Stanford University/Kaiser Permanente Medical Center Residency Reviews

Hello...just thought I'd get some help during this difficult thought-consuming time! I actually really liked stanford. I thought the area was great (only 1/2 hour to san fran), the faculty was laid back, and the residents I met seemed to really like it and said they were a social bunch. However, on the interview trail I keep hearing that the people were stuffy, that you're not exposed to enough patient pathology and that residents are non-social. I really liked the program and am thinking of ranking it highly and am worried that I don't know all the in-and-outs of the program...and want to make sure i do before i make the dreaded rank list. Any help is much appreciated! Thanks!

It has a pretty campus... my wife and I took our wedding pictures there (fighting for space with four other wedding parties)... If you go there, you might be able to get onto the waiting list to use the chapel, too.

Awesome program. Thought the teaching there was great. Downsides that I could see were old facility, 12 hour shifts all three years and significant commute time between the sites (if you think it will only take 30 minutes to drive to San Fran on the 101 or even 280, you've got another think coming). 12 hour shifts bleed into 13 plus 45+ minute commute each way, and I said no to that. Still, I ranked it third. Enjoyed my interviews, and I thought the residents were a great bunch of people.

I am happy to elaborate more about the places I interviewed...
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1) Denver: (+): amazing program, amazing location, 4th years blew me away managing ED. (-): almost no elective time
2) Hennepin: (+): very surgery-based program, Pitbosses run the ED 3rd year, critical care emphasis. (-): Minnesota.
3) Highland: (+): autonomous training, great group of people, nice location, self-sufficient residents. (-): unsure about strength of off-service rotations.
4) MGH/BWH: (+): great city, great resources, phenomenal international health program. (-) young program, 1 million potential consultants to be called
5) New Mexico: (+): great program, super nice people, SICK patients, nice outdoor recreation nearby, critical care strong. (-): location seemed a little ghost-townish for me, issues with movement of pts through department & flow
6) UMichigan: (+): huge critical care, no medicine wards, diverse training sites. (-): not a huge fan of the location/weather, worried about the # of consultants that could be called.
7) Bellevue: (+): big time autonomy, self-sufficient residents, reputation. (-) I am a little intimidated about the idea of living in Manhattan .
8) Maine: (+): the most friendly people ever, location. (-) seemed a little cushy for me
9) BMC: (+): location, underserved patient population, lots of trauma. (-): 2-4, PGY2s do ALL procedures in dept.
10) OHSU: (+): location. (-): didn't gel with the people
11) UC Davis: (+): sick pts. (-): nothing really set them apart, location
12) UCSF Fresno: (+): Yosemite, nice people. (-): couldn't really see value of 4th year, living in Fresno.
13) Stanford: (+): Paul Auerbach, lots of resources, bay area. (-): pts not sick enough, a little too academically snooty for me
14) BIDMC: (+): location. (-): unfriendly, extremely academically snooty people
15) Indiana: (+): fantastic program. (-): location

I also interviewed for the UVM Preliminary Medicine Year and the Transitional year at UC San Diego, so feel free to ask me about those...

Please note: the (+) and (-) are only my opinion. I'm sure there are several other people who had totally different experiences and therefore completely opposite opinions (which is why the match works!)

Stanford

Overview
3 year program in northern California; technically in the Bay Area, but the majority of residents live in and around Palo Alto which is more upscale suburbia than hipster funk. Interestingly, ALL of the other California programs referred it as a "second-tier" program, but when Stanford's PD was asked during the interview day what improvements he think can be made, he replied "Well, it's tough to improve when you're at the top!" Overall, a decent, fairly cush program in an over-priced but attractive area with a lot of resources ($$$) and many connections, especially if you're looking to stay in California and aren't interested in going county. Particularly nice if you want to finish residency quickly and go work at Kaiser.

The Interview Day
Three assistant PDs hang out with the group for most of the day; maybe it's just me, but it seemed like they were at each other's throats a bit, interrupting each other a few times and not being particularly chatty. We got driven around between the hospitals in a souped-up minivan reminiscent of a pimp-mobile: black leather seats in a semi-circular arrangement with a neon pink "VIP" sign on the back wall . The interviews were very laid-back, and lunch was, according to them, "the best on the interview trail"... probably had something to do with the uniformed waiter pouring my soda for me... .

