GenSurg Residencies with the Best Trauma Experience

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By trauma, I assume that you want penetrating trauma, since few people seek out blunt trauma (>80% of trauma @ 90% of places I'd guess) Off the top of my head I would come up with these, but I can't say I know it from first hand experience. Basically, look for something with a city/county hospital experience in a big city.

U-Maryland (Shock Trauma)
U-W (Harborview)
U-Colorado (Denver General)
UTSW (Parkland)
USC (LA County)
Emory (Grady)
U-Fl Jacksonville? Orlando Regional? not sure about this one, but I seem to recall others rotating to those places in FL to do trauma
Wayne State (Detroit Receiving)
Rush (Cook County)

There are probably many more I neglected. One other thing to keep in mind, is the more trauma oriented the program, the higher risk that is crowds out something useful in your education on the elective side. Not a given, but a definite risk at some places.
 
surg said:
U-Fl Jacksonville? Orlando Regional? not sure about this one, but I seem to recall others rotating to those places in FL to do trauma

One other thing to keep in mind, is the more trauma oriented the program, the higher risk that is crowds out something useful in your education on the elective side. Not a given, but a definite risk at some places.

I think U of Miami is the big trauma center in Florida.

As for your last statement, I couldn't agree more. I went to medical school with a very trauma-heavy surgical program. After seeing other programs around the country, I could see the true "general surgery" wasn't at my school (although, they are making significant changes to correct this). Point is, the ACS only requires 10 surgical and 20 non-surgical cases to graduate. If you are looking to do a critical care fellowship, managing a broad-spectrum of criticall ill patients is more beneficial than managing strictly critical trauma patients.
 
But if you want to be a trauma surgeon, wouldn't it be better to train in a general surgery residency that is heavy on trauma?
 
Lemont said:
But if you want to be a trauma surgeon, wouldn't it be better to train in a general surgery residency that is heavy on trauma?

1. You never know what you will end up doing.
2. If you want to be exposed to trauma, that is what your fellowship will offer.

Most trauma fellowships are trauma/critical care and, when not the trauma attending on call, you manage all ICU patients. My opinion is that leraning during residency how to manage the sick colon, the sick transplant, the sick heart and the sick pancreas will (a) make you a better physician, (b) make you better able to manage the sick trauma (who will, at one time or another have any and/or all of the above) and (c) give you the background to go into any other surgical field if you decide later that "trauma" isn't all you think it is now as a medical student.
 
Lemont said:
But if you want to be a trauma surgeon, wouldn't it be better to train in a general surgery residency that is heavy on trauma?
A trauma attending told me that the key to being a good trauma surgeon is learning to be a good general surgeon first. He said that he got a great training at U of Virginia as a general surgeon and trauma training at Vandy. Look for a place where you can become a great general surgeon and worry about trauma later, keeping in mind that you mind may change in the next five years. Good Luck!
 
Hi there,
I have become a great fan of Inova Fairfax Hospital. They are the northern branch of Virginia Commonwealth School of Medicine and located about 10 miles out of Washington, DC in Falls Church, Va. The best thing about this program is that the Trauma Surgeons really love to teach and the facilities are top notch. There are helicopters flying all of the time and the Trauma Bays are totally awesome. Everything is right at your fingertips and the training is excellent. They also have a Trauma fellowship program too.

njbmd 🙂
 
I agree that Fairfax has good surg attendings. However, most of their trauma experience is with blunt trauma (auto accidents, falls, etc) and not penetrating. I have heard that the best trauma experience in the country are at U of WA (Harborview), U of Miami, and U of Maryland (Shock Trauma). If you're concerned about non-trauma surg experience, try a place like U of WA where the main teaching hospital is separate from the trauma hospital.
 
surg said:
U-Maryland (Shock Trauma)
UTSW (Parkland)
USC (LA County)
Emory (Grady)
Rush (Cook County)

I agree with these places. We see a ton of trauma at Grady.
 
ivan lewis said:
I agree that Fairfax has good surg attendings. However, most of their trauma experience is with blunt trauma (auto accidents, falls, etc) and not penetrating. I have heard that the best trauma experience in the country are at U of WA (Harborview), U of Miami, and U of Maryland (Shock Trauma). If you're concerned about non-trauma surg experience, try a place like U of WA where the main teaching hospital is separate from the trauma hospital.

