Boston University Medical Center Residency Reviews

Review: Boston Medical Center

Residents: 12 residents per year in a PGY 2-4 format. The residents I talked to were very happy with their choice. About 1/3 of them chose to do their prelim year at BMC, which is known as being a very tough year, although they have a new chair and changes will be made. All BMC residents are unionized, providing for some great perks.

Faculty: One of the strongest aspects of this program. All the faculty members I interacted with had a great sense of humor, making each interview a fun experience. They are very enthusiastic about the program and are really into teaching the residents and students.

Facilities/Ancillary staff: The residents spend their time at BMC split between two ED’s (since the merger of Boston Univeristy med center and Boston medical center). Most cardiac issues go to the university hospital (since they have the cath lab, etc.) while trauma and many other complaints go to the HAC ED (part of BMC and the larger of the two ED’s). There are two associated hospitals rounding out the tertiary care and community experiences. The peds ED was recently renovated and is very modernized. The facilities are average for the most part. I can’t remember whether charting was electronic or paper, but my gut tells me paper. Ancillary services are strong, with little scut. You do start your own IV’s as a PGY-2 during traumas, as this is one of your primary roles.

Curriculum: The curriculum is pretty standard for a PGY 2-4 format, focusing on ED months. As an EM-1, you are the procedure person and the medical code person overnight (medicine runs it during the day). You work 12’s (with 4 on and 2 off, then 4 nights on and 2 off). As an EM-2, you run the acute side of the ED working 8 hour shifts during the weekdays and 12 hour shifts over the weekend. EM-3, you run the non-acute side of the ED, and have integrated shifts with peds and community ED’s. There are rarely any overnight shifts.

Trauma: Separate from the main ED. ED runs it and as an EM-1, you are starting IV’s, lines, etc and doing many procedures. EM-2 runs the traumas and airway. There isn’t much trauma exposure as an EM-3.

Peds: 4 dedicated months (including one at Boston’s Children’s) and integrated shifts throughout your EM-3 year. Many of the residents felt their peds exposure was average at best. You will get plenty of bread and butter peds in the peds ED…but many felt they were lacking in seeing really sick kids. There in no PICU month.

U/S is strong, there is a SIM man who quotes Borat, EMS exposure with a fellowship, great international opportunities available, 3 months of elective time. Plenty of off-service months also.

Location: Boston!!! A great city to live in, and a great sports city also (although the driving made me somewhat crazy) This is an expensive place to live, and many of the residents rent in the area by the hospital.

Overall: I liked this program a lot. But for me, the biggest downside is that it is a PGY2-4. Although, you could make it a PGY 1-4, even though the prelim year there is tough. Adequate peds exposure is important to me, so an “average” exposure is not what I’m looking for. Though many residents said they are able to moonlight at Boston children’s, increasing your exposure to sick kids. If I can get over the PGY 2-4, this program would likely be ranked highly.

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!)

Residents: 12 residents taken per year. Excellent camaraderie amongst the residents I met, very laid back. The EM1 is expected to do all the procedures in the department.

Faculty: Majority are graduates of the BMC program. Very laid back for the most part. Diverse interests from public health to prehospital care to international medicine.

Hospital: Main site is Boston Medical Center. It serves a largely indigent population. The ED is several years old but very functional. There are plans to build a new ED, but it won't happen for several more years. Community experience is done at Quincy Medical Center and the Lahey Clinic, both of which see very different groups of patients.

Curriculum: PGY 2-4. The intern year can be at BMC if you want it. Off-service rotations are to the units, anesthesia, and OB in the first year. PGY2 works 12 hour shifts. PGY3 serves as either the acute side senior or the trauma resident and also does a month at Boston Childrens. One month of elective time in PGY3, and 2 in PGY4.

Didactics: Didactics divided on Tuesday and Wednesday. You will get an opportunity to see the didactics on your interview day. Very laid back conference style with a mix of presentations from residents and faculty. Faculty very keen on teaching.

City: Boston...great city in my opinion but not everyone's first choice.

