Georgetown University/Washington Hospital Residency Reviews

[SolidGold]

Almost caught up, UNC will be next up which I'll do on the way to Cinci.

Georgetown University / Washington Hospital Center

Residents: 8 residents per class. All seemed very happy with their choice to become part of the first class of this program and the ones I spoke with had this program ranked #1. Residents got along well and the ones I met very nice and laid back. They go out a lot and even have their own budget from the program for monthly social activities. Happiness factor was high.

Faculty: Dr. Love, the PD, has had previous experience in residency program leadership at places like GW. The chair also has lots of leadership experience. Both of them seemed very friendly and excellent leaders with many ties to the EM community because of their previous experience. Dr. Love seemed very open to resident suggestions, which of course is important since this is a new program. The faculty I met was extremely nice, and all of them raved about our friend the mighty Dr. Quinn and how great he is at teaching despite being only an attending for like 6 months. He came up in our discussions because of our similar institutional background.

Facilities: WHC's facilities seem a little outdated but more than adequate, and still better than other ED's I've seen. The facilities at GU's Hospital were about average and the ED itself is small with like 20 beds. They shared with us that WHC has the backing by Congress and funds to build a new state of the art ED that will be designed to handle any situation, including any disaster that could affect the DC area. This probably won't be completed for some time however. In the meantime, they are doing some remodeling of WHC's current ED to add about a dozen additional beds.

Curriculum: Standard 3 year program. Some of the trauma experience is at Maryland's Shock Trauma, so commuting to Baltimore to get there might be a pain. The Peds experience sounds like it is excellent, with the residents going over to Shady Grove for that experience.

Patient population: They treat sick patients and WHC is the major trauma center for DC. Not much more to say, you'll see everything here, from the white collar folks at GUH to the homeless septic guy at WHC.

Location: DC is a great place to live with a ton of things to do. It is rather expensive to live there and most of the residents were renting, not buying their homes. Most of them lived in Arlington, VA. I also heard that Maryland has a few areas that are relatively inexpensive. Expect to commute a lot and maybe have to deal with traffic, but growing up in Miami, I'm no stranger to all of that.

Overall: I was impressed by Georgetown. Despite their program being very new, they seemed to have set up an excellent program and they still have many parts leftover from a few years ago before when there was an association between the GW and Georgetown Universities emergency medicine residency program. In fact, GW may have even made a mistake when they dissolved that relationship because WHC seems to be the best place to train in DC. Some people will be turned off by how new the program is and its provisionary accreditation status, but I would be happy here and I am not a stranger to how good a program can be even in it's infancy, so I will be ranking this place kind of high.

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[membsr-8890]

Sorry if I repeated some stuff from SolidGold's excellent review

ED Facility: RRC said that the ED at WHC was too small, so they will be doing an expansion project starting very soon. They’re breaking down a wall in WHC, a requirement before full accredidation status is attained. Suprisingly, GU's ED isn't much shinier and prettier than WHC. But I'm not in it for looks, and both seem more than functional so who cares? There are some renovated sections in WHC such as the CCU and call rooms. The nearest Metro stop to WHC is 1 mile away and people say it’s not safe to walk to so everybody drives. The metro doesn't go near GT either.

Location: Most of the residents and even attendings live in either Maryland or Virginia. Mad expensive to live in DC. I heard that $1200/month would get you a studio in a crummy neighborhood. It snows about twice a year and supposedly the whole city freaks out and shuts down. WHC is in a moderately bad neighborhood, the Georgetown area is fantastic.

Year Established: 2005; program is provisionally accredited now, up for full accredidation in 2008

Status within Institution: Unsure… new program, but has been around for a while in some form or another. The institution is certainly used to having residents around but it seems as if there are still a few turf battles to be fought, particularly with trauma. Apparently the other services are impressed with the competence of the first year’s class on their off-services.

