Beth Israel Deaconess Medical Center (BIDMC)/Harvard Residency Reviews

I've completed all of my interviews & would be more than happy to share my opinions on the following programs:

Beth Israel Deaconess/Harvard - awesome facility & equipment, very academic, optional 4th year as research/junior attending position. Residents are a very friendly & laid-back crew, and they seem genuinely happy. Faculty seemed nice & eager to teach, occasional tendency to throw the HARVARD name around but not bad. Program director was a little dry during interview & presentation, but that's kind of his way per the residents - assistant program director is very engaging & friendly.

Duke - as mentioned previously in other threads, the program director is a very strong plus. The faculty are very young, energetic, & eager to teach - a lot of diverse interests are available. The Duke hospital is beautiful & huge, but the ED is about average in terms of layout & size. They've renovated the psych section & supposedly plans are in place to build a new ED in the vaguely distant future. Off-service rotations - YOU'RE WEARING THE SHORT INTERN COAT...not to mention white pants on the surgery services! To me this is an extremely unnecessary addition to internship - the year's tough enough without the added humiliation of short coats & white pants. Attire aside, the off-service rotations are reportedly very good. Current residents seemed happy, but a fairly eclectic group of personalities - couldn't get a good grip on the group as a whole. I think it'll be a great program in 5-6 years.

Hopkins - Program director & coordinator were the two biggest positives for this program. Although my interview day was cut short due to inclement weather & I may have gotten a slightly skewed perception - it seemed to me that the program was very much about the "This is Hopkins...you should come because it is Hopkins" idea. This is not based on anything concretely said, but just my overall gut-feeling.

Maine - a very nice little ED, good facility/equipment. Residents seemed like a good group, very happy with their program & decision. Department Chair & Program Director are great - one of the biggest draws to this place. Dynamic young faculty mixed with some emergency doc's with 20+ years there who still love to teach. Portland's a great little town & the pay is the best of any place I've been. Only concern is if it's too small...

Maricopa - the only true "county" program I interviewed at, recently got a funding bill passed to provide for the next 20yrs worth of funding. Program director is great, they just hired the new chair of the dept - one of the editors for Tintinalli's. Residents seemed great & very happy. Good housing market. The only non-East coast program I applied & interviewed at.

Maryland - awesome facility/equipment, new ED, Shock Trauma, very academic/political. Chair & Program director are great. Very impressed with their academics & career development. Residents seemed very happy, personable & capable - current president of EMRA is there & interviewing applicants along with the faculty. Baltimore is fun city, quite a few rough areas but also several great areas - Inner Harbor, Fell's Point, Federal Hill, etc. The only knock that I could possibly come up with is that it's all 12-hr shift over all 3yrs...pros & cons to that, more hours but fewer shifts. I did a second look here & had a great shift in the ED - high acuity but also good bedside teaching, both from ED staff & consulting services.

UMASS - as mentioned by an earlier reviewer, it is a very busy & overcrowded ED (kinda similar to Maricopa in that aspect) although they are building a new ED to be completed in spring/summer of 2005 (start of our 2nd year). Great lifeflight program - not optional. Big on disaster/international medicine. Faculty were great, chairman has been there 20yrs - very stable & established program. Program coordinator is awesome. Very pro-military group, several reservists in the faculty & residents. Rotate at a couple other community hospitals in Worcester - taken there on tour...nice facility. Several nice perks: proximity to Boston yet reasonable housing market, good pay, state-sponsored 401K, free tuition at UMASS for spouse/children.

UVA - great facility/equipment, awesome college town environment. Chair is active in dept - was working shift in ED during my visit. Program director & coordinator were both very personable & seemed genuinely caring. Faculty was nice mix of young & experienced. Residents were happy & laid-back. Definitely the community-program feel, although it's in a large university hospital. Nice chest-pain center in the ED

I think any of these 8 will give me a good experience & training, and I plan on ranking them all. However, my top 5 are clearly Maryland, Maine, UVA, UMASS, Beth Israel Deaconess - order yet to be determined.

Can't really speak to BWH/MGH or BMC, but I did my away at BIDMC.

Great program. The big strong points were the program director and chair as mentioned before, teaching (a component of the attending salaries is dependent on resident/student feedback), happiness of the residents, research (each year they put a ton of SAEM abstracts), the optional 4th year as a junior attending, high medical acuity of the patient population, and great computerized patient record/discharge instruction system. The 3rd year residents seemed pretty independent at the beginning of their 3rd years in running the entire ER (40 some patients) and listening to presentations. They seemed to get about 1-3 major blunt traumas per shift, but nothing penetrating. The only downpoints are that you lose out on some of the inner city pathology/trauma and public health issues (although some of the away ED rotations are supposed to make up for this). This program would prepare you well for a career in academics or in the community.

Yale - The evening preceding the interview, the residents took us out for dinner and drinks in New Haven. New Haven itself, despite the bad rap, has some nice areas with lots of good restaurants and cafes, 3-4 solid places to go out (according to the residents), close access to NY and Boston, and access to all the amenities of being at a major ivy league university. The residents seemed to be very friendly and happy at their program. Their only complaints were that some of the didactics, like the resident lectures weren’t the best, and that the residency is still continuing to iron out some issues with respect to the direction of major trauma resuscitations with the surgery department. They currently split time with the surgery department in who runs the trauma, but they manage all the airways. They said this is made up for in with the rotations at Bridgeport hospital, their community affiliate which they said is a gem of the program, There they do everything on their own and it has a high volume of trauma (including penetrating) since it even more inner city the New Haven. The new PD Laura Bontempo is highly respected by the residents and has some new directions for the program with the incorporation of medical simulation into the didactic sessions and applying for more residents to allow residents to have more time learn about their patients since interns typically see 1-2 patients per hour. During the presentations, the directors of EMS, research, ultrasound, Bridgeport, Trauma, critical care, and a chief resident all spoke about their respective areas. The EMS director is nationally recognized leader in the field and there is an EMS fellowship. There are several funded research projects going on in sepsis, substance abuse, EMS, and ultrasound. There is new critical care guy out of the EM/IM program at Henry Ford. The patient population at Yale has a diverse mix of underserved as well as insured patients. The ED facility is a little cramped, but there are plans under way to build a new facility in about 5 years. Interviews took place in the afternoon and consisted of one 10 minute interview with the PD, and 4 20 minute interviews with the other faculty members. This seems like a very solid academic program on the rise.

Beth Israel Deaconess – BID is situated in the Longwood medical campus of Harvard which seems almost like the NIH. It is surrounded by suburban tree lined streets of Brookline on one side and on the other side by Mission Hill a more inner city type neighborhood. The day began with breakfast and lecture by the PD. The lecture reflected all the strengths of the program including the very happy and academically productive and nationally recognized faculty, all the resources of Harvard with very good working relationships with all the other services, flexibility of pursuing academic interests in the junior attending 4th year (with a nice $100,000 salary as opposed to a resident salary), state of the art ED facilities, and the high acuity of patients seen in the main ED. There were 4 20 minute interviews with faculty and the PD, all of which were very informal. There was lunch with residents who were all extremely happy with the program. They definitely do not have the snotty ivy league fell that one might expect, and rather the program seems like it deserves the reputation of being the most west coast program in the east. This is instilled with vision of Carlo Rosen (PD) and Rich Wolfe (Chair) who are out of Denver and created the program from scratch. The only weakness (or plus for some) is the relative lack of underserved patients in the main BID ED as most of them have a PCP. The addition of St. Lukes and Brockton ED rotations in the 3rd year is supposed to make up for this, and according to the residents they do somewhat in terms of the skills needed for penetrating trauma, but this is not a focus of the residency.

