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EM/Peds combined

Discussion in 'Combined Residencies' started by Med2Heal, Sep 26, 2012.

  1. Med2Heal

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    I don't think there is much info out there on this combined residency program. And since the last post on this topic that I could find was about 5 years ago I am going to go ahead and start up an informative thread.

    I am currently an EM/Peds resident and will do my best to answer any questions people have about this combined program.

    Though this unique, combined training program has been around for more then 20 years, many medical students are still unaware of it.

    The combined Emergency Medicine and Pediatrics residency allows residents to become fully accredited as Emergency Medicine physicians and Pediatricians. Upon completion of this 5 year program, graduates can be found in a variety of practice settings. Due to their broad scope of training, they have the freedom and flexibility to work as an emergency medicine physician skilled in treating both adult and pediatric patients, as a pediatric hospitalist attending, as a general pediatrician, or any combination of the three. Graduate can, if they wish, continue their training by pursuing either pediatric or emergency medicine fellowship.

    Individuals whose only aspiration is to become a Pediatric Emergency Medicine physician may find that this combined program is not for them. Graduates of a combined EM/Peds program are not allowed to sit for the Pediatric EM boards. Though graduates of these programs are gainfully employed in Peds EDs across the country, there are a small number of academic hospital institutions that require board certification in pediatric emergency medicine.

    The combined Peds/EM residency program is ideal for candidates who love caring for children while wanting a broad exposure to a wide variety of acute problems found in patients of all ages in emergency medicine and

    Currently there are three programs that offer this combined training.
    The University of Arizona
    The University of Indiana
    The University of Maryland

    Best of luck
     
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  3. Med2Heal

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    I was asked the following questions and thought I would respond publically for the benefit of all. These are my opinions and my current thought so take them as such.

    1. Why did you choose EM-Peds as opposed to one or the other?
    For me I loved them both. I loved working with kids on the pediatric floors. I think kids are so much fun, and I found myself drawn towards helping kids. I discovered I worked hard, fought harder, and more driven when I was working with kids. Howerver this did not deter my desire to work with adults as well. I enjoyed the proceedures, the critical care, and the acuity of illness that is more commonly seen in adults then in the pediatric population.
    Emergency Medicine was exciting. The pace, the work load, the "on your toes" approach to medicine was exhilirating to me. It required me to think quick and act quick. I felt at home in the ED and found my months in the ED the most pleasurable.
    For me it was a genuine drive to work in the ED and also to work in a pediatric setting. I chose the combined route over the EM followed by a fellowship in peds EM because the combined would offer me the additive advantage of working as a pediatric hospitalist or in a pediatric outpatient clinic or even a pediatric fellowship following graduation. I chose the combined over Peds followed by an EM fellowship because I wanted to work with adults in the ED. Adults presentations differ in acuity and severity. They often are more acute, more critical, and require more intensive care. Which is an area of medicine I enjoy.

    2. How do you see yourself putting both residencies to use post-residency? How can one put them both to use, practically, without essentially working two full-time jobs? (i.e. Is it practical to work as an attending in an adult ED in addition to a pediatrician or pediatric hospitalist, especially given that pediatricians need to be on-call?)
    At this time I see myself working in an ED on both the adult and peds sides, or even in a community ED with skill and comfort to see both adult and pediatric patients. In addition, I hope to work in the outpatient pediatric setting seeing pediatric patients who are underserved or have limited financial resource.
    The indiana website has a good list of things their past graduates have done and are doing with their training.

    3. Without going into details that are likely over my head, how is the training split up during the combined residency? (i.e. 2.5 years of EM followed by 2.5 years of Pediatrics, vice versa, or a combination?)
    6 months of peds and 6 months of EM a year. These aren't 6 straight months in each but often 1month in an EM rotations ( ICU, oby-gyn, ortho, trauma, etc) and 1 month doing a peds rotation (PICU, NICU, wards, clinic, etc).

    4. How difficult is it to match into the combined residency?
    It is getting more competitive as awareness increases. There are now only 7 spots between the three programs.

    5. How research-oriented is the residency, if at all? Is the goal of the combined residency to produce spectacular clinicians or researchers/scientists primarily?
    Nearly all residencies focus on research. Research is an intricate part of medicine. You will learn this as you progress in your training. Since medicine is constantly changing and advancing you can't be satisfied with training the same way throughout your career.

    6. Given the extra length of time in training, are there opportunities to moonlight during the combined residency?
    Yes

    7. What are the benefits of the extra years of training post-training, monetarily and otherwise? (i.e. Is it "worth" enduring an extra two years of living off of / supporting a family with a resident's salary?)
    Beyond the fact that you get to spend your life doing two things that you love? You certainly will be more marketable. You will be a valuable asset because of your ability to manage every patient that comes to the ED, a pediatric ward, and an outpatient clinic. You broaden your post residency career path.
    Is it worth it? I think that is something you will have to decided yourself. I love what I am doing.

    Hope this helps. And all you other EM/PEDS people feel free to chyme in and add to this discussion.
     
