EM residency in Hawaii/tripler?

[Dodadoctah]

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I've heard rumors of an army EM residency starting up out at tripler amc in Hawaii. Anyone have any details on timeline? Etc.?

 

[DoctaJMa]

I've heard rumors of an army EM residency starting up out at tripler amc in Hawaii. Anyone have any details on timeline? Etc.?

I heard the same thing about one being started at Fort Bragg...possibly 2014ish...anyone else hear this?

 

[Commotio]

I've heard rumors of an army EM residency starting up out at tripler amc in Hawaii. Anyone have any details on timeline? Etc.?

I'm a current resident at Tripler. This is more than a rumor. The ED Chief is in the planning phase. The University of Hawaii is also very interested in having an EM residency. My understanding is that the program would likely be a joint military/civilian venture. I have no idea when this will come to fruition, but I know this is likely going to happen at some point.

 

[Apollyon]

I'm a current resident at Tripler. This is more than a rumor. The ED Chief is in the planning phase. The University of Hawaii is also very interested in having an EM residency. My understanding is that the program would likely be a joint military/civilian venture. I have no idea when this will come to fruition, but I no this is likely going to happen at some point.

The UH EM residency is one fart above nonexistent. There's been talk for years, and it has gone nowhere. Jerris Hedges is now the dean at the John A. Burns School of Medicine (Jack Burns was a Honolulu cop in the 1940s, and later went on to be governor), and one item on his agenda, being an EM doc, is an EM residency at Queen's. He has made no ground.

However, the ONLY thing that has occurred has been an ad for a non-tenure assistant professor position for a medical student clerkship director that was posted about 2 weeks ago. To say progress has been meager is giving credit to meagerness. It's as little as can be without being nothing.

As for the Tripler/military side, I have no knowledge, beyond COL Miller being a great guy.

Your typing leaves me questioning your intent, though - "but I no this is likely going to happen..." Did you mean "know"? I sincerely am confused.

 

[chemist157]

I'm a current resident at Tripler. This is more than a rumor. The ED Chief is in the planning phase. The University of Hawaii is also very interested in having an EM residency. My understanding is that the program would likely be a joint military/civilian venture. I have no idea when this will come to fruition, but I no this is likely going to happen at some point.

God, or ACGME, help us. Tripler's ED is, for the most part, a joke. They've recruited some good new young blood but there are some more (sketchy out-of-date ED docs, washed up family med docs, etc) they'd have to replace to have a decent residency.

 

[Commotio]

The UH EM residency is one fart above nonexistent. There's been talk for years, and it has gone nowhere. Jerris Hedges is now the dean at the John A. Burns School of Medicine (Jack Burns was a Honolulu cop in the 1940s, and later went on to be governor), and one item on his agenda, being an EM doc, is an EM residency at Queen's. He has made no ground.

However, the ONLY thing that has occurred has been an ad for a non-tenure assistant professor position for a medical student clerkship director that was posted about 2 weeks ago. To say progress has been meager is giving credit to meagerness. It's as little as can be without being nothing.

As for the Tripler/military side, I have no knowledge, beyond COL Miller being a great guy.

Your typing leaves me questioning your intent, though - "but I no this is likely going to happen..." Did you mean "know"? I sincerely am confused.

Well, I didn't say that the residency would be a joint venture with UH, only that there is interest in creating an EM residency there. I'm not sure why you're confused about my "intent." I think it should be fairly obvious that I made a simple grammatical error. The intent of my post was to provide confirmation that the rumor is indeed legitimate. Given that I'm currently a resident at TAMC and meet with CAPT Kelly (the current ED Chief) periodically, I'd say I have more insight into the situation than you do. I'm not endorsing CAPT Kelly's aspirations. Rather, I'm simply confirming that he fully intends to create an EM residency at Tripler at some point. He managed to get Tripler classified as a "trauma center." You can certainly debate the merits of this designation, but you can't argue with the fact that he made it happen. Tripler would have to radically overhaul the ED staff (both physician and nursing) to make this happen. Nevertheless, I have NO doubt that CAPT Kelly will eventually create an EM residency, if he stays long enough.

