dwgs

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Hi all,

Figured it would be useful to give everyone a "heads up"about these two programs having recently interviewed at both.

York- Wow. Nice, nice program. PD is INCREDIBLE and TOTOALLY devoted to resident welfare. Interview day begins early with a 1.5 h informal lecture about the basic program stats- chock full in information and not at all boring. Brief interviews with 3 attendings and one resident. Painless questions, ie no clinical questioning. Hotel is great and paid for by the program. Also, dinner the night before is GREAT. Nice Italian place and TONS of residents/spouses/children showed up for the festivities. Plan to rank EXTREMELY high, if not #1.

Christiana- Gorgeous facility. Very impressive ED. Attendings are friendly, but did experience some "awkward silences" during interviews. There is no introduction to the program. Day begins with 1 hour conference (5 days/week), then on to a series of five 30 minute interviews with no breaks in between. Felt quite tired by the end. Day ends with a quick catered lunch in the department and tour. Done by 2 pm. Need to do your research beforehand as there was no introduction lecture to fill you in on all the "vital statistics." All in all, a solid program.

Happy to take any questions.

Dwgs
 

SolidGold

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Christiana Care

Residents: 12 per class plus 3 EM/IM. All seemed very happy with their training and all of the ones I spoke with had this program ranked #1. Residents got along well and the ones I met seemed pretty laid back. Happiness factor was high.

Faculty: We did not get to meet the PD, which is a first. Residents praised the faculty and their ability to teach. The atmosphere seemed to be very supportive of resident education. Despite it being a community program, Christiana has had residency programs for a long time so they are very accustomed to teaching and making that a priority.

Facilities: Very nice facilities. The hospital itself is beautiful. The ED was top notch will all the bells and whistles that a modern ED should have. They added a new addition to the complex that houses an amazing conference area that the program is planning on utilizing for their teaching. It also houses the new ICU’s, which are top notch. Rotations are also done at the hospital in Wilmington and AI Dupont for peds related stuff, both of which I did not see.

Curriculum: Critical care emphasis with a NICU and PICU months, one month of ward medicine but they have a night float system.

Patient population: They apparently treat sick patients and do get a good amount of trauma but I’m not sure how diverse the population is at Christiana. The Wilmington hospital apparently gets more of the inner city crowd and slightly more trauma.

Location: Newark is a small town and it seemed to be a slight negative for me. Some residents live in Philly since it is about 30 minutes away. What’s nice is that it is close to many big cities like NYC, Baltimore, DC, Atlantic City, and of course Philadelphia. I would probably look into living in Philly if I ended up here.

Overall: I was impressed by Chrisitana. The have a lot of money, the residents get paid well compared to most places, and the program was impressive. They have a good reputation around the nation, more research going on than I originally expected, and just an absolutely beautiful physical plant. It has everything I’m looking for in a program and I will be considering this place highly.
 

Sweet Tea

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Heh, once again SolidGold and I have different opinions of the residents. The residents at Christiana were happy, but they didn't seem to really be a cohesive group; I think they were happy because they had plenty of time to be wrapped up in their own lives and didn't have to rely on each other for company. They seemed to be making small talk with each other as much as with the applicants. But different places are good for different people; clearly, SolidGold and I are looking for different things in co-workers. Which is fine, and really is rather the point of interviewing.
 
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SolidGold

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Heh, once again SolidGold and I have different opinions of the residents. The residents at Christiana were happy, but they didn't seem to really be a cohesive group; I think they were happy because they had plenty of time to be wrapped up in their own lives and didn't have to rely on each other for company. They seemed to be making small talk with each other as much as with the applicants. But different places are good for different people; clearly, SolidGold and I are looking for different things in co-workers. Which is fine, and really is rather the point of interviewing.

I did notice this too, about them making small talk with each other like they haven't seen each other in a while. When I asked, it turned out they were mostly interns doing the small talk and didn't see each other in a few weeks because they were on off service rotations.

Regarding UMass, I interviewed on the day they had conference which started early, and my opinions of them came after conference was over when they met us for lunch. Their body language could have just been that they were tired from sitting through 5 hours of lectures.

So we might have just caught them at good/bad times. This is frustrating to me because it can be hard to really get a good feel during just an interview day.

Christiana did not have a pre-interview dinner, and that's been a good way for me to get a feel of other programs.

I couldn't make the UMass one, so if anyone did go, maybe you can share your experience hanging with the residents over food and beer.
 

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Residents: Hard to really say unfortunately. This was one of the few programs that did not have a gathering with the residents the night before the interview. We got to see a few of the residents at their morning conference, but didn't get a chance to interact with them much there. At lunch there were a good number of residents, and they all seemed friendly, but again there wasn't much time to really get a good sense of their personality/comraderie/etc. I'm not sure why there wasn't more opportunity for resident interaction, and as a result this is the biggest concern I have with this program.

Shifts: Fewer hours than most programs. They work 9 hour shifts (12's on the weekends), with a built-in 1 hour overlap to allow for signout and tying up loose-ends. Each year you do one month of nights (4 weeks of M-F 11p-7a) and as a result only have 1 or 2 night shifts on your regular ED months. The average hours per week was around 40 for PGY1, ~50 for PGY2, and ~40 of PGY3.

Facilities: Split time between two hospitals that are about 10 miles from one another.
-2/3 of your time is spent at Christiana's main private hospital in Newark, where the ED volume is around 100,000. The Newark hospital is very nice -- brand new critical care tower with awesome ICUs, a nice new library, and new classroom/office space. The ED itself is one of the nicer and larger I've seen, with spacious rooms, in-house radiology, and some technological perks (for example 6 Titan US machines, and an infrared tracking system so you always know exactly where your attending, patients, and equipment are). I believe they use paper charting but I don't recall for certain.
-1/3 of your time is spent in Wilmington which is a typical inner-city type of hospital. There was no tour of this ED, but the residents seemed to like it.

Peds: Pretty good peds exposure. The Newark ED has a decent peds volume, so peds is integrated into all of your ED months there. One month of PGY1 is spent at a children's hospital doing exclusively Pedi EM, and then as a PGY2/3 you have shifts mixed in at that site during your regular ED months. As a PGY2 you do a month of PICU and a month of NICU. I was initially skeptical about the NICU month, but apparently your main role that month is to respond to the complicated deliveries and neonatal resuscitations -- I think it provides a good chance to develop your resuscitation and procedure skills on a population that many programs don't prepare you well for. No Pedi EM fellowship.