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  4. tanya67768

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    thanks so much for the info! what are competitive USMLE Step 1 and 2 scores for EM-PEDS? Do Osteopathic candidates who did well on the USMLE stand a chance? It seems like there are only a couple (literally, 2) DO's in combined EM-Peds residencies. And from what I just read on their website, U Maryland doesn't even let DO students rotate in any of their programs during medical school...
     
  5. Med2Heal

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    what are competitive USMLE Step 1 and 2 scores for EM-PEDS? It is considered, but it is not the only factor involved.

    Do Osteopathic candidates who did well on the USMLE stand a chance? Absolutely. I wouldn't get too discouraged if you don't see them accepted. I spoke with my program director and he says applicants are ranked and no preferences are made whether they are DO or MD.
     
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  6. bubbles!

    bubbles! Junior Member

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    I'm going to jump on Med2Heal's bandwagon and answer the same questions she did.

    1. Why did you choose EM-Peds as opposed to one or the other?
    It was very simple, I looked at the curricula of the three combined residencies and thought "I want to do all those rotations." I love the flexibility I will have in my career, the ability to work general ED, peds ED, and any pediatric situation I'd like. I have a specific interest in disaster medicine and underserved populations and the combined training gives me a huge toolkit of skills that I can apply to pretty much any patient in any situation. As I prepare to graduate and head into an academic career, it's given me a leg-up over other candidates because I have an automatic niche as well as extra research and leadership roles that the two extra years of training allowed me. Finally, the thought of fellowship route didn't feel like a great fit for me because I wanted to see adults and kids throughout my training and didn't love the idea of two years dedicated to seeing just little people, combined residency let me alternate between the two specialties throughout my training.

    2. How do you see yourself putting both residencies to use post-residency? How can one put them both to use, practically, without essentially working two full-time jobs? (i.e. Is it practical to work as an attending in an adult ED in addition to a pediatrician or pediatric hospitalist, especially given that pediatricians need to be on-call?)

    I plan on working in an academic emergency program and splitting time between an all-comers ED and a peds ED. I ultimately hope to enter program leadership. If possible, I would love to dedicate a month or two per year to dedicated pediatric time, either as a teaching hospitalist or some sort of international work.

    3. Without going into details that are likely over my head, how is the training split up during the combined residency? (i.e. 2.5 years of EM followed by 2.5 years of Pediatrics, vice versa, or a combination?)

    At IU we switch from peds side to EM side roughly every two months so you fully integrate both residencies within each year of training. All the EM/Peds websites have a curriculum available that gives you a good sense of what you'd be doing from year to year.

    4. How difficult is it to match into the combined residency?

    It is as competitive as the more competitive residency at each institution so you need to be a good pediatrics candidate and a good emergency candidate for each. Since there are only 6 spots nationwide, it's probably a bit more competitive numbers-wise, but at the same time it's a self-selecting group and many won't ultimately rank a combined program first so if you're very set on Em/Peds and certain it's the right fit for you, you have a decent chance of convincing programs of the same.

    5. How research-oriented is the residency, if at all? Is the goal of the combined residency to produce spectacular clinicians or researchers/scientists primarily?

    It probably varies by institution. IU has a clinician focus and also lots of emphasis on advocacy/outreach and scholarly activity that is not necessarily research-based. Since all the programs are at large academic centers, there would be more than enough opportunity for hard-core research if that interests you, and having 5 years gives you a lot more time to develop those skills and projects.

    6. Given the extra length of time in training, are there opportunities to moonlight during the combined residency?
    Yes

    7. What are the benefits of the extra years of training post-training, monetarily and otherwise? (i.e. Is it "worth" enduring an extra two years of living off of / supporting a family with a resident's salary?)

    You come into the application process with a leg up over other applicants since you have additional years of training and skills compared to your graduating class. You also essentially have all the job opportunities an EM physician or a pediatrician would have as well as some additional peds-ED opportunities so it broadens your options tremendously and allows you some flexibility. (Burned out on ED shifts in two years? You can go into peds private practice etc.) If you're interested in administration, academics, scholarly activity, it gives you an automatic niche and some nice extra skills. In the community ED setting you would be the peds expert which is very attractive to groups. In pediatrics practice, you're the expert on acutely ill patients, also a very marketable skill, especially in more remote locations.

    I'm approaching the end of my residency and loved every second of my training and am extremely excited about the job opportunities available to me (yes, including academic pediatric emergency departments). If you're thinking this pathway is a good fit for you, I highly recommend checking out IU's FAQ section and looking through the curricula of all three programs. Also, feel free to email any of the residents or PDs with specific questions. The more true info you have (there's a lot of myth and rumor out there) the better you can decide if it's the right course for you.
     
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  7. bubbles!

    bubbles! Junior Member

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    I can't speak for the other programs but IU is very DO friendly, you would be considered just like any other applicant.