 

[Commotio]

God, or ACGME, help us. Tripler's ED is, for the most part, a joke. They've recruited some good new young blood but there are some more (sketchy out-of-date ED docs, washed up family med docs, etc) they'd have to replace to have a decent residency.

I completely agree. They would have to replace a number of the physicians and nurses to make it work. Many of the residents at Tripler felt the same way about becoming a designated level III trauma center. Fortunately, we aren't really getting many "true" traumas, because we are not staffed to accommodate those patients, especially from an ED perspective.

 

[Apollyon]

Well, I didn't say that the residency would be a joint venture with UH, only that there is interest in creating an EM residency there. I'm not sure why you're confused about my "intent." I think it should be fairly obvious that I made a simple grammatical error. The intent of my post was to provide confirmation that the rumor is indeed legitimate. Given that I'm currently a resident at TAMC and meet with CAPT Kelly (the current ED Chief) periodically, I'd say I have more insight into the situation than you do. I'm not endorsing CAPT Kelly's aspirations. Rather, I'm simply confirming that he fully intends to create an EM residency at Tripler at some point. He managed to get Tripler classified as a "trauma center." You can certainly debate the merits of this designation, but you can't argue with the fact that he made it happen. Tripler would have to radically overhaul the ED staff (both physician and nursing) to make this happen. Nevertheless, I have NO doubt that CAPT Kelly will eventually create an EM residency, if he stays long enough.

Wasn't trying to hurt your feelings. All I'm saying is that CAPT Kelly isn't the first one to have that idea; I hope he can get it done, but I wouldn't expect it.

And you did post this:

My understanding is that the program would likely be a joint military/civilian venture.

If not with UH, then with whom?

In other words, there is contradiction between your two posts.

Being designated as a trauma center is not an EM-RRC requirement; however, the requirements parallel what it is to be designate a trauma center. However, the EM-RRC also dictates a minimum volume, and, at Tripler alone, they just don't get that volume, and, to have a program, it would have to be associated with Queen's, and QMC is UH - period. Otherwise, what would you do - fly residents in from LA or SF?

When you say the ED Chief is in the "planning phase", that implies that it is a complete go - when plans are complete, construction begins.

I'm just saying that you are casting too bright a light.

 

[DocRGR]

Similar rumors about an EM program at Womack in Fort Bragg.

These things go around from time to time and lots of folks seem to have ambitions for starting new programs. Ultimately, it is the needs of the Army. Joint venture with GHSU in Augusta has continued to take more Army folks year to year. Now we are training like 31-32 EPs per year group at the moment. To start another program would necessitate the Army believing we need 20% + more EPs a year. Not saying this won't happen, but that's a relatively decent jump particularly considering all the questionable budget things in the air right now. Tripler would be sweet locale wise though.

 

[Commotio]

Wasn't trying to hurt your feelings. All I'm saying is that CAPT Kelly isn't the first one to have that idea; I hope he can get it done, but I wouldn't expect it.

And you did post this:



If not with UH, then with whom?

In other words, there is contradiction between your two posts.

Being designated as a trauma center is not an EM-RRC requirement; however, the requirements parallel what it is to be designate a trauma center. However, the EM-RRC also dictates a minimum volume, and, at Tripler alone, they just don't get that volume, and, to have a program, it would have to be associated with Queen's, and QMC is UH - period. Otherwise, what would you do - fly residents in from LA or SF?

When you say the ED Chief is in the "planning phase", that implies that it is a complete go - when plans are complete, construction begins.

I'm just saying that you are casting too bright a light.