EMS: Better than average. The PD here is the past president of the NAEMSP, and pretty much all EMS activity for the state of Delaware is centered at Christiana. EMS fellowship available. One month spent doing an EMS rotation.

US: Strong. There are several programs out there that are at the forefront of US training, and Christiana seems to be one of them. They have an US fellowship, and are fairly prolific academically in terms of US. As mentioned earlier, they have 6 nice US machines in their ED.

Trauma: EM runs the traumas and is responsible for airway. Tons of blunt trauma due to the proximity to I-95, and adequate penetrating trauma (especially at Wilmington).

Faculty: Interviewers were a mix of exuberant, friendly folks, and quiet, somewhat awkward folks. The PD falls more into the latter group, but residents seemed to like him. Similar to my experience with the residents, I didn't really leave Christiana feeling like I had a good grasp of what the people were like.

Curriculum: The big selling point of the program, in my opinion. The schedule has a strong EM-slant, with very few off-service rotations most of which are critical care. The off-service rotations that they do have seem optimized toward what an EM resident wants to learn -- for example, on the NICU month you mainly do resuscitations, on the OB-Gyn month you work 8-5 and just do deliveries and OB/Gyn acute care, and they have a "tube-n-lube" month where you spend the morning on anesthesiology doing all their intubations then spend the afternoon doing ultrasound in the ED. There are 3 months of elective, which I find to be awesome considering this is a 3-year program. There is an EM orientation month, a "subspecialty EM" month, an EMS month, and an EM Administration month. The didactics here are supposedly quite strong, with ~8 hours a week dedicated to conferences and teaching.

Patient Population:
A nice mix between the two hospitals. The main Christiana ED is a referral center and Level I trauma center for pretty much all of Delaware, and some of MD/PA/NJ. The Wilmington ED sees more of an inner-city patient population.

Location: Not a big selling point of the program. Delaware is about the most boring place I could imagine living. That said, Newark is a college town and might have some fun things to do, I just didn't get a chance to explore it much. Philadelphia is only 30-45 minutes away, and some of the residents choose to live in Philly and commute in. Baltimore is about an hour away, DC about 2 hours. The cost of living is pretty good, with some residents owning homes in nearby suburbs. The Delaware beaches, which are pretty popular, are a short drive away. Getting to the mountains is a bit more of an endeavor--probably too far away for a day trip.

Other Info:

-Despite being a community program, Christiana is strong academically... they have a good amount of research going on, and churn out several publications a year.
-The benefits here are the best I've seen. The salary is high, residents get an ~$1800/year educational stipend, residents get ~4 weeks vacation per year, and almost all residents are funded to go to either SAEM or ACEP every year (just have to be on a committee or present a poster).
-There are only 2-3 months of "true" call in the entire program. On medicine and many of the other off-service rotations there is a night-float system in place, so the only call you take is on the weekends. On SICU and trauma you do have to take regular call.
-Depending on your perspective, a positive or negative is that there are not many other residency programs here (just IM, surgery, peds, the basics). As a result, you don't have the same level of subspecialty backup that you would at a more academic program. The advantage is that this means you don't have anyone to compete with for procedures.


Overall:
I was very impressed by this program. The curriculum here is the best I've seen, the pathology is great, the ED is extremely nice, and the perks are incredible. While the reputation is not quite as strong, I feel that Christiana stands shoulder-to-shoulder with Carolinas in terms of pathology, facilities, volume, and didactics, and is close behind in terms of research opportunities. My only hesitation about ranking this place #1 is that I didn't get a good feel for what the people here are like, and I'm not sure how I feel about living in Delaware for 3+ years.
 

Hard24Get

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I am finishing up my away rotation here tomorrow, so let me review it before the memories fade.:) I will add interview info later if/when I get one. Format is stolen from others without apologies. :D

3 year program

Residents: 12 per yr with 3 EM/IM and I think 1 EM/FM. Unlike many prior reviewers, I spent a month there so I have gotten to know the residents pretty well. I can attest to the fact that they are friendly, fun-loving, and smart as hell. Everyone seems happy and the program was a first choice for most. There is a mix of married and single and a lot of socializing within and between years. The senior residents are confident and run trauma alerts and codes without breaking a sweat. Everyone gets skilled with the ultrasound, and it is one of the gems of the program that everyone is clearly proud of. There are 3 chiefs, a scheduling, education, and medical student chief. There was a session on job hunting for the residents during Wednesday conference and there were plenty of employers salivating to get these guys. It's no mystery why.

Faculty: Relatively unique in that the attendings are supplied by a private group. In general, the people who chose to work here like to practice EM and teach without the burden of having to publish (though make no mistake, there is plenty of academics to go around). All seemed pro-resident (though a minority were not pro-student). They do a great job for the most part of stepping back and letting the residents develop their own style, but are ready with well-honed skills when the time comes for their help. Overnight in the lower acuity unit there are no residents, so faculty get a mix of working with residents and doing their own thing, which seems like a great way to keep up ones basic skills. The new PD, Dr. Jasani, is a kind man fiercely devoted to teaching. I found it surprising that people were so collegial and yet many attendings were called "Dr. X". Some EM attendings also called many off-service folks "Dr".

Hospital:

The main facility at Christiana is a Level I Trauma Center with 56 beds in the ED and 100K+ visits/yr, including integrated peds and a separate fast track staffed by NPs and PAs. The ED is large and beautiful, separated into several "Cores". Core A/B is for the sickest patients and includes 4 trauma bays. Core C/E is supposedly for the less sick patients that nonetheless may be having MIs, acute abdomens, etc. There is a Core D for obs that usually serves as overflow. Triage does a lot of treatment itself and has beds and an attending. The patient population is mixed in terms of races and languages, not too many homeless, etc. One of its many nice features is an ob/gy triage and clinic for women with straight gyn complaints.

Wilmington, the secondary site for 1/3 of shifts, is a 25 bed inner city ED where you get your homeless, penetrating trauma, etc. It is small and super busy and lots of people are sick (though many also just want a sandwich). Super fun shifts there.

