Features of the best EM programs

[wonderbread12]

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This is not a "which program is best" but now that we've all gone our interviews and submitted our ROLs, I'm curious what everyone thought were some of the best perks/luxury of some of the programs y'all interviewed at

 

[erasthrowaway328382382]

BIDMC's real 3+1 is amazing

 

[Cinematographer]

Disclaimer: I'm not a resident (yet), so the comments below are based on interview and away rotation(s) experience only.

I thought most of the programs I interviewed at offered nearly the same curriculum and overall I have to agree with what many residents and attendings told me during my away rotations, and that would be that most EM programs offer fantastic training and one should come out as a competent physician by the end of it. There were however, a few key features that helped me rank certain programs higher than the rest. Given my background I am almost certain that I will go into academics, so for me those key features included, but were not limited to, the following:

• Strong ultrasound curriculum/training
• Significant research output and opportunities to get involved
• Opportunities to find your own "niche" in EM (via a 3+1 curriculum or tracks, for instance)
• Presence and participation in the whole #FOAMed movement
• Great relationship between EM and other departments
• Commitment to resident and faculty diversity
• Genuine interest in resident wellness and life/work balance

Minor perks that may or may not have influenced my final rank list were things such as: EPIC + Dragon dictation, Scribes for PGY2 and above, intern orientation ≥2 weeks, free parking, fitness center, shifts ≤10 hours.

And YES,to the gross attendings and jaded residents on here: I understand many of these features won't make me a better attending, but they sure as hell can make my residency experience more enjoyable.


What did you think were the unique features of the best EM programs, @wonderbread12?

 

[EMNation]

Yale had really cool iPhone setup where all residents had work phones where all nurses/other specialists/other staff could reach you via calls or texts. it's a simple thing, but so much more convenient than horribly old technology with paging and sitting by a phone.

 

[Bojack Horseman]

-departmental status. Not that having departmental status makes a program great, but all the great programs have it.

-orientation month

-shifts that aren't exclusively 12 hours.

-good u/s training with u/s fellowship trained faculty reviewing resident scans

-dedicated pediatric hospital. Ideally Peds ED in a pediatric hospital run by EM department (but I think very few places probably have this --- I know Indiana does)

-$$$ to travel to conferences, $ for global health, $ for research/other interests in EM

-good exposure to subspecialties of EM.

-high patient volume

-fast track that is NOT staffed by EM residents. Bonus points if their pedi hospital does the same.

 

[Zebra Hunter]

I see a lot of stuff here that I personally would never consider as that important for an EM program to have. For me, it's all about training me for the job after residency. You'll eventually come to realize that ultrasound is a largely overrated aspect of EM (obviously you need some training in it, but due to ACGME requirements, most programs will do well at training you in the important usages of u/s).

- Diversity and acuity are very important
- Less off-service rotations, more ER rotations
- Lack of graduated responsibility
- Strong pediatric exposure
- Happy residents
- Reasonable hours (meaning no 21 12's a month)
- And being a 3 year program

 

[Janders]

-fast track that is NOT staffed by EM residents. Bonus points if their pedi hospital does the same.

Disagree. While you don't want fast track to be the focus of your existence, the brutal truth is most EM docs spend most of their days in practice settings where huge hunk of their patients are "Fast track". Perhaps they are supervising PAs who cover fast track, or perhaps they are seeing the patients themselves. Just because their chief complaints are seemingly minor/trival, does not mean they have no disease present. While I completely agree as a senior resident I wouldn't want to spend 50% of my time moving the meat in fast track, I also would not want to train somewhere that has the great majority of fast track eaten up by PA/NP/off-service interns.

 

[Bojack Horseman]

Disagree. While you don't want fast track to be the focus of your existence, the brutal truth is most EM docs spend most of their days in practice settings where huge hunk of their patients are "Fast track". Perhaps they are supervising PAs who cover fast track, or perhaps they are seeing the patients themselves. Just because their chief complaints are seemingly minor/trival, does not mean they have no disease present. While I completely agree as a senior resident I wouldn't want to spend 50% of my time moving the meat in fast track, I also would not want to train somewhere that has the great majority of fast track eaten up by PA/NP/off-service interns.

I would personally want my training to err on the side of high acuity than low acuity. Most places close their fast tracks during non-peak hours so I'm sure I'll see plenty of runny noses/sore throats then.

