First EM/Anesthesia Combined Residency at Hopkins

[DeadCactus]

Looks like they are currently accepting applications for the first 2 residents this application cycle.

Combined Emergency Medicine Anesthesiology Residency Program | Johns Hopkins Emergency Medicine Department

Like all combined programs, likely a waste of time and money for most but a cool opportunity for a small subset of applicants with specific career goals. Kind of a shame that it's a 6 year program due to JHU being a 4 year EM program (as opposed to a 5 year program at an institution with a 3 year residency).

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[Robotic Wis-Hipple]

Aside from me seeing absolutely zero utility in this, why would you want to spend 6 years training in the two fields literally every other specialist thinks they could do better?

 

[bashwell]

Aside from me seeing absolutely zero utility in this, why would you want to spend 6 years training in the two fields literally every other specialist thinks they could do better?

We might as well add a third field -- radiology -- since every specialist knows how to read their own imaging!

 

[AdmiralChz]

When will the combined triple program of Anesthesiology/Emergency Medicine/Surgery come up? Then you can be a crazy three-headed hydra who does everything from admits a trauma patient in the ED brings them up to the OR and provides both the anesthesia and the surgical care simultaneously! Throw in some ICU training and you've got it made.

Back to the main point, I also don't see much utility from this. I am suspect of those that do combined residencies at all as it is hard enough to master the knowledge and skills of a single field, throw in a minimally-related one and you might become more of a "jack of all trades but master of none" which may not be in the best interests of patients.

There is some overlap in the two fields (procedures obviously but also resuscitation come immediately to mind) but there is a vast difference in the goals of care. I see this when I moonlight in a community ED a few shifts a month. It takes a couple hours to get into the mindset of the emergency room when one is used to the rapid pace of the OR with less emphasis on diagnosis and more on treatment.

 

[AlmostAnMD]

It takes a couple hours to get into the mindset of the emergency room when one is used to the rapid pace of the OR with less emphasis on diagnosis and more on treatment.

lol

 

[DeadCactus]

I see a clear utility. The goal of combined programs is never to churn out an entire work force of a new type of physician. The goal is to build a small cohort that fill a niche. Graduates from a program like this would be well positioned to be be the local gurus for things like airway, nerve blocks, and resuscitation and play a key role in the research, QI, and educational aspects of those skills. Over time, combined programs and physicians seem to improve collaboration between departments which is an additional institutional benefit. From the trainee perspective, you're giving up 2 years to develop a specific niche. Not much different than doing a fellowship in preparation for an academic job and at least you would get to intersperse anesthesia months into your EM residency for a change of pace.

 

[Psai]

I see a clear utility. The goal of combined programs is never to churn out an entire work force of a new type of physician. The goal is to build a small cohort that fill a niche. Graduates from a program like this would be well positioned to be be the local gurus for things like airway, nerve blocks, and resuscitation and play a key role in the research, QI, and educational aspects of those skills. Over time, combined programs and physicians seem to improve collaboration between departments which is an additional institutional benefit. From the trainee perspective, you're giving up 2 years to develop a specific niche. Not much different than doing a fellowship in preparation for an academic job and at least you would get to intersperse anesthesia months into your EM residency for a change of pace.

If you want to be a guru at airways, nerve blocks, resuscitation you only need an anesthesia residency.

 

[deleted547339]

If you want to be a guru at airways, nerve blocks, resuscitation you only need an anesthesia residency.

Ehhhh....I wouldn't be so quick to say anesthesia is the master of resuscitation. Sure, they resuscitate surgical patients, but they only care for a subset of patients.

 

[Mad Jack]

Up next: anesthesia/dermatology, anesthesia/psychiatry, and anesthesia/pathology.

 

[Birdstrike]

This is really cool, a combined EM/Gas program. But once finished with your training, how the hell would you deal with arguing with yourself about who's better at intubating, you, or you?

