Spent a month there, absolutely LOVED the program. Seriously. This is truly one of those X-factor places and watching their fourth years was insanely impressive. Wish that I could have ranked them higher. But if by some ridiculous longshot we end up there, then I will probably be their most enthusiastic resident EVER.

5. U Texas Med Sch-Houston - solid program in a city that I love, close to family and friends, good research available, extremely familiar with the medical center and area.

6. University of Virginia - Very good program that a friend rotated with, so I know it's dirt to a degree. Gorgeous town, decently close to family. Kind of isolated and would be harder for my wife to find a job since it's primarily a college town.

7. Ohio State Univ Med Ctr-OH - Heard great things about the program, really enjoyed my interview, residents at my med school rave about the city. Would be very happy to end up there.

8. Christiana Care-DE - One of those programs that I wish that I'd been able to rotate with because I hear so many great things. Really clicked with the faculty, kind so-so with the residents. Newark didn't really impress me much as it reminded me of the concrete suburbia that I wouldn't mind leaving behind. Nonetheless, would be happy to match there.

9. U Michigan Hosps-Ann Arbor - Fantastic program, not really thrilled about the amount of snow/winter/winter schmutz we'd have to deal with. Not looking forward to buying a light box and possibly dealing with SAD.

10. U Arkansas-Little Rock - One of the most relaxed and enjoyable interview days I had on the trail. Brand-spanking new ED which is gorgeous and well thought out. A little concerned about the volume and pathology that they see there. Good faculty and the residents seem like people I'd want to be friends with outside of work. Little Rock seems like a very pleasant place to live, and quite affordable.

11. Christus Spohn Mem Hosp-TX - I think that this program is going to be really outstanding in a couple of years. I had a great interview and with the relative lack of other residencies, you get treated like royalty by the hospital - Close, free parking, free food in the Dr.'s Lounge, relatively few low-yield rotations. However, the wife and I weren't too thrilled at the prospect of living in Corpus for three years, and their are still some rough edges to the program. Nonetheless, I believe that you'd come out of this program a very well trained EP.

12. Pitt County Mem Hosp/Brody SOM-NC - Solid program, had a so-so interview day. Location was a bit of a negative for me as Greenville is so small. On the other hand, it is only about forty minutes from family and it's insanely cheap to live in. I've known some folks from the school and they had very good things to say about the program. Would be okay with matching here.

Bottom line is that I didn't interview at a single place that I wouldn't mind training at. I do think that there is a nearly intangible but real difference (for me) between the top-tier and other programs. Having said that though, the one thing that I've learned from this interview season is that the saying "You get a solid education at any of these places because of the RRC," is probably pretty close to the mark.

I have heard very mixed opinions on Duke, but these have all been from people without any strong basis for these opinions. Does anyone with personal experience (especially residents, Duke med students, or students who did away rotations at Duke) have any input about the program? Thanks so much in advance!

EMRocksmyworld said:

I have heard very mixed opinions on Duke, but these have all been from people without any strong basis for these opinions. Does anyone with personal experience (especially residents, Duke med students, or students who did away rotations at Duke) have any input about the program? Thanks so much in advance!

Click to expand...

Program director: Sarah Stahmer. Impressive. Word on street is fully supportive of her residents, more like a Mom. She's an excellent teacher (her specialties in particular are ultrasound and cardiology -- frequent EKG review sessions) and an even better communicator (seen her at ACEP a few times). Good supporting academic team for running the residency.

Rest of EM faculty: Strong. Not a power publishing place (you might have thought otherwise given Duke) but the potential is there if you *want* to publish as a resident, and overall the mix of academics and real-world is a good balance. Many have worked in community including the current Division chief.

Residency history: Program has definitely matured, and is no longer a "new kid on the block"... been around almost a decade now. Now on second set of residency leadership which is important as new ideas have been integrated, and new approaches to existing problems from the original team have been, at least attempted, re-addressed. And make no mistake, the first team was pretty stellar (many are obviously still there, but there's been some turnover) led by Susan Promes (who then opened up UCSF's residency). Residents have autonomy in trauma, airways ... the usual turf battles were fought years ago. Now it's in a maturation cycle that is really involving the faculty and their struggle toward department status more so than the residents and their learning experience. In fact, the whole Division vs Department is a non-issue for the residents, only frustrating, I think, for some faculty who have left over past few years, as they would like to be moving toward departmental autonomy faster, but again, as a resident, it doesn't matter.

