If you are at some mega huge academic Level 1 center.......which sounds really really awesome on paper, you may actually do a lot less, because there are teams and teams of subspecialists with residents/fellows to come down to your ED.
I've trained at both types, I vastly prefer the community/county program, because I do everything. I float the pacer, I handle the septic shock on three pressors and a vent, I manage the wild toxicology case. I have had several trauma cases where we have intubated, placed a chest tube, a cordis cath, before the trauma surgeon even arrived...he walked in, and we were like "your patient is ready for the OR now. haha."
It's not all sunshine and rainbows though. We have no fast track, so I see a lot of sniffles (boring). We have very little social work help, so screening/placing psych patients also falls on the resident's shoulders. If you get a bad laceration, it can really tie up your department (i have had several cases where I have honestly told the patient that I was going to have to do it in stages, so I could slip out a check on other patient's too, he was understanding)..... We have no anesthesia back-up to help with airways ( a "bad airway" has a new definition when you are all this patient has....), limited ortho back-up, so I have to do a lot of reductions (and really know your ortho man!).....but hey, that is actual real deal emergency medicine as you will often get paid the big bucks to practice in the community.
Academic centers see a lot of cool cases, and often will shield their resident's from the mundane. Just by sheer volume alone, you will see lots of stuff I probably never saw in real life. You have to decide what is best for you, but I agree with the above posters. Do not just assume that if an ED residency isn't at a big name place, that you won't get a great education there. I know I have been excellently trained, and I feel I can go toe to toe with anyone from a big name program.
