Christiana questions

[Coleman]

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Hey all,

In speaking with the recently matched 4th years at my school, a few interviewed at Christiana and they were all impressed. They did say that they heard a rumor that everyone is impressed with the interview, but those students who do rotations there are less than impressed and do not rank it highly.

Any validity to this or was it a single case scenario?
Did anyone here do a rotation there and how was it?

Thanks

 

[alextron]

Just wanted to bump up this thread.

I got a brochure from them a few weeks ago, and checked out there website. Besides the info put out by THEM, about the program, I haven't found anything else (i.e. no reviews on scutwork). Anybody rotate through Christiana??? Thoughts/inpressions...

-Alex

 

[Wrangler]

I interviewed at Christiana and I thought that they had a solid program. They see good volume between their two major sites, and a good diversity of cases with a wide catchment area. They seemed to put a bunch of their grads into teaching positions and no doubt anyone would get great training there.

I ranked them a little lower (right or wrong) based on 3 things: (1) Their board and standardized test performance was really good and they seemed a little too obcessed with keeping these stats up. (2) The personality of the PD and residents didn't seem to mesh with mine.

Most importantly though (3) I sat through one of their conferences and I thought it was very telling. They presented and worked up presented patients as though it were an internal medicine program. CC, then subjective, then objective, then a lengthy talk about the differential; rather than ABC's, active patient management, and what to do while the tests were cooking, and disposition. I was suprised no one thought this was strange. No one talked about the airway, or managing the patient's issues AS THE WORKUP was taking place. I know they have a combined EM/IM program, but I really couldn't tell that it was an EM program for a minute.

PS - open talk about the Christiana program is what caused the origional censorship and blackouts of the EMRA forums last year. So happy so see a little freedom over here.

 

[mikecwru]

Totally. In fact, this was the weakness that caused me to rank them low. I sat through a conference, where one attending kept prodding a resident on what to do with a patient who was in obvious hypovolemic shock (not an intern!) and he finally had to tell him "fluids." There were a few other goofy answers given in the conference about other subjects. The only believable positive that the residents brought across was that the residency is really well funded.

The attendings to me seemed awesome. The PD was a little quiet and bookish, but seemed like a really nice guy. Definitely not the weirdest PD I've met.

mike

Originally posted by Wrangler
I interviewed at Christiana and I thought that they had a solid program. They see good volume between their two major sites, and a good diversity of cases with a wide catchment area. They seemed to put a bunch of their grads into teaching positions and no doubt anyone would get great training there.

I ranked them a little lower (right or wrong) based on 3 things: (1) Their board and standardized test performance was really good and they seemed a little too obcessed with keeping these stats up. (2) The personality of the PD and residents didn't seem to mesh with mine.

Most importantly though (3) I sat through one of their conferences and I thought it was very telling. They presented and worked up presented patients as though it were an internal medicine program. CC, then subjective, then objective, then a lengthy talk about the differential; rather than ABC's, active patient management, and what to do while the tests were cooking, and disposition. I was suprised no one thought this was strange. No one talked about the airway, or managing the patient's issues AS THE WORKUP was taking place. I know they have a combined EM/IM program, but I really couldn't tell that it was an EM program for a minute.

PS - open talk about the Christiana program is what caused the origional censorship and blackouts of the EMRA forums last year. So happy so see a little freedom over here.

 

[Scrubbs]

Originally posted by Wrangler
PS - open talk about the Christiana program is what caused the origional censorship and blackouts of the EMRA forums last year. So happy so see a little freedom over here.

Gee... I wonder if that has anything to do with the president of EMRA being a second year at Christiana? 🙄 🙄 🙄

 

[SHOX]

Hey Guys/ Gals,

I will tell you up front that I am a resident at Christiana Care.
I agree that these forums are a wonderful venue in which to exchange ideas (as long as people are being upfront as opposed to trying to start or perpetuate rumors about other programs for whatever secondary gain).

I wanted to perhaps clarify a few issues on this thread:

1)We have anywhere from 8-10 hours per week of conference time and among that time the conference types vary ("classic" morning report, Rosen's Club, Didactic Lectures, Ultrasound conf., Board Review, Cardiology conf., ACLS conf., Radiology conf., Trauma conf., M&M, Grand Rounds, etc...) so perhaps those who visited to interview for one day did not get a representative sample of our multiple educational offerings. The inservice scores at our program are consistently in the tops in the country for many reasons- mainly due to our conferences.