Ancillary Stuff:
At both sites, the ancillary support is amazing. The RNs are smart and skilled, quickly establish IVs, place NG tubes, etc quick as lightening. They will even set up your pelvic exam, LP, or I&D for you, including leaving a consent form at the bedside :eek:. There are clerks who document and place all your calls and automatically redial if they don't call back in 20-30 mins. You just say, "can you call neurosurgery?", it gets done, and you get paged when your phone calls in. You end up admitting to a variety of private attendings so it is a huge time saver not to have to look up numbers, etc. Also, patients, doctors, and some equipment are tracked electronically, so if you are looking for someone or something, they are just a click of a button away. :cool:

It's true that there are only a few other residency programs, like Medicine, Surgery, Peds, and Ob/Gyn. However, there are attendings in just about every specialty that will personally swoop in or offer phone advice when needed. Obviously, they don't expect to be called for BS and are happy to teach EM stuff so that they come in less, but it is nice to have that expert backup.

Documentation:
They use T-sheets, which are clever little papers designed for several chief complaints – abd pain, chest pain, fall, etc. They are handy because they include preprinted important aspects of the history that you can circle or cross out. This ensures not only that you gather the right information but rewards the group financially for doing so in terms of billing. At the end you can circle/add differentials and write in your plan and lab results. The only thing I don't like about it is that you don't get to document what you were thinking at the time – no room to say, "given the pt's blah and blah, I would consider blah, made less likely by blah, so I will order x, y , & z to address the following diagnoses". However, the attending supervision sheet has room for this and is later dictated for the electronic record.

Curriculum:
Lots of ICU time, no medicine floor month. 2nd year residents get the sickest patients in Core A/B and the 3rd years run the traumas/codes and med students. Seems expertly done. Hours are a mix of 8s, 9s, 10s, and 12s (12s are weekend only). More on this later when I do more research.

Didactics: There is an 8am conference every morning for the am shift, and Wednesday conference from 8-1pm with food. Other services, like ENT and ortho, come and give great lectures on their specialties, and often the residents go over Tintinalli in small groups answering previously advertised questions. Seems like a great way to keep up on your reading! There is also monthly journal club at a faculty member's house where they go over 5 or so papers with food and many jokes. I went and had a great time. The vibe and teaching were excellent

City: Delaware is cool, but quiet. Only 40 mins from Philly, though, and lots of residents commute. It is an easy drive. Also, it is a tax-free state!

Extras:
Great salary, benefits, and moonlighting for seniors is encouraged so they can practice working on their own

Negatives:
It seemed that many do not enjoy their peds time at Dumont, largely due to over-consulting and thus decreased meaningful experiences for the residents. Delaware could be viewed as a negative, but that depends on the person.

Away Rotation itself: On the plus side, most of the residents and attending like to teach and will get you involved in lots of things. The dedicated medical student chief resident is fabulous and guarantees there will aways be someone looking out for your best interests. There is also a state-of-the-art simulation lab that allows you to practice central lines and running codes on dummies that have physiological responses. Some negatives - med students don't put anything on the medical record so we are viewed as pests by a minority of attendings who have to do a bit more work if we present to them. Also, many consultants are irritated to talk to med students as opposed to programs owned by medical schools. These things can make for a few rough days for the medical student doing an away. Also, an interview is not guaranteed to away rotators. :(

Overall:
A well-established program with a strong reputation that seems very well deserved. Though there are certainly drawbacks to the away rotation, it was the most autonomy many students I rotated with had gotten, and it doesn't take away from the exemplary residency program itself. I would be honored to match here. Please feel free to PM me with any questions, and any residents feel free to correct the inaccuracies. SDNers at CC include antiveggies (intern), Turtle,MD (senior), peski (attending), and Pelivar just graduated.
 

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These next couple were written while traveling so they may be a bit more scatter-brained...

Christiana Care

Residents: 12 categorical plus a bunch of combined program residents. There seemed to be a significant number of residents married and with children – many people told me the program is very family-friendly. The group seemed very nice, and although they all lived in different areas, they did appear to be friends. I wasn’t able to attend the social, but a lot of the residents came by the talk to us, and they were all very cool.

Faculty: The PD, Dr. Jasani, informed me that when the old PD left to become a chair elsewhere he agreed to take the job (after being the assistant PD for a long time) only if he would be allowed to keep his clinical time – he still works lots of shifts and seemed extraordinarily resident friendly. The other faculty members I met were equally nice, and residents seem to have a good relationship with them.

Hospital:
Most of the time is spent at Christiana, but about 1/3 of the ED shifts are at Wilmington.

Christiana Hospital: 800 bed tertiary-referral community hospital, the only Level 1 in the state. The ED is a for real department – it’s huge! Eighty beds, including a fast track and pediatric section. Well organized with crazy patient (and resident) tracking system. Dedicated CT and radiology. This ED gets about 100,000 people a year – a mix of insured and uninsured (maybe 60-40%), with a high acuity level. It’s a very nice facility that seems very efficient.

Wilmington Hospital: I didn’t see this one, but it was described as smaller (30 bed), with a more urban/county patient population. Around 50,000 visits, level 3 trauma, and a large psych referral population.

Ancillary Stuff: Supposed to be excellent at Christiana, and pretty good at Wilmington.

Admitting/Documentation: No problems with admitting. I forget the exact documentation type – I know it’s in H24G’s review.

Curriculum: Extremely streamlined 3-year curriculum – there are only 7.5 off-service months and 5 of those are critical care. Furthermore, the schedule is pretty awesome – a mix of 8, 9 and 10 hour shifts; PGY1s do 16, PGY2s do 20, and PGY3s do 18 shifts per month. No floor months. Residents rotate through AI DuPont hospital for a dedicated pediatric ED month, and also do PICU there. The off-service months seem very focused towards EM – Procedures only in NICU, catch babies all day in OB, throw tubes all day in Anesth, etc. Residents get tons of procedures both in the ED and on off-service rotations, where they are among the strongest residents in the hospital. Ultrasound use is extensive and very well regarded (practically everyone I spoke to mentioned how amazing it was to train under SDN’s own Peski), and the fellowship program is huge – 4 ultrasound fellows next year.

Didactics/Research: Didactics are one day a week plus a daily morning report. This is another one of those community programs with extensive research, especially in ultrasound. Although O’Connor has left, there are still many clinical projects are going on, but there is little to no basic science at this time.

City: Well, it’s Delaware. The hospital is located on a sprawling suburban campus, surrounded by a few strip malls. University of Delaware is in nearby Newark (pronounced new-ARK – not to be confused with it’s unsightly neighbor with a big airport to the north :)). Wilmington is the closest city, although it is very small, and Philly would be a tough commute (although some residents do it). Delaware is actually a very nice little state (no sales tax!), very conveniently located in the center of the Mid-Atlantic. Most residents live a suburban lifestyle here, and the location is excellent for those with family or those who don’t like living in the city.