 

[winkleweizen]

I would personally want my training to err on the side of high acuity than low acuity. Most places close their fast tracks during non-peak hours so I'm sure I'll see plenty of runny noses/sore throats then.

There's something to be said about moving fast on these patients, you won't get that with only an occasional one overnight. I would say 1, maybe 2 fast track shifts a month is adequate though.

 

[deleted547339]

High acuity.
Good pph by senior residents.
Happy residents.
Tolerable work load.
Moonlighting.
3y.
Supportive chair and PD.
Early responsibility.

 

[Bojack Horseman]

I don't see a problem with working a few fast track shifts a month, but I didn't like it when programs did not have a fast track area or had residents work a significant portion of their shifts in a fast track area.

 

[filhodeinferno]

Things for a good residency where you'll be happy and learn well:

1- Majority of co-residents you get along with
2- Majority of attendings aren't jerks and want to teach
3- Tolerable work hours
4- Department has clout in the hospital as whole
5- Acuity high, volume high....but not so high that you don't have time to learn

The rest of the nitty gritty details don't really matter. Flight, floor month or not, all that....does't really matter.

 

[hundreddaysoff]

I dunno. How would you feel about a general surgeon who spent most of their residency doing "high acuity" cases, but never really learned how to do an appendectomy or lap chole? Yeah, learning how to handle high acuity stuff is important obviously, but you have to learn the bread and butter too.

I'm a senior at a shop where the residents staff fast track, we each do 1-2 fast track shifts per month out of our 20 shifts. Not too bad. Leaves 18 shifts for seeing the high acuity stuff, and we see plenty. And as much as we all gripe and moan about fast track, we all admit at the end of the day that those shifts are very valuable....

1) Lots of ortho experience and procedures since most "ankle pain", "shoulder pain", etc goes to fast track. I feel very comfortable reviewing films, doing blocks, reductions, splinting, etc etc.

2) Lots of suturing experience.

3) Learning to pick out that one sick person in a sea of the walking well. Most of my fast track shifts mean discharging all of my patients home. But I've admitted to the ICU out of fast track more than once, I've sent someone straight to the OR, and have caught more than one zebra. Learning how to detect something subtle yet game changing after slogging through fast track patients for 5 hours is a big deal, and something you're not going to learn if you only see "high acuity". Just as with anything else, you have to see 100 normal sore throats before you can recognize that one that just isn't quite right.

4) I moonlight at a small place with just myself and a PA, and I feel very comfortable discussing their cases with them, popping my head in to rooms and feeling comfortable that the patients are OK and their workups appropriate, etc. It would be pretty embarrassing to have the PA ask me for an opinion on a film or help with reduction or splinting, and to have to say "uh, I'm not really sure how to do that".

Just my opinion, man.

Agree with this. My program has all the good features everyone agrees on, except no resident fast tracking yet (they're working on starting it). In the main ER, there is plenty of acuity, but I probably only average about one lac repair per month and have yet to reduce or splint. So definitely wouldn't be comfortable seeing this stuff while moonlighting at this point. I imagine I will get more in second year, when we handle all the traumas.

But also keep in mind that at some programs, the fast track patients tend to be better mixed into the main ER. At my med school's humongous county hospital, there were plenty of lacs and reductions and the residents got tired of them.

 

[wonderbread12]

Disclaimer: I'm not a resident (yet), so the comments below are based on interview and away rotation(s) experience only.

I thought most of the programs I interviewed at offered nearly the same curriculum and overall I have to agree with what many residents and attendings told me during my away rotations, and that would be that most EM programs offer fantastic training and one should come out as a competent physician by the end of it. There were however, a few key features that helped me rank certain programs higher than the rest. Given my background I am almost certain that I will go into academics, so for me those key features included, but were not limited to, the following:

• Strong ultrasound curriculum/training
• Significant research output and opportunities to get involved
• Opportunities to find your own "niche" in EM (via a 3+1 curriculum or tracks, for instance)
• Presence and participation in the whole #FOAMed movement
• Great relationship between EM and other departments
• Commitment to resident and faculty diversity
• Genuine interest in resident wellness and life/work balance

Minor perks that may or may not have influenced my final rank list were things such as: EPIC + Dragon dictation, Scribes for PGY2 and above, intern orientation ≥2 weeks, free parking, fitness center, shifts ≤10 hours. What did you think were the unique features of the best EM programs, @wonderbread12?