2)The main reason I came to Christiana was it's focus on wellness. From the time I was a first year to now as a senior resident the committment to the residents by the PD and residency coordinator and chiefs in this regard have been unwavering.

3)As I understand it the EMRA forums were closed down not due to comments made about Christiana but due to some rather tasteless comments made about a prominent female PD down south. These comments were so debase that the issue of liability on EMRA's part arose. We are all fairly educated people and we should be able to police ourselves.....

Any way, good luck to you all in your new residencies and good luck to the current 3rd year studs in their search for their dream program. 😉

 

[mikecwru]

The conference I saw was either a morning report or case conference. They were going over a case a senior had. Then one of the interns gave a quick presentation on a topic she had and read from a piece of paper without looking up. The conference was not mind blowing. As we all know, taking a test does not always correlate with clnical practice, but of course, I could have seen somethnig entirely misrepresentative... caught some "less than stellar" residents on a bad day when they were tired, etc.

Another concern of mine was the program seemed to be on the low end of the bell curve for procedures. On the other hand, the ED was probably the nicest physical building I had been in on the interview trail.

I would agree with you, though, the residents seemed very happy. I thought all of the attendings I interviewed with were great. The PD seemed like a really nice guy. I didn't care for when the current EMRA president hopped up at lunch and gave her "Lookie Y'all this is why you should come to Christiana talk." Kind of obnoxious/condescending.

I went to your guys' web site to see your 2003 match, but it hasn't been updated for the past two years. Who did you guys match for the incoming interns?

mike

Originally posted by SHOX
I will tell you up front that I am a resident at Christiana Care.
I agree that these forums are a wonderful venue in which to exchange ideas (as long as people are being upfront as opposed to trying to start or perpetuate rumors about other programs for whatever secondary gain).

 

[SHOX]

Mike,

Thanks for your honest input. I will ask our PD and IS ppl to update the website with regards to residency and match results (which were excellent- over half the class was among our top 20 choices).

As fas as procedures go, do you really think an institution that sees 130K+ patients per year is low on the curve as far as procedures? We do not have multiple specialty residents like ortho/ optho and ENT troving the hospital so we end up doing many procedures that would otherwise be done by subspecialists at other tertiary facilities. We also do plenty of ICU time. Not to mention having one of the more progressive Ultrasound programs.

You cannot faulth the EMRA president for loving her program- she is at times a tad effervescent but definitely means no harm. She's an awesome advocate for emergency residents on the national scene.

SH

 

[kickbackdude]

Just thought I would put my two cents in about Christiana. I interviewed there this year and liked it so much that I made an extra trip with my family to look at the area and investigate the program more closely.
Regarding procedures, I disagree that they are on the low end of the bell curve (based on my time there and information I gathered from multiple people). I spent time in both Wilmington and Christiana Hospital. Out of the 18 places I interviewed, I would put them in the top 5 in terms of procedures.
Regarding conferences, I thought they were great. The ones I attended did focus on the ABC's and on ED management.
Everything else about Christiana was also fantastic.
In the end, the only reason they weren't higher on my rank list was geography.

 

[emdoc21]

I interviewed at Christiana and also did a 2nd look there.

I was very impressed with the program. I felt they offered an extremely strong clinical experience. My impression was that there would be much more opportunity for procedures than at most other programs. I was also very impressed by the incredible facilities and the extra training you receive in the often-overlooked administrative side of EM (efficiency, billing and coding, etc).

I did not rank them at the top of my list, partly because my wife (Couples Match) wasn't as interested in Philadelphia programs, but it seemed like a great place to train.

Also, I'd like to stick up for the current EMRA President who is a resident at Christiana Care. I had the opportunity to speak to her at length on a few occasions about Christiana Care, other programs, and other topics, and found her to be extremely helpful and professional. I don't think it is appropriate to badmouth someone in a public forum like this based on such as short impression on an interview day.

 

[mikecwru]

Well, I'm sure your interview experience was much more valid than mine, but my comment on procedures was due to some numbers the PD quoted me, which were lower than many other places I was interviewing at.