Pediatric Experience: They do EM rotations both at Children's National Medical Center and Shady Grove Children’s. CNMC rotation shared with several other residents including other schools and other programs. At Shady Grove, GT EM is the only program there. There is also about 15% peds census at Georgetown. Peds trauma goes to CNMC. There are also two PICU months.

Trauma Experience: All trauma bypasses the ED and goes directly to this MedStar unit place. Only trauma surgery responds to calls. You do rotate through this trauma service twice though, one month as an intern and one as a PGY-3. An intern said he mainly did the secondary survey, wrote up the Trauma H&P, and did FAST scans during the month. The PGY-3s should be running the trauma team during their month. The Maryland Shock Trauma month second year should be great.

Ultrasound: none of the EM attendings are US trained but they get a certification course yearly. There are 3 machines at WHC and 1 at Georgetown.

Off Service Rotations: the toughest ones seem to be trauma and CCU. I did not get a ton of information on these while I was there. I do know that they have made 2 changes to the off-service rotations already – they added Shock Trauma and they divied up the EMS month into one week each during the 3 years. This shows good PD support to resident input. I did not find out how many call months that there are. One resident said that the radiology rotation needed improvement.

Residents: I really liked the few that I met (there was no dinner before my interview day). They get money to go out together once a month, which I think they take advantage of.

Didactic Time: every Friday. Making it to didactics seems to be taken seriously by program director and residents alike. They all get off any overnights and calls on Thursday so they can make it to didactics. There are mixed reviews on the lectures, some are great and others need improvement. They’re expected to read some Tintinelli’s before each session.

Number of Hours per Shift: almost all 10’s at WHC and GU. 21 as a PGY-1, 19 as a PGY-2, 17 as a PGY-3 with some discussion of switching to 8’s as PGY-3’s. 12’s on peds.

EMS Experience: PD is an EMS guy. Seems to be a great flight program. No issues here.

Injury Prevention: there’s the whole disaster preparedness thing associated with being at a level I trauma center in the capitol. They had a room with some decontamination showers in it, this whole aspect may or may not really play a large role in training.

Orientation: 5 weeks, get ATLS, ACLS, PALS, etc. Also have lots of fun bonding activities and get to know the ED.

Ancillary staff: Nobody said this directly, but I got the sense that it's fairly mediocre at WHC. I kept smiling at nurses during the tour of the ED and couldn't get any of them to return a pleasant look. Somebody mentioned a high nursing turnover rate. But everybody raved about the staff at Georgetown. However, even if WHC staff is not super-friendly, I don’t think this necessarily translates into residents having to do scut to make up for staffing issues simply because the ED is not used to having them around for it?

Attendings – 2 with critical care fellowships, lots of medical informatics stuff. I LOVED every single attending that I met. One of the greatest strengths of the program for me. Who doesn't want to work with such nice people for the next 3 years?

Research – somewhat of a weakness, admittedly not much NIH funding going on here but there are some small projects to become involved in. Bench research is lower priority.

Special Features:
- Teaching opportunites – EM is a required rotation for all 160 Georgetown senior medical students. There is also a dedicated teaching month as a PGY-3
- 2 elective months, very open to self-designed electives, eg “homeland security elective”
- PD repeatedly mentioned resident education as a number one priority. They did not scale back attending coverage at all when starting the residency program in order to prevent turning residents into meat-movers. PD seems to be designing the entire program with resident well-being and education as the driving factor. He also mentioned the institution's financial investment in the residents by allowing so many away rotations (costs GT Medicare $).
- Azyxxi platform seems like a killer resource for demographics and research stuff. Also provides easy access to records from both hospital systems for the patients who like to ED shop.

Overall - loved the people, loved the city, loved the fact that resident education is such a high priority. Slightly concerned about newness of program, traumas never coming through the WHC ED, and cost of living.

 

[SolidGold]

One thing to add about Georgetown, even though the trauma bays are down the hall from the ED at WHC, the ED is still responsible for the airway. (At least i'm 99% sure. Details are starting to fade about programs, but I'm sure that every place I visited, the ED handled the airway.