Curriculum
PGY 1-3, 12 hour shifts. You rotate between three hospitals (they're no longer rotating at UCSF): About a third of your shifts are at Kaiser Permanente (community) and Santa Clara Valley (county 'light'); the other two-thirds are at Stanford. Internship year is VERY off-service heavy, with only two months of emergency medicine. It was tough to get a handle on just how much respect/autonomy the department has within the hospital, but here's something that happened during my interview day: While touring Kaiser, we ran into an apparently very important cardiologist (our group stopped and we were introduced). He then spent about five minutes literally lecturing us on when we should and shouldn't be giving heparin to patients... and the EM assistant PD who was with us just stood idly by with a meek smile. Totally anecdotal, of course, but...

Two months of electives are available during the third year which can be used to do anything - international, wilderness, and sports medicine opportunities are particularly strong. An aeromedical transport elective is available, but you would be strictly an observer. There is also an optional opportunity to stay on for a 4th year as a fellow/junior attending; this year's administrative fellow seemed VERY happy. The various opportunities available through Auerbach and other famous gurus of EM, as well as financial benefits (see below) are probably the strongest selling points of the program.

Facilities
The Stanford ED is pretty much what you would expect from an older, academic place - and it's also very small. Their annual adult volume is only around 35,000. They're a level 1 trauma center (doesn't seem to take much these days), and trauma surgery is pretty heavy-handed. Kaiser and Santa Clara Valley are within a half-hour drive of the Stanford campus. Kaiser is part of a very large HMO system, so all of the patients you'll see there are insured. While at Kaiser, you work one-on-one with attendings and there is no graduated responsibility (no running the department). About two months per year are spent at Santa Clara Valley, a level 1 trauma center with around 90,000 patients per year. During 2nd and 3rd year, residents rotate in the ED (and on the surgery service during 1st year); many residents said that Santa Clara Valley was their favorite hospital to work at.

Benefits
In addition to your salary (which I believe is one of the highest in California), you also get a $3,000 moving stipend and a $2,000 yearly bonus in January. There's an additional $1,000 bonus for 2nd and 3rd years for "food and parking" expenses (you do have to pay for these if you intend to eat/park at the Stanford hospital - parking is free at the other two). The hospital is located on the undergraduate campus, so you have full access to all of their recreational facilities, libraries, etc. There is also a limited number of apartments available on the edge of campus (a ten minute walk from the hospital) that residents can apply for by lottery; it's not guaranteed and it's not subsidized, but it is pretty nice, and certainly convenient.

Residents
Very nice, definitely the "polo wearing/tennis playing" type overall, but that may be a plus if you think you can fit in here. Most of the residents go on to community/private practice, but a few take the optional 4th year fellowship/junior attending position, which seems like a nice bonus for those thinking about academics. A lot of outdoors enthusiasts, and a few girly-girls . A good mix of married and single, but probably a little more on the single (or at least child-less) side, and many of the residents were on the younger end. Many come from "top" medical schools.

Location
It's in Palo Alto, about a 45 minute drive from San Francisco. Most of the residents live within walking or short driving distance of the Stanford campus, which has a very upper-class suburban feel. Housing is expensive, but then again Stanford pays you a little more than most of the other programs. Lots of outdoors opportunities - bike trails, vineyards, skiing, etc, is all relatively close. A nice location if you want to be in northern California.

Hi Everyone,
I'm currently a second year resident at Stanford EM! I love it. We have a very talented group of residents, amazing faculty, ,and of course, live in one of the most beautiful places in the country. Not only that, but we make more than any other California program. I have met many of you on the interview trail! One of our very talented interns put together the following video that sums up our program. It's actually part of a contest so feel free to vote for us after you watch it!

www.youtube.com/watch?v=0WYnYdV7GO4


If you have any questions when you are making your rank list, please feel free to email me: [email protected]

take care!
PGY-2
Stanford/Kaiser EM

Stanford is awesome.

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.

pros and cons:

Stanford-
+) resident run, high profile attendings with a lot to teach, fantastic ancillary staff, familial vibe in the department, high acuity with difficult/sick patients, if you rotate here there is very little you haven't seen. Get along well with trauma team, ED owns all airways. Lots of toys to play with. Much higher volume than previous - >50,000/yr. Great learning on off-services. All consultants rotate at Kaiser and Valley so you know each other well.
Now more ED time in 1st year, no more Medicine!