Hi there,
Most trauma period is blunt. There are a few places around like U of MD; Metro Hosptal in Cleveland; Washington Hospital Center etc. where the knife and gun club still kicks into high gear but most trauma in general is blunt.

njbmd 🙂
 
njbmd said:
Hi there,
I have become a great fan of Inova Fairfax Hospital. They are the northern branch of Virginia Commonwealth School of Medicine and located about 10 miles out of Washington, DC in Falls Church, Va. The best thing about this program is that the Trauma Surgeons really love to teach and the facilities are top notch. There are helicopters flying all of the time and the Trauma Bays are totally awesome. Everything is right at your fingertips and the training is excellent. They also have a Trauma fellowship program too.

njbmd 🙂
I interviewed there and was highly impressed. The ED is newly renovated and the trauma bays seemed very nice. If I didn't want to be on Boston so much, I think they would have ranked much higher. They have had surgical residents from elsewhere forever, but they just started their OWN program (last yaer was the first year they were on ERAS); the PD stressed how family friendly the program is and how it's to everyone's advantage (esp the residents') that they are a new program, started under the new duty hour guidelines. I think it's likely to be a hidden gem.
 
Vincristine said:
I think it's likely to be a hidden gem.

Absolutely. A friend of mine matched there last year and really liked it. My med-school roommate also raved about it. I hear it is a fantastic program.
 
njbmd said:
Hi there,
Most trauma period is blunt. There are a few places around like U of MD; Metro Hosptal in Cleveland; Washington Hospital Center etc. where the knife and gun club still kicks into high gear but most trauma in general is blunt.

njbmd 🙂

Hi there,

I think the purpose of the thread was to inquire as to which programs had the best trauma experience. I would say that the best trauma experience is gained at programs where you see both blunt and penetrating trauma. Having done a trauma rotation at Fairfax, I can tell you that I was bored out of my mind, with most of my time spent on wheeling patients to the CT scanner and waiting for results. Rarely were patients taken to the OR. I would say good trauma surgeon needs to be comfortable dealing with both blunt and penetrating trauma. Given that the trauma load at Fairfax is overwhelmingly blunt and rarely penetrating, I would say Fairfax is not the best place to get your trauma experience. That was the point of my original post.
 
surg said:
By trauma, I assume that you want penetrating trauma, since few people seek out blunt trauma (>80% of trauma @ 90% of places I'd guess)


This is the wrong perspective. In contrast, penetrating trauma is "dumb". There's frequently a very straight-forward clinical pathway on those cases. You don't need a whole lot of experience with it know what to do. In addition, many of the operations required are MUCH more straight forward unless you get complex retroperitoneal vascular or proximal pancreatic iunjuries. Blunt trauma & the decision making on those patients on operating or not is the real ballgame. These are the patients that give you ulcers - they're often older, sicker, fatter, and more badly injured. Blunt intraabdominal injuries after can be much more devastating & trickier to diagnose & repair.

If you look at trauma literature you can appreciate this paradox. There is very little being published on penetrating injuries because there is very little new in this area. Blunt trauma & its diagnosis, treatment, and outcomes dominate because so many new areas are rapidly evolving ( IR treatments, trauma ultrasound, abdominal compartment sydromes, immuno-modulation, specific issues re. morbidly obese and geriatric patients, ICU technology, etc...)
 
Oh, I totally agree that the blunt ones are the harder to manage long term, but given the level of the person asking, I assumed something about what he/she wanted. Also, most programs provide plenty of blunt trauma experience, but only a few really provide a lot of penetrating to go with it. You certainly wouldn't want to do only penetrating trauma, but there are many otherwise excellent programs that have trouble getting a sufficient number of trauma laparotomies any more, what with non-operative management of solid organ injuries and I think that is something that everyone will be a little worried about until they have done a few (kind of like ruptured AAA), even though they aren't technically any more challenging than most elective cases.