 

[membsr-8890]

Hmm... I was specifically told that EM was not called at all for the traumas (thus not responsible for airway?). So conflicting information here. If SolidGold is right, I would be thrilled, this a a fantastic new program and I'd hate to have to rank it a little lower due to this trauma issue. Perhaps somebody else has visited Georgetown and can act as a tiebreaker?

 

[DrQuinn]

Hmm... I was specifically told that EM was not called at all for the traumas (thus not responsible for airway?). So conflicting information here. If SolidGold is right, I would be thrilled, this a a fantastic new program and I'd hate to have to rank it a little lower due to this trauma issue. Perhaps somebody else has visited Georgetown and can act as a tiebreaker?

At Washington Hospital Center (one of the two places the residents go to), trauma "alerts," i.e. anything that meets previous EMS criteria for trauma patients (GSW to thorax/abdomen, CHI with LOC, two long bone fractures, etc), goes to Medstar, which is down the hall from the main ED. The main ED staff (attendings, residents, and nurses) do not go to the Medstar wing. We are busy enough seeing our 75k adult patients on the main side. Our residents do rotate on the trauma service twice as well as a month of anesthesia. We see lots of airways on our main side, though, and do get traumas "dropped" off gangsta style quite a bit out front that end up in our main ED that we handle everything (yesterday had a triple GSW that was kicked out of a car in front of the ED). Anyways, any airway that is in the main ED is the ED's responsibiltiy only (unless we call for backup).

The EM residents on the trauma service as a PGY-3 will be the "captain" and will run the trauma, so they will take care of the airway. You won't find many places that would allow an intern to be solely responsibile for the airway at a trauma during PGY1 year.

At Georgetown, the ED residents do all the airways.

At WHC, we tend to intube between 2-8 patients a day (sometimes many more on Mondays/Tuesdays). And we have scopes for intubating and nice trays with a wide arrange of tools to intubate. Far better intubating experience than I had at my program as a resident.

Q

 

[2008 EM Reviews]

Residents: 8 residents per year, currently only PGY1 and PGY2 classes in the program, as it is pretty new. Next year will be the first time they will have all three classes, which will lead to some changes in the way the ED is run. Did not go to the pre-interview dinner, but residents at the interview seemed very laid back. Many were from the Mid-Atlantic region, but others were from Midwest or West Coast. There seems to be good repoire among them.

Faculty: Dr. Love, the program director, used to be PD (or assistant PD?) at George Washington University. Lots of faculty who graduated from GWU's residency. Because the program is new, they stress that it's a plus because the faculty is not inbred. Indeed, they have faculty from all over the Northeast (BID, Mass, Jeff, Maryland) and even Cinci. They did mention, that this leads to varied practice patterns that may leave residents a little confused. I think there is currently only one member of the faculty who will be RDMS certified. I really was not too clear about this, so it may be best to clarify.

Hospital: Washington Hospital Center & Georgetown are the main hospitals. WHC seems like the hospital that catches a lot of the more indigent population, although it is a huge referral center that prior to this was not attached to a big academic name. They are one of the largest cardiac cath centers in the region and see tons of referrals, so it is a bit of a mix of urban/community + tertiary center. Georgetown is in a very posh area and is a much smaller ED. Neither ED is incredibly modern, but looks like a typical curtain-style ED. Ancillary services were noted to be pretty good at both places, possibly better at Georgetown.

Documentation: Azyxxis (sp?) is a computerized system that tracks all patient visits, labs, orders, and notes (although some docs still write notes). It is used at WHC and Georgetown, as well as all of Medstar's satellite hospitals. This program was impleted in the ED, spread to the whole hospital, and now Microsoft is planning on buying it. It seems like a very good system that helps keep the ED efficient.

Curriculum: 10 hour shifts, 21 PGY1, 19 PGY2, 17 PGY3. Good peds exposure as there are a total of 5 months (including 2 PICU months).