City: The Carolinas is a fabulous place to live. Durham makes up (with Raleigh and Chapel Hill) the Triangle area. About 1.3 million people all told. Raleigh, typical small to mid-size city. Durham, some bad areas of inner city rot (see clinical experience, below) but lots of lush forest and a beautiful campus for running, etc. Good, edgy bar and restaurant scene. Chapel Hill, one of the prototypical American College towns. Beach is 2.5 hours away.

Clinical experience: Huge physical plant that was purpose-build and opened in the last three years. 4 full resuscitation bays, an integrated pediatric department, and a pod system in the rest of the (adult) ED. 65 to 80 beds all together I guess, at least that was the plan when I was last there three years ago. The characteristics of Durham mean you get a fair bit of penetrating trauma, but proximity to highways etc. ensures steady diet of blunt, and the ivory-tower types of Duke ensure good bread and butter experience. It's no knife-gun-club -- if you want maximum exposure to Trauma, go to Cook, LAC-USC, Highland, etc. -- but definitely in the second (next) tier of exposure, and thus you get a lot of it. EM gets airway 100% of the time. EM and trauma resident (which, actually, might be another EM resident) alternate days between who runs trauma, the other gets procedure (central line, chest tube). Works very well with trauma Attendings who let residents truly run the show while they stand in the background, and help if necessary, but let you swim if you look like you're above water. EM and Trauma surgeon faculty get along real well, this is a huge factor as many places have turf wars.

Pediatric experience.... so so. Department gets minimum amount of peds cases a year to remain credentialed I think, but enough for you to get comfortable with pediatric fever. They're produced a couple of peds EM fellows, I think,though volume is too low for them to have done their fellowship at Duke (I think they went elsewhere). A lot of pediatric hearts, etc. that go straight to inpatient, so questionable value. Most faculty are EM-trained/peds fellowship but some are primary peds with EM training, but they're superstars in their own right.... think like ER docs as opposed to some you come across elsewhere who are good pediatricians but don't "get" the EM aspect of it.

Off-service rotations - Fair to middling. You would think strong since the services are so strong (cardiology , etc.) but a lot of academic types in medicine and cardiology make it painful, and think that EM isn't really a specialty. Good pathology, though, just questionable faculty leadership on these off service rotations. Cardiology in particular, extremely malignant. ******* attendings with only a few exceptions. It might be a research powerhouse, but i absolutely would not want my family member cared for by Duke cardiology... to interested in reseach, and they neglect patinet care. Rule out MI means labs get cycled, no actual attending presence or considered evaluation done while in hospital. Peds experience blows. Residents were pulled out of PICU a few years ago it sucked so bad, a lot of mid-levels in PICU who think they know everything and try and boss the residents around (including the peds residents). ICU rotations are very strong - MICU, SICU, fortunately no CT surg. Strong in critical care here, and a good track record via the ED as a recent grad from EM continued at Duke to do a SICU fellowship through anesthesia and is now attending in another institution in the unit.

Duke: Well-funded. Beautiful facilities. Nice name on your lab coat and stands well when looking for a job post-residency. In practice, some people that work here believe in Duke elitism, but mostly that's their pathology, not yours.

PM me with any other questions.

Previous years' ROL threads were a great help to me when I decided where to interview, so here's my part this year.

My list would also be much different were it not for 1) a spouse in the picture and 2) my interest in international EM, so take it with a grain of salt and to echo SuziQ, feel free to PM me with questions regarding any of the programs I interviewed at. Honestly, I'd be thrilled to land anywhere on my list.

1. Vandy Pros: INCREDIBLE faculty, residents, unparalleled teaching, the PD and chair are a dynamic duo that are very involved in resident education. Busy, busy university ED where you see ALL the trauma in a large catchment area, plus all the weird tertiary stuff, and your bread and butter. Great international opportunities with the Guyana residency, New Zealand, ect. Off service rotations are great, peds shifts are mixed into your regular ED months, residents are happy, 10 hr shifts with 1 hr built-in overlap, COL is incredibly low, Nashville has a great live music scene. Cons: Less diversity (in both staff and patient population), you're in a smaller southern city (+/-). Caveat: I rotated here, so I'm bias in that I'd already spent a month getting to know and love the people. But honestly, couldn't find a better program on the interview trail.

2. Brown Pros: this was the program that snuck up on me. I even considered canceling the interview. Like Vandy, a university program with a large single hospital program with a huge catchment area, very busy ED. Happy residents, warm faculty, great peds experience, strong support for international work and opportunities (currently setting up a training program in Nicaragua), 9 hrs shifts all 4 years, Providence has surprisingly low COL for the northeast and is a great little town with amazing food and recreational opportunities. Cons: It's in Rhode Island, 4 yrs > 3yrs.

