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Best EM Residencies?
- Thread starter The Fuzz
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Paying a lot in terms of shift length x shift/month x residency length for that prestige, especially those second two. Agree with your post, but 22 12's a month for four years ain't for erybody.
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22 12s a month???? That would be horrible.
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Most programs would advertise 22 9s, but those 9s really turn into 12s once all is said and done with charting at the end of the shift.
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Arcan's residency selection algorithm (non-couples match addition):
1) Develop awareness of self. You've been in an educational environment for 2 decades and have been successful in that environment. What environments seemed to make learning easier and what environments were detrimental to learning? Make a list of both positive and negative factors, you'll need it later.
2) At every interview, do not leave the day without having collected info for the following 3 variables:
Assess every program you interview at against your list of positive and negative factors. Develop a gestalt for how well the program's learning environment fits your ideal.
Find 2-3 areas of emphasis of the program. Most programs are going to be pretty upfront about what they care about (ie. Cincy - progressive responsibility, leadership, flight, research).
Have at least one negative about each program. Programs generally don't advertise their weaknesses (although your idea of negatives and the program's idea of positives are sometimes the same), so queries like "What would you most want to see improved?" or "Give me a list of things this program sucks at" may be required.
If you don't come away from the interview day with all data elements from step 2 completed, you have failed and should try harder the next time.
3) Sit down in a quite place with some time on your hands
4) Develop your ROL in stages
1) Develop awareness of self. You've been in an educational environment for 2 decades and have been successful in that environment. What environments seemed to make learning easier and what environments were detrimental to learning? Make a list of both positive and negative factors, you'll need it later.
2) At every interview, do not leave the day without having collected info for the following 3 variables:
Assess every program you interview at against your list of positive and negative factors. Develop a gestalt for how well the program's learning environment fits your ideal.
Find 2-3 areas of emphasis of the program. Most programs are going to be pretty upfront about what they care about (ie. Cincy - progressive responsibility, leadership, flight, research).
Have at least one negative about each program. Programs generally don't advertise their weaknesses (although your idea of negatives and the program's idea of positives are sometimes the same), so queries like "What would you most want to see improved?" or "Give me a list of things this program sucks at" may be required.
If you don't come away from the interview day with all data elements from step 2 completed, you have failed and should try harder the next time.
3) Sit down in a quite place with some time on your hands
4) Develop your ROL in stages
- The gestalt "fit" round - this usually separates out your list into 1-3 top choices, a bunch of roughly equivalent middle choices, and a 0-3 "hell no" basement dwellers.
- Take your poorly differentiated list and apply the areas of emphasis filter. This will cause the middle of the group to shake out more as you realize that you really don't care that much about flying or that you've made it your life's work never to do chart abstraction.
- Now apply the negative filter. Everything is fair game in this including: location, length in years, shifts/month, bad caferia food, etc. Now the trick is that you can only move a program down a max of 2 spots based on negatives. Your gestalt matters more than any individual factor. If your manic pixie dream residency is a 4 yr program in the scenic town of Sludgepit then you have to own that. 20 hrs more or less a month clinically sounds absolutely staggering but unless you're a hyperefficient machine (in which case you've already made your ROL algorithm) it's probably going just translate to an extra 40 minutes a day crashed on the couch. Also, if a resident goes down in your class (especially as a senior) then you're sucking up those extra shifts.
- Voila you now have your ROL
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My program does 9hour shifts but only 20 and I'm out pretty quick. I must be lucky
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The wealthiest counties in the US are basically all in VA/MD/NJ.
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I might thr
I might throw gas on this fire, from my experience with new hires in a community setting,, I don't necessarily think County Grads are necessarily the best. There's something to be said about working some shifts in a community hospital, and in general, I'd say the best hires I've seen have some kind of experience outside of their residency training (eg moonlighting or one year at another hospital.). Some county grads, while great with sick patients, struggle with the "softer" stuff of community practice, such as making customers happy (which if you think doesn't matter at your current hospital, it will matter to the hospital that buys out your current hospital) and dealing with vague and soft complaints (eg abd pain, not ttp, here's Bentyl, go home--doesn't fly if you work at a community place.)
The best residency I think is where you fit in, but there's also something to be said for places which let you rotate at a few different campuses, and work with different docs (eg Academic attendings, more community attendings, etc.) And if you aren't planning on doing academics, a place which lets you moonlight trumps all--I'll take a grad who moonlit at City U program any day over an Ivy-League Resident who lived in an Ivory tower with every specialist in medicine a phone call away.