I thought anything that hit on resident wellness was important because to me it meant the program cared more about the residents than a typical program

I saw some programs have built in time for cross cover (none of that 10 hr shift becomes 12) and having a food break and I also liked the idea of having a hospital/work specific phone as others have mentioned but few had this

Seeing how happy the residents were was important and by the end of it you start to tell the differences between "everyone looks happy" to those that are actually loving life outside of working as residents and doing other things

I also loved the 3+1 idea but none of my programs offered this.

Shift preference of 8 > 10 > 12 hours ....especially if its expected to stay longer

I also felt having a strong peds showing was important but very few programs can offer this so at least having a focus with longitudinal exposure was important

Things that made life easier to me were: 1) free parking 2) nice lounge area 3) EPIC 4) Decent random money (GME/cafeteria/etc)
I come from a hospital/med school with subpar facilities at best so it was crazy to see how beautiful all other hospitals are

 

[wonderbread12]

On a similar note, what do you guys think would be the most easily implementable change to suggest to a PD to make your program instantly better? Obviously can't make a peds ED or change how fast track is run but seems like if you're at the right program they be open/ should want to borrow from the best features of other programs to improve their own

 

[gman33]

Some of the most important things may be things that you wouldn't pick given the choice.
My program had a ton of ICU team. Much more than most places.
Those blocks were brutal. I viewed that as a negative in evaluating the program.
Looking back, that was the strength of my program.

Some of my attendings were giant a-holes. Not most, but some of them were.
Would I pick this? of course not. It did train my how to deal with difficult consultants, etc.

A lot of the things that appeal to candidates do nothing to help you as an attending.

 

[Modafinil]

A lot of the things that appeal to candidates do nothing to help you as an attending.

This is one of the most important things in the thread.

 

[Renaissance Man]

Some of the most important things may be things that you wouldn't pick given the choice.
My program had a ton of ICU team. Much more than most places.
Those blocks were brutal. I viewed that as a negative in evaluating the program.
Looking back, that was the strength of my program.

Some of my attendings were giant a-holes. Not most, but some of them were.
Would I pick this? of course not. It did train my how to deal with difficult consultants, etc.

A lot of the things that appeal to candidates do nothing to help you as an attending.

Definitely agree with your post, however some of the things listed above that appeal to applicants (like me) are still definitely important. Of course, I want to be a competent and well-prepared attending coming out of residency. But I also want to pick somewhere that has upside for residents, even if it doesn't really matter during attending-hood. It is 3-4 years of time during the "prime" of my life; it might as well be as good as possible.

 

[EM/CC_23]

During an away sub-I, I worked with wonderful, intelligent, and happy/nice nurses (at an extremely busy inner city county facility with a rough and very sick patient population). This made me realize how horrible nursing is in general at my home institution, and how they make everyone's life miserable there. Thus, I made it a priority during interviews to find out how the residents and nurses got along at each place. I think working in a non-toxic/positive learning environment is key to preventing burnout (at least for me), and, in the limited amount of experience I've had so far in med school, I think a resident's relationship with nursing is as important as his/her relationship with attendings or other residents in regards to being happy at work. Nurses can be very helpful and a critical resource, or they can pretend their entire shift is their lunch break, and then purposefully haze you by ignoring your orders, doing the minimum necessary to not get fired, and being rude to your face but not saying anything specific that could be documented to get them reprimanded. I've seen both situations on different EM sub-Is, and the latter is really not worth suffering through for 3-4 years (no matter how prestigious the program in my opinion). (One clarification: I'm not talking about whether you put in your own IV's or whatever; to me this is more a question of attitude than it is who does which tasks at one particular institution.)

 

[link2swim06]

Anywhere you will be happy. That's it.