BIDMC (cont.) - Another unique aspect is that the ED is truly resident run with the 3rd year managing the dispo of 30-35 patients on the acute side and the attending running around in the background and there for advice and teaching. Will I have not been to other 3 year programs, this has to be among the best for academic 3 years in the country.

Curreiculum: PGY1-3 + optional 4th year. The PGY3 truly runs the ED, like the philosophy of many PGY1-4 programs. A guaranteed 4th year for those who want to do fellowship or complete a research project. Work as junior attending that 4th year with about 20hrs/wk in ED and make about $100k. Can also pursue MPH with Harvard. To get exposure to trauma and more bread-and-butter peds, they go out to community hospital in the suburbs. Sounds like great community hospital experience with lots of one-on-one with ED attendings and exposure to admitting directly to private attendings. You will need a car in order to get to these hospitals. To get more penetrating Trauma expsore, they go to St. Luke's, which doesn't have a trauma team so EM residents learn to deal with everything, including when to transfer. Didactics is 1 day/week and protected time.

Residents: happy bunch. Likes to hang out together for beer, movie nights, shopping, etc. Girls night out every month... I'm assuming that means the guys get together on their own too. Program graduates seem to do well on job market. 65% goes into academic (I guess counting those staying for the 4th year).

Faculty: Department chair and PD both trained at Denver, started the BWH/MGH program, then came to BIDMC to start this residency. They believe in the 4-year system but ultimately came up with this optional 4th year idea. This is why they believe PGY3 should run the ED, like PGY4's. The faculty members are trained at various institutions so you get a good exposure of different ways of practicing EM. All on first name basis with the residents, except Dr. Peter Rosen who spends about 2 months/year at BIDMC (residents said they just can't bring themselves to call him Peter, which I totally understand). The faculty here are known to be very dedicated to teaching (according to Harvard med students, majority of the HMS teaching awards go to faculty at BIDMC).

Location: It's Boston. You decide for yourself.

Research: They don't seem to push for research project during residency. I guess for those going into academics, that's what the 4th year is for. Instead, there are lots of opportunities to do a "scholarly project", like write book chapters, publish case reports, etc. For those who want to do research, the opportunity is definitely there - both clinical and bench research goes on at BIDMC. Also required is a Q&A project to be completed during the administrative month during PGY3. It's a quick and easy project and everyone I talked to say it's no big deal.

Facility: Nice, clean, plenty of space. Great computer tracking system, with the function of tracking your old patients and find out what was the final diagnosis, hopsital course, etc. (great for learning). Currently doing paper charts but apparently going to electronic charting in 2-3 months. Has a obs unit in ED. Honestly, my review on facility is probably not going to be helpful. I don't care much about the facility, as long as it's not way below the standard, like leaky roof or mold growing on the wall.

Sorry I can't remember the details of the program from my interview back in early Dec, but I can tell you I liked this program the most out of MGH, UMass, and the BI. Love the 3 + 1 option. If you're not sure, and would like a 4th year, a guaranteed job working only 22 hrs a week for about 100k isn't bad. Then again, you should have no problem getting something similar as a 1/2 time faculty at another institution. I also wonder about their pathology with the BWH across the street. Boston is a cool city. Little pricy, but probably worth it.

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!)

(First props on the bump from 3 years ago... solid work)

Well guys and gals, BIDMC is the best residency since sliced bread, and the residents are the fittest, happiest, most productive residents ever.

Seriously, I think I am the only current BI resident who posts on SDN. Feel free to PM me or email me with specific questions. I certainly am not the official spokesman for our lovely program, but I'd be glad to answer anything I can.

Before I give my general comments, my background: I'm an intern, I'm mostly done with my off-services this year, I'm not from the Boston area (Florida actually), and I like long walks on the beach.

sooo... I love my program. I think its just peachy. If you are interested, you probably already know the basics: 1-3 format, In Boston, Mostly at BIDMC (one of the three main Harvard Hospitals), optional fourth year (basic idea is that you get hired as half time faculty and get to use the rest of the time on a scholarly project, an MPH, or something of the sort). The residents are a mix of single, involved, and committed. There is a solid representation from all areas of the country. They even take southerners with accents, like yours truly. Solid number of female residents, with my class being 7 ladies to 4 men. Attendings are equally varied, with a number of "old hands" with great experience and maybe famous names, to young attendings from here and elsewhere.

Other random points:
* We are the official hospital of the Red Sox (cough, world champions), which means residents get to work games (and thus go to the game for free, with the bonus of additional free tickets for games worked).
* Our ED is run by our 3rd year residents. Presentations go to them, and they make the big decisions. This is a good thing.
* A good portion of our graduates go into academic positions or fellowships, but it certainly isn't mandatory. I know a few who went/are going to great community positions.
* We are a respected part of the hospital at BI. As an off-service resident I always felt welcomed by the "other" team, and felt like they counted on me to carry my weight and help out. In turn you get some great teaching.
* Relationships between residents and attendings, like almost all EM programs, are great. Lots of first names, lots of humor, lots of fun at work.

whew, I'm totally done typing.... ask if you want to know more

I will echo the sentiments of the good doctor before me- the BI is a great place to train. I love the residency and cannot imagine I would be happier at any other residency program. A few of the real positives I think in the program are the following:

*Seniors run the ED- All patient presentations go through them, even those from the medical senior residents. They act as attendings and teachers, rarely seeing patients primarily. At the end of each shift it is the senior resident signing out the entire ED to the next senior. When I looked at residency a few years back this was relatively unique for a three program to let their seniors run the ED so independently.
*2nd years get all the sick patients- Every code, sick trauma, intubation, central line goes through the EM2. When there are too many sick patients for the EM2, they go faster.
*Great group of attendings- Includes old schoolers that came up through the ranks when EM was just establishing itself, as well as younger attendings. We have people from all different programs but nearly all are outstanding teachers (there is so much emphasis on teaching here that part of the attendings' salaries are based on resident evaluations of their teaching abilities). All attendings are interested in resident development and are on a first name basis with residents.
*Sick patients with significant co-morbidities. Several of our attendings that trained at other great EM programs, have commented that the BI has the sickest medical patients they have encountered. This is partially due to the Boston/Brookline area, where people live to be 107 with their 107 different co-morbidities.
*Pediatric experience- Train at Boston Children's, the best Peds EM program in the country.
*Residency leadership- Our PD is extremely invested in the program. He takes our feedback about our experiences seriously and is always open to making changes to improve the program.
*Department leadership- Our chair has worked hard to ensure that our dept. is well regarded in the hospital. I was initially worried that EM would not receive any respect at Harvard, but it is the exact opposite. Our program has more power than most depts.. in the hospital. We run all airways in the ED, have a very collegial relationship with trauma, and perform all procedures with consultant involvement only when we want them in the ED.
*Research- Attendings are always asking you to participate in projects. For any idea you come up with in the ED, you can find an attending to help you study it. Almost all residents publish at 1 least thing (if not more) during residency.

Other nice perks:
*The Red Sox- for every game you work (with work being a relative term since you watch half of the game from the Green Monster), you get tickets to another game.
*Interns don't have to work nights.
*All the benefits of being at a Harvard hospital (research, advising, people in every field imaginable) without the hassles of being at the major Harvard hospitals, where surgery and IM tend to have much more control of the hospital
*The optional 4th year- This worked perfect for me, because I was considering 3 and 4 year programs. At BI you have the option to be an attending during your 4th year, making more money and running the ED, while still enjoying all of the benefits of being in the residency. Many people use this year to get a Harvard MPH at a discounted rate, while functioning as attendings. This option seemed much better than just being a 4th year resident. This option is guaranteed for all incoming residents.
*Italy- We have a partnership with a hospital in Florence. All residents have the option to go on a paid trip to Italy to teach at the ED associated with this hospital.
*Your fellow residents- We all live by the philosophy of "work hard and play hard."