 

[evilbooyaa]

This is really cool, a combined EM/Gas program. But once finished with your training, how the hell would you deal with arguing with yourself about who's better at intubating, you, or you?

Don't ya know, this combined residency was only CREATED in response to that thread about Anesthesiologist vs EMP and who was better at intubating, so that in 6 years somebody could necrobump it and say "The best person at the airway is me, the guy double-boarded in EM and Anesthesiology!"

 

[SamtheWise]

Next time someone complains about how EPs suck at chest tubes I'm going to respond by creating a 10 year combined CT surgery/EM residency

 

[DeadCactus]

If you want to be a guru at airways, nerve blocks, resuscitation you only need an anesthesia residency.

Or I guess they could just go to CRNA school.

But in all seriousness, the combined EM programs tend to be geared toward people who want to bring the expertise of specialties that overlap with EM into the ED (as well as to have the option to diversify their practice).

 

[Robotic Wis-Hipple]

I think it's so the graduates can bill q15min in the ED. No more playing the magic number of CC time you put in your notes game if you tube and GA everyone while you're waiting for consultants to admit the patient or the hospital to find a bed for em.

 

[deleted126335]

Up next: anesthesia/dermatology, anesthesia/psychiatry, and anesthesia/pathology.

Anesthesia/investment banking.


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[Mad Jack]

Anesthesia/investment banking.


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No, no, that's too synergistic! We need useless combos!

Anesthesia/child neurology!

 

[gutonc]

No, no, that's too synergistic! We need useless combos!

Anesthesia/child neurology!

Isn't child neurology more or less useless on it's own?

 

[Mad Jack]

Isn't child neurology more or less useless on it's own?

Exactly

 

[Birdstrike]

EM/Porn?

 

[gutonc]

EM/Porn?

Seems much less useless than most of the other options.

 

[Fox800]

Would rather see a combined EM/critical care pathway (without the IM).

 

[deleted547339]

Would rather see a combined EM/critical care pathway (without the IM).

What's the point? You can already do both in 5.

 

[KGflyboy]

This seems like such a random combination. I can't imagine any real world need for doctors trained in both. I can see some people who just can't making up their minds between anesthesia and EM applying to this program, but that is probably not a good reason to consider a combined program like this. I keep seeing more and more people choose combined residencies with the intent of practicing in 2 fields only to realize later there simply isn't much need for this. Everyone interested in these combined programs always "knows a guy" that seems to have carved out a niche after residency in order to practice 2 specialties, but that's not the norm. The vast majority of these graduates seem to end up working in 1 field.

 

[anbuitachi]

If you want to be a guru at airways, nerve blocks, resuscitation you only need an anesthesia residency.

Doesn't sound like a very useful combo. Anesthesiology residency is 4 years long because you have to familiarize yourself with all the surgeries from every department.. similar to how medicine needs to familiarize themselves w as many diseases and treatments as possible. You aren't doing much anesthesia in the ED, and you aren't doing ED in the OR. It's not worth doing 66% of an anesthesia residency to be good at airways, nerve blocks, resuscitation which is such a small part of the actual residency. This may make your resume look a bit more attractive to employers, but who needs it for the extra 1-2 years?? And if you want to do anesthesiology after, this may even be detrimental.

 

[Tenk]

EM/Porn?

Well I can only think of one individual to run that program...

 

[deleted109597]

Well I can only think of one individual to run that program...

I dunno, there's that guy from USC/LAC as well...

 

[Hamhock]

As an EM grad who -- yes, I was insane -- spent at least one day off per month in the OR and at least three days per month in the OR before my swing shift, I feel confident saying this combined residency is misplaced. I would have jumped at this residency when I was in training...but I would have been making a mistake.

I appreciate this as a move towards more complete acute care training, but this transition point is not necessary.

In six years, a critical care resident (must break free from our fabricated mindset of "specialties" in the US) would graduate with a better knowledge base and skill set in anesthesiology, emergency medicine, AND critical care than anyone who did both residencies and a fellowship.