Interview Day: Early start, as with most of these things. If taking public transport, the closest T stop is Andrew, but then you need to take a bus. Hence you really do need a car. In the morning, faculty representing the various divisions will give you a short talk about their particular interest and resident/fellow opportunities. The chiefs then talk about the program structure and life in Boston. Depending on which day you go, you may sit in on their conference. This is followed by lunch and an opportunity to talk to the residents. Five interviews, four of which are double ups and one of which is a pair of residents interviewing. Having said it, it's pretty laid back. The tour follows.

Positives: Very well-developed curriculum. Numerous opportunities including prehospital care and international medicine. Regular participation in events like the Boston Marathon. No overnight shifts as a PG4! Large amount of autonomy as a senior. Boston Medical Center sees the majority of the penetrating trauma in the city, with surgery being consulted only as necessary. Boston EMS has its base medical control from here, and BU runs the only EMS fellowship in Boston. Opportunity to treat a largely indigent population. Excellent ancillary service. Residents are part of a union and so get great perks and salary.

Negatives: The 2-4 format is going to be the big sticking point for some. (Of note, if you get selected for residency here, you automatically can do the PGY1 year at BMC without a second interview if you choose to) Faculty are largely BMC residency graduates, which might be a detractor for some though the residents didn't seem to think this was a problem.

Overall: Excellent program with ample opportunities and backing from the department. Large amount of autonomy and situated in Boston. Format may be off-putting for some.

Overview: former 2-4 program going to 1-4 next year. 12 residents/yr.

BMC is Boston's "safety net" hospital - so this is where you'll see a lot of "pathology unhindered by primary care/prevention." This is also where most of the penetrating trauma will go. BMC does EMS control for all of the city-owned ambulances - so this is the place to go in Boston if you are interested in EMS.

Note: interviews here are 2 faculty members to 1 applicant, which was a bit intimidating at first - but was a nice way to create a conversation.

Curriculum: Newly designed PGY1 year, which sadly still includes ward months since they took away positions from other specialties to move to a 1-4 program. 2 medicine months. The rest of the curriculum is very appealing (http://www.ed.bmc.org/residency/residency-curriculum to see). Spend most of your time at BMC, but also go to the "other" BMC campus (more tertiary care), and several outside hospitals. Do peds at children's (not integrated) and at BMC (also not integrated, I believe, but please don't quote me on that). Community rotations in blue-collar suburb and at Lahey Clinic. PGY2 is the "procedure resident" during their months at BMC, so they get tons of procedures during PGY2. 4 months of total ICU time (CCU x2, MICU, SICU/trauma), 4 months of electives.

Neighborhood: border of Boston's knife and gun club and some nicer parts, but most of the patients are from the poorer areas.

Facilities: city hospital with more resources than many, but ED is still crowded and chaotic. 4 trauma rooms, in dept. scanner. Have an acute side and a less acute (but NOT fast track) side. Expanding the ED by 8 rooms/beds by next fall.

Residents: really come from all over, good mix of single/married. Very friendly, all I met (and they were at conference, lunch, and drinks the night after) were VERY happy with BMC. They were some of the nicest, most genuine residents I met on the trail.

Overall: Fantastic program, PD is very engaging and genuine. Loved the "city hospital with resources" idea. Loved the new intern year (if only they could get rid of those last 2 medicine months). Wish they had more elective time and more ICU time. Finished the day with a great impression of the program, but without the requisite warm fuzzy feeling that I want in a program at the top of my list. One of my interviewers was oddly confrontational about one of my away rotations (a place I loved) so that may have affected how I felt.

I had a quick question for anyone who has interviewed at BMC (or is a resident there), and particularly to the person who just submitted an anonymous review about it. Did you get the impression that it was a 'knife and gun club' so to speak, along the lines of USC, Jacobi, Cook County, etc., or did it have more of a private/academic feel? I know that it's the underserved/public hospital in Boston, particularly compared to the other programs around, but I was concerned that since it IS Boston, it would still not have all that much great pathology, or at least not as much as some of the famous/infamous programs out there. Would you call this a "hardcore" program?

Please post or PM me (if you wish to remain anonymous), and I can post your answer on this thread.