 

[gman33]

During an away sub-I, I worked with wonderful, intelligent, and happy/nice nurses (at an extremely busy inner city county facility with a rough and very sick patient population). This made me realize how horrible nursing is in general at my home institution, and how they make everyone's life miserable there. Thus, I made it a priority during interviews to find out how the residents and nurses got along at each place. I think working in a non-toxic/positive learning environment is key to preventing burnout (at least for me), and, in the limited amount of experience I've had so far in med school, I think a resident's relationship with nursing is as important as his/her relationship with attendings or other residents in regards to being happy at work. Nurses can be very helpful and a critical resource, or they can pretend their entire shift is their lunch break, and then purposefully haze you by ignoring your orders, doing the minimum necessary to not get fired, and being rude to your face but not saying anything specific that could be documented to get them reprimanded. I've seen both situations on different EM sub-Is, and the latter is really not worth suffering through for 3-4 years (no matter how prestigious the program in my opinion). (One clarification: I'm not talking about whether you put in your own IV's or whatever; to me this is more a question of attitude than it is who does which tasks at one particular institution.)

Having terrible nursing can be an essential element of your training.
You will have to learn to get everything done yourself.
You will also learn how to make sure things actually get done.

It will be terrible at times, but it will force you to learn some important skills.

 

[alpinism]

I dunno. How would you feel about a general surgeon who spent most of their residency doing "high acuity" cases, but never really learned how to do an appendectomy or lap chole? Yeah, learning how to handle high acuity stuff is important obviously, but you have to learn the bread and butter too.

I'm a senior at a shop where the residents staff fast track, we each do 1-2 fast track shifts per month out of our 20 shifts. Not too bad. Leaves 18 shifts for seeing the high acuity stuff, and we see plenty. And as much as we all gripe and moan about fast track, we all admit at the end of the day that those shifts are very valuable....

1) Lots of ortho experience and procedures since most "ankle pain", "shoulder pain", etc goes to fast track. I feel very comfortable reviewing films, doing blocks, reductions, splinting, etc etc.

2) Lots of suturing experience.

3) Learning to pick out that one sick person in a sea of the walking well. Most of my fast track shifts mean discharging all of my patients home. But I've admitted to the ICU out of fast track more than once, I've sent someone straight to the OR, and have caught more than one zebra. Learning how to detect something subtle yet game changing after slogging through fast track patients for 5 hours is a big deal, and something you're not going to learn if you only see "high acuity". Just as with anything else, you have to see 100 normal sore throats before you can recognize that one that just isn't quite right.

4) I moonlight at a small place with just myself and a PA, and I feel very comfortable discussing their cases with them, popping my head in to rooms and feeling comfortable that the patients are OK and their workups appropriate, etc. It would be pretty embarrassing to have the PA ask me for an opinion on a film or help with reduction or splinting, and to have to say "uh, I'm not really sure how to do that".

Just my opinion, man.

Meh

You see enough low acuity crap in the main ED as it is now.

Using that same argument we should all be spending hours in clinic seeing "100s of normal patients" to recognize the 1 sick patient. I don't see anyone in their right mind advocating for spending a month in FM clinic during residency. If you want more experience with suturing and reductions just send these patients to the main ED.

 

[Tenk]

Moonlighting ability > all.

 

[TheBlueBlazer]

so I'm advocating for the way my program did things without a tremendous amount of comparison, but I loved really having minimal hierarchy. We worked one-on-one with an attending and I learned mostly from attending docs, not from senior residents who were still figuring out things for themselves. Our ED was fully capable of being run without residents, but by the time we were seniors, your pod was expected to be able to be run without an attending. Conference time was truly protected, meaning no overnights the night before. We were truly there to learn and not just to move the meat.

 

[HooliganSnail]

-departmental status. Not that having departmental status makes a program great, but all the great programs have it.

-orientation month

-shifts that aren't exclusively 12 hours.

-good u/s training with u/s fellowship trained faculty reviewing resident scans

-dedicated pediatric hospital. Ideally Peds ED in a pediatric hospital run by EM department (but I think very few places probably have this --- I know Indiana does)

-$$$ to travel to conferences, $ for global health, $ for research/other interests in EM

-good exposure to subspecialties of EM.

-high patient volume

-fast track that is NOT staffed by EM residents. Bonus points if their pedi hospital does the same.

I think high acuity is more important than high volume. You want to be at a high acuity shop, where you see lots of really sick people.

 

[deleted547339]

so I'm advocating for the way my program did things without a tremendous amount of comparison, but I loved really having minimal hierarchy. We worked one-on-one with an attending and I learned mostly from attending docs, not from senior residents who were still figuring out things for themselves. Our ED was fully capable of being run without residents, but by the time we were seniors, your pod was expected to be able to be run without an attending. Conference time was truly protected, meaning no overnights the night before. We were truly there to learn and not just to move the meat.