Extras: Christiana has some of the best benefits around; higher than average salary (starting at $47,000) with lower cost of living than the surrounding areas, healthcare for dependents for no extra cost, very subsidized food at the hospital, free parking, and a crazy amount of CME money (nearly two grand a year!). Moonlighting is available.

Negatives: Not too many. The big one for me is location – I like the general area it’s in, but I’m not ready for suburban living quite yet. Wilmington is too small and Philly is a bit too far away. If I had kids, this location would be great. Additionally, there are not a lot of job opportunities for Mrs. UE within easy commuting distance. A few of the residents admitted that living near the hospital was not very exciting, but they all said the program was worth it.

Overall: I really like community programs with an academic alter-ego – I think they may provide the best mix of clinical exposure and academic opportunity for me - and Christiana is definitely one these. This is a well-respected program with great clinical experience, devoted faculty, and friendly residents. Graduates enter both academic and community practice. I’m a big fan of the program, but the location may not be ideal for us at this time.
 

brucecat

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I'm an MSIII set on EM. My wife has a great job in Philly which we really don't want to leave so I'm looking to stay in the Philly area. I was talking to my EM advisor the other day, and he gave me a brief overview of the programs in Philly. Basically he said that all the programs in Philly are good programs but that Christiana is really on a different level (ie exceptional). I was ready to completely commit to programs within Philly but now that I hear that Christiana is so much better (from a reputable source) I'm trying to figure out the plausability of working there given my situation.

My question is this: I know you're probably somewhat biased but do you feel that Christiana is significantly better than other Philly programs and why? Also where do the Christiana residents live? My wife needs to have access to Philly (at least by train) so living in Delaware is not an option (too far). Are there any places nearby that are cool towns with train access and have somewhat of a downtown area (with shops, restaurants). And is living in Philly an option (knowing the traffic on I-95 at rush hour, I can't really imagine doing this everyday)?

Thanks.
 

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i am a second year EM resident at Christiana. Let me address a few of your questions to the best of my ability.

1. It is definitely possible to have a SO work in philly. We have residents who do the commute from philly. We have others who live in nice towns(Media, Pa) in between wilmington and philly which is convienent for both parties. I think that you would be driving into delaware while your SO can either drive or take a train.

2. I think our strengths are: a huge volume of pts(>140k at our two main sites, wilmington hospital gives a flavor of inner city with plenty of HIV, drunks, drug abusers, dental pain), we get a fair amount of trauma- blunt > penetrating though the numbers are increasing, we work hard but are well supported in every way from our program and the hospital(protected lecture time and JC, generous educational funds, highly encouraged to attend conferences- in seattle we had over 15 residents there), curriculum reviewed every year to maximize learning and minimize scut, top notch ultrasound.

3. To address the other post regarding procedures- because we are a community-academic hybrid we are forced to do a lot of procedures because we don't have in house subspecialists to call....all the ortho we handle, we handle all the airways(and just got some sweet fiberoptic/video equipment), when we have to place pacers a lot of times we are doing it with an attending cardiologist by our side, etc etc. It also prepares you to the reality of working in the community with consultants.

4. I can't comment on the strengths of other local programs because I haven't experienced them. I agree that most programs will give you what you need to be a good EM doctor. I think almost all of our residents ranked Christiana number one, many for the reasons above. If you are seriously interested in coming here, I strongly encourage you to rotate here as a student to give you a feel of the area and the program itself. You can contact Lauren Rinheimer at 302 733 4176.

Hope this was helpful! I'm sure a few of our other residents will add their comments as well.
 

antiveggies

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like boo said, it is possible to do the philly commute. several of my fellow interns do just that, and while i would not want to make that drive, they do so with no problems. the residents live all over, in bear/newark/wilmington/philly/and some in elkton,md to mention the more popular places.

i would also echo that our strengths are incredible volume and lots of really sick patients. we have a good mix of a "county" feel at wilmington, and a "community/academic" feel at christiana. we arent a knife and gun club, but i think we see a good representation of blunt v penetrating that you would see in most areas of the country. we have great attendings, are well respected in the hospital, and treated very well by the program. our ultrasound training is one of the best in the country, with one of the top fellowships in US out there.

i dont think christiana would limit your practice area at all. as i said above, we can handle county to community/academic and we have graduates attending all over the country, across the entire gamut of EM practice. if anything, i think our programs reputation opens doors rather than limits where we can practice

we do most of our own procedures, as stated before. this is something i actively sought out, because i wanted to leave a skilled proceduralist. we manage all of our own airways, we do our own central lines, we reduce our own dislocation and fractures, we get to do plenty of procedural sedations, we do lots of ultrasounds, etc. a few procedures we have specailty assistance for, like chest tubes, pacer wires, etc. there are places where this is not the case, and i didnt want to graduate from a place where i would not feel completely competent in these skills. i wouldnt want to leave having never tapped an ankle, feeling uncomfortable with reductions, relying on anesthesia to control my airways, etc. which can happen at some places

i also dont have 1st-hand experience with the other local programs, and have never heard anything bad about them. i think you'll find a great education at any EM program, its just finding the one which feels right and has that added bonus you are looking for.
for me, christiana was a place where i get to do all the procedures, we are involved in all traumas, the airway is ours, we have strong off-service ICU months with the majority of 2nd and all of 3rd yr months spent in the ED, incredible ultrasound training, and the attendings are extremely bright, fun, and easy to work with.

i'm happy to reply to any other questions/comments you might have via PMs or the forum.
 

EvoDevo

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Residents: All seemed really nice. Only a handful showed up to the dinner (applicants >> residents), and pretty much the same ones were at the lunch on interview day. Decent variety of single/married/kids.

Shifts: Fewer hours than most programs. They work 9 hour shifts (12's on the weekends), with a built-in 1 hour overlap to allow for signout and tying up loose-ends. Each year you do one month of nights (4 weeks of M-F 11p-7a) and as a result only have 1 or 2 night shifts on your regular ED months (done on weekends). The average hours per week was around 40 for PGY1, ~50 for PGY2, and ~40 of PGY3.