Thanks!

Q

This was emailed to me, so i'm keeping it anonymous:

As far as it being a "knife and gun club" - it borders the tougher parts of Boston (Dorchester/Roxbury) so it gets that part of Boston. It's definitely much less "county" than a place like Cook County/LAC. I'd put it more on par with U of Chicago (but with higher volume). It probably doesn't have quite the tertiary referral base that places like BIDMC, MGH/BWH have - but I think it has the best variety of any Boston program. It's still a referral facility with tons of subspecialists, and with Boston being the medical "mecca" that it is - there is tons of pathology to go around.
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Any other thoughts/ opinions?

Interviewed at BMC - "Boston City" way back when, two years ago, but also worked as a medic in the surrounding areas for 12 years before med school.

No comparison to places like USC-LAC - when I rotated there, got to see seven shootings - all unrelated, two thoracotomies, in the same shift. And that's not an atypical day there.

BMC will get the brunt of the penetrating trauma, but since there are so many Level I trauma centers within spitting distance of each other, exposure gets diluted amongst all of them.

Boston Medical Center

Overview
In my opinion, it's the best program in the Boston area. It gets, by far, the most trauma (70% of all Boston trauma), and serves the underserved/poor population that is the closest to 'county' in the region. With the move to being a 1-4 and a fantastic 1st year planned, plus 5 electives, great research, ancillary staff, and social work resources, this is overall an excellent program. That being said, if you're looking for a VERY intense exprience, be advised that this program is not in the same league as Cook County, USC, Jacobi, etc., in terms of acuity and chaos - but if you're okay with that (don't need to be in a perpetual war zone), then this is a fantastic program, and definitely one of the best in the Northeast. Happy residents, though some of the 2nd and 3rd years seemed tired - but then again, this IS residency.

Curriculum
Very well-rounded, well-planned program. The details of the curriculum are on their website. The highlights inculde 5 months of electives (can be used for ANYTHING), a very off-service heavy 1st year, and well-defined roles for your 2nd-4th years. PGY2 is the 'procedure' resident, while PGY3s run the show on the acute and trauma sides, while PGY4s function as the non-acute chief and have more time for research and electives. The schedule is 12hr shifts, 4 days on - 2 days off - 4 nights on - 2 days off. PGY3s do 8hr shifts weekdays and 12hrs weekends, and PGY4s have a very chill year - no overnights! Residents mentioned that their orthopedics knowledge and peds experiences were a little weak (no NICU or PICU rotation), but these can be supplemented during elective months.

Negatives?
Some things I noticed while shadowing:
- There's a discrepancy in what we're told in terms of how trauma is run. They claim that the EM residents run the show, but several of the attendings (including one who worked at a big county) said this really wasn't the case entirely, and that while residents do a lot, surgery is still very involved. The 3rd year residents I asked had all done approx 20-30 chest tubes by the end of their 3rd year... take that for what you will.
- Peds is weak, and while i've previously read that you can moonlight at Boston Children's, this doesn't seem to be true
- Only 3 US machines between the two EDs, and they don't use them very much for FAST exams because "the CT is right there, it's easy just to get one". Supposedly US is strong, but I didn't see much evidence of that
- How acute is their acute side? As I said before, it's not Cook/USC/Downstate, but not everyone needs that level of insanity. Shadowing is a good idea to get a feel for what they see.

Benefits
Residents get paid more than any other program in Boston. PGY1s this year make approx $52,500 and it goes up by around $2,000 each year. Chiefs get the salary of a PGY5. Lots of study/work space, $70/month parking, meal tickets on call. $600 per year for educational expenses is added to your salary so you can spend it on any books, programs, etc., that you deem important. 1 month of vacation each year, and you can schedule it however you want.

Location
Boston! Take it or leave it. It's not NYC or LA, but then you might hate NYC or LA. It's cold, but not the coldest. Great skiing/hiking nearby, lots of great restaurants, cafes, etc., all around. About half of the residents live within walking distance in the South End, while the others (especially those with families) live in Cambridge, JP, or Back Bay. Most rent (1br apt - $1200+) but a few have bought houses. A good mix of single/married/married w/kids, and definitely less family-heavy than other programs i've seen.

