EM Residencies / Universities with International Focus

[valkener]

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Hi,

Just wondering if somebody could list EM residencies that are part of a school with an international focus. I personally am very interested in this and have solid experience abroad.

Thanks, much appreciated!

 

[migm]

MGH/BWH
USC Palmetto
Brown? i think

..

 

[EM4Reals]

UCLA-Olive View had good international support (not sure if it was a focus though)

 

[winkleweizen]

Loma Linda has some of the best

 

[fahimaz7]

i'll second MGH and Palmetto in SC. Both allow for extensive international experience. I think the most would be at Palmetto. Great PD and 6+ mo of international experience possible in a 3 year curriculum. Amazing opportunities and very supportive staff.

 

[impact2d]

Hi,

Just wondering if somebody could list EM residencies that are part of a school with an international focus. I personally am very interested in this and have solid experience abroad.

Thanks, much appreciated!

I'm a lowly m1 to be so my opinion should be taken as lightly as possible. I was told at my interview for Ohio State that they have a strong international exchange and global health mission and that EM is a major specialty there (from what I understand the Midwest housed the first EM residencies and have the longest histories)
I think they even offer a 25k grant for travel to residents.
Sent from my SCH-I535 using SDN Mobile

 

[winkleweizen]

i'll second MGH and Palmetto in SC. Both allow for extensive international experience. I think the most would be at Palmetto. Great PD and 6+ mo of international experience possible in a 3 year curriculum. Amazing opportunities and very supportive staff.

6 months? I dont remember this at all.

 

[DeadCactus]

Indiana University would be worth looking into. The teaching hospital they've set up in Kenya seems highly regarded in the global health community. Not sure of about the level of involvement EM residents have though...

 

[fahimaz7]

6 months? I dont remember this at all.

Yea 6 months. With 12 hour shifts and the "hour bank" it is possible to front load your schedule and take off a lot of time duringthe 36 months of training. Remember that as a PGY3 you only work like 14 days in 28.

 

[Cerberus]

Yea 6 months. With 12 hour shifts and the "hour bank" it is possible to front load your schedule and take off a lot of time duringthe 36 months of training. Remember that as a PGY3 you only work like 14 days in 28.

As a chief who is intimately familiar with the duty hour rules, I have a hard time believing this. There is absolutely no way you are going to get 6months off consecutively during residency at a 3 year program without violating duty hours or severely diminishing your educational experience. I also have a hard time believing a hospital will pay for half a year when you are contributing zero hours.

In regards to the international thing, the best advice I can offer is that this should not be your focus when looking for a residency. Residency should be about teaching you how to practice medicine the right way, not the "I'm in rural Africa with 2 antibiotics to choose from and if I give them to X patient there will be none for Y patient" way. You can get that experience after you are already a competent EM physician. Also, international medicine is sexy, but very few physicians will actually end up doing more than the occasional weekend warrior trip as an attending. Half the people we interviewed this year were gung ho about international EM. I doubt more than 1 or 2 of them will do much more than the occasional trip in their careers. Why? Because A) priorities change B) it's hard to find a job willing to support your desire to travel abroad C) most international medicine is "pissing in the wind" and if you really wanted to improve care in Sub Saharan you should have gone into public health D) $$$$$$.

/I like international work
// I like international vacation more

 

[EMquest3]

Maryland has a ton of international work

 

[DeadCactus]

As a chief who is intimately familiar with the duty hour rules, I have a hard time believing this. There is absolutely no way you are going to get 6months off consecutively during residency at a 3 year program without violating duty hours or severely diminishing your educational experience. I also have a hard time believing a hospital will pay for half a year when you are contributing zero hours.

In regards to the international thing, the best advice I can offer is that this should not be your focus when looking for a residency. Residency should be about teaching you how to practice medicine the right way, not the "I'm in rural Africa with 2 antibiotics to choose from and if I give them to X patient there will be none for Y patient" way. You can get that experience after you are already a competent EM physician. Also, international medicine is sexy, but very few physicians will actually end up doing more than the occasional weekend warrior trip as an attending. Half the people we interviewed this year were gung ho about international EM. I doubt more than 1 or 2 of them will do much more than the occasional trip in their careers. Why? Because A) priorities change B) it's hard to find a job willing to support your desire to travel abroad C) most international medicine is "pissing in the wind" and if you really wanted to improve care in Sub Saharan you should have gone into public health D) $$$$$$.

/I like international work
// I like international vacation more

If you believe this forum, then any program will train you to be a competent EM physician, so what is there to focus on, after people and location, other than the opportunities to do interesting stuff?

The fact that most emergency physicians won't go on to do much more than work a few shifts and take on some admin duties is exactly the reason many applicants consider things like international electives, tactical EMS, helicopter EMS, and wilderness medicine big draws. It's the last realistic opportunity for many trainees to experience those areas of EM...

 

[fahimaz7]

As a chief who is intimately familiar with the duty hour rules, I have a hard time believing this. There is absolutely no way you are going to get 6months off consecutively during residency at a 3 year program without violating duty hours or severely diminishing your educational experience. I also have a hard time believing a hospital will pay for half a year when you are contributing zero hours.