HH

 

[Robotic Wis-Hipple]

As an EM grad who -- yes, I was insane -- spent at least one day off per month in the OR and at least three days per month in the OR before my swing shift, I feel confident saying this combined residency is misplaced. I would have jumped at this residency when I was in training...but I would have been making a mistake.

I appreciate this as a move towards more complete acute care training, but this transition point is not necessary.

In six years, a critical care resident (must break free from our fabricated mindset of "specialties" in the US) would graduate with a better knowledge base and skill set in anesthesiology, emergency medicine, AND critical care than anyone who did both residencies and a fellowship.

HH

Other than ventilator management (which a CCM trained physician is better at) and sedation of critically ill patients, what exactly does CCM training teach anyone about anesthesia? I absolutely concede that CCM has a much better medicine knowledge base, but I regularly drop off pt's in the unit to docs that literally have no idea what we do or why. These fields are just different, that's not a slight aimed at any of the specialties in this discussion, it's just the truth.

Why we continue to add more years of training with little utility to differentiate ourselves while lawmakers are fast tracking lesser trained "providers" I will never understand.

 

[Birdstrike]

Ahh...There's nothing more fun than an inter-specialty turf war.


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[engineeredout]

A combined resident should be able to augment their care/treatment of their patients by bringing experience from one of their fields to the other. Speaking as an EM/IM, I think I use skills/knowledge/experience brought from one field to the other. I'm just not quite seeing in this particular program what one field would bring to the other. What does your ED experience provide when you're in the OR? What does your anesthesia experience provide for the ED that an ED doc isn't already trained in?

 

[Hamhock]

Other than ventilator management (which a CCM trained physician is better at) and sedation of critically ill patients, what exactly does CCM training teach anyone about anesthesia?

Right. Very little.

The pulm/ccm guys know very little about anesthesiology. And I think that's a bad thing, especially for an intensivist working in at CTICU, for example.

It's even one more reason we should get rid of surgery-CCM, anesthesiology-CCM, IM-CCM (nevermind the addition of pulm) and move straight to a residency in critical care medicine.

The best thing I can see about this EM-anesthesiology residency is that is a potential step towards the concept of a residency in critical care.

It would be a waste of time, but this combined residency would prepare one well for a CCM fellowship later.

HH

 

[deleted109597]

They have a critical care residency in Australia.
Comically, if you get boarded there, you can't work here, because you don't have a primary board, and CMM isn't recognized by itself.

 

[Mad Jack]

They have a critical care residency in Australia.
Comically, if you get boarded there, you can't work here, because you don't have a primary board, and CMM isn't recognized by itself.

I wish CCM would just pull an EM and become its own thing already, since so many different fields board in it. Enough of this IM/neuro/surg/anesthesia/EM critical care nonsense, let critical care be freeeee

 

[AdmiralChz]

I wish CCM would just pull an EM and become its own thing already, since so many different fields board in it. Enough of this IM/neuro/surg/anesthesia/EM critical care nonsense, let critical care be freeeee

Issue is, CCM is so vastly different between units. There are lots of common threads, but the overall care provided in a neuro/MICU/trauma/Cardiac ICUs are all very, very different and often the coverage, management (open vs closed) and even approaches to care (surgical vs medical) are very different as well.

I think it's a little different than EM in that the background of the providers is (at least mostly) is consistent and if any major interventions are needed (e.g. Surgery) they are whisked away to the OR then up to the ICU post-op for different care.

All that being said, the idea of a separate residency is intriguing. But I don't see any consultants going for it (medical or particularly surgical).

 

[dragonark]

I think the anesthesia/EM double boarding would be great. Number one at taking blame/crap from other specialties!

 

[Groove]

Soon enough they'll have EM/anesthesiology/general surgery/radiology 10 year combined residencies. On graduation day, you get a diploma and one of these...