crazy vs. cushy EM residency program

[photodr2]

With one last month to go before submitting my rank list I thought I'd get this forum's opinion on the pros and cons of two types of residency programs I am considering for my #1 spot.

Type 1: county hospital, big established program, tons of procedures, lots of autonomy, but a traditional curriculum that takes you out of the ED for much of your intern year. No pushing patients down the hallway, but definitely a work-and-learn program.

Type 2: big academic tertiary referral center with relatively new EM program, more attending supervision/teaching, less autonomy, more time in the ED, especially as an intern, relatively easy schedule with off-service rotations being tailored to EM needs. Fewer procedures. More time at home with family.

Which type of program do you think produces a stronger, more competent/confident resident? Graduates of which type of program holds a stronger hand when the time comes to find a job in the community/academics? If you had to do it all over again, which would you choose?

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[Rendar5]

It's whichever environment you thrive on. You don't need that many procedures to get good at them, but don need too few either. You don't need tons of floor months, but you need sufficient ICU months to get proficient at taking care of teh critical patient when you can't get them to the ICU in a timely manner. You will have plenty of autonomy when you graduate, no matter what, but if you learn best by just doing and making some mistakes or getting constant supervision, you want the practice style that suits you.

 

[dotcb]

Easy - #1. You learn the most when you're in the driver's seat. You want a long enough leash for flexibility, plus good teaching and enough supervision to be safe.

 

[QuackaDO]

What does your gut tell you? Then that's your answer cuz any answer you get from anyone to this post will be THEIR gut feeling since nobody has actually done both styles, even if they have experienced both (one as a resident, one as attending for example). Everyone will tell you what they think is best but what IS the best is what's the best for you, not for them. Kinda like the whole match thing, lol!

 

[NERDY]

Don't forget you need time to study/read/etc. Would program #1 give you time to study the material that you don't see everyday in the ED?

 

[DeadCactus]

No right answer. Books can't replace patient contact, patients can't replace books, and both are useless if you're too burnt out to remain engaged in learning. Everyone has a different optimum between the three factors, you have to decide on your own.

 

[da8s0859q]

No right answer. Books can't replace patient contact, patients can't replace books, and both are useless if you're too burnt out to remain engaged in learning. Everyone has a different optimum between the three factors, you have to decide on your own.

This for sure. I am a lowly PGY ~1.5 but would argue that you will get more or less out of residency compared to others depending on how much you put into it, and residency is hard as a rule, so there is nothing inherently wrong with #2. Do what suits you best.

 

[photodr2]

Thanks for all the thoughts on this. My gut tells me that the county program is best for me, but I was also curious if there is a difference in perception between the different types of programs from an employment perspective.

 

[EvoDevo]

Go with program number 1.

As an attending about 1.5 yrs out of residency and working in a community hospital, I have been amazed at how relevant all of those other "useless" off service months turned out to be. In my practice today, I have used it all, including the PICU, trauma surgery, trauma and surgical ICU, MICU, medicine floor months, pediatrics, etc. I mean, just about every bit of it. In fact, I even wish that some of them had been even harder/less "tailored to EM" because you know what? Sometimes you don't know what you don't know until it's too late.

TL;DR: go for the harder, less tailored program (at least in intern year). Your older self will thank you in 4-5 years.