In regards to the international thing, the best advice I can offer is that this should not be your focus when looking for a residency. Residency should be about teaching you how to practice medicine the right way, not the "I'm in rural Africa with 2 antibiotics to choose from and if I give them to X patient there will be none for Y patient" way. You can get that experience after you are already a competent EM physician. Also, international medicine is sexy, but very few physicians will actually end up doing more than the occasional weekend warrior trip as an attending. Half the people we interviewed this year were gung ho about international EM. I doubt more than 1 or 2 of them will do much more than the occasional trip in their careers. Why? Because A) priorities change B) it's hard to find a job willing to support your desire to travel abroad C) most international medicine is "pissing in the wind" and if you really wanted to improve care in Sub Saharan you should have gone into public health D) $$$$$$.

/I like international work
// I like international vacation more

I never said 6 mo off consecutively. Their residents are taking off 10-15 days/month during their ER rotations and heading abroad. This is not "vacation time" that is included in the typical residency package. If you have 25 months of ER shifts, 3 months of electives in the 4th year, and 3 weeks of "vacation" a year then why is it so hard to believe that it would be possible to get a total of 6 months "off" to travel abroad? I think they work 18 12's as a pgy1, 16 12's as a pgy2 and 14/15 12's as a pgy3.

 

[b-real]

From what I remember from the trail last year, Georgetown also has a decent international track.

 

[Cerberus]

I never said 6 mo off consecutively. Their residents are taking off 10-15 days/month during their ER rotations and heading abroad. This is not "vacation time" that is included in the typical residency package. If you have 25 months of ER shifts, 3 months of electives in the 4th year, and 3 weeks of "vacation" a year then why is it so hard to believe that it would be possible to get a total of 6 months "off" to travel abroad? I think they work 18 12's as a pgy1, 16 12's as a pgy2 and 14/15 12's as a pgy3.

This still doesn't make sense unless they are violating duty hours. Assuming they are working 12s and thus working 14-15 shifts a month during their PGY-3 year, that leaves 13-14 days off during a typical 28day work month. If they are working 12s, they can work no more than 5 shifts a week without violating duty hours. This will require about 3 weeks to avoid running afoul of the ACGME regulations. They could theoretically get a week off a month if they were able to arrange their schedules that way (easier said than done in residency) but that isn't really a lot of time to accomplish a lot. Not to mention, that unless you are independently wealthy, it's going to be quit difficulty to fly out of the country every month on a residents salary.

 

[DeadCactus]

ACGME duty hours are averaged over a rotation. Two weeks of 6 days, with one week of 2-3 days and you have almost two weeks off at the end of a rotation. Do the same in reverse with another rotation and shove your month of vacation in between and you have 2 months to go do some international work.

Then you have 3 electives that could all be international with the same strategy for a month of time off book-ending it and you have another 4 months to go do international work.

Fund it with GME, scholarships, and grants.

Reasonable enough, you just need a department that supports it. I don't know if Palmetto does, but it's not an impossible proposition...

 

[eastcoastEM]

UCLA Harbor had at least one faculty member who was doing awesome intnl stuff and taking residents - I saw him speak at ACEP

 

[DreamingTheLive]

I feel like most places (at least that I've seen) have some strong international opportunities.

 

[eastcoastEM]

... Also, international medicine is sexy, but very few physicians will actually end up doing more than the occasional weekend warrior trip as an attending. Half the people we interviewed this year were gung ho about international EM. I doubt more than 1 or 2 of them will do much more than the occasional trip in their careers. Why? Because A) priorities change B) it's hard to find a job willing to support your desire to travel abroad C) most international medicine is "pissing in the wind" and if you really wanted to improve care in Sub Saharan you should have gone into public health D) $$$$$$.

The challenging truth. Regarding C, though, if public health/policy is not one's strength then why do it? I wanted to be a doctor.

Edit: I had about the same experience as DreamingTheLive - Almost every place had international opportunities. One exception was MUSC which supports it but didn't have any relationships with sites yet and you had to take vacation time to do it. I remember reading/hearing somewhere that international experience was one of the top things applicants are looking for, which echoes what Cerberus has said, so any programs that do not currently have it will probably be looking to add it if only to attract applicants.
Edit2: +1 on Palmetto having great international stuff.

 

[Hair Police]

...Also, international medicine is sexy, but very few physicians will actually end up doing more than the occasional weekend warrior trip as an attending...

I completely agree. Of the physicians I've met (FM, EM, G Surg, etc.) who are involved in international work, they fall into four categories: 1) people working to bring EM as a specialty to other countries, setting up EMS and hospital systems, 2) people who do disaster response and leave once the the country is on the mend, 3) docs who run long-standing GP clinics or projects like Operation Smiles, or lastly 4) people who like traveling and use medicine as justification.

#4 is what a lot of students think of when they think international medicine. It's easy to tell, too - ~90% of their travel pics are of them near the local flora/fauna/point of interest/bonfire.

If you believe this forum, then any program will train you to be a competent EM physician, so what is there to focus on, after people and location, other than the opportunities to do interesting stuff?...

