I would add that most of the descriptions in this thread can be found at most busy level I academic trauma centers. Trauma is formulaic by design, and the trauma experience is similar/the same at most institutions. Most general surgery residencies at level I centers will provide residents with way more trauma experience than necessary to handle trauma as a general surgeon (imho). I had the opportunity recently to tour the storied baltimore shock trauma bay and it was somewhat of a letdown. After all of the oft-repeated stories coming out of that place I expected a chorus of angels to sing out as I followed the red line into the place. What I found was a stereotypic trauma set-up, albeit larger than any I had ever seen.
I think that, the (University of Maryland's) trauma program is strong not for the volume of trauma, or the facilities, or the amount of penetrating trauma, (which is still relatively small compared to the amount of blunt and is less complex to manage) but for the people there, and for the way in which trauma is handled. For someone interested in an academic/leadership position in trauma surgery then Baltimore is an outstanding option. The culture there is probably among the best for trauma innovation, and improvement. From the attendings to the the x-ray techs, the concept is "team" which is the key for excellence in any field.
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I have much respect for collegial opinions and certainly can't disagree that experiences highlighted on this thread probably are similar to those at any busy level one trauma center. I would counter, however, that the experience over at the STC is not all that academic. Trauma, as you said, is quite formulaic and every virtually every patient gets the same workup, every time. Moreover, the system at "STC" revolves around patient throughput. They have two dedicated MDCT scanners adjacent to the 12+ resus bays that pump contrast into veins and prompty rule in or out acute pathology. At least for me, as an EM physician, the value was contained within managing many of these trauma patients at ONCE. When patients did travel to the OR, it was my experience that junior and senior EM residents were left to manage the resus bays. Running through ATLS algorithms is not unique to the disciplines of EM and trauma surgery- matching those formulas with clinical instinct, however, requires practice and a certain degree of competence.
"A chorus of angels" will probably never fly through Shock Trauma's doors and beckon people inward. However, its definitely the one place in Maryland that can provide the acutely injured patient with, if needed, a ready operating room, and trained trauma surgeons. The sheer volume of patients that cycles through that places necessitates certain capabilities that simply aren't found at other institutions. In addition to the requisite trauma operating suite (there are six), STC has perfusionists, neurosurgeons, trauma anesthesiologists, trauma radiologists, and critical care fellows in house 24/7. It was not at all uncommon, while tasked with triage in the resus bay, to hear of a bedside laparotomy occuring on one of the trauma ICUs. Prior to coming to Baltimore, I had never heard of ECMO being used as a salvage therapy for badly damaged adult lungs. Though I personally would enjoy working in a hospital that has an integrated trauma service, I can honestly say that the experience at STC stands out for its uniqueness. Few other US institutions follow the model of a stand-alone trauma hospital, and it is interesting to see how STC's resuscitation strategies play out.
Whether considering a critical care, "observationship" or a rotation on a trauma team, here are some distinguishing facts about the STC to keep in mind:
1) Dedicated trauma resus bays- access to care only via ambulance or helicopter
2) Dedicated trauma operating suites; six of them are adjacent to the "trauma resuscitation unit"
3) Dedicated trauma surgical intensive care units: three floors of intensive care beds for neurosurgical, multi-trauma, and surgical intensive care patients
4) Two dedicated MDCT scanners (the CT techs are quite possessive of their scanners- getting an emergency department patient to the STC CT suite for a trauma scan CT can be a minor miracle.)
5) Dedicated trauma angio suite
6) Trauma anesthesiologists supervise greet every trauma admission (EM residents rotate on the trauma anesthesia service)
7) The trauma helipad can accomodate 3 choppers on its roof
8) Dedicated laboratory services (makes the ED quite jealous with their turn around time for routine admission labs)
9) Trauma critical care fellows (from EM and surgery) supervise admissions to the three trauma ICUs
Just my two cents. Best wishes,
-P