Potential drawbacks:
*We rotate at a number of outside hospitals. Some people see this as a negative, because several times a year you have to go to a totally new hospital, where you have to learn the system and earn your place. It also can require a commute. Having now done several of these rotations, I see them as an advantage. I feel comfortable going into multiple types of hospitals and practicing EM. I had the opportunity to practice in a true community ED, pseudo academic ED where surgery and IM residents work, a knife and gun club ED, and multiple different pediatric EDs.
*A definite academic bent to the practice of EM. At first this annoyed me in the ED, because I wanted to see patients and felt it slowed me down. However, as a more senior resident I love it, because we are always discussing the current literature and reasons why we are making a particular patient care decision.
*No longitudinal peds exposure- We only do peds in isolated blocks each year and probably do not do as much of it as we would like in 3 years. Although, I think this is a problem at almost all EM residencies, and we do as much as any other program I applied to as a med student.
*Boston can be an expensive city although no more so than NYC, LA, Chicago, etc. Boston also is not the most diverse city.

*Feel free to PM me with me any questions. You should definitely come look at the BI. There are so many great programs in EM but the BI is definitely a unique place- one where you will work hard but have fun and graduate with a diverse skill set, prepared for any career in EM.

Thanks to Janders and TylerDurden for informative posts! I am very excited about this program. Your posts raised a few questions I'm hoping you can answer here to benefit everyone:

1. So since all presentations go through the senior resident, what role do the attendings play? Do they hear each case from the senior and also see the patient? Does this format lead to only the senior residents getting to know the attendings or do the other residents present twice?

2. Since the 2nd years "get all the sick patients", do the interns see a high enough degree of acuity during the first year (ie, 3s and some 2s) or are they basically stuck on fast track? And does not working nights (although nice) detract from the diversity you see in the ED?

3. Speaking of diversity, you mentioned Boston is not very diverse. Is this reflected in the patient population in terms of cultural differences and the types of diseases you see?

Thanks!

Oh fun, good follow-up questions. Allow me to answer:

1. So since all presentations go through the senior resident, what role do the attendings play? Do they hear each case from the senior and also see the patient? Does this format lead to only the senior residents getting to know the attendings or do the other residents present twice?

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Well, first a little more about the organization of the BI ED. It is split into two basic areas, the core (sick patients) and the periphery (less sick patients). A lot of places are like this. Trauma Bays are attached to the core. Psych rooms attached to the periphery. There is one attending in each area.

The periphery is staffed, in addition to the one attending, by (usually) 3 interns. Generally one or two of these is an off-service rotator (IM, Gsurg, Ob.Gyn, podiatry). Sometimes an EM PGY2 is out in the periphery, in place of a tern. I haven't seen an EM3 out there, but I guess it could happen. When I, as an EM1, work out there I present directly to the attending. I basically get to pick up a couple charts, see the patients, order things, cause trouble, and then go present. Less sick patients are usually out in the periphery, but you certainly see some sick ones, be it due to mis-triage, high overall acuity, or the fact the positive pressure neutrapenic rooms are out there. People certainly get admitted to the ICU from the periphery, though we try to avoid tubing or coding people there Lots of 1-on-1 time with the attendings to get to know them.

Now in the core, the organization is attending + EM3 running the show, EM2 doing all the hard work, IM senior helping out, and then random others (EM1, off-service juniors) doing what they can. Each EM3 and attending has a different style, but most often when I work out there it goes like this: I grab the next chart up, see the patient, get some orders going, and go present. Often the EM3 and the attending are sitting/standing next to each other, so I can kinda present to both at once. Often, before I even saw the patient, the EM3 sprinted by the room to get the gestalt of the case. Sometimes I just present to the EM3 and they let the attending know later. If the EM3 is busy doing something (say a procedure or a trauma) I might run the case by the attending and get things moving and catch the EM3 up in a few minutes. It all sounds more complicated than it is... in the end, I rarely double-present cases, and I certainly get time to talk to attendings directly.

On a related note, we have two "away" ED rotations during intern year, one at Children's Hospital Boston (which is right across the street), and one at a BI-affiliate in Needham. At Children's you present directly to attendings and get to know them well. At Needham, it is you (the intern) and the attending and 10 beds. And a couple nurses. You certainly get plenty of alone time there.

2. Since the 2nd years "get all the sick patients", do the interns see a high enough degree of acuity during the first year (ie, 3s and some 2s) or are they basically stuck on fast track? And does not working nights (although nice) detract from the diversity you see in the ED?

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Interns work about 2/3+ shifts out in the periphery, and 1/3- shifts in the core (guesstimation). So of course, interns have a less acute overall population than the EM2s, who are doing 90% core shifts. That said, it is a natural progression in your education to start with sick patients and move to horribly sick patients. As an intern I am very content that I get sick people to take care of. My first core shift I was throwing patients on CPAP, getting nitrous drips running, and managing septic patients. Granted I probably only saw 3 patients that shift The second year is expected to handle multiple critically ill patients at once. As an EM1 I've gotten the exact same patients, but with my EM3 watching my back/helping me as need. I think my seniors/attendings have done a great job challenging me as the year progresses with more responsibility, especially by pushing me to take more patients, sicker patients, and to let me do more on my own. Also, since EM is know as a strong residency here, I have frequently been given a lot of responsibility for sick patients during my off-service rotations. And trust me, if someone crumps on the medicine wards (or better yet, up on labor and delivery), they expect the EM intern to know/do something

As far as not working the overnights, EM1s (when in the department) generally work shifts like 10a-9p, 3p-11p, etc. This corresponds to the peak demand times at BI. I don't think I'm missing any special pathology that comes in at 3am only. While on some off-services (Trauma, Plastics, OB-Gyn) you do some combination of nights or overnights and hang out in the department then... and besides a couple more drunks, I don't think I'm missing anything specific.

3. Speaking of diversity, you mentioned Boston is not very diverse. Is this reflected in the patient population in terms of cultural differences and the types of diseases you see?

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Well, i'm not sure what my more-seasoned colleague meant by not very diverse. Boston is a pretty open-minded town. The bars close a bit early for my tastes...

Clinically, I frequently see patients who speak other languages. I see a fair number of weird diseases. BI's population is not hugely diverse, mostly consisting of Caucasians, with a largely than usual Jewish and Russian population, also seeing a fair number of Spanish-speakers and Cape Verdeans. I don't think you can compare it to, say, Elmhurst. But I think it does better than, say, Gainesville (where I went to med school) in regards to diversity.


Pardon the lengthy answers, but I hope they answered your questions!

Beth Israel Deaconess Medical Center

Residents: 11 residents in the intern class. BIDMC was hands down their first choice and they seemed very happy. I liked these guys a lot, they were very down to earth and fun to talk to. As with most programs, there was a mix of single and married. They come from all love the country and were happy they made the trip.

Faculty: Quite impressive, including Peter Rosen, Nate Shapiro, PD Carlo Rosen, and chair Richard Wolfe (stolen from MGH). They heavily attended didactics and participated with the group. They all seem very invested in the residents. Dr. Tibbles, the associate director, seems extremely dedicated to the residents as well and has increased mentorship and observation of them. Research kicks booty and includes lots of translational research opportunities, especially in the area of sepsis.

Hospital: Training occurs at several hospitals, including Beth Israel Deaconess (a big tertiary care center); South Shore (a hospital with few other residencies, so you get to do a lot of stuff during ICU etc); St. Luke's (a small community hospital the seniors run pretty much by themselves (with oversight, of course) as the only residents in the hospital. Documentation is all paper.

Ancillary Stuff: Great ancillary services, you won't have to do any wheeling people around, starting IVs, or making your own phone calls.

Admitting: I think admitting privileges are only to medicine, but I always forget to ask these kinds of things.