As to the other comments: how could I forget Miami (Jackson Memorial) as a major center. *smacks self on head*
 
Hello,

I did a SICU rotation at UC Davis not two months ago. I did call q3 with the trauma team and I can not say enough good things about the trauma/sicu team at Davis. First of all UCDMC is situated in Sacramento and is the only level 1 trauma center in the central valley so it draws from a large and diverse population. There was a good share of penetrating trauma (roughly 30-40%). The attendings are phenomenal and the nursing staff is exceptional. Look into this fellowship seriously if you are considering Trauma.

Also, I have to agree that though penetrating trauma is "sexy" the damage done by a bullet or a few stab wounds is usually well defined and if they are not found dead at the scene, the trauma management is strait forward. Conversely the worst level of trauma is usually sustained by motorcyclists and they are the most complicated. I have seen motorcycle accident victims come in with superficial lacs, talking, acting fine and then acutely decompensating in the CT scanner and needing an emergency airway established and the whole 9 yards.
By the way, the CT scanner is the bermuda triangle of trauma (many enter, a few don't return). Almost every chest I pounded that month was in the CT scan room. This was also the case at my home institution. Beware of declaring someone stable enough to go to the scanner prematurely. And if you want to look good to the trauma team, watch the monitor carefully as the patient goes into the scanner. On more then one occasion, I was the only one who noticed that the patient was decompensating in the scanner while everyone else was sitting around bull****ting.
 
Back from the dead...

Hi there,
I have become a great fan of Inova Fairfax Hospital. They are the northern branch of Virginia Commonwealth School of Medicine and located about 10 miles out of Washington, DC in Falls Church, Va. The best thing about this program is that the Trauma Surgeons really love to teach and the facilities are top notch. There are helicopters flying all of the time and the Trauma Bays are totally awesome. Everything is right at your fingertips and the training is excellent. They also have a Trauma fellowship program too.

njbmd 🙂
I've heard mixed reviews myself...so I'm trying to get more info to make the right decision... http://forums.studentdoctor.net/showpost.php?p=4858615&postcount=4

I agree that Fairfax has good surg attendings. However, most of their trauma experience is with blunt trauma (auto accidents, falls, etc) and not penetrating.
Yep...pretty much. I think the essence of what you're saying is that most "Trauma-heads" consider trauma to be the blood 'n guts routine, ie penetrating trauma requiring immediate surgical intervention. Fairfax does indeed get a LOT of blunt trauma (they say 80% or so), so many of the trauma cases result in non-surgical managament. That's not in line w/ the preconception of what a Trauma Surgeon does, but I think it IS representative of what Trauma Surgery REALLY is on the whole.

I have heard that the best trauma experience in the country are at U of WA (Harborview)
Weather sucks lol. That may seem somewhat fickle, but when you consider that you'll be a resident for 5 years in the same place, that's quite a while, and for some (including myself), weather is a considerable factor I gotta take into consideration. I'm trying to stay away from the cold and rainy areas...

U of Miami
Def. heavy on penetrating trauma (moreso than other hospitals in the country), but one of the major problems that I've found is the atmosphere. Many of these inner city hospitals see tons of penetrating trauma due to their locale, but what I've found also goes w/ that is a good deal of friction/attitude that you have within the hospital - doctors, nurses, ancillary staff, etc. If you're lucky enough to be at a hopsital that doesn't have that problem in the first place, you have NO IDEA how big of a deal that is. Residency is tough enough as it is; the LAST thing you want are rude doctors, nurses w/ an attitude, and an ancillary staff that doesn't really feel like doing their job. A lack of organization is a common problem as well. Of course this is a generalization, but it holds true for the most part, so I'd be weary before committing to a program in such places. In the least, visit it first, and see what you think first-hand...(doing an elective there is a good idea). And that's just me being real.

U of Maryland (Shock Trauma).
I've heard they're pretty much #1. A friend of mine rotated there, and told me while it's EXCELLENT experience-wise, it's an *incredible* amount of work, and they treat ya like crap, given they are a wee bit high on themselves and their reputation... so you gotta be willing to deal w/ that atmosphere for quite a while.

Personally, I LOVE the Fairfax type environment...
 
Kings County in Brooklyn has had the most penetrating trauma in the nation for the last 16 years (or at least they said at my SUNY Downstate interview in Jan).
 