My response had nothing to do with hurt feelings. Give me a break. You were intentionally snarky under the guise of being confused about the intent of my original post, which adds nothing to the discussion. Queen's could potentially be a training site without UH having a civilian program. That is what I meant by "joint military/civilian venture," not that the program would necessarily accept both civilian and military applicants or that UH would need an EM residency. I think regardless of the affiliation status with Queen's, the residents would certainly be sent to mainland facilities to round out their education. This is exactly what happens with General Surgery (trauma at LAC/USC), Ortho (Baltimore Shock Trauma), Urology (Memorial Sloan Kettering), and other programs. CAPT Kelly envisions a setup similar to other Tripler residencies, which utilize Queen's and Kapiolani as affiliated training sites. Obviously, Queen's has stand-alone residencies in some of the same specialties but not all of them. For example, Tripler has ENT residents that rotate at Queen's, even though Queen's doesn't have an ENT residency.


I realize that previous Tripler ED chiefs have had aspirations of opening an EM residency. That has no bearing on CAPT Kelly's desire or ability to develop the program. People said the same thing about the trauma designation. Once the Department of the Army got onboard, there was enough momentum to complete the process, which began several years ago. If the Army feels a 4th military EM residency is needed, then Tripler will be a likely training site. Once again, I am NOT endorsing the idea, and I think there are a number of obstacles in the way of creating the program. However, nothing that you have posted shows that I am "casting too bright a light." The "planning phase" is just that, planning (i.e. how many trainees would be accepted each year, affiliated training sites, staffing requirements, etc.). CAPT Kelly and others have met with officials from UH, Queen's, the Department of the Army, etc. to discuss these issues, which implies some degree of planning.

 

[Commotio]

Similar rumors about an EM program at Womack in Fort Bragg.

These things go around from time to time and lots of folks seem to have ambitions for starting new programs. Ultimately, it is the needs of the Army. Joint venture with GHSU in Augusta has continued to take more Army folks year to year. Now we are training like 31-32 EPs per year group at the moment. To start another program would necessitate the Army believing we need 20% + more EPs a year. Not saying this won't happen, but that's a relatively decent jump particularly considering all the questionable budget things in the air right now. Tripler would be sweet locale wise though.

I think the reason that rumors continue to surface about EM residencies developing at Womack and Tripler is that there is genuine interest in adding another program. The total number of EM trainees would obviously increase across the board, but it wouldn't necessarily imply a 20+ percent increase in the total number of trainees per year. I would imagine some, if not all, of the GHSU trainees would be redistributed to the new military training site. This is obviously speculation. I'm not predicting that Tripler will develop an EM residency in the near future, but I know that it is more likely to happen now than in previous years based on discussions with CAPT Kelly, COL Miller, and other members of the ED administration. I know the TAMC Command is very supportive of the idea. It really comes down to the Surgeon General's Office and MEDCOM being supportive, as well. If so, the specifics of the program (i.e. number of residents, training sites, etc.) could be worked out fairly easily.

 

[Apollyon]

My response had nothing to do with hurt feelings. Give me a break. You were intentionally snarky under the guise of being confused about the intent of my original post, which adds nothing to the discussion. Queen's could potentially be a training site without UH having a civilian program. That is what I meant by "joint military/civilian venture," not that the program would necessarily accept both civilian and military applicants or that UH would need an EM residency. I think regardless of the affiliation status with Queen's, the residents would certainly be sent to mainland facilities to round out their education. This is exactly what happens with General Surgery (trauma at LAC/USC), Ortho (Baltimore Shock Trauma), Urology (Memorial Sloan Kettering), and other programs. CAPT Kelly envisions a setup similar to other Tripler residencies, which utilize Queen’s and Kapiolani as affiliated training sites. Obviously, Queen’s has stand-alone residencies in some of the same specialties but not all of them. For example, Tripler has ENT residents that rotate at Queen’s, even though Queen’s doesn’t have an ENT residency.


I realize that previous Tripler ED chiefs have had aspirations of opening an EM residency. That has no bearing on CAPT Kelly's desire or ability to develop the program. People said the same thing about the trauma designation. Once the Department of the Army got onboard, there was enough momentum to complete the process, which began several years ago. If the Army feels a 4th military EM residency is needed, then Tripler will be a likely training site. Once again, I am NOT endorsing the idea, and I think there are a number of obstacles in the way of creating the program. However, nothing that you have posted shows that I am “casting too bright a light.” The “planning phase” is just that, planning (i.e. how many trainees would be accepted each year, affiliated training sites, staffing requirements, etc.). CAPT Kelly and others have met with officials from UH, Queen’s, the Department of the Army, etc. to discuss these issues, which implies some degree of planning.