Curriculum: Probably the coolest in the country. They offer a 3yr program with an optional junior attending year that features 1/2 the shifts with 1/2 the attending pay and opportunities to do a mini-fellowship or begin a full one. Otherwise the curriculum is pretty basic. The intern yr features 5.5 mos of EM, 1 mo of which is in EM; MICU, trauma surg, ob, plastics, and a medicine floor mo. PGY2s get the sickies, and the PGY3 runs the critical side of the ED as a junior attending.

Didactics: Conference days on Wednesday include some simulation, M&M, etc. Lectures are given by faculty members. The M&M we watched was quite lively and the cases were hard as heck and attended by other services.

City: (pasted from above) Boston is a relatively big city with a small town feel. The food is good and there are lots of things to do. However, it is not very diverse racially or ethnically. It is pretty much black and white and mainly white, with a few latinos. It is also cold...

Negatives: Well, maybe the fact that Boston doesn't provide the most diverse patient population...

Overall: This is a fantastic EM program that was an overnight success - I asked Dr. Rosen about it and he attributes it's already kick-butt reputation to the welcoming attitude of Beth Israel, the dedication of the leadership to smoothing things over for their residents, and super strong residents. This would be a wonderful place to train!!!

BIDMC

Residents: 12 residents/yr. Extremely laid-back residents who obviously go out often with each other. Off-service residents are strong, being a Harvard program and all, but there isn’t the Haaavard attitude present at BIDMC (or at least not the ED). No ortho program so get to do all the manipulations. Relations are good with other services and off-service rotations seem to be really good as well. Last resident to leave was >5 yrs ago and he switched specialties. The one faculty I asked about this couldn’t remember any others leaving. There are monthly resident meetings and bi-annual retreats (with lots of fun to be had) where they give feedback about rotations.

Faculty: Faculty are excellent, winning several national teaching awards, and all on a first name basis with residents. PD is Carlo Rosen, with Peter Rosen also being on part-time staff. Very little faculty turnover, with last faculty member leaving three years ago because his wife told him he had to. There are several faculty who wrote books, are editors of books, are editors of large journals, etc. A good type of people to know. Since BIDMC covers like 6 hospitals or something, there are 70+ faculty all with great connections so getting the job you want shouldn’t be too difficult. Of course, they will make calls on your behalf to do what they can for you. Faculty were trained all over the place, so very little inbreeding. PD and chair both do about 8 shifts/mo and chair is apparently really working when he is working a shift. Many of the faculty are on hospital leadership.

Ancillary Staff: Nursing staff are your standard ED nurses.

Curriculum: Three year program plus a guaranteed optional fourth year as junior faculty which gives you a faculty salary (albeit I’m sure much smaller than full faculty) and less shifts with protected research time. 4 out of 11 in graduating class planning to stay on and do this. Standard stuff in rotation with 3 wks ward medicine and average amount of critical care. Plenty of trauma with lots of really sick people. PD mentioned admission rate is 40% with 10% ICU admission rate. This program will definitely prepare you for the sickies, but may be too much sick patients if you want to go practice rural. There are 6 or so hospitals with you doing about 2 months per year away from the mother ship. This at first was a big con to me, but all the residents love this and explain that it gives them the feel of several different types of emergency medicine (rural, community, tertiary, etc). St Luke’s is where they get all of their penetrating trauma. This is also how they can give a guaranteed optional fourth year and absorb 12 new junior faculty members if all 12 decide to do it. You will need a car to get to some programs, with some of them being an hour away and others being ~4 miles away. Trauma’s are split between surgery and EM with EM running trauma and surg doing procedures on even days and vice versa on odd days. This kinda sucks in that you get less experience yourself, but is kinda cool because you get used to doing it the way it is often done in the real-world. 56% go academic with 44% doing community practice. Every US is QA’d by US faculty. Two US machines with every scan being recorded on DVD. Four toxicologists on staff with an inpatient service. The guy who wrote the book on disaster medicine is on staff, who apparently is bigger into the government side of things rather than NGO stuff. Lots of international if this is your thing. A paid-for trip to Florence/Tuscany, Italy in third year is possible for two weeks to teach at a satellite institution training Emergency Physicians. Apparently other places are being set up in Iceland and Russia. There is an International Fellowship here (in addition to Disaster and critical care, with additional sports med and US in works). There is also a Harvard Humanitarian Initiative for Residents thing available where you take a two week course and then get placed somewhere for 4 weeks. I’m not sure if this counts as your elective time, but expect it does. 6 weeks of elective total. Awesome simulation center across street that is jointly used by MGH, but only do simulations every other month. Residents can moonlight third year, with some choosing to do so but unsure of how much. Every patient in ED is run by EM3 before attending, to give them the opportunity to run ED. EM gets all airways. Residents do 19-20 shifts/mo with core shifts being 8 hours (really 9) and periphery shifts being 11 hours (really 12). Interns do more periphery shifts and less core shifts, with more core shifts being added as you progress. EM2s pretty much run the red zone which is where all the really sick people come. In admin month, you spend time in law office reviewing closed-case malpractice suits. 2 wks of ped anesthesia in 3rd yr. EMS directions given to some private ambulance companies, but not for Boston EMS.

Peds: Peds is, in my opinion, the weak point of program. They stick to the month block program, rotating through children’s hospitals and seeing some peds on their outside hospital rotations. Children’s hospital sees sick patients, but problem is that everyone and their mother does a rotation there. Peds blocks are scheduled for different parts of the year, so as to get exposure to seasonal variations. Despite this, residents say that they feel they come out of residency just as prepared, or unprepared, as anyone else. PICU shift present.

Didactics: 5 hours weekly; but not protected for EM2+3. Harwood is text (Carlo Rosen is an editor).

Research: Scholarly project required with research available if interested.

Facilities: Fairly new ED with hard walls between most patients. Department is split into concentric squares with the central square (“the core”) being sick patients who pretty much will be admitted. The outside square includes the red zone, which are trauma and the really sick patients, the “periphery” which is easier/faster/less sick patients, psych, and triage. Psych patients are cleared by ED and then psych takes care of everything. No true fast track.

Charting: Awesome computer system that was created by one of the faculty. It connects with everything and has a great function to follow up on all patients for past 3 months, including if they died or bounced back. It is probably the best EMR I’ve seen. In the ED all orders and actual charting is done on paper. The EMR is more for organization – you put in a few sentences and do all consults, lab results, etc in the EMR.

Location: Boston, MA – you love it or hate it. Most people live in Brookline or Jamaica Plain and walk/bike to work (even in the cold). You can drive to work, but parking is $100/mo. A few people live out in the ‘burbs in houses. Most people rent of course.

Extras: Vacation taken in ED months in 1 week blocks. You must tell chiefs when you want to take vacation a year in advance before rotation schedule is made. Chiefs make schedule a few months at a time and there is no problem switching days. Accreditation status is fine. They will send you to any one conference in third year as well as any conference that you get accepted to present in. Journal club is at sushi restaurant. Every Journal of EM there is a BIDMC case report that you can help write. There are opportunities to teach EMS lectures for $200/lecture. Can practice event medicine as Red Sox physicians! You won’t see as much of the poor population.

Interview: M&M, hour long intro by PD, four interviews 20-30 minutes long all very conversational, lunch, tour.

Albany

Basics: 3 years, 10 residents per year. No floor months – off services are 2w ob/anesthesia, and unit months. CCU sounds a little floor-ish (and you, for some odd reason, cross cover a certain group of private pulm patients). Also do MICU, SICU, PICU (2nd year for that last one).

Shifts: 9 hours – 20 as intern, then 19, then 18. 2nd year about 1/4 of your year is more dedicated to trauma (but in the ED – which I think is great) and you work 12s with a shift reduction. Residents said they usually end up with fewer shifts than listed above.

