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BIDMC residency q's
- Thread starter champ1999
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I was wondering the same thing? I have heard that they are up and coming? but I kno little else?
I hear great things about this program...but there's not much info on this forum for this program....would love to hear peoples' thoughts...especially with interview season coming up!
thanks!
-emfosho
thanks!
-emfosho
(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🙂
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🙂
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- Attending Physician
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.
*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.
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- Resident [Any Field]
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!
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:
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.
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.
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!
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.
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.
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!
ive heard a lot of people talk about the commuting to many (i heard 5 or 6 months at away sites) sites...in boston weather and boston traffic - i was wondering how bad that is for the current residents?
seems like it would be a huge pain, but i dont know much about the area or commuting there.
any thoughts would be appreciated! the commute seems like one of the biggest drawbacks to what otherwise seems like a great program.
thanks!👍
seems like it would be a huge pain, but i dont know much about the area or commuting there.
any thoughts would be appreciated! the commute seems like one of the biggest drawbacks to what otherwise seems like a great program.
thanks!👍