Separate, awesome peds ED and no shortage of peds experience, lots of sick kiddos, lots of weird diseases

-) much more consultant heavy, and sometimes hard to get pts admitted. Old
hospital hence old ED, cramped fishbowl. Academic-minded for better or worse.

Valley (santa clara valley)-
+) 2nd busiest ED in CA, LA county/USC is first. >170,000 pt visits/yr. Sick pts and lots of them! Awesome faculty. County vibe. Super efficient. Easy admissions. bread&butter EM. Tons of procedures esp airways. Lots of nasty trauma. Burns. Peds traumas. Great collaboration with trauma as there is plenty to go around.

-) 25 min drive from palo alto. Mostly 12 hour shifts.

Kaiser-
+) 1:1 with attendings if you like that, lots of septic folks, plenty of procedures, more teaching time with attendings, better sense of community medicine

-) 25 min drive from palo alto, also 12 hour shifts. Feels moe isolated as there is no pit or fishbowl, facility is almost too nice. Where are the drunk crazy folks?

Residency overall:
+) fun, genuinely kind and loving residents. Perfect living environment with access to every kind of fun. Super mix of experiences. You bust your but seeing and doing a lot and you get really good at what you do.
Great learning - best of the best come to grand rounds, journal club, which is well attended with great discussions
Opportunity galore - you can have a fellowship, any fellowship. You can start a project with any one you want and tap into the experiences of some of the most well respected faculty in the field

-) Mostly 12 hour shifts, but more days off in return. You work a lot, but in return are really well prepared to graduate. Not specifically county, community or academic. You do have to drive some. It is expensive if you want to live in palo alto but there are other more affordable options.

_

_

SCC EMS is "interesting" I don't know what it is like at the physician level, but until they allow medics in the field to actually perform at the medic level, other then numbers (volume) I would think it was more an exercise in fantastic management skills, and political battles.

VMC is a great hospital, I never ran into many residents there (while working EMS) not like Stanford.

Does Regional have a program? Because that would be one BA hospital to work at, think Stanford ED size, but always much busier and in the heart of the bad areas (for the Trauma Junkies) and the hospital farthest south and therefore closest to I5 and the major highways that cover central Cali. Also with Regional and VMC you have the waves of SNF patients that come in from some not so skilled facilities, unlike up north where they are a little bit better.

Things might have changed since I was there last 2 years ago.

This is good reading as I am considering the long process of medical school, once again as always thanks for the info (to all the posters)

What type of scores are needed to get into Stanford? Are all their residents in the 240+ range?

SoyMilk said:

What type of scores are needed to get into Stanford? Are all their residents in the 240+ range?

Click to expand...

Noone is going to be able to answer that definitively except for the admissions staff at Stanford. That said, I would assume that you're probably right. I'm in the 240+ club and did not get an interview there despite getting interviews at most of my other competitive programs. I also did not rotate there, nor am I from that part of the country which may factor into their decision. Regardless, it's a tough program to get into.

The few people I know who got interviews here had steps ranging 230s-250s.

220-230 worked for my roommate

Thanks for the updated review and advice! Could you please answer some more questions about your EM program?

- you said mostly 12 hour shifts, approximately how many for each PGY year in a month?
- are there any procedures that residents are not allowed to do (e.g., RSI, thoracotomies)?
- is there frequent commuting between the 3 major sites outside of dedicated training blocks?

Thank you!

Hi, since it's been a while since the last major updated review, can someone familiar with the program (preferably a current resident or recent grad) comment on the following:

• Average number and length of shifts per month for each PGY year (I know 12H shifts dominate the schedule, but can someone give a more precise breakdown as time goes on?). 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 seen on each shift? In other words, is trauma only seen during concentrated blocks of training or throughout the entire residency experience in the ED?
  
  
• Which team runs the trauma? Is it an alternating schedule with the surgery residents? Who does the procedures (intubations, chest tubes, resuscitative thoracotomies, etc), is it shared with anesthesia/surgery residents based on odd/even days or MRN numbers? Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
  
  
• How awful is the commute between off-site locations? Do they make the schedule somewhat tailored around traffic, or does everyone just come up with their own strategy to avoid it?

• How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
  
  
• Is the environment family friendly? What percentage of the residents are married, have children?

Thank you so much for your time!

rhcp0216 said:

Hi, since it's been a while since the last major updated review, can someone familiar with the program (preferably a current resident or recent grad) comment on the following:

• Average number and length of shifts per month for each PGY year (I know 12H shifts dominate the schedule, but can someone give a more precise breakdown as time goes on?). 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 seen on each shift? In other words, is trauma only seen during concentrated blocks of training or throughout the entire residency experience in the ED?
  