No intentional snark. You sound butthurt in the first 3 sentences. Seriously, since the rest of the post made sense, it was odd that there would be some "leet" word in there, or that you consider it a "grammatical error".

You're getting hung up in details. The next step after planning is execution. You sound deceptive when you say "implies some degree of planning". Where did I doubt planning? I said that planning implies the next step. You are going backwards and saying it "implies...planning".

To use the examples of surgery or ortho or Sloan-Kettering, those are one to three months out of 5 years. Shuttling EM residents to CA every month is not the same thing. That clouds your point.

I'm just saying that I'll believe it when I see it.

 

[colbgw02]

Being designated as a trauma center is not an EM-RRC requirement; however, the requirements parallel what it is to be designate a trauma center. However, the EM-RRC also dictates a minimum volume, and, at Tripler alone, they just don't get that volume.

The volume of the TAMC ED is ridiculously close to that of Queens. In fact, I want to say that it was actually a little higher around the 2008-2009 timeframe. The Tripler ED is about half the size, but its throughput is nearly twice as much as downtown, aided - no doubt - by considerably lower acuity.

 

[Commotio]

No intentional snark. You sound butthurt in the first 3 sentences. Seriously, since the rest of the post made sense, it was odd that there would be some "leet" word in there, or that you consider it a "grammatical error".

You're getting hung up in details. The next step after planning is execution. You sound deceptive when you say "implies some degree of planning". Where did I doubt planning? I said that planning implies the next step. You are going backwards and saying it "implies...planning".

To use the examples of surgery or ortho or Sloan-Kettering, those are one to three months out of 5 years. Shuttling EM residents to CA every month is not the same thing. That clouds your point.

I'm just saying that I'll believe it when I see it.

No one is "butthurt." You doubting that a Tripler-based EM residency is possible or likely has no impact on the potential for such a program to exist. As I pointed out in my previous post, Queen's would likely have to be an affiliate teaching site. If the ED folks felt that they needed to round out the experience by utilizing facilities on the mainland, then that's what they would do. Provided Kapiolani and Queen's agreed to being training sites, the Tripler residents wouldn't have to travel to the mainland every month. You're making straw man arguments. Look at the EM residency at Darnall Army Medical Center located in Kileen, Texas. Their residents spend between 7 and 10 months at other institutions in Texas, Arizona, and New York. All of their trauma experience comes from other institutions. Darnall is a community hospital. Spending 6-12 months away from Hawaii is entirely possible. The Urology residents at Tripler spend 7 months (out of the 48 Urology months) at Memorial Sloan Kettering. You really have no idea what you're talking about and are simply stating your opinions as facts. I couldn't care less if Tripler ever gets an EM residency. As I stated more than once above, there are clearly many obstacles in place that would make such a venture difficult. The Army would like to add a 4th military EM residency and has been using the civilian program at GHSU in Augusta, Georgia, as a stopgap. Given the current command climate at Tripler, I wouldn't be surprised at all Tripler ends up being the spot.

 

[Apollyon]

The volume of the TAMC ED is ridiculously close to that of Queens. In fact, I want to say that it was actually a little higher around the 2008-2009 timeframe. The Tripler ED is about half the size, but its throughput is nearly twice as much as downtown, aided - no doubt - by considerably lower acuity.

I just looked that up - yes, you are right and I am wrong. I had no idea. All sources that quote volumes never state TAMC.