BMC

Residents: 12 residents/yr. The residents get along well with each other and appear to be relaxed and enjoying the place. Everyone I talked to had ranked BMC first. Espirit de corps was ranked extremely high by one resident. Another resident mentioned her class gets together on the last day of every month. Residents are looked upon favorably by other services with other services all being strong, but not the dominate forces present at MGH. 70% of all admissions come through the ED here, so the EM Dept has lots of clout with administration. 50/50% do academics/community with a few doing fellowships. Several people have come right out of residency and found jobs in Bay area and New Zealand.

Faculty: Faculty were all extremely nice, laid back, and on first name basis with all residents. Per residents, ED teaching is good varying widely depending on the attending. PD is extremely fun and nice. Little faculty turnover with one attending mentioning that faculty come there to stay. He said the only reasons people really leave is if their spouse makes them or they are moving higher up on the food chain. Varied training amongst faculty so not too much in-breeding. Not sure where alumni mostly end up. Not sure if PD will make calls on your behalf, but having seen personality I have no doubt he would do everything he could for you. PD works >2 shifts/wk and Chief works 1 shift/wk. Annual faculty vs resident sporting events.

Ancillary Staff: Nursing staff is good to excellent, with most being the typical ED nurse who has been there a while. You have to earn their respect, and with it you gradually are treated better. With that being said, apparently they do spoil you and usually have labs drawn before you see the patient. There was several mentions in passing of having to line patients yourself, but forgot to ask specifically what they meant considering they also kept referring to the nursing staff having already drawn labs.

Curriculum: Four year program with the usual stuff. Not to heavy on critical care and two ward medicine months plus a ward surgery month. Ortho is what you make of it, with residents saying that if you didn’t want to go nobody would probably miss you. ED sees a ton of patients, but rarely sees boarding due to how fast people are shipped upstairs. EP’s have admitting privileges, just calling the medicine service and telling them the patient needs to be admitted. ED covers a large area and serves both as tertiary care as well as being the main county hospital for Boston. They see lots of the indigent population with questionable pre-hospital triaging – some said there was none while some noted that certain OB or ENT things would go to specialty hospitals. Regardless of this, there is no certain “stroke hospital” or “MI hospital”, etc, in Boston. As of next year, there will be a “no diversion” law that will keep all hospital EDs open, but this is expected not to affect BMC as much as the other hospitals. International is really big here with most residents having gone on at least one international trip during residency. I forgot to ask if a fellowship was starting up. Most trips are funded by self, but there is one trip that you can get help with I think. Lots of elective time to go do trips as well as opportunity to do MPH during residency through BU, but no one has ever done it. US seems to be really big here with one of the original guru’s heading it up. I didn’t see the actual machines. Feedback is given once a week on your US month, where you are given the opportunity to scan people with an attending there. The US guy said he has a giant database of scans on his computer, but I did not ask if he records all scans and gives feedback. Boston EMS is run out of BMC with the residents giving medical direction for entire Boston EMS – even if they are going to a different hospital. No flying on helicopter except on elective. Helicopter doesn’t fly too much since ground transport time is so short, but BMC is only hospital to have ground helipad and thus receives all flights on windy days. On regular days it rotates hospitals. Simulation center is less than stellar, with one manikin (not high-fidelity) and only 3-4 simulations per year. New sim center is in process of being made, so apparently this is recognized as a weakness and is trying to be improved on. Residents can moonlight beginning during third year, but few do until fourth year. All moonlighting must be approved by hospital. Every resident is required to do a research project. Very active public health program that seems to be a passion of some of the staff. ED is set up with an acute side and a non-acute side. Third year runs the acute side (the Acute Side Senior or A.S.S.) where all patients are reported to the senior and the senior reports to the attending. Fourth year runs the non-acute side. There is only one resident of each year (of EM) in the ED at a time and when trauma comes they meet in the trauma bay which is between the two sides. In Traumas, EM1 gets line, EM2 gets procedures, EM3 does airway, and EM4 supervises/teaches. All traumas are run completely by EM with Trauma Surg only being called if needed. Residents don’t rotate in Urgent Care. Off service rotations seem to be good and useful with average amount of scut for an intern. Lots of elective time without restrictions.