  
• Which team runs the trauma? Is it an alternating schedule with the surgery residents? Who does the procedures (intubations, chest tubes, resuscitative thoracotomies, etc), is it shared with anesthesia/surgery residents based on odd/even days or MRN numbers? Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
  
  
• How awful is the commute between off-site locations? Do they make the schedule somewhat tailored around traffic, or does everyone just come up with their own strategy to avoid it?

• How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
  
  
• Is the environment family friendly? What percentage of the residents are married, have children?

Thank you so much for your time!

Click to expand...

Someone please answer these questions. I asked a lot of these during the interview, but I did not get very straight up answers. I hate 12 hr shifts, but then when I asked they said it was changing, but nothing very clear.
From what I got: not much scut work at either one of the sites, a third or so of the people are married but only a few have children. Commute people say is not too bad unless after night shifts going from Kaiser/Valley Med center back to Palo Alto.

I too would like clarification on the shift situation. If they really are changing to 8s that would be a huge plus in my book. When I asked about number of shifts I was told it was more based on hours than number of shifts, and the various answers I got were "about 59 hrs/wk" and "closer to 52" as an R1. The goal I was told was to decrease as the years went on with goal of being about 40/wk as an R4. Since there's only one class of 4-yr program now, it's hard to imagine they would be able to decompress the schedule much until we would be R3s.

I was also told the 8 vs 12 hr debate was something the residents vote on every so often, so seems like change is possible but I hadn't heard it was actually happening - would love to hear the answer!

bananasinpijamas said:

Someone please answer these questions. I asked a lot of these during the interview, but I did not get very straight up answers. I hate 12 hr shifts, but then when I asked they said it was changing, but nothing very clear.
From what I got: not much scut work at either one of the sites, a third or so of the people are married but only a few have children. Commute people say is not too bad unless after night shifts going from Kaiser/Valley Med center back to Palo Alto.

Click to expand...

Current Stanford EM resident. It's been a while since anyone updated this, but let's see what I can do.
As always, any opinions here are just mine and this isn't an official Stanford EM Residency post. Email the program director if you have specific questions; she's very open to chatting.

Shifts:
We work at 3 different hospitals, Santa Clara Valley Medical Center, Stanford, and Kaiser Santa Clara. Shift structures vary by location and where you are working in the ED. Historically we've been almost exclusively 12 hour shifts, but this year we've made a large shift and moved to almost exclusively 10s. There are some 8s and 9s, and still some 12s, but we're looking to change those as well, especially as we continue to expand the residency and go from 3 to 4 years. The shift structure changes over time, based heavily on resident input, and we have a new Stanford ED that will open in the next year, which will likely cause a redesign of the shifts there since pods will be different and at that point we should have 60 residents.

Types of Shifts:
Most shifts are "high-acuity" shifts. We have a Delta zone at Stanford which is lower acuity "vertical" patients (patients in chairs, not gurneys) that we work, but everything else is high acuity. From day one you pick up sick people, you just get closer supervision with them.

Procedures:
Your patient, your procedure. People have intubated and helped run codes on day 1. A senior or attending will be helping you at the beginning, but we try to get juniors into as many sick patients and as many procedures as possible. Seniors routinely hand off procedures to juniors to help get you experience early. Everyone has more than enough numbers and I feel very comfortable with procedures.

Trauma:
We have a very good relationship with trauma. Generally they run the survey (often by one of our interns on their service). Airway is always ours. I've seen anesthesia come down for airway maybe 2-3 times over the last couple years. We have ultrasound. Procedures are split up between the two services. We do have a formal every-other-day arrangement, but in reality the procedure generally goes to the resident on either team who needs the experience or hasn't done whatever the procedure is in a while. I can't think of any procedure we aren't "allowed to do" as someone asked.

Hours:
We don't have a set number of shifts per month. Instead we have goal hours per week. We are transitioning into the 4 year program with final goal hours of
R1: 48 hours / week
R2: 44
R3: 40
R4: 36
These are scheduled hours in the ED. They don't include conference, off-service, time after shift to wrap up (typically 30-45 minutes, although longer as an R1 and R2 as you get the hang of it). Right now we're averaging 44 for the R2s and R3s since we don't have any R4s.