3. New Mexico Pros: another single-hospital system with a huge catchment area (which I like for the reasons above), incredibly nice PD, down to earth faculty, happy happy residents, strong commitment to underserved care with a large indigent community, great international/wilderness opportunities, one of the best programs for critical care exposure, great reputation, large Spanish-speaking population, only 4 months of call all 3 yrs of residency, 9 hr shifts with 1 hr built-in overlap, you have skiing and hiking less than an hour away. Cons: the city's economy somewhat depressed, less job opportunities for spouse (this program would be my #1 or #2 if not for this), less ethnically diverse.

4. Highland Pros: well-respected program, hard-core county training, in a beautiful part of the country. Great service commitment, residents are happy, strong pedi exposure at CHO, tox at SFGH, 8 hr shifts. Cons: the faculty are quirky (+/-) and somewhat inbred, very weird interviews, draw your own labs as PGY1, ED itself felt a little small, not a Level 1, the cafeteria food (yes, that's picky).

5. OHSU Pros: old, well-respected program with happy residents in a beautiful part of the country, diverse hospital exposure (university, VA, community), faculty very supportive of residents, 1:1 with attending as PGY2.10 hr shifts PGY1, 8 hr shifts PGY 2-3. Cons: low-volume primary ED, only 1 mo elective time, have to drive a lot.

6. Stanford Pros: Dynamic faculty, content residents, 3 hospital system with exposure to university (Stanford), community (Kaiser) and county (Valley), an AMAZING amount of resources for anything you could possibly be interested in, great fellowships, great international and wilderness opportunities, beautiful part of the country to live,time for research/scholarly project built into rotation schedule. Cons: COL (highest of anywhere I interviewed-this was huge for me), low-volume at primary ED (Stanford) which is where you spend 1/3-1/2 of your time, intern year spent with a lot of off-service rotations (including medicine and surgery wards and NICU time), 12 hr shifts, "country club" feel (the catered lunch comes to mind).

7. Carolinas Pros: incredible community program with great training, I loved the PD and faculty I met, residents are very tight and social, 1 hr conferences daily instead of a 5 hr block, single-hospital system, great U/S experience, starting an international fellowship, great COL. Cons: I thought Vandy was a better fit for me when it comes to Southern programs, their int'l focus is in Tanzania (my interest is Latin America), medicine and peds wards months, Charlotte, a very "proud" program.

8. USC Pros: Incredible faculty and residents who obviously enjoy working at LAC, probably the most amazing county training out there (certainly busiest ED in the country). Great diversity in both staff and patients, huge volume ED that probably sees some of the craziest trauma and pathology, residents run their own "pods" and jail ED, commitment to indigent care, in SoCal. Cons: 12 hr shifts all 4 years, maybe a little too autonomous for my taste, can only do international rotations on your vacation time, LA is not my favorite city.

9. BWH Pros: amazing resources for international EM, great U/S program, friendly, well-connected faculty, great opportunities for research and an interesting mix of pathology, shifts are a mix of 8,9, and 12 hrs. Cons: residents were the geekiest bunch of the trail (but seemed very happy!), greater focus on research, Mass Gen's ED felt very cramped, COL in Boston, 4>3 yrs.

10. Emory Pros: great service commitment, huge county program that is also academic, diverse residents and patients, busy ED. Cons: the number of patients I saw in hallway beds!, not as much international support, very county feeling, strange interview.

11. Harbor UCLA Pros: amazing country program in LA, great training, well-respected, good autonomy. Cons: not much international support, LA.

12. Baylor Pros: amazing county hospital with incredible pathology and young, enthusiastic faculty. Shifts 8's on weekdays, 12's on weekends. Cons: too new of a residency program.

13. Duke Pros: Dynamic PD, good mix of faculty, happy residents, time for scholarly track, COL. Cons: not very diverse, Durham, still young residency program, hard PGY1 year with lots of off service rotations, not as many intl opportunities.

This residency review is by a user who interveiwed at the program and wishes to remain anonymous.

Hospitals:
• Duke University Hospital: Brand new, 80 bed ED
• Durham Regional Hospital (community): ED shifts, some OB time
• VA: SICU rotation

Resident Life:
-Vacay: 4 weeks/year (1 wk on OB, 1 wk on ped ED, 1 other week + 5 days off either Christmas or New Year's)
-Hours: PGY1 18-21 10 hr shifts (no built in check out time), PGY 2-3 18 8 hrs shifts. Long hours on offservice months.
-Culture: Most of the residents seem happy, intern year seems particularly hard. Talking to some residents, it seems there is some pushback when admitting (run-around type stuff), surgery comes down for ALL traumas (not just Level 1s) and makes it difficult to get procedures except for airways. Defer to trauma surgeons for all Level 1s, no formal odd/even schedule yet. Unusual in that PGY2 and PGY3 have the same responsibilities, not as much graduated responsibility. Trauma numbers seem like they might be low, only 16K peds numbers as well.
-Living: Relatively cheap cost of living, economy is decent, Durham is experiencing a revival in terms of new restaurants, arts, ect.
-Benefits: Free parking, gym memberships, free food daily from 5:30p-7p.