Baylor's residents get tons of trauma experience. Houston is one of the nation's leaders in penetrating trauma. At Ben Taub, the county hospital, they typically do 2-3 x-laps/thoracotomies on a weekday call night (more on the weekends). PGY4's and PGY5's alternate call in the ORs, and PGY2s run the shock rooms (last week the 2nd year resident did a crich for a surgical airway). It's fantastic trauma training, and to practice trauma surgery you won't need a fellowship coming out of Baylor.
 
UT-Memphis has not been mentioned yet. I've been told (by my ortho PD) that UT is #2 for penetrating trauma behind Shock Trauma.
 
With some of the most dangerous traffic and the highest large city violent crime rate in the country, I hear we do pretty well down here in Miami. High blunt and penetrating trauma. Motorcycles are also popular down here. Ryder is ALWAYS busy. I was informed just last week by one of our trauma surgeons that most graduates here get trauma experience in general surgery that rivals that of most trauma fellows from other programs. It's supposed to be an excellent trauma experience if you don't mind half of your patients speaking something that isn't English.

Correct me if I'm wrong, but I would think that working the major trauma center in ANY city with a violent streak would give you a lot of trauma experience. Miami, Philadelphia, Baltimore, NY, LA, Chicago, Saint Louis, or any other big for that matter what work. Maybe NY would be a little less due to the huge number of training programs there.
 
Quote:
Originally Posted by Carbon
The 3 most trauma-heavy hospitals in the US are:
Shock (Baltimore)
Cook County (Chicago)
UMC (Las Vegas)

How can you not include LAC and Grady?

It's a silly list to begin with, but I second the wtf factor on leaving Grady off. It's the only trauma center for like the sixth or seventh largest metro area in the country, plus another third of Georgia, and the coauthor of Trauma happens to work there. Also, when I interviewed at UIC, they said that the private hospital on the southside they rotated at, Christ, recieved more trauma admissions than Cook County. That's not to bag on Cook County, but to point out that you don't have to go to places that have their own TV shows to get a good experience.
 
HUP-University of Pennsylvania--I can't believe that nobody has mentioned them. That show Trauma:life in the ER started at penn. Also, if you've ever been to philadelphia you'll know that about five blocks away from penn's campus is west philadelphia, where will smith was born and raised (in the playground was where he spent most of his days).

I did a trauma surgery rotation at the university of New Mexico. It is the only level 1 trauma center for the entire state. that's a population of 1 million, and they get a lot of people from rural arizona and western texas and stuff. There are a LOT of drugs and gangs in new mexico. pretty much every night on call we went to the OR for penetrating trauma. You spend 6 months in total on trauma (3 as a pgy3 and 3 as a pgy4). As a 4 you're pretty much the ICU chief as well. The residents there told me that you'll graduate with enough trauma numbers for a fellowship. albuquerque is a great place to live, also.

i, too am interested in trauma/critical care, and i ranked them quite high.
 
Baylor's residents get tons of trauma experience. Houston is one of the nation's leaders in penetrating trauma. At Ben Taub, the county hospital, they typically do 2-3 x-laps/thoracotomies on a weekday call night (more on the weekends). PGY4's and PGY5's alternate call in the ORs, and PGY2s run the shock rooms (last week the 2nd year resident did a crich for a surgical airway). It's fantastic trauma training, and to practice trauma surgery you won't need a fellowship coming out of Baylor.
I can't believe more people aren't talking about Baylor either. Ben Taub sees a ton of trauma. Great training there. And another author of Trauma--Ken Mattox--happens to work there.
 
just wanted to contribute some more objective info...i'm a nerd for this type of stuff sorry.

here's some chicago info

quick notes on chicago...
usually top 5 for total homicdes each year out of all US cities. in 2003, it had more total homicides than nyc even though its population is 3x's smaller than NYC. FOr 2005, LA had 489 homicides while Chicago and 448, even though LA's population is twice as big as CHicago's.


now for hospitals...
Cook County has 5,000 level 1 traumas each year.
it's covered by Rush gen surgy residency
it has 1 of the 2 burn centers for chicago(the other being Loyola).

Mount Sinai Chicago has 2,000+ level 1 traumas each year.
it's covered by UIC-Mount Sinai
Northwestern sends its gen surg PGY-4's there for trauma.
U of C sends its PGY-1 ER interns there for trauma.