Patient Population:
Stanford: Very medically complex patients. You will be completely comfortable managing complex cancer, multiple transplants, LVADs, genetic syndrome pediatrics, etc. I had a shift last week in which over half of my patients had at least one transplant. This is mixed in with bread and butter EM, and more underserved than you'd expect. Trauma here is generally MVCs, bike accidents, horses (yes horses), with assaults mixed in.

Kaiser: Community ED with a skew towards older and sicker. Lots of STEMI/strokes. Lots of sepsis. Working within the Kaiser system is very different since you have resources that you don't normally have elsewhere, which is a great experience. Lots of bread and butter community ED as well, and we do fast track shifts here to get comfortable moving the true low-acuity patients fast.

Valley: County. Depending on how you measure it's the 2nd or 3rd business in the state. Lots of sick patients, more interesting trauma, burns. You have more resources than a typical county hospital (minimal scut work, no transporting patients, etc). Lots of underserved.

Living near Stanford:
It's expensive to live here. No use denying that. But we get paid well, we have a $6000/year housing bonus, and no one struggles. Most people have roommates, but you can live alone if you're willing to sacrifice beer/travel money. Stanford also has great resources to support research, conference attendance, etc. So you can get a lot of travel and fun in by doing that kind of work and getting reimbursed.

Commute:
If you live between the sites you generally have a reverse commute. There are only a few shifts that you'll hit traffic. Generally not a big deal.

Family:
This varies a lot by class. We have a good mix of married, married with kids, and single. It's a very family friendly program, and the area is good. Good schools, etc. The residents are very close. I will be close friends with my class for life, and the classes mix well. Lots of social events, family/kids generally welcome.

Jobs after residency:
We have a huge alumni network, and this shows. People get the jobs they want anywhere in the country. We send a higher number to fellowship than most programs, but the majority still go to community practice. Everyone who wanted fellowship my year got their top choice.

That's all I've got for now. It's a great program; I'd come back again if I had to make the choice over.

EM_Resident said:

Current Stanford EM resident. It's been a while since anyone updated this, but let's see what I can do.
As always, any opinions here are just mine and this isn't an official Stanford EM Residency post. Email the program director if you have specific questions; she's very open to chatting.

Shifts:
We work at 3 different hospitals, Santa Clara Valley Medical Center, Stanford, and Kaiser Santa Clara. Shift structures vary by location and where you are working in the ED. Historically we've been almost exclusively 12 hour shifts, but this year we've made a large shift and moved to almost exclusively 10s. There are some 8s and 9s, and still some 12s, but we're looking to change those as well, especially as we continue to expand the residency and go from 3 to 4 years. The shift structure changes over time, based heavily on resident input, and we have a new Stanford ED that will open in the next year, which will likely cause a redesign of the shifts there since pods will be different and at that point we should have 60 residents.

Types of Shifts:
Most shifts are "high-acuity" shifts. We have a Delta zone at Stanford which is lower acuity "vertical" patients (patients in chairs, not gurneys) that we work, but everything else is high acuity. From day one you pick up sick people, you just get closer supervision with them.

Procedures:
Your patient, your procedure. People have intubated and helped run codes on day 1. A senior or attending will be helping you at the beginning, but we try to get juniors into as many sick patients and as many procedures as possible. Seniors routinely hand off procedures to juniors to help get you experience early. Everyone has more than enough numbers and I feel very comfortable with procedures.

Trauma:
We have a very good relationship with trauma. Generally they run the survey (often by one of our interns on their service). Airway is always ours. I've seen anesthesia come down for airway maybe 2-3 times over the last couple years. We have ultrasound. Procedures are split up between the two services. We do have a formal every-other-day arrangement, but in reality the procedure generally goes to the resident on either team who needs the experience or hasn't done whatever the procedure is in a while. I can't think of any procedure we aren't "allowed to do" as someone asked.

Hours:
We don't have a set number of shifts per month. Instead we have goal hours per week. We are transitioning into the 4 year program with final goal hours of
R1: 48 hours / week
R2: 44
R3: 40
R4: 36
These are scheduled hours in the ED. They don't include conference, off-service, time after shift to wrap up (typically 30-45 minutes, although longer as an R1 and R2 as you get the hang of it). Right now we're averaging 44 for the R2s and R3s since we don't have any R4s.