Curriculum:
-3 year program, with built in scholarly tracks. 7 months EM PGY1, no ICU exposure PGY1, 4 mo PGY2. Off-service rotations are changing. Prior, residents had to do a month of neuro, cards which involved a lot of scut work. Changing these months to CCU and have dropped the neuro month altogether. Still have to do a medicine wards month. Only 1 mo of elective time as PGY3, EMS combined with administrative month PGY3. International opportunities are limited to Duke affiliated sites in Africa, Singapore if you want program funding. Associate PD very into ultrasound, program has U/S and Anesthsia for 1 mo PGY1.

Didactics:
Typical conference schedule. Have unique “service” curriculum where they focus on customer service, ect. Residents didn’t seem too excited about journal club.

Research/Fellowships:
- Sports Medicine, EMS, International

Faculty:
-27 full-time faculty, amazing PD.

Overall:
Solid program, still fighting some battles in terms of relationship with surgery and establishing their domain. Great PD, nice aspects to the program such as the built-in time for the scholarly track, service focus. Durham can be a +/- for some people, not as much funding for international work.

Any current or recent residents here to comment on how Duke is going to implement the new RRC requirements for peds?

Does duke currently have longitudinal peds? Do residents feel comfortable with peds despite the relatively low volume of pediatrics seen at Duke?

Also, do residents feel comfortable running traumas despite the low volume of trauma at Duke? I'm not a huge trauma junkie, but want to make sure I am completely comfortable running any trauma that comes in the door after residency

I've definitely felt that peds was Duke's biggest weakness. I think the annual peds visit count is around 15k- and I think just barely enough to meet reqs. I've heard rumors that they are trying to sends their residents to WakeMed for more peds exposure- but again, purely rumors.

The Research Triangle is not a hotbed for trauma, but there are definitely some seedy activity going on in Durham.

Emurgency said:

Any current or recent residents here to comment on how Duke is going to implement the new RRC requirements for peds?

Does duke currently have longitudinal peds? Do residents feel comfortable with peds despite the relatively low volume of pediatrics seen at Duke?

Also, do residents feel comfortable running traumas despite the low volume of trauma at Duke? I'm not a huge trauma junkie, but want to make sure I am completely comfortable running any trauma that comes in the door after residency

Click to expand...

Im not sure youll find many residents who dont feel comfortable running trauma by the end of residency. Cant, help you with the Peds question though.

winkleweizen said:

Im not sure youll find many residents who dont feel comfortable running trauma by the end of residency. Cant, help you with the Peds question though.

Click to expand...

That's good to hear. So would it be safe to assume that (unless you are a trauma junkie and really enjoy trauma), the number of penetrating vs blunt traumas or the number of traumas in general is something that is largely irrelevant when evaluating a program?

Emurgency said:

That's good to hear. So would it be safe to assume that (unless you are a trauma junkie and really enjoy trauma), the number of penetrating vs blunt traumas or the number of traumas in general is something that is largely irrelevant when evaluating a program?

Click to expand...

No. That's all important. Go somewhere where it's insanely busy and the residents are getting slammed with floods of all types of patients, including tons of trauma patients. You will get adequate (i.e.: at least the minimum) in training at any program that is accredited, but the more you see, the more you learn, the better you are... there are programs with more than "just barely enough". My .02...

Hi, since it’s been some time since the last major update, can someone familiar with the program (preferably a current resident or recent grad) comment on the following?

• What are the average number and length of shifts (in hours) per month for each PGY year? Is there enough time to pursue academic/professional/extracurricular interests?
  
  
• Are shifts stratified by acuity (e.g., “trauma” shift or “resuscitative” shift), or is the entire spectrum of pathology/trauma seen on each shift?
  
  
• Who runs the trauma, EM or surgery residents, or is it an alternating schedule?
  
  
• Who does the emergency procedures (intubations, chest tubes, resuscitative thoracotomies, etc), is it shared with anesthesia/surgery residents based on an alternating schedule?
  
  
• Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
  
  
• Is there frequent commuting between off-site locations (not including the dedicated training blocks)?
  