Didactics: Protected time with the prior night usually off (or at least you leave your shift early). They bring huge names in EM to grand rounds, recently having Rosen come to speak. The faculty seems very energetic and enthusiastic about teaching, but of course there must be kinks to work out as this is the only the third year they have been having lectures.

City: DC is expensive to live in... Most interns rent apartments in the city while some of the PGY2's live out in Maryland or Virginia (typically the married ones). Commute can be a pain, and residents explained ways in which you can avoid traffic by living near certain highways. It didn't make much sense to me since I'm not from the area, but commute can be 15-30 minutes between the two hospitals.
Interview Day: Meet in the lobby and then have breakfast and a 1 hour powerpoint from Dr. Love. Onto interviews (3x20 minutes) which were all very low key. You get an individual tour from one of the faculty members of the WHC hospital, which was cool but kind of weird bc it felt like a walking interview. Afterwards, shuttle to Georgetown for a very nice lunch at the faculty club. This is a late lunch -- about 2pm -- so make sure you eat something for breakfast! Tour of Georgetown and then you are done by around 3pm.
Positives: 3 year program in Washington DC with young and dedicated faculty. These guys really have a lot of energy and I think the curriculum is very well planned out. Being a new program, residents get a lot of say in the curriculum and Dr. Love is very willing to change rotations if they are not giving residents the educational value they deserve. I got the feeling that the program would like academic minded people -- not necessarily research, but people who will be movers and shakers. The two hospitals seem to be a great complement to each other

Negatives: Pretty new program which means some kinks to work out. Medstar covers all of their traumas and it is in a physically separate area of the hospital (near the ED). You rotate on trauma, but it's definitely it's own entity and not incorporated onto normal ED shifts.

Overall: I think this program will continue to attract great residents given its location and curriculum. WHC seems to be a great hospital to work out, with Georgetown hospital giving the training a bit more of an academic spin. It is already a good program with well thought out rotations -- give it a couple more years to establish itself and I think med students will be chomping at the bit to train here.

 

[Universe_Explorer]

Georgetown University/Washington Hospital Center

Residents: 8 residents per year, only two classes so far so there are no PGY3s. The social event was held after my interview and I was not able to attend. During the day we really only met 3 residents – all interns. It’s tough because they don’t have that many people yet, but I would have liked to meet more of them. The folks I met were all very nice and down-to-earth, and they were all very happy they chose this new program.

Faculty: This is a “new” program really in name more than reality – the leadership was all part of the GW program, and have decades of experience and tons of contacts in the world of EM. The PD, Dr. Love, is passionate and approachable. He and the chair, Dr. Smith (who was also extremely nice and really interesting) seem to have a very distinct vision for the program – both of them individually told me they expect to be a “top 15 academic program” within 10 years. There are also a bunch of young faculty members that came and are very interested in teaching (including SDN-favorite Quinn – although I unfortunately did not meet him).

Hospital:
Time is split mostly between Washington Hospital Center and Georgetown University Hospital, although there are Ped ED months at Children’s National and Shady Grove hospital. The sites are about 20min apart, but there is little travel between the two.

Washington Hospital Center: The largest hospital in The District by far, a 900 bed tertiary referral center, Level 1 trauma, burn center, with reportedly the busiest cath center in the country. ED sees 77,000 a year of largely county-type patients. The facility is kind of small for the census, but there is a big new addition about to open that will double it’s size. Patient tracking and records are kept in their sort-of-famous computer system, but charting is still on paper. They have plans to build a new ED. Additionally, they have a big movie-set awesome decontamination/mass casualty area filled with survival suits and portable vents. Trauma is in a dedicated area called “medstar” - sort of an extended trauma bay. They see a lot and the chopper is busy, but residents still do a month at Shock Trauma in Balitmore for addiiotnal exposure.

Georgetown University Hospital: University-style academic hospital known for transplants. The Chair said they have almost 44,000 per year here. The ED is tiny and cramped – plans are on the way for an addition, but it didn’t seem imminent. More private patients here. Awesome part of town.