Peds experience is integrated – one of the sections of the ED is dedicated to peds. They have just hired two peds EM boarded attendings, but otherwise you are precepted by EM attendings for peds. You have one dedicated month in the peds section of the ED and pick up peds patients during your shifts.

The PD is a Pitt grad who worked to build the Maine program before coming to Albany. He seems great –young, friendly, great relationship with the residents. He's very outdoorsy – rock climbs, etc. and it seems like a lot of the residents do too.



UMass

Basics: 3 years, 12 residents, no floor months. Effective use of off-service months (do your anesthesia, intro flight shifts, and u/s all in the same month).


Shifts: 9 hours (?)

Residents: northeast, some from outside region. All I spoke with said it was their first choice. Seem happy – but not the most cohesive group I've met on the trail.

Cost of living – much better than Boston (some do live in Boston, though – some have SOs that matched there)

Overall amazing opportunities and dedication to training. Integrated peds in last two years (I think). Good community experience without a huge commute. Powerful dept in the hospital (as evidenced by brand new ED, dedicated space on floor below it). Good sim training. Something like 5 u/s trained (RDMS!) attendings and 8 toxicologists. Very strong U/S and tox experience. Dedicated flight shifts in 2nd and third year (bulk in third). Volume is somewhere around 80-90K and growing. Supervisory rotation as part of third year (but not the entirety of third year)

PD – dynamic, funny, very involved in recruiting next class of residents. The faculty are about ½ UMass and ½ elsewhere (impressive list from elsewhere)



Boston medical center – "county with resources"

4 years, 12 residents/year. Just converted to 1-4.

Curriculum – first year lots of off service. 2 months ward medicine (which the PD pretty much admitted to me he HAD to do in order to get his 1-4 program), 1 months floor surgery, then lots of more fun stuff (ENT, MICU). One of the stronger departments in the hospital. The ED is theirs – consultants are there at the program's invitation and all turf battles have been long since fought and won. Residents have no assigned role on ob/gyn and ortho. They said it's "You get out what you put in." Probably not an issue for ob/gyn (10 deliveries and out) but ortho seems like it could get tricky. Ortho has to see EVERY fracture in the ED so that they can f/u in clinic – so unless you are aggressive with splinting/reductions I'm guessing you could miss out on a lot of that.

Electives – lots of opportunities but funding is up to you. International opportunities abound if you can save or beg the cash.

Residents: from all over, all said it was their first choice. VERY personable, anxious to share why they LOVE BMC. Shifts are 20 12s PGY2 year (I assume this will apply to PGY1 as well), mix of 8s and 12s PGY3 (but busy – you run trauma this year), and 8s during week/12s on weekends PGY4 year (NO NIGHTS in PGY4). Some of those details could be wrong – I don't pay too much attention to shift length.

Sites – Quincy, Lahey Burlington, the old Boston City Hospital ED (HAC) is the main site, and then HNC (I think) is the old BU Medical Center ED. Volume at HAC is about 130K if I recall correctly. HAC is divided into 2 sections – acute side (chest pain, SOB, trauma) and the less acute side. PGY2s work on both sides, PGY3s run the acute side, and PGY4s run the less acute side. PGY2 you are the "procedure resident" and essentially do all the procedures AND cover your patients – seems like this would be crazy busy and fun!

PD – personable, funny, very unassuming. Seems to genuinely want everyone to find their "happy place" on the trail. Was very very very involved in interview day – which I appreciated. Interviews are 2 faculty (or residents) to 1 interviewee.

Overall: I think this is a fantastic program and I think it will only get stronger now that it's 1-4. I liked the residents.



BIDMC

Format- 3 year (optional jr attending year), 12 residents/yr

Residents: from ALL over (actually seems to be a lack of people from the Northeast), 12/year. All are personable and excited about their program, everyone I spoke with said it was their first choice.

Curriculum – 3 weeks medicine wards, otherwise pretty standard. 6w elective time – including a "teaching" week in Italy if desired. Their u/s and tox programs seem to be works in progress. Just started an EM critical care fellowship. Optional fourth year during which you work ½ time as an attending and can pursue research, further education (MPH, Kennedy school). About 1/3 of the residents take advantage of this.

Faculty – amazing names, lots of research money, faculty are mostly from outside (Hennepin, Denver). Peter Rosen (the textbook author/editor) is part time faculty. PD is Dr. Carlo Rosen. Graduate of Denver, first PD of this 9 year-old program. Seems like a good resident advocate. Residents are getting jobs in competitive job markets.



Advocate Christ Medical Center

Advocate Christ is a medical center in Oak Lawn, IL, a suburb of Chicago. The hospital itself is a big community hospital with many subspecialties. It is a busy (90K, I think) ED. The ED itself has a very busy community feel – lots of patients, some in hallways but with everything running fairly smoothly, good ancillary staff. The program has good ultrasound and tox experience. They do a LOT of EM months for a 3 year program.

The attendings are from all over – many from ACMC (also known as "Christ). The resources at this program are phenomenal. There is lots of funding for conferences, etc. The residents have produced a HUGE number of posters at academic conferences in the last few years. The residents are paid well, many live in Chicago and reverse commute to the suburbs. They are a very happy group – well protected on off-service rotations and treated well during their EM months. Overall I felt like this program is the "hidden gem" of Chicago. Be aware, though, that it's supposed to be tough to get an interview – they only interview 80 candidates per year.



Uof Chicago

Large program (18/yr, 3 years), longstanding and very well-established with a great alum network. The well-known PD (Dr. Howes) will be handing over the reins to Dr. Tupesis (current assistant PD) in July. Howes will be the assistant PD for a year while they find a replacement. UofC Hospital is a peds level 1 trauma center, but adult level 2 due to financial concerns (when they were level 1, they were getting ALL the penetrating trauma and couldn't afford it). I had my interview at Lutheran, so didn't see U of Chicago, but from what I hear it is a busy, urban ED. Residents spend about 10 months at Lutheran General, which is out near O'Hare and is a busy, level I trauma center. They work 1 on 1 with the attendings at Lutheran (as opposed to the graduated responsibility model at U of Chicago) and really seem to like their time there. You also do trauma (I forget how many months) at Mt. Sinai (community hospital located in a knife and gun club neighborhood). UofC as a whole also just affiliated themselves with the hospital at Evaston, Illinois. This is a big, tertiary referral type hospital that used to be affiliated with Northwestern. The hospital is best known (in the EM world) for it's simulation center, so that is one aspect of EM at UofC that will grow overnight.

I did not get a good sense for what tox and ultrasound were like at UofC. Overall I did feel that they made a very good use of time by not having an OB rotation, but instead having you take OB calls to get your deliveries during your EM months intern year. They also combine your anesthesia month with NICU call – so you can get your neonatal resuscitations and procedures and your airways all at once. I think the PD mentioned that they really start preparing interns for flight shifts, so you WILL get the sickest patients early in your EM career rather than being protected from them for the first year, which is pretty status quo for programs.

Chicago has (mandatory, I believe) flight time. When you are the R2, you fly during your shifts in the department as well as see patients. They also do fixed wing transport flights, which are a moonlighting opportunity (you get about 1000). The residents at Chicago are a VERY social bunch. The department sponsors a monthly social event (they get money from the fixed wing flights as well) for residents.

Sorry about the change in font on my last review. I was having computer/internet issues and had to copy and paste from a Word document. Also, sorry for any typos... I'm usually watching TV and enjoying a cold beer while I'm writing these. Anyways... on to Beth Israel Deaconess.

Overview: A 3 year academic program located in Boston, Massachusetts with an optional (but guaranteed) 4th year as a junior attending. There are 4 months of ICU time, 2 months of trauma, 3 months of Peds, and 7 weeks of elective in the third year. The base hospital is BIDMC, and you will be rotating at a total of 7 other sites over the course of your training. There are 12 residents per year.