That does not sound ideal. Being overnight before lecture doesn't mean conference isn't protected, it just means you have to put in some hard work. This is how real life is - we're going to have meetings after overnight shifts after residency, why should we get babied now?

Also, I would see a department where the department can run without the residents as a huge red flag. Out department can hobble through brief periods without residents, but our work is critical to the department workflow and the nurses hate working without residents.

Regarding moving the meat, I damned sure wanted to be known for moving the meat at my residency. You know what they care about in the community? Who can bill the most rvus and get the least complaints/make everyone happy. Besides, yes I study a ton, but you learn from your patients. You'll learn a lot more seeing 2.5/hr than you will seeing 1.5/h.

 

[TheBlueBlazer]

That does not sound ideal. Being overnight before lecture doesn't mean conference isn't protected, it just means you have to put in some hard work. This is how real life is - we're going to have meetings after overnight shifts after residency, why should we get babied now?

Also, I would see a department where the department can run without the residents as a huge red flag. Out department can hobble through brief periods without residents, but our work is critical to the department workflow and the nurses hate working without residents.

Regarding moving the meat, I damned sure wanted to be known for moving the meat at my residency. You know what they care about in the community? Who can bill the most rvus and get the least complaints/make everyone happy. Besides, yes I study a ton, but you learn from your patients. You'll learn a lot more seeing 2.5/hr than you will seeing 1.5/h.

Agree to disagree I guess. To me, the focus on residency should be learning more than working, but yes, including learning how to work. Learning how to be efficient and manage your workload is important, but more important - learning to be a GOOD DOCTOR. When you're focused on seeing as many patients as possible instead of giving the best care possible to each patient, that's betraying what I went into medicine to do. Numbers don't mean a damn thing if you're a mediocre clinician, and I think it's sad that in our day of CMGs and our difficulty measuring quality that instead we focus on quantity. I don't want my family member being seen by the guy that comes to work and rips through charts because they want to hit metrics, I want them seen by the guy who gives the best care. I'm not saying that's you by any means, I have no idea how you are as a clinician, but I think that this sort of mentality can be dangerous. I also don't want to give the impression we weren't seeing adequate numbers of patients by the end, rather that early in training, being good was WAY more valued than being fast

And to clarify my previous point our department is ABLE to be run without residents, doesn't mean it's at its best when that is happening by any means.

 

[Bojack Horseman]

I think high acuity is more important than high volume. You want to be at a high acuity shop, where you see lots of really sick people.

So maybe a high volume shop that has a separate fast track not staffed by residents?...

 

[exsanguination]

Agree to disagree I guess. To me, the focus on residency should be learning more than working, but yes, including learning how to work. Learning how to be efficient and manage your workload is important, but more important - learning to be a GOOD DOCTOR. When you're focused on seeing as many patients as possible instead of giving the best care possible to each patient, that's betraying what I went into medicine to do. Numbers don't mean a damn thing if you're a mediocre clinician, and I think it's sad that in our day of CMGs and our difficulty measuring quality that instead we focus on quantity. I don't want my family member being seen by the guy that comes to work and rips through charts because they want to hit metrics, I want them seen by the guy who gives the best care. I'm not saying that's you by any means, I have no idea how you are as a clinician, but I think that this sort of mentality can be dangerous. I also don't want to give the impression we weren't seeing adequate numbers of patients by the end, rather that early in training, being good was WAY more valued than being fast

And to clarify my previous point our department is ABLE to be run without residents, doesn't mean it's at its best when that is happening by any means.

I've been thinking along the same lines recently.

I'm only a PGY2, and I really used to look up to my attendings who could push 3-4 (!!) per hour. But now that I have some more experience, I realize that they're not giving the care I'd want as a patient if I came into my ED, and that the attendings that are super "slow" (maybe 1.5 per hour) tend to be the ones that I'd want taking care of my family.

It's a struggle I currently have. I'm definitely not "good enough" to be seeing 2 per hour SAFELY at this point.

 

[TheComebacKid]

Everyone's list is different. My list is from the perspective as a single individual without any real restrictions in terms of location or significant other etc. I am in no way minimizing what other people prioritize because I understand that people have different circumstances. This was just MY thought process.