  
• How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
  

Thanks so much for your time and contribution.

Recent grad here. Figured I would chirp in on the prior post.

Interns in the ED work 10 hr shifts, on average ~19 shifts/month. 2nd and 3rd years work 8 hr shifts. The 2nd yrs work ~18/month, 3rd years slightly less.

Residents have time to pursue research, other academic, and other extracurricular activities. Dr. Broder encourages carving out a niche and works hard to ensure this. Multiple residents with multiple research activities. Residents have time to go out as a group to concerts, day trips, etc.

Aside from dedicated "resus" months where you see only the acutely ill, you will see the full spectrum of disease on all your shifts aside from peds. There are dedicated peds months in the ED to see solely children.

Trauma is run on an alternating schedule. 12h of day, EM residents run trauma, other 12h run by trauma residents.

In trauma, EM residents always have airway, no anesthesia residents presents. With respect to procedures, the 12h that the trauma service is running the traumas, EM residents in charge of all procedures. There is a lot of opportunity for chest tubes, large bore access, etc.

Never ran into a procedure that we were not allowed to do. Felt comfortable with procedures after graduating residency here. No fighting over procedures like I have heard at other locales.

The community hospital is ~10 mins from Duke proper. Great experience there, lots of freedom to practice a bit more independently. 1 dedicated month 2nd year, then 2-3 shifts/month afterward. The VA where the SICU rotation takes place is across the street from Duke hospital. No far flung commutes.

Scut work is minimal compared to other residency sites. No need to start own IVs (unless you want practice), never transported someone to radiology. The general consensus on off service rotations like GM was that you are there to learn and have the same amount of work the other residents have (admission/discharge summaries, rounding, etc)

Overall, Duke was a great residency program for myself and I think my class would agree. You get comfortable quickly dealing with both bread and butter sick as well as the acutely unwell with complex histories. I feel comfortable with nearly all procedures, and the sim center helps alleviate unfamiliarity with rare procedures like TV pacing or lateral canthotomy. The attendings are focused on your education, and go out of their way to help you both on and off shift. Dr. Broder is a tireless PD who constantly advocates for his residents. Lots of young upcoming attendings eager to teach and advance in the field. Would happily rank them #1 again with hindsight.

Hey guys. I've been on the site but made a new profile for anonymity. I'm a 4th year going into EM and I found these threads so incredibly helpful that I want to help contribute to keeping them up to date.

I interviewed at Duke so I though I would share my thoughts:

Residents: super cool people. Easy to talk to and willing to answer any questions honestly which I always appreciate. I could definitely hang out with them outside of work. Only 10 per class which is smaller than ideal for me but it felt like it was appropriate. Very little diversity within the residency which wasn't my favorite.

Faculty: easily one of my favorite things about the program. They are all very down to earth and the type of people I would want to work with. The PD is simply amazing. He goes out of his way to make you feel appreciated and to sell his program to you. I fully anticipate him being my favorite PD of the season. The other faculty were great too. They have a younger faculty which I think is a positive because they are easier to relate to and they've always grown up with EM so they have a different perspective. Perhaps other people feel differently about young faculty. Dunno.

Facilities: You really can't complain training at Duke University Hospital. The ED looks relatively new and the flow seems good to facilitate taking care of people. They also work at Duke Regional which is not far from Duke University -- pretty nice when considering commutes. I was concerned that the patient population would be a little too ritzy and entitled for me (I'm more of an underserved, un/underinsured type of person) but I was assured by multiple residents and faculty that it wasn't. Durham isn't the fanciest of towns so I suppose it could be true. I don't think I'm totally convinced but I also don't think it's a terrible thing to be trained on the "zebras" that come to and live near a major academic center

Location: Durham sure isn't much to look at It's a perfectly fine place that seems to have everything you would need but it's not particularly special at least at first glance. I was told by one of the faculty members, however, that once you live there a year you'll love it. I asked around to the residents and it seems to be true.

Global Health: If you're interested in international EM, you simply must apply to this program and check it out. I am interested in possibly doing a fellowship so I was blown away by their global health institute that has many countries you could potentially go to (i.e. Tanzania, Indian Health Reserve, Kenya, among many others) AND collaborate with docs from other specialties who are also doing work overseas. This international program was amazing. Leaps and bounds better than others I've seen.

Overall: loved this program. The people were great, the facilities were nice, the international opportunities were unparalleled. It was just a great interview day. I would probably like a more underserved population if I was being picky but if I matched here I would be more than satisfied.

Hope this was helpful. Happy interview season!

Any word from current residents or students who rotated there?