Facilities: Split time between two hospitals that are about 10 miles from one another.
-2/3 of your time is spent at Christiana's main private hospital in Newark, where the ED volume is around 100,000. The Newark hospital is very nice -- brand new critical care tower with awesome ICUs, a nice new library, and new classroom/office space. The ED itself is one of the nicer and larger I've seen, with spacious rooms, in-house radiology, and some technological perks (for example 6 Titan US machines, and an infrared tracking system so you always know exactly where your attending, patients, and equipment are). They use T-sheets for charting.
-1/3 of your time is spent in Wilmington which is a typical inner-city type of hospital. There was no tour of this ED, but the residents seemed to like it. There is plans for renovation/expansion of this ED, but probably would not affect the incoming class.

Peds: Pretty good peds exposure. The Newark ED has a decent peds volume, so peds is integrated into all of your ED months there. One month of PGY1 is spent at a children's hospital doing exclusively Pedi EM, and then as a PGY2/3 you have shifts mixed in at that site during your regular ED months. As a PGY2 you do a month of PICU. No Pedi EM fellowship.

EMS: Better than average. EMS fellowship available. One month spent doing an EMS rotation.

US: Strong. There are several programs out there that are at the forefront of US training, and Christiana seems to be one of them. They have an US fellowship, and are fairly prolific academically in terms of US. As mentioned earlier, they have 6 nice US machines in their ED.

Trauma: EM runs the traumas and is responsible for airway. Tons of blunt trauma due to the proximity to I-95, and adequate penetrating trauma (especially at Wilmington).

Faculty: All very likable, and you can tell they enjoy teaching. Some have been around for ages, and others are recent grads.

Curriculum: The big selling point of the program, in my opinion. The schedule has a strong EM-slant, with very few off-service rotations most of which are critical care. The off-service rotations that they do have seem optimized toward what an EM resident wants to learn -- for example, on the OB-Gyn month you work 8-5 and just do deliveries and OB/Gyn acute care, and they have a "tube-n-lube" month where you spend the morning on anesthesiology doing all their intubations then spend the afternoon doing ultrasound in the ED. There are 3 months of elective, which I find to be awesome considering this is a 3-year program. There is an EM orientation month, a "subspecialty EM" month, an EMS month, and an EM Administration month. The didactics here are supposedly quite strong, with ~8 hours a week dedicated to conferences and teaching.

Patient Population: A nice mix between the two hospitals. The main Christiana ED is a referral center and Level I trauma center for pretty much all of Delaware, and some of MD/PA/NJ. The Wilmington ED sees more of an inner-city patient population.

Location: Not a big selling point of the program. Delaware is about the most boring place I could imagine living. That said, Newark is a college town and might have some fun things to do, I just didn't get a chance to explore it much. Philadelphia is only 30-45 minutes away, and some of the residents choose to live in Philly and commute in. Baltimore is about an hour away, DC about 2 hours. The cost of living is pretty good, with some residents owning homes in nearby suburbs. The Delaware beaches, which are pretty popular, are a short drive away. Getting to the mountains is a bit more of an endeavor--probably too far away for a day trip.

Other Info:
-Despite being a community program, Christiana is strong academically... they have a good amount of research going on, and churn out several publications a year.
-The benefits here are the best I've seen. The salary is high, residents get an ~$1800/year educational stipend, residents get ~4 weeks vacation per year, and almost all residents are funded to go to either SAEM or ACEP every year (just have to be on a committee or present a poster).
-There are only 2-3 months of "true" call in the entire program. On SICU and trauma you do have to take regular call.
-Depending on your perspective, a positive or negative is that there are not many other residency programs here (just IM, surgery, peds, the basics). As a result, you don't have the same level of subspecialty backup that you would at a more academic program. The advantage is that this means you don't have anyone to compete with for procedures.


Overall: I was very impressed by this program. The curriculum here is the best I've seen, the pathology is great, the ED is extremely nice, and the perks are incredible. While the reputation is not quite as strong, I feel that Christiana stands shoulder-to-shoulder with Carolinas in terms of pathology, facilities, volume, and didactics, and is close behind in terms of research opportunities.
 

2008 EM Reviews

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Below are my biased short reviews:

Maine Med: +good residents, lots of camaraderie, cushy number of shifts, do lots of stuff in the ED (do not consult as much), lots of ED time as opposed to offservice, lots of outdoor opportunities in area
-not too much pen trauma, fair blunt, cold winters, small program, homogeneous population

U Mass: +good residents, very nice ED, well respected residents, good research, Hawaii elective, awesome helicopter experience, good reputation in area, great ultrasound
-hard to switch shifts, some unhappiness with residents, seemed like residents stay 1-3 hours after shifts for cleanup

Baystate: +work less than allmost anywhere else, good blunt trauma, good patient mix, very little offservice
-residents did not seem strong, faculty I interviewed with seemed disinterested, cramped department, city sucks and lots of residents live far away in nice town, bad ultrasound

OHSU: +very nice hospital, good research, cool city, residents were friendly
-small program, go to lots of different hospitals because primary does not see enough variety, residents did not seem strong

Carolinas: +great teaching, great research, awesome facilities, strong off service, good ICU experience, great reputation, strong residents
-lots of off service months, city not exactly what I expected

ECU:+strong residents, good teaching, nice department, great patient population, good reputation
-electronic records seem poorly implemented, city is very undesirable for some people

Wake Forest: +good teaching, good facilities, strong residents, good US
-Winston-Salem shuts down on Sundays

Christiana: +good residents, huge department, good records, good patient population, great benefits, nice facility, good teaching, very little off service, great ICU experience, great ultrasound
-area may not suit some

U Conn: +nice PD, nice facilities, good relationships with trauma
-area,

Duke: +New PD seems awesome, nice hospital, would be a good area to live in,good teaching
-not enough electives
 

EvoDevo

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I originally posted this in the Unofficial 2009 ROL thread but I'm posting here so that folks down the line can get more hits when they search for various programs.

1. Texas A&M-Scott & White - Loved the facilities, great reputation in Texas and surrounding regions, LOVED the residents and faculty. Feels like home. Brought my wife back for a second look and it was a giant love-fest. :) Training is extremely good, great location, and extremely family friendly.

2. Duke Univ Med Ctr-NC - I loved the PD (Sarah Stahmer), the faculty, and the residents. I definitely felt as if I could spend three years with these guys. The feel-goodness started at the resident social and continued on. I was also impressed by the group of applicants who were there with me (one of my hidden indicators). Excellent training, though a bit too university hospital biased. Duke name and reputation, facilities, and Raleigh-Durham is gorgeous. Family in the area. Would be excited to end up here.