Fair enough. Residency should be, to some extent, a safe playground for you to test out what interests you. But I would keep the priorities in the order you wrote it - people/fit > location > other x-factors.

I never said 6 mo off consecutively. Their residents are taking off 10-15 days/month during their ER rotations and heading abroad. This is not "vacation time" that is included in the typical residency package. If you have 25 months of ER shifts, 3 months of electives in the 4th year, and 3 weeks of "vacation" a year then why is it so hard to believe that it would be possible to get a total of 6 months "off" to travel abroad? I think they work 18 12's as a pgy1, 16 12's as a pgy2 and 14/15 12's as a pgy3.

Traveling abroad isn't the same as international EM. Lots of residents go to the Caribbean, Mexico, or Europe to vacation, not to work. There's a lot more planning and resources that go into a medical trip. And you will want a vacation during residency.

The schedule you propose would be exhausting in any residency. Many programs taper the shifts like you describe, but the shifts are still spread throughout the month. It would be extremely difficult to schedule all of your shifts such that your ten days off are in a single block. And most humans need a rest day after switching from nights to days.

I recall some 4 year residencies having a total of six months of electives, but I'd expect the faculty would not let residents repeat the same rotation over and over. I think it would significantly detract from your residency experience to do so. It would be impossible to fit six months of IEM within a three year EM residency.

Maryland has a ton of international work

Yes, they do. 😀

 

[fahimaz7]

I recall some 4 year residencies having a total of six months of electives, but I'd expect the faculty would not let residents repeat the same rotation over and over. I think it would significantly detract from your residency experience to do so. It would be impossible to fit six months of IEM within a three year EM residency.

Yes, they do. 😀

MGH/BWH has 6 months of electives. While I agree that it would be exhausting to work the proposed schedule, the fact of the matter is that I met numerous residents that had ~6 months of international experience while there were at palmetto. While some of this was definitely vacation, they did so in eastern Europe, Asia, Africa, etc in addition to the usual suspects. They also spent weeks/months doing international medicine service in places like China, India, Ghana, Chile, etc.

It's not for everyone, but if you have the means to do it they will support your endeavor through creative block and shift scheduling.

I have classmates here that leave for 4 days and take trips abroad.. why would it be any different in residency? Some have parents with deep pockets and others have parents who work for the airlines. Either way, they travel first class and make most look like home bodies.

 

[Cerberus]

The challenging truth. Regarding C, though, if public health/policy is not one's strength then why do it? I wanted to be a doctor.

Edit: I had about the same experience as DreamingTheLive - Almost every place had international opportunities. One exception was MUSC which supports it but didn't have any relationships with sites yet and you had to take vacation time to do it. I remember reading/hearing somewhere that international experience was one of the top things applicants are looking for, which echoes what Cerberus has said, so any programs that do not currently have it will probably be looking to add it if only to attract applicants.
Edit2: +1 on Palmetto having great international stuff.

While I understand the sentiment (I'm not wild about public health policy either) the fact is medical adventurism doesn't really benefit anyone other than the doc. If you just want to take care of disadvantaged patients and travel internationally, I'd recommend work in almost any ER in the US and using your vacation time to take international trips (your tourist dollars will probably benefit the locals more anyway). I used to talk about doing international (i've traveled and lived abroad and rarely stay in the US if I'm off for a week) but I realized I'd rather just travel than work overseas.

 

[Cerberus]

The challenging truth. Regarding C, though, if public health/policy is not one's strength then why do it? I wanted to be a doctor.

Edit: I had about the same experience as DreamingTheLive - Almost every place had international opportunities. One exception was MUSC which supports it but didn't have any relationships with sites yet and you had to take vacation time to do it. I remember reading/hearing somewhere that international experience was one of the top things applicants are looking for, which echoes what Cerberus has said, so any programs that do not currently have it will probably be looking to add it if only to attract applicants.
Edit2: +1 on Palmetto having great international stuff.

ACGME duty hours are averaged over a rotation. Two weeks of 6 days, with one week of 2-3 days and you have almost two weeks off at the end of a rotation. Do the same in reverse with another rotation and shove your month of vacation in between and you have 2 months to go do some international work.

Then you have 3 electives that could all be international with the same strategy for a month of time off book-ending it and you have another 4 months to go do international work.

Fund it with GME, scholarships, and grants.

Reasonable enough, you just need a department that supports it. I don't know if Palmetto does, but it's not an impossible proposition...

The average is not true for all states, some have more stringent requirements than the ACGME. Even if you follow the ACGME average of 80hrs and 1 day off per week, doing more than 5 12hr shifts in a week is brutal (even 5 12 hr shifts in the ER in 1 wk is quite hard).

 

[NE2013EM]

While most programs seemed to have some sort of opportunity, the variety of opportunities and extent of funding/support varied quite a bit (as with getting paid during vacation time). I'd add Stanford to the list, they've got a couple faculty working on establishing EM/EMS in other countries and were very open about how supportive they were financially. BIDMC usually has a few good places as well (connections Reykjavik and Tuscany, and soon Sweden), with their own version of the Harvard Humanitarian Initiative established as well.