Patient Population:
Stanford: Very medically complex patients. You will be completely comfortable managing complex cancer, multiple transplants, LVADs, genetic syndrome pediatrics, etc. I had a shift last week in which over half of my patients had at least one transplant. This is mixed in with bread and butter EM, and more underserved than you'd expect. Trauma here is generally MVCs, bike accidents, horses (yes horses), with assaults mixed in.

Kaiser: Community ED with a skew towards older and sicker. Lots of STEMI/strokes. Lots of sepsis. Working within the Kaiser system is very different since you have resources that you don't normally have elsewhere, which is a great experience. Lots of bread and butter community ED as well, and we do fast track shifts here to get comfortable moving the true low-acuity patients fast.

Valley: County. Depending on how you measure it's the 2nd or 3rd business in the state. Lots of sick patients, more interesting trauma, burns. You have more resources than a typical county hospital (minimal scut work, no transporting patients, etc). Lots of underserved.

Living near Stanford:
It's expensive to live here. No use denying that. But we get paid well, we have a $6000/year housing bonus, and no one struggles. Most people have roommates, but you can live alone if you're willing to sacrifice beer/travel money. Stanford also has great resources to support research, conference attendance, etc. So you can get a lot of travel and fun in by doing that kind of work and getting reimbursed.

Commute:
If you live between the sites you generally have a reverse commute. There are only a few shifts that you'll hit traffic. Generally not a big deal.

Family:
This varies a lot by class. We have a good mix of married, married with kids, and single. It's a very family friendly program, and the area is good. Good schools, etc. The residents are very close. I will be close friends with my class for life, and the classes mix well. Lots of social events, family/kids generally welcome.

Jobs after residency:
We have a huge alumni network, and this shows. People get the jobs they want anywhere in the country. We send a higher number to fellowship than most programs, but the majority still go to community practice. Everyone who wanted fellowship my year got their top choice.

That's all I've got for now. It's a great program; I'd come back again if I had to make the choice over.

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Thanks for helping us out. Really appreciate your thoughts on the program.

Any chance Stanford EM will prioritize greater county exposure? Only 20% at a gem like Santa Clara Valley sounds like a bummer, especially as one of the busiest trauma centers in the nation. I know SCV isn't covering resident salary/training costs like the flagship hospital in Palo Alto, but 30-40% there would really make up for the lack of penetrating trauma/lack of procedures (chest tubes/thoras) at Stanford Hospital. The lack of (penetrating) trauma/fighting for procedures with surgery was repeatedly noted as a small weakness by applicants and even residents (when I interviewed, although the program has so many incredible strengths, and I'd be lucky to match there). More SCV exposure would also make Stanford one of the best county/community (Kaiser is a beast)/academic combos in the country.

Gray Fox said:

Thanks for helping us out. Really appreciate your thoughts on the program.

Any chance Stanford EM will prioritize greater county exposure? Only 20% at a gem like Santa Clara Valley sounds like a bummer, especially as one of the busiest trauma centers in the nation. I know SCV isn't covering resident salary/training costs like the flagship hospital in Palo Alto, but 30-40% there would really make up for the lack of penetrating trauma/lack of procedures (chest tubes/thoras) at Stanford Hospital. The lack of (penetrating) trauma/fighting for procedures with surgery was repeatedly noted as a small weakness by applicants and even residents (when I interviewed, although the program has so many incredible strengths, and I'd be lucky to match there). More SCV exposure would also make Stanford one of the best county/community (Kaiser is a beast)/academic combos in the country.

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It's definitely something that people want, but the money side of things (as you mention) is one of the limiting factors. We are getting more funding from Valley now that they changed groups, and we've increased our time there accordingly. And with a 4th year you're essentially getting 50% more Valley time than before (previously 2nd and 3rd year, now 2nd-4th). Outside of a few places in the country you're not going to see a high percentage of penetrating trauma, so if that's a huge priority there aren't many programs that really get huge exposure. Although honestly, trauma is pretty straight-forward and algorithmic. The medically complex patients are way more interesting (at least to me.)

Just in case anyone is still considering stanford, and has this question or comes across this thread. Valley time is decreasing now that we have 4 years, Kaiser time is too. Expect to work 24 (R1) to 21 (R4) shifts per month at SUH, with little to no flexibility or free-time. Moonlighting is basically highly discouraged/prohibited.
This is a shame, the valley is a great experience, and why stanford dropped Kaiser’s name from the residency, I have no idea.
mostly agree with above, bit just wanted to update the thread on the trajectory of the program.