What I think are the best features:
- Acuity. This is seriously IMO the only way to differentiate between programs. Different patient populations have different pathology. The bread and butter EM in terms of lac repairs and CHF exacerbations while extremely important to get comfortable with, I was able to find that at every program I interviewed at. I couldn't find the patient's with tension pneumo's, ruptured ectopics, or retrobulbar hematoma's at every program.
- Does EM get dibs? This was an important question to me. The program can have all the acuity in the world, but if the EM residents don't get first crack at most things, then what's the point
- How confident and clinically competent are the residents? Another important question. I didn't care if the residents were sleep deprived, or if they hated their 1 ward month, I cared if they felt confident taking care of sick patients. Very difficult to deduce from interview day, perhaps easier if you rotated at a place.
- Does the PD advocate for his/her residents? If the PD doesn't go to bat for you, you'll never get the experience you are looking for.

What I don't understand people getting all crazy over:
- 1 medicine ward month: Yeah, it probably sucks. Yeah it's debatable if it's necessary. But it's one freaking month. People literally lament over this and throw amazing programs to the bottom of their rank list over 30 days of their life.
- Moonlighting: I guess for some people with kids/family/mortgages etc. the extra money is important. I'm not going to lie it would be nice to pocket some extra change during residency when I'm already going to be broke. But it's just a perk, nothing that I would even factor in when making my rank list. Besides, most of the moonlighting gigs sound like they are just fast track type stuff which would bore me.
- Salary: 48K versus 52K. Sure there's a difference. But either way, you are poor during residency. I'll take the better training program and eat ramen. Again, if I had a different financial situation I may have considered this more heavily.
- Shift length: I can't tell you what the shift length is for my number 1 program that I ranked. I really honestly don't remember, and I don't really care. 8 hours versus 12 hours... 8 hours sounds nice, but again, I'm not excited about the prospect of going to a program with low acuity and poor training just because it's a chiller schedule. Now, if I had a wife and kids that I wanted to spend time with, I may think differently.
- How "happy" the residents were: I know this is probably really against the grain of what most EM applicants look for, but I really didn't look too much into this. I rotated at a ED where the residents were by all standards "ecstatic" but the acuity was low and the teaching didn't seem very strong. I rotated at another program where the residents were tired and felt overworked, but clinically they were absolutely outstanding. My thought process towards residency is that it is a finite amount of time in your life. I would rather be tired for 3-4 years and work long days/nights, but feel confident taking care of sick patients when I go out into practice versus living the dream life during residency and being lost when I get out. Another thing is that it's really hard to tell how happy residents are from a random interview day or pre-interview dinner. Lastly, just because residents don't "seem" happy it doesn't mean that the PD and the program doesn't value or care about the residents. Part of the philosophy of the program could be "work hard play hard" in which case depending on when you catch a resident, they may just be really sleep deprived and miserable.
- Reputation: Wasn't that important to me. At the end of the day, the only thing that will make you feel good about yourself is if you can look at your training and if you feel it afforded you with the tools you need to be comfortable taking care of patients. Doximity rankings may tell you that program A is better than program B, but in reality, maybe program B is a program that will maximize your training and cater more towards your learning and thus help you to become a better physician.
- Location: Again, I'm lucky in the sense that I didn't have to take this into consideration, but I do understand why it's a big deal for others. My take on it goes back to what I said earlier which is that residency is a finite amount of time. Seasonal affective disorder sucks, but I think I can put up with it for a few years and then head over to a nicer place after training is done.
- Honorable mention for things that I felt were overrated: quality of cafeteria, how sexy the EMR is, parking, scribes, money for conferences


I know my approach to making my rank list was pretty unconventional. Again, not trying to knock anyone for prioritizing moonlighting/schedule/location, I'm just sharing my own thought process.

 

[JustTryingToHangOut]

Hours and resident happiness as something people get crazy over? Interesting

 

[future_dr_house]

I went to a residency with a couple of diametrically opposed sites. One you could move meat and get used to high throughput workflow (mainly as a upper level, pgy-1 you're limited by your own abilities) and the other a more academic tertiary center with the sickest patients (40% admit rate, 1/3 of admissions to icu). I loved the variety and it trains you well to be exposed to it all and figure out what environment you want to be in later. We all have different preferences. Why settle for one type of setting?