Ancillary Stuff: Reportedly very good.

Admitting/Documentation: No problems with admitting. Both sites use paper charts and the Azyxxis computer system – a really great tracking and record-keeping program with immediate access to labs, films, EKGs, and old charts. Tons of info is kept and a huge database allows for a wide breadth of research.

Curriculum: 3-year curriculum with emphasis on ED, critical care, and Peds. Interns start off with a 7-week orientation (seems cool, but really long), and spend half of the year in the ED. PGY2 is critical care heavy. Third year will supposedly consist of lots of autonomy running the ED. They have 2 elective months and amazing Peds exposure (4 dedicated Peds ED months at 2 separate Children’s hospitals plus 2 PICU months). Definitely the most Pediatric exposure I’ve seen – including 4-year programs. The off-service months have been streamlined towards EM, and there are no floor months. Residents work 10 hour shifts; PGY1s do 21, PGY2s do 19, and PGY3s will do 17 per month. They report lots of procedures – second years pass them to interns (but there also haven’t been a full set of residents yet). The goal is for PGY3s to run a section of the ED, PGY2s to take critical patients, and PGY1s to do procedures.

Didactics/Research: Once a week I think – lots of great speakers for grand rounds last year. They have very strong informatics research and disaster preparedness research, and other stuff that is getting off the ground. Dr. Love calls this an “academic program” and claims to support any resident interest. Interns go to SAEM for free. No basic science – I was told this was due to the fact that Dr. Smith is an animal lover and is uncomfortable with animal research, which seems odd for a chairman of an academic department, but noble nonetheless.

City: Washington DC is a unique melting pot of a city – very cosmopolitan in some respects, and very working class in others. There are beautiful neighborhoods (like Georgetown) and sketchy ones (like the area around WHC). It’s the seat of our government, and also known to have among the highest crime rates in the U.S. The area is expensive, and most residents rent. Some live in The District, and a bunch live in the Baltimore/DC burbs. Driving in DC is maddening, be it the traffic jams or the confusing layout (why a city has a grid with overlaying sets of “diagonal streets” is beyond me). However, there is great food, nightlife, and culture here. Being so close to Baltimore adds a distinct flavor too – twice as many sports teams, radio stations, concerts, etc are available to those willing to put up with traffic.

Extras: Salary starts at > $43,000, which is not great for DC living, but doable. Cheap food is available at the hospitals and free parking at both sites is a big plus. They have 3 weeks of vacation, which is a week less than a lot of places. Moonlighting will be allowed for seniors, but you can’t moonlight at either of the main hospitals for some reason.

Negatives: Newness of the program may be an issue for some, since no one can be sure how it will work when they have a full set of residents - but I don’t think there will be any problems. RRC reviews them next week, and their biggest problems were with facilities and pediatric trauma. The facilities do seem a bit lacking, although the addition at WHC will improve it quite a bit. I really wish we met more residents at the interview, but I understand it’s tough without seniors. Expensive location.

Overall: I was very impressed with this place – I think the curriculum is fabulous; an emphasis on ED time, critical care, and Peds is a great way to streamline a 3-year program. The diversity of the 2 sites, and the strength of the faculty, both young and old, is also a plus for me. Definitely and up-and-comer…

 

[sleepymed]

Georgetown University/Washington Hospital Center

Residents: 8 residents per year, only two classes so far so there are no PGY3s. The social event was held after my interview and I was not able to attend. During the day we really only met 3 residents – all interns. It’s tough because they don’t have that many people yet, but I would have liked to meet more of them. The folks I met were all very nice and down-to-earth, and they were all very happy they chose this new program.

Faculty: This is a “new” program really in name more than reality – the leadership was all part of the GW program, and have decades of experience and tons of contacts in the world of EM. The PD, Dr. Love, is passionate and approachable. He and the chair, Dr. Smith (who was also extremely nice and really interesting) seem to have a very distinct vision for the program – both of them individually told me they expect to be a “top 15 academic program” within 10 years. There are also a bunch of young faculty members that came and are very interested in teaching (including SDN-favorite Quinn – although I unfortunately did not meet him).