    USMLE scores are just one tiny puzzle piece but you should be in the ballpark range of the more competitive residency at each institution. It feels like 220+ is probably a good starting point for most EM residencies, but if you're not quite there and have great grades and evaluations you probably have a good shot (and vice versa- a good board score will not make up for bad grades, poor evals, or a so-so interview).
     
  8. jlmucci

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    Do you think top quartile class rank at allopathic school, AOA, Step 1 240, Step 2 249, and good letters of recommendation are enough to match #1 on my rank list for Peds/EM?
     
    #7 jlmucci, Feb 19, 2014
    Last edited: Feb 19, 2014
  9. Med2Heal

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    Jlmucci
    I can tell the stress of match is upon you. I had the same question when I was at that point in my training and awaiting the match. I don't think I can give you any answer because there are so many variables considered beyond what you have listed. Be content in knowing you did your best and endure the wait.
     
  10. Med2Heal

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  11. reverieinvictus

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    Hello! I just wanted to say that I'm a 3rd year interested in applying for EM/Peds. I'm an osteopathic student with USMLE step 1 in the 250s, COMLEX level 1 in the 700s, no research and some volunteer experience. Hopefully I have a shot at getting in!
     
  12. via92

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    Hey all,

    I'm a second year medical student who's had my heart set on the combined em/peds program since I learned about it. Any tips on how I can successfully set myself up during the next few years to be a competitive candidate as it pertains specifically to the em/peds programs?

    Also, any insight from the real people out there on the differences between the four programs?
     
  13. witzelsucht

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    Bump. Any current EM/peds people here? 3rd year thinking about EM, but really liking peds inpatient floors. I know this track is kinda weird since you can't sit for peds em boards. I guess you're pretty much stuck in academics if you want a job doing all ages EM and peds floors, huh?
     
  14. TraumaBlonde

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    Me!
     
  15. Med2Heal

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    I think all are set up to help you become an excellent physician. Go where you'll be happy, factor in the non medical things such as cost of living, weather, location, proximity to family, etc may be a deciding factor. When you interview try and get a feel for the residents and such to see how well you fit in.
     
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  17. Med2Heal

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    If you like the adult ED and peds medicine floors then EM/PEDS is definitely the kind of residency you want to consider.
    The diversity in training of the EM/PEDS combined residency makes graduates very hirable. Imagine how attractive you will be by seeing adult and pediatric patients in the ED, can take a few shifts as a pediatric hospitalist, and can even start your own clinic. No other tract gives you that much diversity. In fact I think you are more confined to academic medicine doing pediatrics followed by an EM fellowship.
    We can't take the peds em boards, and as a result, are not hirable to work in some academic peds EDs. So if you are interested in working soley academic in a peds ED, then the combined path may not be the way to go.
     
  18. KaapstadMK

    KaapstadMK No turning back now - Too much debt

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    Couple questions here. I'm a 2nd year osteopathic student and I'm very much interested in the EM/Peds combined programs, having read up on some of the differences between EM/Peds and PEM.

    When looking up the program information on FREIDA, I noticed that none of the 4 schools took more than 18 or so interviews. How many applicants do the schools have in average?

    Also, I saw Dr Woolridge's report on where many EM/Peds graduates were [then] presently working and I noticed most were in academic hospitals. Would you say that EM/Peds equips you well for underserved/rural locations?

    Thanks!
     
  19. mhammy

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    Hey there.
    3rd year D.O. student here seriously considering EM/Peds as I simply haven't been able to choose between the two and have a passion for both.
    Quick questions for current or past residents of these programs:
    --Since there are only a few programs, do most applicants also apply to either Peds or EM only programs as well? If so, how do you go about writing your personal statement?
    --Does anybody have a list of academic hospitals where Peds EM sub-board certification is required to work in the Peds ED?

    Thank you in advance!
     
  20. Med2Heal

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    Sorry for the delay in response.
    The number of applicants varies I think between the programs. I think most programs interview between 10 - 20% of applicants. Interviews are heavily screened because the fit is unique. Your application really needs to demonstrate an interest in both fields.

    EM/Peds are well equipped to work in underserved areas. I just think most graduates plan on working academically until they pay off their loans and get grounded before moving on to serving in rural locations.
     
  21. Med2Heal

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    I think applicants apply to the back up they are most interested in. If the interest is equal I would apply EM as back up. You will be a better physician going ER residency to peds fellowship then vice versa (mostly because of all the critical care training you will get with adults). Also if you decided to do a peds residency after an EM residency I think you are a bit more competitive in applying for peds residency as an EM grad then you will be applying to EM residency as a peds grad.

    Identifying Peds EM sub board certification requiring hospitals is tricky. And I don't think there is a solid list out there. Some programs that have a PEM fellowship will only hire those who are PEM trained to train their fellows, which makes sense. Other PEM programs consider the training equal. If you love adult EM and you want no limitations on the academic settings you can work I would suggest EM residency with Peds fellowship. The combined is a great option if you are okay with some centers not willing to hire you.
     
  22. It's lupus!

    It's lupus! SDN Gold Donor
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    Anyone know about duall fellowship possibilities for med-peds ccm after em-peds residency?

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