Design Your Own Residency

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Vandalia

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A couple of us were discussing residency programs recently. (No, we are not thinking about starting one.) So that led me to wonder how would you design you own ideal residency program?

3-year or 4-year? (I think I know the answer to that one.)
What off-service rotations? And when?
Shift lengths and variation by year?
Things not emphasized enough, or emphasized too much?
Unique features? Wilderness, International, etc., etc?

And where are you in your career? Med student? Resident? New graduate? Ran a field hospital at Antietam?

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- 3.14 years.
- Zero internal medicine floor months.
- Off service includes plenty of ICU work.
- Shifts = 12 hours as an intern, 10 hours as junior/senior. Ratchet the number of shifts up/down as you see appropriate.
- Any procedure done in the ER must be done by the ER resident. No, you can't call the ortho res to manipulate the fracture because well, you have other patients to see and dispo unless you've already logged two dozen of that particular one and there's another one to be done. Or whatever.
- Rotate thru several different ER "types" to see which one you like the best (Academic Ivory Tower, Community General, County Free-For-All).
- A ban on any CMG involvement (I'm looking at you, USACS and "Envision").
- An EMR that doesn't freaking suck.

I am six years out of residency and work in community general with a "bullpen" of jobs to call up/bench as I see fit.
 
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-3 years
-Zero floor months
-Financial support for conference attendance
-Second the all procedures being done by ED resident (Almost zero orthopedic training in my 4 year program) and rotations across ED types
-Unit secretaries that actually do stuff
-Attendings that see a patient solo every once in awhile or make a phone call
-Nurses that don't question every order
-Resident consultants that don't whine every single time you call them
-Fair increases in salary, commensurate with experience (aka senior resident with higher workload, stronger skills, and ludicrous speed shouldn't be paid less than fresh midlevel grad who hasn't sutured once in their life)

1 year out, community (shocking how things change once you're an attending. I've changed nothing about my practice style and 95% of my nurses and consultants are awesome!)
 
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For those of you who want the ED resident doing all the ortho manipulations (and I agree in principle), but how do the ortho residents learn those skills too?
 
They can learn those skills in the clinic or operating room.

You could make those same arguments for surgery and chest tubes or anesthesia and intubations.

I've never understood academics who say we should share emergency procedures with other specialties. If thats the case then there's no reason to even have emergency physicians. We should go back to the old days when medicine residents saw ED patients and consulted specialists for procedures.
 
- 3.14 years.
- Zero internal medicine floor months.
- Off service includes plenty of ICU work.
- Shifts = 12 hours as an intern, 10 hours as junior/senior. Ratchet the number of shifts up/down as you see appropriate.
- Any procedure done in the ER must be done by the ER resident. No, you can't call the ortho res to manipulate the fracture because well, you have other patients to see and dispo unless you've already logged two dozen of that particular one and there's another one to be done. Or whatever.
- Rotate thru several different ER "types" to see which one you like the best (Academic Ivory Tower, Community General, County Free-For-All).
- A ban on any CMG involvement (I'm looking at you, USACS and "Envision").
- An EMR that doesn't freaking suck.

I am six years out of residency and work in community general with a "bullpen" of jobs to call up/bench as I see fit.

So.....pi?
 
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For those of you who want the ED resident doing all the ortho manipulations (and I agree in principle), but how do the ortho residents learn those skills too?

Does it matter how ortho residents learn that procedure? ER docs are who reduce the fractures in the community. They can do whatever they like upstairs and in the OR.
 
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- 3 years
- 1st month of intern year, orientation and workshops. First week orientation to ED and hospital with lectures on charting efficiently, managing stress, substance dependence, work life balance. The remaining month being 8hr ED shifts where you are the go to person for any procedures such as central lines, art lines, reductions, LP's, paracenteses, I&D, lac repair.
- agree with no floor months
- 1 month peds ED each year
- 1 month PICU for 2nd and 3rd year
- 2 months adult ICU for 2nd and 3rd year
- 1 month EMS/fast track during 3rd year. Two weeks ride along with EMS and two weeks staffing the ED fast track or triage.
- 3rd year first month, career focus, 1st week for one half of residents, 3rd week for other half and remaining time working in the ED. Lectures on writing and maintaining a CV. Different practice structures. Pros and cons of locums, IC, democratic groups, moving forward with boards, MOC, etc.

I'm 6 years out and working at a community lvl1 trauma center.
 
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Total length will be 3 years residency + a 3 year Work note and Percocet fellowship.

All core faculty will be either complete minimalists who order nothing or zebra chasers who literally order things like ANCA and anticardiolipin antibodies. Residents will flip between the two types between every shift.

All residents will be required to document everything they do in the department including documenting about documenting on patients.

Residents will be required to see one, think about one, see another one, mime one, watch yet another one, almost get to do one but have the attending interrupt you at the last minute and maybe you can get the next one regarding every procedure.

Didactics will consist of a power point that is just Tintinalli copy pasted as free text.

Residents will be able to attend free applicant dinners that will be taken out of their paychecks.

Trauma airways will go to anesthesia on days that end in “day.”

Nurses will be required to question every order a resident enters in front of the attending.

Nurses will also be able to cancel any resident order they don’t feel like doing.

I’m sure there will be others but I lost funding for them.
 
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