Peds: Peds is based in month shifts through first three years and integrated in fourth year. When asked about whether this affected their training, one of the chiefs said she didn’t think so. PICU was discontinued in the past because most people were complaining they did little but calculate calories, vent settings, etc. Most of peds is done at Boston Children’s which is said to be an amazing experience.

Didactics: Weekly; protected time. 5 hours every Tuesday and then another 4 hours every 2nd and 4th Wednesday. Can’t remember what they read of what their curriculum is. They have a strong first time board pass rate with all residents passing the boards, but can’t remember what percentage.

Research: Research project mandatory.

Facilities: Trauma bay and rest of ED is standard with no real bells or whistles – just your regular county ED. A new “pushout” project is underway with the ED expanding. 2 CT scanners. Radiology reading rooms close by. I didn’t see any of the other EDs that you rotate at, just the HAC (main ED).

Charting: Charts, orders, labs, and rads all on computer but unfortunately not all on one system. Residents say they can chart at home, and sometimes do this.

Location: It’s Boston. Most people live somewhat close by in South End or Jamaica Plains. Some own, but most rent apartment/triple decker flat. One guy lives out in Milton b/c he has family and he wanted to buy a place with yard, trees, etc.

Extras: Vacation must be taken in 2 week blocks. Chiefs make the schedule a year in advance, so you will know at the beginning of the year if you will work X day. Your vacation is scheduled in the same way with you choosing your favorite choices of where to put it, but not necessarily being guaranteed that spot. Trading days is easy with other residents and has never been a problem. PGY2 is designated procedure resident and does all procedures for the whole ED. Can work Boston marathon. EM2 Schedule: 12 shifts with 4 days on, 2 days off, 4 nights on, 2 off at HAC; at E Newton it is 8-12 hr shifts. EM3: 8 hr days and 12 hr w/e’s. EM4: all 8 hr shifts with no nights. True month long blocks. Accreditation status is fine and the 3 residents who have left program in past left for legitimate reasons (i.e. didn’t transfer programs). Administrative training as an elective.

Interview: Breakfast provided. Talk with PD followed by “human slideshow” where people from different division of EM come and talk about tox, EMS, etc. Sit in for two lectures followed by lunch. Tour and 5 15-minute interviews with two interviewers per interview. PD is in one and another is 2 residents. Interviews conversational in nature.

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.

Overview: A 4 year program located in Boston, Massachusetts. This is a high-volume place which takes care of a largely county-type patient population. There are 4 months of ICU time, 1 month of general/trauma surgery, 4 months of Peds EM, and 5 months of total elective time. Graduate responsibility. In-house fellowships in US and EMS. This program also seems pretty strong in International Medicine and Public Health. There are 12 residents per year.

Residents: I couldn't attend the social event as it was after my interview day and I had to drive to my next interview. The residents I met during the interview day were all very nice and easy to talk to. I remember that a lot of them came up to our interview group during a break in their conference and started talking with us and stuff. I thought that was pretty cool and telling of how nice the residents are. They all seem to get along well with each other and definitely a group of people I would enjoy working with.

Interview Day: The day began at around 7:00am with breakfast and coffee. This was followed by a program overview by the PD and a "human slide show" which basically was faculty talking about different aspects of the program (i.e. research, EMS, international, etc.). Next we sat in on a part of their conference (for 2 hours... kinda painful but informative). This was followed by lunch with some of the residents. Then the applicants were split into to groups, with one half touring and the other half interviewing. There were 4 interview sessions, each with 2 interviewers per applicant. All very low-stress, conversational.

Faculty: I really liked the PD and associate PD. They were both very friendly, witty, and easy to talk to... definitely people I wouldn't mind working for. The other faculty I met were equally friendly. Residents said that the faculty were very supportive and were open to their comments/suggestions. Broad area of expertise here with experience in ultrasound, EMS, toxicology, and research. Most of the attendings are from BMC/Boston City Hospital with a few from other places (i.e. Denver, Northwestern, Jacobi, NYU, etc.).