3. UC San Francisco-CA - One of those programs with that "X-factor" that's hard to describe; yet you know it when you see it. Really liked the PD and Assistant PD. ;) Fantastic facilities, really top-notch faculty, residents were nice and very welcoming. New program and that brings with it problems; however, I've made something of a habit of helping to establish new organizations and I love a challenge. Though SF is hideously expensive, we think that we can make it happen. Plus it's SF! Gorgeous city and TONS to do when we're not working. Family (a well-traveled bunch) would be thrilled too and have already promised to visit all the time if we end up there. :)

4. University Hosp-Cincinnati-OH - My favorite program by far when considered in and of itself. However, when those "other factors" get thrown in, it was hard to rank them higher. Spent a month there, absolutely LOVED the program. Seriously. This is truly one of those X-factor places and watching their fourth years was insanely impressive. Wish that I could have ranked them higher. But if by some ridiculous longshot we end up there, then I will probably be their most enthusiastic resident EVER. :)

5. U Texas Med Sch-Houston - solid program in a city that I love, close to family and friends, good research available, extremely familiar with the medical center and area.

6. University of Virginia - Very good program that a friend rotated with, so I know it's dirt to a degree. Gorgeous town, decently close to family. Kind of isolated and would be harder for my wife to find a job since it's primarily a college town.

7. Ohio State Univ Med Ctr-OH - Heard great things about the program, really enjoyed my interview, residents at my med school rave about the city. Would be very happy to end up there.

8. Christiana Care-DE - One of those programs that I wish that I'd been able to rotate with because I hear so many great things. Really clicked with the faculty, kind so-so with the residents. Newark didn't really impress me much as it reminded me of the concrete suburbia that I wouldn't mind leaving behind. Nonetheless, would be happy to match there.

9. U Michigan Hosps-Ann Arbor - Fantastic program, not really thrilled about the amount of snow/winter/winter schmutz we'd have to deal with. Not looking forward to buying a light box and possibly dealing with SAD.

10. U Arkansas-Little Rock - One of the most relaxed and enjoyable interview days I had on the trail. Brand-spanking new ED which is gorgeous and well thought out. A little concerned about the volume and pathology that they see there. Good faculty and the residents seem like people I'd want to be friends with outside of work. Little Rock seems like a very pleasant place to live, and quite affordable.

11. Christus Spohn Mem Hosp-TX - I think that this program is going to be really outstanding in a couple of years. I had a great interview and with the relative lack of other residencies, you get treated like royalty by the hospital - Close, free parking, free food in the Dr.'s Lounge, relatively few low-yield rotations. However, the wife and I weren't too thrilled at the prospect of living in Corpus for three years, and their are still some rough edges to the program. Nonetheless, I believe that you'd come out of this program a very well trained EP.

12. Pitt County Mem Hosp/Brody SOM-NC - Solid program, had a so-so interview day. Location was a bit of a negative for me as Greenville is so small. On the other hand, it is only about forty minutes from family and it's insanely cheap to live in. I've known some folks from the school and they had very good things to say about the program. Would be okay with matching here.

Bottom line is that I didn't interview at a single place that I wouldn't mind training at. I do think that there is a nearly intangible but real difference (for me) between the top-tier and other programs. Having said that though, the one thing that I've learned from this interview season is that the saying "You get a solid education at any of these places because of the RRC," is probably pretty close to the mark.
 

Punisher

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Here are some quick facts about programs from last year of interviewing. I tried to be non-biased as possible, but sometimes I threw in some subjective comments. Hope this helps.

FYI, some things may have changed at programs so be sure to ask.

Christiana - 3 years, 12 EM residents/year (+3 EM/IM and 2 EM/FM), 9 hr shifts with 1 hr overlap, 40 hr/wk as intern, 1 mo of night shifts with minimal night shifts on other ED months, >110k volume at main hospital with 72 beds, ~200k combined volume, 5 hrs lecture/week, daily morning conference, monthly animal lab, 1 month orientation, dedicated CT and radiology dept, OR in the ER, $200 mil expansion of Wilmington hospital by 2011, EM gets airway AND procedures in trauma, no anesthesia residents to intubate, no ortho/ENT/NS/optho residents either, fellowships in admin/EMS/US, 6 U/S machines with great U/S faculty, $49k as R1, 6 mo of ICU rotations over 1st two years, interns work >1/2 shifts at Wilmington, no floor months, no state sales tax, 30-45 min to Philly, 1 hr to Baltimore, 2 hours to DC/NY, 90 min to Atlantic City, moonlighting available

Hennepin - 3 years, 11 residents (+2 EM/IM)/yr, 9 hr shifts, >100k volume, very little floor months but surgery heavy, 2 mo neurosurgery as R2, believer in "graduated responsibility" (AKA delayed gratification) so that as R1 you don't have many duties but by R3 you are running the dept, "pitboss" as R3 with no note responsibility, free food, 4 stabilization rooms with U/S mounted on each bay, airways only as R3, 12 U/S machines total which are directly linked to PACS, U/S tech hired to teach residents, EM on ALL traumas and surgery as consult, 1 mo community experience, OB/gyn involves inpt and outpt care, EMR (Epic), sim lab integrated into curriculum, great EMS relationship, 1 wk hospital orientation and 2 wk EM orientation, hyperbaric chamber

Brown – 4 years, 12 residents/yr, >100k volume, brand new ED with cath lab, 2 CT scanners, 72 beds with 6 crit care beds, awesome sim lab 1 day/mo, no boarding in the ED (is that possible?), strong peds EM program, large amount of trauma since they are the only show in town from New Haven to Boston, strong U/S program with fellowship available, 4.5 mo electives, trauma surg without scut work, conferences supposed to have more small group discussion this upcoming year, 20-22 shifts/mo, 9 hr shifts with 1 hr overlap, great international EM, 75 full-time facult, $50k salary as intern

Yale – 4 years, 12 residents/yr, 1 full month orientation, stong U/S program, 12 hour shifts, 18-20/mo as intern, 6 mo crticial care over residency, tox month at NYU Bellvue, 2 hours sim lab per month, 6 mo elective time, $51k as intern