My comment regarding the EMRA president was an opinion. I was not saying anything maliciously to badmouth her. She was, in my opinion, jumpy and hyper like a lap dog. That's a personality trait I find obnoxious. I also found her presentation to be condescending regarding what *I* want in a program. By her own admission, she gives this same speech to all applicants.

And I stand by what I experienced in their teaching conference. A second year EM resident, when presented with someone in hypovolemic shock (surgical abdomen that becomes profoundly hypotensive and tachycardic w/o fever) and asked (HINT HINT) "What should you absolutely do first?" (fluids bolus) Should not start rattling off lab tests (the tests, BTW weren't pertinent to the case anyway). Sorry guy, just bad impression.

I'll be sure to run my next opinion by you.

mike

Originally posted by emdoc21
I interviewed at Christiana and also did a 2nd look there.

I was very impressed with the program. I felt they offered an extremely strong clinical experience. My impression was that there would be much more opportunity for procedures than at most other programs. I was also very impressed by the incredible facilities and the extra training you receive in the often-overlooked administrative side of EM (efficiency, billing and coding, etc).

I did not rank them at the top of my list, partly because my wife (Couples Match) wasn't as interested in Philadelphia programs, but it seemed like a great place to train.

Also, I'd like to stick up for the current EMRA President who is a resident at Christiana Care. I had the opportunity to speak to her at length on a few occasions about Christiana Care, other programs, and other topics, and found her to be extremely helpful and professional. I don't think it is appropriate to badmouth someone in a public forum like this based on such as short impression on an interview day.

 

[Coleman]

First of all, I want to thank SHOX for the input on Christiana, it is great to have resident's advice from within the program.

I have a couple comments. In regards to the conference with less ABCs and too much Dif DX, there are very few emergency cases in which pt subjective and objective info are not important and documented and where a differential dx is not considered. Since when did EM care stop at ABCs?

After hearing what SHOX had to say about the variety of topics in the conferences, I am more impressed with Christiana. Especially in EM, I think didactics and quality conferences are integral to your training. At least for myself, I feel there is little point in having great patient exposure if you are not going to learn about what you're seeing.

Also, I've met and spoke with the EMRA president, as previously stated, her excitement for EM and advocacy for our speciality is amazing. Being "annoyed" by her enthusiasm says more about that person than it does her. What SHOX said about the previously closing and so-called "censoring" of the EMRA site is true. The comments were getting pretty rediculous near the end, and, if you'll notice, there are no such comments offered up here now that the boards is "free".

 

[Wrangler]

Everyone knows that Christiana has a solid program. It came highly reccomended to me when I was an interviewee, and still I suggest to applicants that they look at it when they are looking for balance, volume, and a nonurban setting.

I think that it is good when forums are open and people can voice their own opinions though. We are all grown ups and know enough not to believe everything we read. It's also understood that alot of crap can get through and things can definitely turn a bit sour sometime. BUT IT IS BETTER THAN THE ALTERNATIVE, where the almighty Man decides what we are allowed to hear and think about.

Two years ago the EMRA forums first went really crude after the inital censorship took place (at least that's how I remember it). At the peak of interview season it became suddenly closed for "maintainence" or "upgrades", and I literally was having chest pains I was so pissed off. I didn't need it this year, but I heard something similar happened again???.

I remember some of your handles, that were around for that, and a truely feel that an open discussion is still better than The Man's blessing.

PS- Mr. Man (or woMan -no christiana people implied), if you are listening please bless this forum and withhold your almightly forum-closing power from causing another terrible plague of silence. Your servent always, Amen.

 

[DrQuinn]

Hahha, I remember those EMRA days... The Man WAS the man...

For those who haven't been in "the know," MIKECWRU is a force to be reckowned with... and I have always appreciated his insight and honesty throughout this whole ERAS debacle of 2002-2003. I have a good friend who rotation through Christiana this past year, I shoudl ask her her opinion of it (she did not rank it top 3, I know that).

But from what I hear (90% from this board), Christiana has a great program.

Interesting to see that but a few posts after a few somewhat less than stellar comments were made about Christiana, that a resident from their program chirps in. Who was the little bird? Always interesting to hear that.