Hospital:
Time is split mostly between Washington Hospital Center and Georgetown University Hospital, although there are Ped ED months at Children’s National and Shady Grove hospital. The sites are about 20min apart, but there is little travel between the two.

Washington Hospital Center: The largest hospital in The District by far, a 900 bed tertiary referral center, Level 1 trauma, burn center, with reportedly the busiest cath center in the country. ED sees 77,000 a year of largely county-type patients. The facility is kind of small for the census, but there is a big new addition about to open that will double it’s size. Patient tracking and records are kept in their sort-of-famous computer system, but charting is still on paper. They have plans to build a new ED. Additionally, they have a big movie-set awesome decontamination/mass casualty area filled with survival suits and portable vents. Trauma is in a dedicated area called “medstar” - sort of an extended trauma bay. They see a lot and the chopper is busy, but residents still do a month at Shock Trauma in Balitmore for addiiotnal exposure.

Georgetown University Hospital: University-style academic hospital known for transplants. The Chair said they have almost 44,000 per year here. The ED is tiny and cramped – plans are on the way for an addition, but it didn’t seem imminent. More private patients here. Awesome part of town.

Ancillary Stuff: Reportedly very good.

Admitting/Documentation: No problems with admitting. Both sites use paper charts and the Azyxxis computer system – a really great tracking and record-keeping program with immediate access to labs, films, EKGs, and old charts. Tons of info is kept and a huge database allows for a wide breadth of research.

Curriculum: 3-year curriculum with emphasis on ED, critical care, and Peds. Interns start off with a 7-week orientation (seems cool, but really long), and spend half of the year in the ED. PGY2 is critical care heavy. Third year will supposedly consist of lots of autonomy running the ED. They have 2 elective months and amazing Peds exposure (4 dedicated Peds ED months at 2 separate Children’s hospitals plus 2 PICU months). Definitely the most Pediatric exposure I’ve seen – including 4-year programs. The off-service months have been streamlined towards EM, and there are no floor months. Residents work 10 hour shifts; PGY1s do 21, PGY2s do 19, and PGY3s will do 17 per month. They report lots of procedures – second years pass them to interns (but there also haven’t been a full set of residents yet). The goal is for PGY3s to run a section of the ED, PGY2s to take critical patients, and PGY1s to do procedures.

Didactics/Research: Once a week I think – lots of great speakers for grand rounds last year. They have very strong informatics research and disaster preparedness research, and other stuff that is getting off the ground. Dr. Love calls this an “academic program” and claims to support any resident interest. Interns go to SAEM for free. No basic science – I was told this was due to the fact that Dr. Smith is an animal lover and is uncomfortable with animal research, which seems odd for a chairman of an academic department, but noble nonetheless.

City: Washington DC is a unique melting pot of a city – very cosmopolitan in some respects, and very working class in others. There are beautiful neighborhoods (like Georgetown) and sketchy ones (like the area around WHC). It’s the seat of our government, and also known to have among the highest crime rates in the U.S. The area is expensive, and most residents rent. Some live in The District, and a bunch live in the Baltimore/DC burbs. Driving in DC is maddening, be it the traffic jams or the confusing layout (why a city has a grid with overlaying sets of “diagonal streets” is beyond me). However, there is great food, nightlife, and culture here. Being so close to Baltimore adds a distinct flavor too – twice as many sports teams, radio stations, concerts, etc are available to those willing to put up with traffic.

Extras: Salary starts at > $43,000, which is not great for DC living, but doable. Cheap food is available at the hospitals and free parking at both sites is a big plus. They have 3 weeks of vacation, which is a week less than a lot of places. Moonlighting will be allowed for seniors, but you can’t moonlight at either of the main hospitals for some reason.