Residents: I attended to pre-interview social, which was journal club held at a Japanese restaurant. I thought it was a little hard to mingle with this kind of format, but I was able to talk to a few residents during this time. They seemed nice and happy with the program. Afterwards, a few of us applicants and a handful of residents when to a nearby bar for a few more drinks. I was able to meet a few more of the residents but actually spent most of this time talking with the other applicants (some of whom I had known from previous rotations and interviews). During the interview day, I met a good amount of residents (with a good representation of all the years), and they all seemed happy with the program and got along well with each other. Overall a pretty easy-going group.

Interview Day: Started at 8:45am (I love the late starts!) with breakfast and coffee. This was followed by an hour overview of the program by the PD. The applicants were then split into two groups, with one group going on the ED tour and the other doing interviews. There were a total of 3 interviews each about 20 minutes long (PD, associate PD, attending). All were low-stress with questions geared towards things on your application. I really enjoyed my interview with the associate PD. Next was lunch with the residents, tour, then final interview with the head RN, which was an interesting touch. The day was over by 2:30pm.

Faculty: Nationally recognized and from diverse training backgrounds. The PD trained at Denver and the Associate PD trained at Hennepin. Per the residents, the majority of the attendings were good at teaching.

Curriculum: 3 year program with an optional but guaranteed 4th year as a junior attending. Graduated responsibility with you assuming more of an "attending" role by the third year. The specifics of their curriculum can be found on their website. Some highlights include: 3 weeks of floor medicine in first year, 3 weeks plastic surgery, 3 weeks Tox in the second year, 3 weeks EMS/Administration in the third year. Like I said in the Overview, you will be rotating at an additional 7 site throughout your training. The residents reported good experiences on the majority of the off-service rotations and good relationships overall with the other services. International EM seems to be pretty strong here, with involvement in areas such as Russia, Europe, Central and South America, and programs in Italy. Another cool thing about this program is that work shifts at Fenway Park for Boston Red Sox games.

Peds experience seems pretty standard with 3 dedicated Peds EM months (2 of those at Children's Hospital Boston) and a PICU month in third year at Tufts. There may be integrated Peds experiences at the community sites, but I'm not 100% sure about this.

For trauma, ED gets all of the airways and the trauma/EM teams rotate for running the trauma and performing procedures. The thing about trauma in Boston is that there are three level I trauma centers: Boston Med Center, BIDMC, and MGH. So, if you do the math, splitting trauma activations between three sites could mean less trauma here than if you were working at an institution that is the only level I trauma center in town.

During the junior attending year, you work about 22 clinical hours per week and spend your remaining time working on an individual academic/administrative project. This year is geared for those interested in academic emergency medicine and is optional.

Didactics as per required 5 hours a week. This includes monthly grand rounds, simulation sessions, weekly M&M conferences, skills labs, monthly journal clubs, and monthly follow-up conferences. Also, they have daily change-of-shift teaching rounds, which I thought was pretty cool.

Facilities: Like I said, you will be working at a total of 8 different facilities. I'm only going to talk about two of them.

BIDMC is the base hospital. It's teaching hospital for Harvard Medical School and a level I trauma center. The annual census is about 53,000 per year and the patient population here is mostly elderly patients and people with PMDs who come in when they are really sick. I forgot how big the ED is, but it's divided into two sections - the Core, which handles the high-acuity patients, and the Periphery, which deals with less acute patients. I think interns work the majority in the periphery with movement in to the core as you progress in experience. There is a really cool (and efficient) patient tracking system and EMR with consults just a point-and-click away.

Another site were you do some shifts is St. Luke's Hospital. This is where you'll deal with a more urban/inner city patient population and where you'll get most of your exposure to penetrating trauma.

Location: Boston, Massachusetts. Seems like a mid-sized city with a big-city feel. Cost of living is a bit high with most residents renting. The street layout of the city is atrocious, with no sane organization of the streets. I had a rental car with a GPS and still got lost about 10 times. Also, traffic around the medical center was ridiculous when I drove in for my interview. I think most residents use public transportation, but a car is necessary as you'll need to drive to some of your rotation sites. Boston has a lot to offer - sports (Patriots, Celtics, Red Sox, Bruins), bars, restaurants, and close proximity to other northeastern cities. Winters can be cold here, and this year they (along with all of the Northeast) are getting pummeled with snow.

opb's final thoughts: If you're interested in pursuing a career academic EM, then I think this one of the better places you can go to. If you're not sure, then I think this place is still a great place to go to because of the optional 4th year. If you go in academically inclined but change your mind, it's all good because you can finish your 3 years and go to community practice. If you go in unsure and decide to do academics, then you can stay on as a junior attending (with a nice 6-figure income) and gain more academic experience during your extra year. I really loved the 3+1 option... I think it gives you a lot of flexibility. One thing to keep in mind is that this is an academic program... so if you're looking for a hard-core county experience then this is probably not the place for you. Also, with 3 level I trauma centers in Boston, you'll get less experience than if you worked at a place which is the only game in town. That being said, the residents said that they had enough trauma exposure, and that their experience at St. Luke's gave them enough experience with penetrating trauma. Peds experience seems average, but International EM seems really strong here. I liked Boston and think that you'll be entertained here for 3 (or 4) years... granted you don't get lost trying to get to where you're going.

The curriculum is extremely well thought out as designed by Carlo Rosen and Rich Wolfe ( both from Denver) with the help of Peter Rosen (from Rosen's textbook). There is a very well dictated reason for each rotation and for each site that you go to. Downside is that there is a lot of traveling because the home ED is very rich Boston folk who have good healthcare. Although the PD values the County experience the staff there seems to love the cushy Boston feel.

Tons of chances to do research since it has the Harvard name and everyone is publishing

PD and Chair have a west coast feel but the residents seem to be very Bostonian and some were really intense and didn't stop talking about all the research they did.

Peds doesn't sound like a great experience at Boston Children's so they farm you out to another site

Tox affiliations with Boston Children's and Mass Poison Center sounds like a lot of fun

Only 3 yrs with option to stay as a 4th with attending salary although most only do this so they can get an MBA or an MPH.

Trauma is hit or miss and they even have prepackaged trauma sent in from other outside sources that are already worked up but some of the away sites like St. Luke's sound like they get a ton. so you probably get enough after rotating.

If this program were in LA County or NYC it would be one of the best residencies in the country but I feel like the niceties of Boston and always talking about the Harvard affiliate soft it's hardcoreness

This is a couples' match list...if it were just me, my list would likely look pretty different. Some programs would have been higher on the list (especially Cinci), but Vandy definitely would still have been my #1.

I interviewed at 18 programs, and ranked all 18. This ROL is obviously just my (and my fiance's) opinion- no offense to anyone is intended. It was really helpful for me to look through ROLs from past years, so I thought I should reciprocate by posting mine.

I felt so fortunate to get to interview at these programs and honestly thought each of them had notable strengths. The couples match certainly complicates things (and requires LOTS of negotiation) but luckily I feel like I would be happy at a lot of these places.

Let me know if you have any questions about my list or the programs I visited. I'm happy to give my advice/thoughts to next year's applicants too- just message me!

1) Vandy: I am absolutely in love with this program. Love the faculty, love the Chair and PD, love the residents. It's one of the most resident-centric programs I have seen, with the best teaching in the country. Very busy ED with so many critical care patients. Tons of trauma because of huge cachement area; great relationship with trauma surg. Curriculum extremely well thought-out, including no floor months. Residents are very close and are amazing people. Very diverse patient population (tertiary care, uninsured/underinsured, bread and butter EM, peds, immigrants). Nashville is a really fun city, great COL, easy to live right by the hospital. Grads go anywhere in the country they want. This program has everything I want.

