Hey guys, I'm almost done with my intern year at UA and am happy to share my thoughts. I love the program - we have great attendings (including some of the national experts on airway management, ultrasound, and pediatric EM), a tight-knit class, very accessible outdoors with tons of trails and nearby mountains to explore, amazing cost-of-living, top-notch ultrasound training, and a high-volume department with good acuity and variety of pathology. It’s a super well-balanced program in an awesome SW setting.
One thing that can be confusing at first is we have 3 programs here. The University Campus residency is the original UA program that has been around since the 80s. We have 16 residents per year in this program. 70% of our EM shifts are at the University Medical center 30% are at South Campus. The South Campus Residency does the reverse – 70% shifts at South Campus and 30% at University. As of this year they have 6 residents per year. Their curriculum has more built in Spanish and rural medicine. The Peds/EM program is a 5 year combined pediatric EM program that is based primarily at the University Campus.
All 3 programs have different residency directors, and they are all awesome. We share the same group of faculty. Curriculums are different between programs. Socially we are one big group. If you are applying in EM, It is worth interviewing at both the University and South Campus programs, as they are both great and similar in many ways, but you may find you fit better in one versus the other.
I’m at the University Campus program so my answers below will be tailored to it.
What are the average number and length of shifts (in hours) per month for each PGY year? Is there enough time to pursue academic/professional/extracurricular interests?
All shifts are 9 hours, you pick up new patients for 7.5 hours and then have 1.5 hours at the end to wrap things up and sign-out. PGY-1s work 20 days per 28 day block; PGY-2s work 19 days per block; PGY-3s work 18 per block. A few of the PGY-3 shifts are “resus captain” shifts where they help with codes, procedures, and teaching, but aren’t the primary doc for patients, meaning little to no charting. Also chief residents work 2 shifts less per block to make time for other responsibilities.
Are shifts stratified by acuity (e.g., “trauma” shift or “resuscitative” shift), or is the entire spectrum of pathology/trauma seen on each shift?
We are not stratified, you pick up whatever you want starting on day 1. This was a big draw for many of us, you get to see a good variety of patients each day and naturally step up to taking sicker patients without prescribed timelines or shifts. Interns typically don’t pick up the sickest patients in their first couple months, but that’s by choice. PGY-3s do have resus shifts as explained above, but their role is helping out other residents, not cherry picking the sickest patients. We have a dedicated pediatric ED and we have several shifts in it per block. We have a really strong pediatrics/EM program and as a result I think we get great peds training.
Does EM still own airway, and take turns with surgery on running trauma?
We definitely own airway. Anesthesia only comes to the ED if called, which is very rare. We have amazing airway faculty like John Sackles, great airway equipment and training. We have the airway on all traumas. As far as traumas go, we take all trauma greens (lower acuity trauma) and run them without any surgery presence (unless we call them). We share all the higher acuity trauma with the trauma surgery service, we are technically supposed to have right-sided procedures, depending on the attendings and trauma teams sometimes you have to be assertive for this to happen. Residents who are confident, ready, and/or have good relationships with the surgery residents seem to get the most procedures.
Who does the emergency procedures (intubations, chest tubes, resuscitative thoracotomies, etc), is it shared with anesthesia/surgery residents based on an alternating schedule?
Intubations are always us. Crics would be us as well. Any chest tubes on non-trauma or non-high acuity trauma pts are ours, we split the trauma tubes with surgery (see above). Surgery would be the team performing thoracotomies unless there were crazy circumstances like multiple thoracotomies happening at the same time.
Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
We are allowed to do any procedure in our scope of practice, but if you perform a thoracotomy it would definitely be in conjunction with surgery – with surgery taking the lead. I remember before residency thinking thoracotomies were a badass procedure that I wanted to master, but now I think I’m a bit more humbled by the responsibility and risk of big surgical procedures. We learn thoracotomies in cadaver lab and I would do one if indications were right, but I sure would want surgery around if possible.
Ortho does our difficult reductions, but those guys are awesome and we have a really good relationship with them, so they will totally supervise you and let you do most reductions if you want. Often they will even ask us to try reductions ourselves before they come in, especially at South Campus.
Is there frequent commuting between off-site locations (not including the dedicated training blocks)?
We do 70% of our EM shifts at the University Campus (academic center, level one trauma center) and 30% at South Campus (more county-style). The campuses are about 15 mins from each other. If you live centrally you can be close to both. We do 3 rotations at the VA, which is about 18 mins drive from the university in the same direction as South Campus. So not a ton of commuting, and to make it even better Tucson doesn’t have much traffic.
How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
We don’t transport pts. RNs do all the vitals. Our scut-work is non-existent on EM months. On off-service rotations like trauma and ortho we do a lot of charting for the team, but not transport or vitals.
I think I remember you don't really work as a single team/pod during shifts - aka may present to different attendings?
Yeah there are 2 attendings on during most hours, you present even rooms to one attending and odd rooms to the other. It’s an easy system, and nice to be able to pick the brains of different attendings if needed.
How the whole waiting for anesthesia/trauma rotation before doing codes actually plays out - is it an issue if you’re one of the people who doesn’t do them till late?
I think this is referring to the fact that as interns you ideally complete your trauma and anesthesia rotations before being in charge of airways on traumas. It’s nice to have both rotations under your belt so that you understand the trauma process and get more airway experience. But if you don’t have them till really late in the year you can still manage trauma airways once you have enough experience to be competent. Honestly though, you will have so many opportunities to go to traumas. If you don’t get to it in the first 6 months it’s no big deal.
As far as codes in general go, you can absolutely run medical codes before doing those rotations. Like anything else, you gradually gain experience, confidence, and more independence with codes and really sick patients– we don’t have a hard set of requirements that determine when you can start running codes. Your classmates and attendings will be around for help, and it is expected to need more support earlier in residency.
What is patient population like?
At the University Campus, it is a mix of your average folks, pts with crazy or severe diseases who see specialists at UA, college kids, snowbirds who come into town to soak up the sun (and have acute medical problems), and trauma/transferred patients. Ethnically the population is mostly white, Latino, and native American, though Tucson does have a refugee population with immigrants from Africa.
The South Campus hospital serves a lower-income area and people who generally have more barriers to accessing the healthcare system, so the ED has a bit more of a county-feel to it. South Campus also sees more border-health – e.g. patients brought in after being out in the desert for days, in border patrol custody, etc. It also has the psychiatric hospital so has a generally has more psych patients. Also more Spanish-speaking patients. Less trauma, but no surgery presence at the traumas.
I used to think that we get less penetrating trauma than many places, but on my trauma rotation we had a steady supply of gun-shot wounds and stabbings. I feel like it’s plenty. We also see some real wild-west stuff – rattlesnake bites, scorpion stings, and cactus trauma.
If you have more questions let me know, I’d be happy to answer.