Negatives: Newness of the program may be an issue for some, since no one can be sure how it will work when they have a full set of residents - but I don’t think there will be any problems. RRC reviews them next week, and their biggest problems were with facilities and pediatric trauma. The facilities do seem a bit lacking, although the addition at WHC will improve it quite a bit. I really wish we met more residents at the interview, but I understand it’s tough without seniors. Expensive location.

Overall: I was very impressed with this place – I think the curriculum is fabulous; an emphasis on ED time, critical care, and Peds is a great way to streamline a 3-year program. The diversity of the 2 sites, and the strength of the faculty, both young and old, is also a plus for me. Definitely and up-and-comer…

I think Universe Explorer pretty much nailed it with his review. Just thought I would add a couple of things.

I did attend the pre-interview gathering and it was very well attended. This is a great group of people with a mix of married/single folks. Very laid back, very fun group of people. I laughed a ton during this thing, and had a blast! The group seems very, very close knit and in fact this is something that the PD kept emphasizing (hence the eight week orientation at the beginning as well as a team-building retreat). I also really enjoyed the attendings I met with (we had a personalized tour by one, interviewed by three, and there were a bunch that kept coming in and out of the room the entire day); they were just a down to earth group of people, we discussed DC nightlife, the live music scene, and the great outdoors. The residents all said that with very few exceptions, they loved working with all of their attendings.

Just one other thing, because this program is where it is, I think there are some opportunities that are available here that may not be available elsewhere. During the intro, the PD was discussing the possibility of being involved in health care policy changes at the government level. I think that is just very cool!

Other than that, I think Universe Explorer said everything, thanks!

 

[anonyEMguy]

Overall: Fairly new program, this is the first year with PGY3s, but definitely has a ton of experience among the administrative faculty giving you the feel that they have been at this for a while, and they have in a sense.

Residents: 8 per year from all over the country. I didn't get a chance to interact with them at the pre-interview dinner because it was held on a Tues night in an attempt to corral both the Mon and Wed interview groups and I had already RSVP'd to another social. During the interview day and at lunch a handful of residents joined us, not nearly as many as I've encountered at other programs, but to their defense there was some mandatory meeting for all the residents regarding compliance with work hours on their off-service rotations. However, the few we met were friendly and appeared happy with their choice.

Faculty: The faculty is what makes this program seem much older than it is. The PD, Dr. Love, was at GW and many of the other faculty have been recruited from other well established residencies. Dr. Love is definitely interested in resident success and encourages academic involvement and research. He wants you to take advantage of Georgetown's unique location in the nation's capital. It's interesting that Georgetown had an EM program 30 yrs ago, which was merged and then absorbed by GW, and now it's back (of course there is more to the story, but that is the gist). Also, a lot of younger faculty members with enthusiasm who really want to see the program become one the best.

Ancillary Staff: Good according to the residents. The nurses at Washington Hospital Center have been welcoming to the EM residents and the staff at Georgetown University Hospital are great as well. I don't remember much more about this aspect.

Curriculum: 3 year program with 1 elective month in years 2 & 3. Highlights include a focus on procedures in PGY1 year, so you're often called to do things on other patients which you have to balance with seeing your own patients. Also, more 1:1 attending time in first year compared to other programs. PGY2 is critical care with a month spent at Shock Trauma (housing provided). The PICU rotation is being moved to a community hospital in Virginia from Children's National because it will be "a better experience" according to the PD. PGY3 is the majority of your trauma experience with all ED shifts split between the ED and Medstar (the separate trauma area). There was some discussion as to what exactly is the R3's role when they are assigned to Medstar and there are no traumas. I guess some of the attending felt as though they should cross cover the ED. Peds is a heavy focus with 5 ED months total at 3 different hospitals. Didactics are protected and emphasized. Attendings cover the ED and residents get the night off before lecture. Grand Rounds is a who's who of EM with all the big names coming to speak.

