Hey Cal2Lane, great questions. Back in 2002, UTSW was #1 on my rank list and I never regretted it. UTSW was awesome! Tons of volume, tons of acuity, tons of autonomy. You bring up some good points....I'll try to address it and throw in some others....
1) Trauma airways. I never knew any trauma airway that wasn't handled by our residency first. But, those Trauma attendings really are constantly breathing down your neck. It's unfortunate, but yes, I have seen anesthesiology intubate trauma airways if we couldn't get them. On the difficult ones, we typically got two attempts. After that....and this always seemed weird to me....anesthesiology would go from there....not the EM attending. But, you know, I saw some of that change my last year there as the faculty they're hiring are new and trying to help bring about change. For what it's worth, though, anesthesiology's need in intubating trauma airways was a rarity. I never had it happen personally and I don't think too many of my classmates had it happen either. BUT, it did happen as rare as it was and you should know about it.
2) EM is still a youngster among IM and Surgery. That has made HUGE strides, though. More progress has been made with IM than Surgery in my opinion. I never had a problem, though, and I don't think most people ever do. On a day-to-day basis you do what's right for the patient and things really do have a tendency to work out.
3) 12-hour shifts turn into 13 hour shifts after sign out. Yeah, this is true. The East ER and West ER are huge places. By nature of the place, sign out does take awhile. Plus, most of us took a lot of pride in making sign-outs easy on the next guy. The compromise, though, was doing a little bit of leg work after your shift to help track down labs/radiology studies/consults/etc.
4) I loved Parkland! Honestly, I never felt like a small fish in a big pond or like the red-headed stepchild of Surgery/IM or anyone else. I'd imagine my experience was like anyone who went somewhere else - you, personally, will gain a reputation based on your clinical acumen and how you interact with others. There is by no means any hand-holding at UTSW. But at the same time, I never felt overwhelmed or abandoned. You learn at your own pace and you get faster at your own pace. Trust me, like everyone here has said about the training process in general, the learning curve is exponential.
I hope you go ahead and rank it #1. I can promise you that you won't regret it. I've been out a little over a year now and Parkland trained me for this so-called "real world" EM! Feel free to PM with any more questions!
And by the way guys, Carolina girls over Texas girls? Whatever!!!!