No one is "butthurt." You doubting that a Tripler-based EM residency is possible or likely has no impact on the potential for such a program to exist. As I pointed out in my previous post, Queen's would likely have to be an affiliate teaching site. If the ED folks felt that they needed to round out the experience by utilizing facilities on the mainland, then that's what they would do. Provided Kapiolani and Queen's agreed to being training sites, the Tripler residents wouldn't have to travel to the mainland every month. You're making straw man arguments. Look at the EM residency at Darnall Army Medical Center located in Kileen, Texas. Their residents spend between 7 and 10 months at other institutions in Texas, Arizona, and New York. All of their trauma experience comes from other institutions. Darnall is a community hospital. Spending 6-12 months away from Hawaii is entirely possible. The Urology residents at Tripler spend 7 months (out of the 48 Urology months) at Memorial Sloan Kettering. You really have no idea what you're talking about and are simply stating your opinions as facts. I couldn't care less if Tripler ever gets an EM residency. As I stated more than once above, there are clearly many obstacles in place that would make such a venture difficult. The Army would like to add a 4th military EM residency and has been using the civilian program at GHSU in Augusta, Georgia, as a stopgap. Given the current command climate at Tripler, I wouldn't be surprised at all Tripler ends up being the spot.

Yes, you sound personally insulted, and I am trying to recall what someone said about any online discussion when someone invokes the "straw man". However, the straw man argument deliberately misrepresents, and I did not intentionally do that.

But, also, you seem to use all the internet buzz words ("straw man", "intentionally snarky", "adds nothing to the discussion"), so you seem to be experienced at this.

As for "opinions stated as facts", uh, no. Tell me which one(s), and I'll give you my sources. You can go to www.acgme.org and http://www.pers.hawaii.edu/wuh/Jobs/NAdvert/14600/1479411/1/postdate/desc to start. Wait, I DID say that Queen's would not be part without UH being part, and being a combined civilian/military program. That was opinion, but, if I could press it, I would be able to get some people to say it, which would make it factual.

I am simply saying that, for the predictable future, there will not be an EM program. I don't know how you are privy to the Army's wishes. But, as I said above, I'll believe it when I see it.

 

[Commotio]

I just looked that up - yes, you are right and I am wrong. I had no idea. All sources that quote volumes never state TAMC.



Yes, you sound personally insulted, and I am trying to recall what someone said about any online discussion when someone invokes the "straw man". However, the straw man argument deliberately misrepresents, and I did not intentionally do that.

But, also, you seem to use all the internet buzz words ("straw man", "intentionally snarky", "adds nothing to the discussion"), so you seem to be experienced at this.

As for "opinions stated as facts", uh, no. Tell me which one(s), and I'll give you my sources. You can go to www.acgme.org and http://www.pers.hawaii.edu/wuh/Jobs/NAdvert/14600/1479411/1/postdate/desc to start. Wait, I DID say that Queen's would not be part without UH being part, and being a combined civilian/military program. That was opinion, but, if I could press it, I would be able to get some people to say it, which would make it factual.

I am simply saying that, for the predictable future, there will not be an EM program. I don't know how you are privy to the Army's wishes. But, as I said above, I'll believe it when I see it.

Time will tell, I suppose. The only real barrier to this happening is at the Department of the Army level. I KNOW the Army would ultimately like to have 4 military EM residencies based on discussions with COL Wedmore, CAPT Kelly, and several other senior ED staff members to include EM residency program directos. The GHSU program was created as a temporary solution to augment the number of EM graduates. All of the requisite components of an EM residency could be worked out at TAMC, provided the Army selected it as the site of the next program. That much is clear. CAPT Kelly and other members of the TAMC ED administration and Command staff have had multiple meetings over the last 18 months with officials from Queen's and the Department of the Army to discuss the feasibility of having an EM program at Tripler. There really isn't much more to say than that. You think it's an impossibility. That's your OPINION. We'll leave it at that, because I find this entire debate to be tiresome at this point. I'm not an EM physician, will never work in an ED, and don't care if Tripler ever develops a residency program. I was simply passing along information gained from my interactions with COL Miller, CAPT Kelly, and others.

 

[DoctorDoom]

Just came across this gem. Anyone have any new gouge on this?