Both hospitals are a 1/2 mile from each other. Together, they help cover Chicago's West side, including Harrisson Police District, historically the most violent district in Chicago, in 2006 having the highest homicide count of all of CHicago. By the way, the west side also produced Isaiah THomas, Dee Brown, and Luther Head, excellent basketball players.


Christ hospital receives the most annual level-1 traumas of all CHicago hospitals.
It's covered by UIC gen surg.
It's in the west suburbs but receives Chicago's south side trauma, hence its high volume.


As far as non-Chicago programs, I only know reputation. LAC is LAC, lots of trauma. Emory has grady and Feliciano. Baylor has Mattox, both the editors of Trauma.



As far as the blunt v. penetrating debate. Yes indeed, blunt can be complex, lots of scans and decision making, maybe best exemplified by the occassional aortic transection that actually gets saved. but penetrating also has a lot to offer in the way of thinking on your feet; acting fast; and all the physical aspects, from your exam in the trauma bay to suturing that gaping hole in your stab wound patient's heart after your carted him to the OR with a foley balloon stopping up the hole in the meantime.

phew that was a lot of typing.

oh and www.east.org is a good resource of program info and just in general...
 
SUNY Downstate and Kings County Hospital is pretty good for trauma. The Army even occasionally sends its medics to train there for GSWs.
 
SUNY Downstate and Kings County Hospital is pretty good for trauma. The Army even occasionally sends its medics to train there for GSWs.

Actually, I think Kings County has lead the nation in penetrating trauma for the last 15+ years. Apparently the support staff there isn't that great (this coming from a Medicine attending at Kings County and Downstate, he told me at my interview), but you get to see some stuff...
 
Lol, alot of you all are saying that your hospitals are #1 or #2 or #3 for penetrating trauma in the U.S. Is there an actual list somewhere that has actually numbers of penetrating trauma cases per year or is everything based off of reputation among programs?
 
Lol, alot of you all are saying that your hospitals are #1 or #2 or #3 for penetrating trauma in the U.S. Is there an actual list somewhere that has actually numbers of penetrating trauma cases per year or is everything based off of reputation among programs?

Welcome to the subjectivity of medicine.

Everybody wants to feel special.
 
UT-Houston is a pretty nice place for trauma as well. Admittingly, not as much of the "knife and gun club" as Ben Taub, however, volume at Hermann is roughly 30% more than Ben Taub annually. Ben Taub has the knifes and guns, Hermann's got the choppers (6 of them) and all the MVCs.

It is hard to believe a city the size of Houston (geographically and by population) has only two trauma centers. I'm not here to say that Hermann is better than Ben Taub, as the tit-for-tat that is present in surgery is somewhat nauseating. There is great trauma exposure at each program. I think trauma is something you learn with experience, and both places do a pretty good job of it.
 
UT-Houston is a pretty nice place for trauma as well. Admittingly, not as much of the "knife and gun club" as Ben Taub, however, volume at Hermann is roughly 30% more than Ben Taub annually. Ben Taub has the knifes and guns, Hermann's got the choppers (6 of them) and all the MVCs.

It is hard to believe a city the size of Houston (geographically and by population) has only two trauma centers. I'm not here to say that Hermann is better than Ben Taub, as the tit-for-tat that is present in surgery is somewhat nauseating. There is great trauma exposure at each program. I think trauma is something you learn with experience, and both places do a pretty good job of it.
 
UT-Houston is a pretty nice place for trauma as well. Admittingly, not as much of the "knife and gun club" as Ben Taub, however, volume at Hermann is roughly 30% more than Ben Taub annually. Ben Taub has the knifes and guns, Hermann's got the choppers (6 of them) and all the MVCs.

It is hard to believe a city the size of Houston (geographically and by population) has only two trauma centers. I'm not here to say that Hermann is better than Ben Taub, as the tit-for-tat that is present in surgery is somewhat nauseating. There is great trauma exposure at each program. I think trauma is something you learn with experience, and both places do a pretty good job of it.

Agreed. I did a month of trauma at Hermann, and two weeks of EM at Ben Taub, and your assessment of the case distribution seems about right. Hermann does get the GSWs when Ben Taub closes to trauma, and Ben Taub will get the MVAs inside loop 610 and/or without insurance.