Although I would likely do the same, if someone said something profoundly negative about USF/TGH's EM residency, I would likely come to the defense of it as well.

BTW, I hate lap-doggy people too.

Q

 

[SHOX]

Personally, I am more the stodgy old guard-dog type.

I am on an endorphin high right now after an 8 hour shift full of great procedures (trauma thoracotomy- successful I might add, LP for HSV meningitis, 2 complex lac repairs, shoulder reduction, US guided IJ line)... as opposed to the all to often daunting array of 90 yo weak & dizzies. Earlier this week I showed a pgy1 how to do a transvenous pacemaker insertion for a 3rd deg. AVB patient- something often done by a cardiologist or fellow at other programs- it's a definite lifesaving procedure all ED docs should be able to do and far more effective/ definative than transcutaneous pacing. Procedures are definitely one of the more attractive features of our specialty.

As a combined (EM/IM) resident- yes, "one of them"- I often get to see the patients in which the ED may have droppped the ball on in the haste of trying to get the patient admitted. Many of us have come to realize that there is a definite difference between "seeing" patients and "caring" for patients... the old quantity versus quality debate- however both are not mutually exclusive. I wholeheartedly agree that the ABC's are key to this specialty but it is just the tip of the iceberg in caring for the whole patient. It is important that we get our residents to expand their differential diagnosis and understanding of the pathophysiology of diseases and treatments so that we are not just glorified rote triage doctors but true resuscitative specialists.

Sorry to change the subject... my 2 and 1/2 cents!

SH😛

 

[mikecwru]

Originally posted by SHOX
As a combined (EM/IM) resident- yes, "one of them"- I often get to see the patients in which the ED may have droppped the ball on in the haste of trying to get the patient admitted. Many of us have come to realize that there is a definite difference between "seeing" patients and "caring" for patients... the old quantity versus quality debate- however both are not mutually exclusive. I wholeheartedly agree that the ABC's are key to this specialty but it is just the tip of the iceberg in caring for the whole patient. It is important that we get our residents to expand their differential diagnosis and understanding of the pathophysiology of diseases and treatments so that we are not just glorified rote triage doctors but true resuscitative specialists.
SH😛

I agree that EM doctors do and should do more of a work-up then they are accused of. But obviously, you have to pay attention to the ABCs.... you can't let someone die because of them because you're doing your work-up. Of course an EM doctor should be able to come up with a decent differential diagnosis, including more obscure things. If all we needed to do is say "MI" when someone comes in with chest pain, we wouldn't need doctors.

BTW, the procedure that your PD quoted to me was chest tubes. I can't remember the exact #, but he quoted what was at the time a very low # compared to other programs. Another question I asked him was that if you came from a very theortetical med school and didn't do IVs, etc, etc, how would you be when you finished, since your ancillary services are so good. He kind of brushed off that question.

mike

 

[kickbackdude]

The simple truth is that any program, person, sports team, etc that is at the top of their/his/her game gets a lot of attention. Most people realize how great the program, person or team is. However, success often brings controversy regarding the potential flaws that the program, person or team may have. The fact is that Christiana has the reputation for being one of the most desirable and elite programs in the country.

Everyone loves to hate the Lakers, but the simple truth is that they are the three time defending champions.

 

[Coleman]

That was a great point Kickbackdude, a very nice analogy to the greatest of all NBA teams, the LAKERS!!

It is impressive that the worst thing about the program is that their conferences require their EM residents to know more than is the standard in typical training.

Long live Christiana,

Long live the Lakers!

 

[mikecwru]

Originally posted by Coleman
That was a great point Kickbackdude, a very nice analogy to the greatest of all NBA teams, the LAKERS!!

It is impressive that the worst thing about the program is that their conferences require their EM residents to know more than is the standard in typical training.

Long live Christiana,

Long live the Lakers!

If you guys are referring to MY post, that was not my comment. I saw a resident missing basic tenets that an EMT could tell you, not going beyond the "standard."

But, think what you want. I said my part. It's not worth arguing about. God bless.

mike

 

[kickbackdude]

A resident?

Must have been Shaq trying to play point guard. Every residency most likely has a resident who is lacking some fundamental skills. However, the simple truth remains: The Lakers team has dominated for the last three years and the Christiana program is superb.