2) UCLA-Olive View: Truly amazing PD who has the residents over to his incredible house (and he was the medical director for the show ER- I thought that was pretty cool), and distinguished faculty. Well thought-out integration of county and tertiary care experience. Ronald Reagan is an incredible facility, and Olive View is a nice little hospital that has a new ED opening this April. Program curriculum is "front-heavy" (easier 3rd and 4th years), which I liked. Intern year is getting much better every year- there will be 6 months of EM during intern year 2011-2012 and fewer medicine/surgery ward months. PD described the program as a "liberal arts EM program," which I thought was an apt description and a pretty neat concept. Amazing international opportunities and a lot of elective time. My Spanish is mediocre at best, and that seems pretty essential (especially at Olive View). Trauma not as extensive as at other LA area programs. COL high and lots of commuting in nasty LA traffic.

3) UNC: Residents were very happy and welcoming. I really liked the dual hospital system. I went back to do a second look and shadowed at both hospitals, which only served to increase my enthusiasm about their way of training. Of course, it does result in a lot of commuting but the traffic isn't bad so that didn't bother me. Amazing PD who is an outstanding teacher and very supportive of the residents. Program produces very well-trained EPs who also have satisfying personal lives. I love the location and the COL. Great moonlighting opportunities. Medicine and surgery ward months intern year (but at WakeMed so relatively laid-back). Not as much trauma as some other programs. Duke is obviously nearby so there is some division of patient populations, but I felt that was made up for by the WakeMed experience.

4) Highland: This is a well-known program that I felt lived up to its strong reputation. Faculty and residents are all very laid-back and fun. Strong family feel. A lot of the faculty trained at Highland (which may be a negative), but of course they stayed on faculty because they love it so much there. GI rounds TID seem like a great idea. Not an "official" Level 1 trauma center but there is none in the county, so serves as the de facto trauma center and see a lot of trauma. Not a stroke center, so do a month of neuro at UCSF. Amazing U/S experience. Peds is not integrated (no peds beds in HGH). Highest salary I saw on the trail (because they are unionized). Tahoe ski cabin sounds like fun. Sounds like they have everything worked out in regard to UCSF's EM program, but still made me a tiny tiny bit nervous.

5) BIDMC: The 3+1 (Junior attending year) is an amazing opportunity that I was very excited about. The curriculum is very well thought-out with a clear graduated responsibility. Rotate through 5 "affiliate" hospitals (community sites), which seems like a good experience to see how different systems work. Amazing EMR. Peds not integrated. Trauma pretty good but obviously there are a lot of hospitals (including four Level 1 trauma centers) in Boston. Relatively new program (10ish years) but has established itself extremely well. Had a great feeling about this program on the interview day and it was initially higher on my list; in the end, I decided that Boston is not at all ideal for me and that's what pushed it down the list a bit.

6) LA County: Another program that was initially much higher on my list. I was in awe of this program during the entire interview day. Very sick patients and a lot of trauma, in which EM has a huge role (they do essentially all procedures). EM also manages airways during codes on the floors (which at most other places is done by anesthesia or MICU)- I thought that was cool. Residents were really fun people and amazingly impressive. Work 12s all four years (except on peds). Facilities are amazing but very much divided up into pods. Not as many academic opportunities as a lot of other programs I looked at. This place, in my opinion, provides the best clinical training in the county but wasn't the best fit for my career aspirations and personal life once I got over the "sexiness" of the amazing clinical experience. Location also not ideal for me personally.

7) Wake Forest: I love this place. PD and Chair were both very enthusiastic. Very well-established (30 years old) program with a long history of producing great EPs. Residents were very family-oriented. Very busy ED, which pleasantly surprised me. Loved the city (can get an amazing house for very little money) but it did feel a bit isolated.

8) Emory: So many faculty, and a lot of them are really well known in EM. Increasing focus on research- get a lot of NIH funding. Grady is Grady- tons of trauma (only Level 1 in Atlanta). Hugely busy, exciting ED. Patient population at Grady not very diverse- primarily African American. ED divided into red (surgery/trauma) and blue (medical) pods. Residents were very diverse and most were single. Atlanta is amazing but of course the traffic sucks and it's relatively expensive. I expected to like the program more than I did, but I got a weird vibe on interview day. It was probably just me, though!

9) Indianapolis: LOVED this program but in the end the location just wasn't going to work well. Residents were incredible- really sociable, welcoming, and proud of their program. Outstanding clinical experience, with time split between Wishard (county) and Methodist (tertiary care). Residents have a huge role in their program (49% ownership) which I thought was amazing. Very much a team attitude. In ICUs, work one-on-one with CC-trained EM faculty- so a great experience. Residents were more regional than I had expected for a nationally well-known program.

10) BWH/MGH: Strong academic program. Well-known faculty and lots of research opportunities. Felt like this was a great place to jump-start a career in academics. Lots of elective time. Program grads are highly recruited and go wherever they want after training. From talking to the residents, seems like they do fewer procedures than most other programs I looked at. Also, medicine and surgery ward months. Residents said they felt a bit "looked down on" by other residency programs at the hospitals, for what that's worth. I'm not a fan of Boston.

11) UAB: Their PD is awesome. Very responsive program leadership. The residents are pretty Southern and a lot of them have kids. Great lifestyle. Do LOTS of moonlighting. 10-year old program but feels like it's been around longer (that's a good thing). Birmingham was a very pleasant surprise. Great physical set-up of the ED. Very impressed by the program but realized as interview season progressed that I wanted a place that produces more academicians.

12) Wash U: Very busy ED. Great elective opportunities. Strong off-service rotations, but lots of ward stuff 1st year. Division status (I asked about this and the program leadership said it's not an issue). Didn't really care for St. Louis.

13) Cincinnati: LOVED this program- would have been among my top few programs, but my fiancé really disliked it for his specialty. Oh well.

14) UVA: Very nice program leadership, good reputation. Relatively low volume (although also smaller class so it works out.) Not much trauma. I didn't really click with the residents. City was too small and isolated for me. Great program but not a good fit for me.

15) Michigan: Awesome program. Love the PD. Survival Flight sounds great, as does the trauma experience in Flint. I didn't really click with the residents. The main problem for me was the location. I just don't think I could tolerate those winters- I almost crashed my car about 5 times just while I was up there interviewing.

16) Duke: I thought the PD was incredible and the faculty were very impressive. Residents were nice but seemed pretty guy-dominated. The program seems to be still fighting some battles. Wasn't a good fit for me.

17) Louisville: Had a really weird interview day, in my opinion. I found the group interviews to be awkward. Relatively low volume ED but lots of trauma. Not what I was looking for, but it had a lot to offer.

18) Harbor: This one was a surprise. Very well known program with great pathology and amazing faculty, but not a good fit for me. I personally don't want to have to deal with the transition from 3 to 4 years and the move to a new physical ED. I greatly preferred USC-LAC, but that's obviously just me and it's good that not everyone loves the same program!