Best is in the eye of the beholder....figure out what you want and do it. If you like research, strong didactics, and wearing your white coat then your best program may be very different from the person who wants to ditch the white coat at graduation, wear cargo pants, run codes and do ED thoracotomies every day. EM is a special breed but there are many divisions in that and residencies that cater to all of them. You'll come out well trained from any of them but to get the most out of it you need to go to the one that approaches it in the way you do.
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deleted547339
I would go further with your statement about moonlighting. I'm doing a CC fellowship after EM residency and I cannot tell you how valuable moonlighting has been, and I'm not just heading straight into a community shop.
I'm in a PGY-3 program. I've learned more in the past 6 months moonlighting than I think I would if I were to stay here for another year an a half were this a PGY1-4 program. I'm discovering my deficiencies and reading more than I did last year.
To my resident colleagues who don't moonlight - I cannot explain how different it is calling an ortho attending at 2AM who is at home asleep than it is to just page the ortho resident who is already awake and running around the hospital. Deciding whether or not to activate the cath lab on a borderline EKG. Deciding when to scan someone's belly with a pretty benign exam (was moonlighting 2d ago had an appy on a young patient with no fever, vomitting, white count and a kinda underwhelming exam - something didn't feel right and I scanned her).
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All good, guess we'll have to agree to disagree.
I'm not saying that moonlighting isn't useful, it is.
I want to add balance to a thread likely being read by med students. In my opinion one should prioritize a quality clinical and educational experience.
I'd tell any EM-bound student to pick the place they think they'll get the best training over a place that happens to have residents who do a lot of moonlighting.
If you've never had a chance to see kids (let alone sick kids) outside of the fancy mega-tertiary peds shop in residency, do you want your first time to be when you're by yourself in the community?
FWIW, I moonlight.
Cyanide, you have no idea what you're talking about. There is no list of best programs that is universal for everyone. I rotated at one of your so called elite programs when I was a 4th year and have colleagues at other programs. Some elite programs can be considered a piss poor residency experience. Also some of the county programs can prepare you for anything that comes your way. The best thing for you to do at this point, is to refrain from speaking-it will make you look much smarter.
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Lol wow!
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I mean, he's right. No one has trained at two programs. Even the most seasoned faculty member has been at what, 3-4 programs? So it's always rich when someone tries to name the best programs. People like lists, and people love creating hierarchies, emergency medicine is no different.
The only tangible benefit to some of these programs are their vast alumni networks, and that's only secondary to the programs' age, which shouldn't be a particularly compelling reason to rank them above other programs. Buick has been making cars for years, and they suck.
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I will point out that there are a number of residents that have trained in two EM programs.
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Yes...
There's a fair amount of truth to the "all EM programs provide adequate training". In addition, the lack of clear benefit to pursuing fellowship for the typical EP means that there's no compelling need to attend a "name" program to improve your chances of matching into a fellowship. This is in contrast to IM or gen surg where a fellowship may have a substantial effect on income and quality of life compared to their non specialized bretheren . This makes lists of "best" residencies significantly less useful in EM.
With that out of the way, some residencies do provide better training than others although intra residency variation makes determining an absolute difference difficult. The problem as I see it is not so much the desire for a list but that the metrics that should go into that list are difficult to obtain. So instead of picking the right metrics we pick the easy ones.
This isn't true. There are 5 level 1 trauma centers in Boston (BMC, BIDMC, BWH, MGH, Tufts). While MedFlight splits traumas evenly through a rotation, Boston Medical Center get the most traumas BY FAR of any hospital in the area. The BMC EM residents run ALL the traumas and do ALL the procedures. Trauma surgery doesn't run any of the traumas. BMC is the safety-net / county hospital and is the affiliate hospital for Boston EMS (HQ attached to BMC). BMC gets about 70% of all the penetrating trauma in the entire city. The other 30% is splint among the other hospitals. BMC is near the most high-crime neighborhoods in the city. Residents also give med control to Boston EMS regardless of which hospital EMS is taking the patient. So if you want a lot of traumas and want to be in Boston, BMC is the best residency for you.
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God hath spoken.
If they are a masochist, they could do a surgical prelim year just to get a ton of procedures under their belt. Betcha didn't think of that, huh?
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