Curriculum: Recently converted to a 4 year program. First year is off-service heavy, second year you are the "procedure resident". Graduated responsibility. Specifics can be found on their website.

Some highlights:
- 1 month floor medicine
- 4 months of critical care experience - MICU, CCU x2, SICU
- ENT/Ophtho rotation and EMS/Ortho as well
- 5 months of elective time
- 4 months Peds ED experience (1 month each year)

Graduated responsibility. PGY2 year is the "procedure resident" meaning that all of the procedures in the department belong to you. Seems like this will put your multi-tasking skills to the ultimate test as you are balancing your own patients with performing procedures in the department. PGY3 and PGY4 years more supervisory with you running resuscitations, running traumas, staffing patients, handling department flow, etc.

Trauma experience seems pretty strong with the majority of it coming during your ED months. The department is the domain of EM, so trauma surgery is called at the department's discretion (at least this is what was told to me). Also, BMC sees more trauma compared with the other Level I centers in Boston (BIDMC, MGH/BWH) and more penetrating trauma as well.

Peds experience seems average with one month of Peds EM per year. Not sure if the community site has integrated Peds in their shifts.

International medicine seems pretty strong here with sites including Haiti, Guatemala, Ethiopia, and India. However, it seems that you would be going on these trips on your own dime.

Didactics as per required 5 hours a week. Protected time while in the department. Standard stuff with lectures (attendings and residents), case discussions, simulation sessions, procedure labs, etc.

Shifts are 12 hours during PGY1 and PGY 2 years, 8 hour weekdays and 12 hour weekends during PGY3, and mostly 8 hours shifts with rare overnights as a PGY4.

Facilities: Boston Medical Center's ED definitely had a county feel to it. Not sure of how many beds but it seemed pretty large. They see over 100,000 patients per year at BMC, with the majority being your typical county patient (urban/inner city).

Other rotation sites include Quincy Medical Center, Lahey Clinic Med Center, and Children's Hospital Boston.

Location: Boston, Massachusetts. See my review on BIDMC regarding the city of Boston.

opb's final thoughts: Overall very impressed with BMC. This is definitely a county-type program, so keep that in mind. Being the procedure resident as an second year seems to have both positives and negatives - positive in that you'll become very adept at a lot of procedures during your second year, negative in that it might get a little cumbersome having to carry your own patients while also performing procedures throughout the ED. If anything this will allow you to hone your multitasking skills. Five months of electives would allow you plenty of opportunity to explore other areas of interest. Peds experience seems average so that would be something to think about if you're looking for a program with very strong peds exposure. And, as with any other program, location may or may not affect your decision. Overall, I think this is a very strong program that will train you well.

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)

tumble said:

propofol

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You mention propofol a lot. Is this an issue? Where I trained, which is a no-name, it wasn't.

tkim said:

You mention propofol a lot. Is this an issue? Where I trained, which is a no-name, it wasn't.

Click to expand...

This probably shouldn't go here since this is a Review about BMC and maybe the Admin can move this to a separate topic. Nonetheless, I used "whether or not the ED can use propofol" as a surrogate of how strong EM is in the hospital. In a hospital where it can't use propofol, it's usually/probably because of politics or anesthesia. Emergency medicine physicians, not Anesthesia or "politics", should be dictating what EM can do and can't do in the EM speciality.

http://forums.studentdoctor.net/showthread.php?t=790113

When CMS came out with guidelines in 2/5/2010, it sent off a storm because it pretty much would have made it impossible for EM to give propofol due to the restrictions.
http://www.epmonthly.com/features/c...d-deep-sedation-a-win-for-emergency-medicine/
Fortunately, after ACEP, AAEM and ENA negotiated with CMS, CMS issued add-on rulings to clarify EM as a specialty uniquely situated in handling emergency airways and sedation drugs. We all need to remember as EM physicians to participate in hospital administration and to make sure that we have a seat at the political table.