The real difference between them is that the ER at Ben Taub is run by surgery and medicine rather than Emergency Medicine. So the surgery residents manage everything that comes in rather than consulting on the potentially surgical cases. Hermann has an EM residency, and the ER is staffed accordingly. There are pros and cons for each setup, but as a future surgeon, I would choose a Ben Taub-like setup over one similar to Hermann's.
 
St. Louis University.

They get most of the knife and gun club stuff while WashU gets most of the MVA. And SLU doesn't have an EM residency so surgery runs the show on traumas.
 
Agreed. I did a month of trauma at Hermann, and two weeks of EM at Ben Taub, and your assessment of the case distribution seems about right. Hermann does get the GSWs when Ben Taub closes to trauma, and Ben Taub will get the MVAs inside loop 610 and/or without insurance.

The real difference between them is that the ER at Ben Taub is run by surgery and medicine rather than Emergency Medicine. So the surgery residents manage everything that comes in rather than consulting on the potentially surgical cases. Hermann has an EM residency, and the ER is staffed accordingly. There are pros and cons for each setup, but as a future surgeon, I would choose a Ben Taub-like setup over one similar to Hermann's.
I thought EM at Ben Taub was an oxymoron. Do they even have EM board-certified MDs there now? For a while, they didn't. I know that gen surg does run the show there, but I didn't think there was any EM presence.
 
It was my Emergency Medicine rotation for Tulane, the year we were at Baylor. They assigned the 3rd years to the surgical side, and the 4th years to the medical side.
 
A couple points:
1. One way to look at this question is to see which programs have to send their residents out for trauma experience. That means there is really not any at their home institution.

2. By area here are my (narrow) opinions.
Florida: Miami and Tampa and Orlando all get lots.
Altlanta: Emory
Philly: Penn and Temple both get lots
Baltimore: Hopkins and Maryland actually split the trauma in Balitmore
New York: Downstate and NYU and UMDMJ
Boston: BU
Chicago: Rush and UIC
Texas: Baylor and Southwestern
West: Colorado and Washington are the famous ones. Also heard about Harbor-UCLA.

IMHO.
 
A couple points:
1. One way to look at this question is to see which programs have to send their residents out for trauma experience. That means there is really not any at their home institution.

2. By area here are my (narrow) opinions.
Florida: Miami and Tampa and Orlando all get lots.
Altlanta: Emory
Philly: Penn and Temple both get lots
Baltimore: Hopkins and Maryland actually split the trauma in Balitmore
New York: Downstate and NYU and UMDMJ
Boston: BU
Chicago: Rush and UIC
Texas: Baylor and Southwestern
West: Colorado and Washington are the famous ones. Also heard about Harbor-UCLA.

IMHO.
"Sending out" residents for trauma is a relative term. Often, residents do numerous rotations at other institutions and trauma may be one of them. For instance, most residencies operating at county programs do many rotations at the county hospital affiliate, and do not just go there for trauma.

In Chicago, the level 1 trauma centers include:
1. Northwestern (staffed by northwestern)
2. Loyola (staffed by Loyola residents)
3. Christ (staffed by UIC I believe)
4. Mt. Sinai (staffed by Mt. Sinai/Chicago Med and Northwestern residents since NWU gets a lot of blunt)
5. Cook County (staffed by Rush and UChicago). Rush residents ARE the cook county surgery residents...Cook County is across the street from Rush.
6. Illinois Masonic (staffed by UIC-Metro residents)
May have missed one or two....

Official Peds trauma centers are Childrens (NWU) and UChicago, but kids get sent to other trauma centers as well.
 
Trauma at Harborview and Ben Taub are staffed by UW and Baylor surgery residents, respectively--the programs with which those hospitals are primarily affiliated for all other services, as well. No "sending out" required.
 
UIC-Metro covers 3 level 1 trauma centers, although they only have designated trauma rotations at 2 of these. Generally the residents consider it a trauma heavy residency, and although it lies in the shadow of county and sinai in chicago, it sees a LOT of trauma.
Rotated at Henry Ford in Detroit as a student and had tons and tons of trauma there too - at least as much as Detroit Receiving. Cant beat detroit for trauma....the worst neighborhood in Chicago looks like Pleasantville next to downtown Detroit.
 
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