USC – 4 years, 17 residents/yr, 12 hour shifts, 20? shift/mo, top-notch U/S program with over 20 machines, 12 resus bays, tons of procedures, EM has ALL hospital codes, work in the underground jail ED, excellent teaching with tons of videos uploaded every month, attendings doen’t write notes so that have more time to teach, observation unit run by attendings and NPs, new hospital with good facilities, no EMR using all paper notes but plans to upgrade

Highland – 4 years, 10 residents/yr, one month EM orientation, awesome U/S training with 2 U/S fellows, county program, great salary, uses EMR, ski cabin in Tahoe that residents share, one month off per year, 3 informal teaching session in the ED per day, free food all the time, no OBS unit so you must admit all low risk chest pain, rotate though many hospitals (Kaiser, UCSF, Children’s, SFGH), ortho rotation includes time in OR, great tox month at SFGH, weaker IM program can be frustrating

Carolinas - 3 years, 14 residents/yr, >100k volume, very nice hospital, only 1 hospital to rotate through, labs results broadcast to free PDA, didactics daily with free lunch and protected on off-service rotations, fellowships in tox/EMS/US/peds/research, large amount of off-service rotations but I was reassured that they are important, $45k/yr as intern, no EMR but orders by computer coming soon, no orientation month, 4.5 resus bays, no direct medical school affiliation, residents go to SAEM 2nd year and ACEP 3rd year

UMass - 3 years, 12 residents/yr, no medicine floor months but lots of ICU, 10 hr shifts, 20-22 shifts/mo, 5 u/s trained attendings and 8 toxicologists, volume 80-90K and growing, 200+ million dollar ED, new CT scanner, located in worcester (pronounced wooster), helicopter medicine - one month in PGY1 with a 2 or 3 running the show (the bird never flies without a resident) but can be grounded often in winter, every U/S is recorded and Q/A'd by U/S doc, likely elimination of PGY3 elective to Hawaii with free housing/car, 45-60 min from boston, plenty of trauma with all procedures/airway being done by EM residents, residents can moonlight in the ICU starting 2nd yr, 5 hours weekly of didactics, computer tracking system with labs/rads results but orders/vitals/nursing notes/MD notes are all paper and then scanned into computer that you can pull up later if needed.

Vanderbilt – 3 years, 12 residents/yr (increased by 1 this year), no floor months, 1 hr lecture each morning by PD or chair of EM, 1 month orientation with reduced ED shifts and great teaching, awesome EMR, >100,000 combined volume of main hospital and children’s, teaching by U/S fellowship trained EM physician, >3k level 1 traumas/yr, video review for each trauma, 2 BS toxicologists, ED radiology 24 hrs/day, emergency cardiologist in ED, 6 wks community ED, moonlighting allowed, 2 CT scanner, 4 active trauma bays, 10 hr shifts as R1, great sim lab with 1 day/mo, Keeping Up! (EBM review website) run by attendings, $49k as R1, fellowships for EMS/international health/peds, no anesthesia residents/attg necessary for PSA, tons of airway devices, evals p every shift/month/6mo, great EMS relationship
 

2008 EM Reviews

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Below are my biased short reviews:

Maine Med: +good residents, lots of camaraderie, cushy number of shifts, do lots of stuff in the ED (do not consult as much), lots of ED time as opposed to offservice, lots of outdoor opportunities in area
-not too much pen trauma, fair blunt, cold winters, small program, homogeneous population

U Mass: +good residents, very nice ED, well respected residents, good research, Hawaii elective, awesome helicopter experience, good reputation in area, great ultrasound
-hard to switch shifts, some unhappiness with residents, seemed like residents stay 1-3 hours after shifts for cleanup

Baystate: +work less than allmost anywhere else, good blunt trauma, good patient mix, very little offservice
-residents did not seem strong, faculty I interviewed with seemed disinterested, cramped department, city sucks and lots of residents live far away in nice town, bad ultrasound

OHSU: +very nice hospital, good research, cool city, residents were friendly
-small program, go to lots of different hospitals because primary does not see enough variety, residents did not seem strong

Carolinas: +great teaching, great research, awesome facilities, strong off service, good ICU experience, great reputation, strong residents
-lots of off service months, city not exactly what I expected

ECU:+strong residents, good teaching, nice department, great patient population, good reputation
-electronic records seem poorly implemented, city is very undesirable for some people

Wake Forest: +good teaching, good facilities, strong residents, good US
-Winston-Salem shuts down on Sundays

Christiana: +good residents, huge department, good records, good patient population, great benefits, nice facility, good teaching, very little off service, great ICU experience, great ultrasound
-area may not suit some

U Conn: +nice PD, nice facilities, good relationships with trauma
-area,

Duke: +New PD seems awesome, nice hospital, would be a good area to live in,good teaching
-not enough electives
 
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I used past posts about people’s thought on the programs on their rank order list to help formulate my own preferences in the programs I interviewed at so I thought I would pass my thoughts along about the programs on my ROL, now that all interviews are said and done. Be forewarned: I’m not very picky about where I do my training, so I ended up making a lot of decisions based on gut feeling and eccentric preferences.

1. JPS, Ft Worth: Really clicked with the faculty and residents. Hospital and program is very well funded and the EM program has a lot of pull and respect within the hospital. Really like the city for its size, low cost of living, and reasonable traffic volume. Almost all the training (except three months) is at their hospital.
2. Christiana, Delaware: Very well respected program that’s been around a long time. I did a rotation there and its clear that many of their residents are very strong. Has many of the same qualities I liked about JPS (strong and respected program within the hospital), but I grew up in the area and am hesitant to move back. Has two training sites that are 20 minutes apart.
3. Ohio State, Columbus, OH: Really liked a lot of the residents I met. Had trouble clicking with some of the faculty, but did get to sit in on a small group session with one of their younger faculty members leading who was a phenomenal educator. Columbus seems like an awesome town. Just a little hesitant about the separate training sites.
4. Summa, Akron, OH: The nicest cafeteria I’ve ever been to. New YMCA connected to the hospital. Maybe that shouldn’t have influenced me so much, but it did.
5. York, PA: I was really into the program director’s pride in having a strong sense of community in the program. I also thought their simulation and other educational programs sounded really engaging.
6. Baylor, Houston, TX: Assistant residency director (Tyson Pillow) was the most personable, fun, and candid person I met the entire interview trail. Would love to work under him.
7. Jefferson, Philadelphia, PA: Three different training sites, some of which appeared to be long commutes. Really cool neighborhood for the university hospital, but pricey. Awesome airway course included with the education.
8. Little Rock, Arkansas
9. CHRISTUS Spohn, Corpus Christi, TX: Program director seemed a bit awkward and not very personable, but the assistant program director and a lot of the other faculty seemed cool. Didn’t really click with any of the residents. Seemed like they have a cool simulation experience.
10. St. John’s, Detroit, MI
11. UTSW: Very cool residents. Did get the impression that their training experience was a bit skewed to free labor taking priority over education side of things. Clerkship director was very arrogant. Very insistent on his excellent clinical and educational abilities.
12. Metro/Clevland Clinic: Great reputation, but many of their residents seemed burnt out and dissatisfied. They were also the only place where the residents didn’t seem to hold their program director in especially high regard.
13. New York Hospital Queens: The fact that this is one of the most ethnically diverse areas in the US makes me think I’m going to have to use a translator way too much.
 