I loved BMC and thought the residents were super friendly. It felt like a true "county" program with resources that help your patients really get connected into the system.

Hi, since it's been about 4 years since the last review, can someone familiar with the program (preferably a resident or recent grad) give an update? Specifically on the following:

• Is the average number and length of shifts per month still 20x12h for PGY-1&2, 12h shifts for PGY-3, and 8h shifts for PGY-4? Can someone give a more detailed breakdown for the PGY-3/4 years? Is there enough time to pursue academic/professional/extracurricular interests?
  
  
• Based on posts above, there is an acute and non-acute side. Is this still true? 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?
  
  
• Based on the posts above, EM runs the trauma and only calls surgery as necessary. Is this still true? Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
  
  
• Is there frequent commuting between site locations outside of the dedicated training blocks?
  
  
• Is there an EMR? Is it Epic quality or a horrendous excuse for a computer program? Is there still paper charting?
  
  
• 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?

Thanks for your time and help!

Can anyone who has interviewed or is a resident comment on shift schedule? What is it in PGY1-4? Thank you so much!

Current resident chiming in with updates:

Avg shifts: 20ish x8h (except 12h on weekends so we can get every other weekend off). We definitely have time for other interests with most residents doing research, intramural sports, teaching, etc.
Clinical: We mostly work on the two more acute sides. There is a fast-track staffed by NP's, two less acute sides that we rotate through as 4's, and then the two acute sides. Graded responsibility with PGY2 a resuscitation year (awesome, all the cool procedures, all the sick medical pt's), PGY3 a mix of running a side (20-35 pt's with intern(s), PGY2, students) and then trauma shifts. We see high acuity on every shift and regularly send people to ICU that were triaged to hallway!
Trauma: EM run! We call surgery as needed, which includes procedural cases. We get dibs on all procedures except thoracotomy where surgery takes lead. We do all intubations unless we call for cric team.
Outside sites: We do rotate to multiple other sites, usually 1-2 months/year. Includes Good Samaritan in Brockton MA, Lahey clinic in Burlington, St Elizabeth's in Boston, and Children's. It's nice to see a mix of settings, different acuity and patient populations (ie Lahey is more high maintenance, medically complex suburban). Many residents have cars, others borrow or rent just for that month.
EMR: is Epic, pretty good. Only paper comes out when system is rebooting.
Scut: Overall minimal. Non-EM months have longer hours, some notes, orders but I've never had to transport my own pt. Nurses are ED nurses and from Boston, so can be edgy but are also awesome and helpful clinically.
Environment: Solidly family friendly. It's Boston, so expensive but many residents have families. Over half of residents right now are women, along with about half of faculty. The young single folks go out dancing and then we all go to brunch together...

Overall I absolutely love this program. We get to see a very sick, underserved population. Plenty of trauma, most of the penetrating injuries in Boston. Lots of medically sick with social complications as well (IVDU, homelessness, international/refugee). That said it feels very friendly and warm as a resident. First name basis with every attending and many will invite you to their house or out for drinks after shift. Hospital and residency are very focused on social determinants, underserved care, with amazing programs for substance use, food bank, etc. (Look up Thea James who is one of our attendings and now vice president for mission at the hospital.) EM is a strong program, clout in hospital, GME, etc and we are very well-respected with consultants and off-service. Boston is expensive but a great city for young people.

We don't spend lots of time on SDN anymore, but find us on website or Twitter if you have questions (or just come visit!)

Recently interviewed here, here's what I thought/found:

Boston Medical Center: 4 year de facto county program. No EM-CCM faculty but recent matches to Mass Gen for CCM. Weak ortho experience due to strong ortho surgery program. Very strong trauma experience (run the show, all procedures except thoracotomies although im sure you can advocate for it!). HUUUUGE emphasis on social EM (harm reduction, pipeline program, food pantry, global health, etc.). Ultrasound is decent no TEE. Boston seems cool, expensive. Opportunities for teaching and medical education. Apparently nursing-physician relations are meh and volatile, but they’re working on improving it. Moonlight as PGY4.