1. Brigham/MGH: POS: Two amazing institutions, The Name (Partners) which helps if you want to do something in addition to medicine, faculty, resources, admitting powers, off-service education, true SIM-lab along with true integration into curriculum, fellowship in US (not that i'm interested in doing US fellowship, but having a fellowship makes it more likely that we will get a good ultrasound experience), getting an expanded ED at MGH, impressed with 4th years (they get experience running obs unit and getting presentation from PAs- say what you will about the importance of knowing how to run OBS unit and PAs, but all you need to do is look at the news and realize the possible future of EM), can use propofol, You get bread and butter at both hospitals (albeit, you're more likely to see zebras at these hospitals). NEG: Surgery floor rotation (I don't mind medicine floor), only 4 ICU months (I wish there was one more instead of surgery floor), slightly worried about admission pushback (but ED has admitting powers, so it's okay).
2. BMC: POS: "Boston City Hospital"- so many people have trained there, admitting powers, ED is powerful there, trauma is truly run by ED, largest ED visits in the New England area, largest number of trauma (penetrating) in Boston, sees the most number of patients in the New England area, Boston EMS medical control, great number of fellowships. NEG: Ortho experience is what you make of it, POTENTIALLY a weaker peds experience as it's a Level II peds center, limited propoful use, trauma is run sort of inefficiently (3rd year does tube AND leads the trauma, which is contrary to the principles of leadership)
3. UPenn: POS: this place has everything I want (perfect number of ICU rotations), true integration with trauma, residents can use propofol, admitting powers, great off-service rotations, great airway toys, Pharmacy is in the ED to help with codes (drug calculations) and drug questions. NEG: The number of ED visits they see seems a little low, weaker/building from scratch a SIM lab curriculum.
4. NYP (columbia and cornell): POS: Two great hospitals, best peds experience in NYC (which is tough in NYC), subsidized housing available, resources, admitting powers, can use propofol. NEG: relatively new (that being said, it's made a name for itself). High cost of living in NYC
5. Beth Israel Deaconess Medical Center: POS: Academic, 3+1 option, the name, the residents, the faculty. NEG: lower number of ED visits compared to other programs in Boston, many off-site rotations (which are worth it for this program, but driving can be a hassle)
6. UMass: POS: Great toys, helicopter- TRUE integration of residents and nurses as a team, residents, the BEST facilities of any program on my list, PD is AMAZING, busy level 1 adult/peds, great number of fellowships, ED is very powerful here. NEG: location in Worcester (but that being said, cost of living is great with it still being relatively close to Boston)
7. Brown: POS: Amazing number of fellowships in everything you could want to do in the future, VERY busy with large volumes of patients (second largest in New England), Large sim lab, has access to basic science research (if you're into that thing). NEG: location
8. Northwestern: POS: perfect number of ICU rotations, well known, great facilities, great location in Chicago, gets a lot of trauma from the South side of Chicago (since U. Chicago is not a level I trauma center). NEG: No fellowships, except a research fellowship (I'm worried I won't get a good US experience if there is no US fellowship)

BIDMC

PROS: really clicked with the PD; huge emphasis on graduated responsibility -- pgy1s and pgy2s get to see sick patients while pgy3s "run" the department; love the attitude of "owning" procedures here (apparently a consult is usually only called if a attempts by an EM resident fails); most off service rotations and away sites highly praised by residents; lots of "medically sick" patients since local PCPs filter out the BS; Extremely strong ED leadership; many diverse, yet strong areas of research here and great fellowship opportunities; love the 3+1 curriculum and you can do one of their fellowships or work 20 hrs/wk as a junior attending (while getting paid ~$100k + moonlighting) while doing your own research

CONS: Boston traffic blows and driving +2 months per year to away sites that can be over an hour away depending on traffic doesn't sound fun (though residents say it's worth it); some of the residents were kind of intense; peds is not integrated and residents say its so-so overall (apparently there's competition for patients and procedures at Children's); trauma is so-so

Hey all, I'm a first year at BIDMC and wanted to update this with my experiences so far and also to invite anyone to PM if they have any questions about the program. This was my first choice and I have no doubt it was the right decision.


This is the most well designed program in the US, which comes from having the most experienced leadership in EM. Our program director, Carlo Rosen has been in the position since the start of the program 15 years ago. He came from BWH/MGH with our current Department Chief, Richard Wolfe, who was previously the program director for BWH/MGH and the Denver Program before that. Additionally, Peter Rosen is a regular contributor to educational opportunities at our program.

To get to the details: First years have as much autonomy as they want, get all of the procedures relating to their patient's care, and can end up with the sickest patient in the department if that’s how things unfold. This is appropriately balanced by readily available oversight from both the 3rd year running the department and the team attending. With the other teams' attendings and the other junior/senior residents, there is no shortage of people available to help you deal with any problem in the department. Second years are responsible for responding to all of the triggers and traumas that roll through the door, in addition to moving the department. Once you make it through that, the third years are responsible for running the department; meaning they oversee the interns and juniors (more exposure without the grunt work of putting in orders and writing notes) and gain experience with department flow. The positive feedback that we receive from our rotating sites (including sites that have residents from the other Boston programs) suggests that this structure works well.

It’s not just the structure of the program that works well, but also the structure of the Emergency Department itself. Key to this is the ED Dashboard, designed in house by our ED IT Fellowship, which streamlines sharing of information between the interns/juniors with 3rd years and Attendings but also with the nursing staff, consulting services, and admitting services. Of note, all consult requests are placed electronically through the dashboard and their recommendations are also placed through the dash, which minimizes time waiting for them to call you back at a phone. Furthermore, there is no need to verbally discuss with an admitting medicine team if admitting to floor medicine, all of those exchanges are done electronically. Additionally, all nurses and techs have pagers as well, so you can page them with updates or requests through the dashboard if you cant find them in person.

Location is also a big plus. Boston is, in my opinion, the best city on the east coast. It’s clean, has a great public transit system, a good mix of colleges, and all the food/activities I could want. Massachusetts also has had healthcare reform a bit longer than most of the US, so most people here have PCP’s, which alleviates a large part of the primary care burden on the ED. I went to medical school at a hospital with 100,000+ ED visits a year without a lot of primary care access, and I greatly prefer the 60,000 medically sick individuals that come through our doors each year. There is just more to learn with each patient.

Also, a lot of thought was put into where we do our community rotations, so that we can have exposure to all varieties of socio-economic problems and hospital systems. It amounts to about 2 months a year of travel time, varying from 15 minutes to 1 hour in transit, but it is definitely a positive and gets us more comfortable with any type of system that we will ultimately get a job in.

On the other side of things, we do work a bit. As a first year, we do about 22 8-9 hr shifts a month right now, which will decrease as the year goes on and we become more efficient in the ED. This was definitely a shock coming out of fourth year, but something I’ve gotten used too. That said, I absolutely love everyone who I get to work with, from my fellow residents, attendings, nursing, and ancillary staff.

This is an amazing program where you’ll find the opportunities and support to do whatever you want to do. PM me if you have additional questions about the program, and I look forward to meeting you if you’re interviewing with us over the next few years!

Hi, 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. The post above mentioned 22 x 8-9hr for PGY-1, but I haven't heard much about the PGY-2/3/4 years.
  
  
• Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
  
  
• Is there frequent commuting between hospital sites (outside of 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 help.

1-- I've been out to long to know the exact shift details; PGY2s/3s do a couple less shifts a month than the interns. When I was a 3, we did 12s on the weekends as it got us more days off... not sure if they still do that.

2-- EM residents are allowed to do everything, of course. That said, you have to take turns and play nicely with the surgical residents during trauma activations

3-- The BIDMC residency is built with a couple of "away" months a year, and during those blocks you commute. Obviously commuting is a negative, but the positive is you get a wide range of experiences in EDs from 18k visits a year to around 100k, academic to community, with a wide range of computer/paper charting systems, including dedicated PEDs time, and a wide variety of ICU months. After graduating, I thought the benefits of this system strongly outweighed the negatives. But usually you are "away for the month" (except for conferences) or you are home. Its not a day-to-day variable.

4-- BIDMC has minimal scut. Frankly, about the same amount I have as an attending at a nice community hospital now... I rarely push a patient to CT. If I do, there is a damned good reason. I frequently take vitals, occasional do an EKG or IV, and very frequently get patients drinks. Sometimes the nurses are busier than me; sometimes its good medical care; sometimes its just to make a patient/family happy. I love serial EKGs, so I often get a 2nd one while taking my history. One of the first things I teach med students showing up to an ED is how to put a patient on a monitor, get a set of signs, run a 12-lead, and get an IV in with a bag of saline running. Not rocket science, but handy when you need to pitch in.

Thanks for your input!