Lacheln

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Posting for an anonymous submitter...

Basics- 3 year program. Well established program with great pay and benefits.

Curriculum- Good critical care exposure and terrific ultrasound experience. Lots of ED months which are at two different facilities.

Shifts - I honestly dont remember. I dont think they worked a ton and i think they work 8 or 10s?

Facilities -EDs are pretty meh, with one being pretty ugly, but they are building a new one shortly

Faculty - Faculty are from all over, but with a ton being from the NE obviously.

Residents - Not very impressive. I met like a total of one resident at the dinner the night before and she didnt seem too interested in conversing with us and really didnt say anything about why we should come to Christiana. I think i met two residents the next day and they were a little more friendly, but still not impressive. Honestly, I felt that the resident showing was just pathetic and that is a huge red flag in my book.

Wilmington - UGLY. Its like a big concrete jungle with all sorts of strip malls. I would rather live in wyoming then here. When the biggest selling point about your program is that you are less then an hour away from philly, that doesnt bode well.

Overall - I came away super unimpressed with this program. The residents were probably the least social bunch I have met so far, and I really would be miserable hanging out with them for 3 years in wilmington. They probably get solid training, but not good enough to move this program up from dead last on my list. The biggest draw of this program though would have to be their ultrasound curriculum...they probably have the strongest ultrasound program that Ive been to, and perhaps in the nation.
 

Apollyon

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Wilmington - UGLY. Its like a big concrete jungle with all sorts of strip malls. I would rather live in wyoming then here. When the biggest selling point about your program is that you are less then an hour away from philly, that doesnt bode well.

For the anonymous poster, have you ever lived in Wyoming?

I mean, if you WANT Wyoming, or states like it (Idaho, Montana, the Dakotas), you're zero for 5 for EM programs. And the "Big Sky" country aspect (it's the nickname for MT, but can apply to al the above) is just about completely antithetical to where is EM training. Only close places are Utah and Denver, which are still in the city.

It's just that I have spent a lot of time in WY, and you REALLY have to want to be there. I mean, if you like it, you LOVE it, but, if you don't, you DON'T.
 

Lacheln

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For the anonymous poster, have you ever lived in Wyoming?

I mean, if you WANT Wyoming, or states like it (Idaho, Montana, the Dakotas), you're zero for 5 for EM programs. And the "Big Sky" country aspect (it's the nickname for MT, but can apply to al the above) is just about completely antithetical to where is EM training. Only close places are Utah and Denver, which are still in the city.

It's just that I have spent a lot of time in WY, and you REALLY have to want to be there. I mean, if you like it, you LOVE it, but, if you don't, you DON'T.

If anonymous sends me a reply to this, I will post it. I think they were just making a mildly hyperbolic point, however.
 

Apollyon

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If anonymous sends me a reply to this, I will post it. I think they were just making a mildly hyperbolic point, however.

Well, it is akin to saying "I would rather not match than match there". That is quite a ballsy statement to make (which reminds me of an ortho resident from 12 years ago in NYC - he ranked 16 programs - and matched #16).
 

boo2

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Posting for an anonymous submitter...

Basics- 3 year program. Well established program with great pay and benefits.

Curriculum- Good critical care exposure and terrific ultrasound experience. Lots of ED months which are at two different facilities.

Shifts - I honestly dont remember. I dont think they worked a ton and i think they work 8 or 10s?

Facilities -EDs are pretty meh, with one being pretty ugly, but they are building a new one shortly

Faculty - Faculty are from all over, but with a ton being from the NE obviously.

Residents - Not very impressive. I met like a total of one resident at the dinner the night before and she didnt seem too interested in conversing with us and really didnt say anything about why we should come to Christiana. I think i met two residents the next day and they were a little more friendly, but still not impressive. Honestly, I felt that the resident showing was just pathetic and that is a huge red flag in my book.

Wilmington - UGLY. Its like a big concrete jungle with all sorts of strip malls. I would rather live in wyoming then here. When the biggest selling point about your program is that you are less then an hour away from philly, that doesnt bode well.

Overall - I came away super unimpressed with this program. The residents were probably the least social bunch I have met so far, and I really would be miserable hanging out with them for 3 years in wilmington. They probably get solid training, but not good enough to move this program up from dead last on my list. The biggest draw of this program though would have to be their ultrasound curriculum...they probably have the strongest ultrasound program that Ive been to, and perhaps in the nation.




Is this post one of those that tries to deter others in hopes of increasing your chance to match? :rolleyes: Ha ha.

If what you took away as the biggest selling point is that they are an hour away from philly, then I think you missed out on all the other standout points that make this program a gem and a top East Coast program.

I got a great training there. The network we have is incredible, and current colleagues/directors always seem to have great things to say about Christiana grads.

In all seriousness- Good luck with the match and finding a program that fits you well!
 
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Christiana

PROS: massive amount of procedures (no surgical subspecialties to compete with) and crazy high patient volume but with the resources to handle them—between the design of the ED, attention to patient flow, and high quality ancillary staff this place really seems to run like butter (and less BS = more time caring for patients and learning); very high patient acuity; fantastic PDs; ultrasound here seems spectacular; nice rotation setup with solid critical care and great pediatric experiences; forgiving schedule; great mix of rotation sites: tertiary/Level 1 at Christiana, urban/community in Wilmington, peds at freestanding children's hospital; main hospital is really nice and there seems to be tons of money and resident support here

CONS: some residents (and a few faculty members) seemed a bit reserved and tough to chat with; location is fine by me, but SO takes issue; seems like lots of systems and quality research going on, but wish there was a little more clinical research in the mix
 
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