Sent from my iPhone using Tapatalk

 

[Swingman]

Everyone's list is different. My list is from the perspective as a single individual without any real restrictions in terms of location or significant other etc. I am in no way minimizing what other people prioritize because I understand that people have different circumstances. This was just MY thought process.

What I think are the best features:
- Acuity. This is seriously IMO the only way to differentiate between programs. Different patient populations have different pathology. The bread and butter EM in terms of lac repairs and CHF exacerbations while extremely important to get comfortable with, I was able to find that at every program I interviewed at. I couldn't find the patient's with tension pneumo's, ruptured ectopics, or retrobulbar hematoma's at every program.
- Does EM get dibs? This was an important question to me. The program can have all the acuity in the world, but if the EM residents don't get first crack at most things, then what's the point
- How confident and clinically competent are the residents? Another important question. I didn't care if the residents were sleep deprived, or if they hated their 1 ward month, I cared if they felt confident taking care of sick patients. Very difficult to deduce from interview day, perhaps easier if you rotated at a place.
- Does the PD advocate for his/her residents? If the PD doesn't go to bat for you, you'll never get the experience you are looking for.

What I don't understand people getting all crazy over:
- 1 medicine ward month: Yeah, it probably sucks. Yeah it's debatable if it's necessary. But it's one freaking month. People literally lament over this and throw amazing programs to the bottom of their rank list over 30 days of their life.
- Moonlighting: I guess for some people with kids/family/mortgages etc. the extra money is important. I'm not going to lie it would be nice to pocket some extra change during residency when I'm already going to be broke. But it's just a perk, nothing that I would even factor in when making my rank list. Besides, most of the moonlighting gigs sound like they are just fast track type stuff which would bore me.
- Salary: 48K versus 52K. Sure there's a difference. But either way, you are poor during residency. I'll take the better training program and eat ramen. Again, if I had a different financial situation I may have considered this more heavily.
- Shift length: I can't tell you what the shift length is for my number 1 program that I ranked. I really honestly don't remember, and I don't really care. 8 hours versus 12 hours... 8 hours sounds nice, but again, I'm not excited about the prospect of going to a program with low acuity and poor training just because it's a chiller schedule. Now, if I had a wife and kids that I wanted to spend time with, I may think differently.
- How "happy" the residents were: I know this is probably really against the grain of what most EM applicants look for, but I really didn't look too much into this. I rotated at a ED where the residents were by all standards "ecstatic" but the acuity was low and the teaching didn't seem very strong. I rotated at another program where the residents were tired and felt overworked, but clinically they were absolutely outstanding. My thought process towards residency is that it is a finite amount of time in your life. I would rather be tired for 3-4 years and work long days/nights, but feel confident taking care of sick patients when I go out into practice versus living the dream life during residency and being lost when I get out. Another thing is that it's really hard to tell how happy residents are from a random interview day or pre-interview dinner. Lastly, just because residents don't "seem" happy it doesn't mean that the PD and the program doesn't value or care about the residents. Part of the philosophy of the program could be "work hard play hard" in which case depending on when you catch a resident, they may just be really sleep deprived and miserable.
- Reputation: Wasn't that important to me. At the end of the day, the only thing that will make you feel good about yourself is if you can look at your training and if you feel it afforded you with the tools you need to be comfortable taking care of patients. Doximity rankings may tell you that program A is better than program B, but in reality, maybe program B is a program that will maximize your training and cater more towards your learning and thus help you to become a better physician.
- Location: Again, I'm lucky in the sense that I didn't have to take this into consideration, but I do understand why it's a big deal for others. My take on it goes back to what I said earlier which is that residency is a finite amount of time. Seasonal affective disorder sucks, but I think I can put up with it for a few years and then head over to a nicer place after training is done.
- Honorable mention for things that I felt were overrated: quality of cafeteria, how sexy the EMR is, parking, scribes, money for conferences


I know my approach to making my rank list was pretty unconventional. Again, not trying to knock anyone for prioritizing moonlighting/schedule/location, I'm just sharing my own thought process.

Respect.

 

[justaregularmed]

I will never understand this obsession with acuity, sick patients that appear sick are easy, its the ones that don't appear sick but really are that you want to train on but that's hard to advertise.

 

[alpinism]

Huh?

Sick patients that don't appear sick are still sick patients.

I don't think anyone's arguing that it isn't helpful to see as many different disease presentations as possible during residency.