Facilities: WHC is the main teaching facility. It is a level 1 trauma center with a burn center, NIH stoke center, and has the busiest cath lab in the country. Est 70K ED visits/year seeing a mix of patients (uninsured > insured). ED is divided into zones, but not based on acuity so interns can get some really sick patients. Computer system for order, labs, imaging, previous visits, but still paper charts. Trauma is done in Medstar which is just through a door, but considered a separate facility. Georgetown University Hospital is the other major facility which sees more affluent patients with transplants and some rarer conditions. The ED is small and old, but works.

Location: Washington DC is an amazing city with so much to do. Yes it is expensive, but the opportunities to do free stuff are endless. Most residents live in MD or VA, although the drive from VA is more hectic b/c you have to cross the river. Living in DC itself would be a challenge but can be done with roommates and recognizing that the neighborhood may be a little rough around the edges. A car is necessary due to the hrs residents work and public transportation doesn't run all night.

Negatives: No final product, so hard to gauge how residents do post-residency. DC can be expensive.

Overall: Solid 3 year program that is growing and making a name for itself. I would be glad to train here.

 

[quicknss]

The other reviews do a great job describing the specific details so I'll just touch on a few specific aspects.

Washington Hospital Center seems like the best place to train in the DC since it is the "county" hospital for the city seeing the sickest patients and also being the only level 1 trauma center in DC. They are extremely busy getting to do a lot of procedures and treating a wide diversity.

They really aren't a new program because they have been around for 20+ years training EM docs when they were owned by GW. The only new part is their accreditation with Georgetown. All of the docs are seasoned and they come from everywhere in the country so you have a lot of connections when graduating.

Trauma may be a little on the low side since DC is safe but they make up for it by going to shock trauma for a month.

Georgetown is pretty slow as an ED but WHC has 80+k so it makes up for it plus there are only 8 residents so you have tons of access to every procedure.

Staffing: unlike other ED programs they staff the ER to run without residents so when you are there you there you work 1:1 with an attending every time except on the 3rd year run service(blue team) where you run 20+ patients on that side.

PD: Dr Love is a blast to talk to and seems like a great patient advocate.

Overall: best program in DC and a solid 3 yr program overall but it is still growing

 

[onomatopoeia09]

Thought I should chip in since I know I read these threads incessantly last year. I added in a bit about my overall thoughts on each program, in case anyone finds that helpful. Feel free to PM me if you have questions and I'll try to at least give my personal insight (which was mostly gleaned from a 1 day interview so it for what it is!).I didn't go to all the interviews I was offered, but I ranked all the places I interviewed and honestly feel I'd be happy at any of them. Yay for EM.

1. Vanderbilt: Loved this program. Had everything I was looking for in terms of having great people, tremendous leadership, great academic/research opportunities, nice city with good COL. Overall the hospital is super supportive of resident education, good benefits, etc. SO liked it too, so it was a fairly easy choice.

2. U of AZ: This was a strong #1 for me until I went to Vandy (which was my last interview). Totally loved the residents, wanted to go out for drinks with the rockin' PD, and Tucson in December was awesome. Great research and terrific curriculum, too. In the end, though, it's far from family and didn't outshine anything Vandy could offer so being a direct flight from family won out.

3. Maine: Totally loved this program, too. Fantastic residents, great hospital, fabulous location. I've spent a lot of time in Maine so this place felt great to me. Thing is, they have no NIH funded research, and since it's important to me to have mentors with NIH grants, etc, I decided I had to pass this one up. I do hope to get back there later in my career, though, and if Match Day brings me there now I'll still be really happy.

4. Carolinas: Great, well established program that has been turning out fantastic EPs for a long time. I liked the new PD a lot on a personal level, although it felt like she's still working out her vision for the direction of the program from here. I don't think that really takes away how great the program is, necessarily, but the leadership at other programs pushed them above this one for me. Again, I think I could be very happy here.

5. UMass: Again, another very well established, very strong program where I could be very happy. I absolutely loved the PD here and it's clear that he puts the education/health/happiness of his residents at the top of his to-do list every day. Worcester is really a drab, post-industrial city with horrendous winter weather, though, and SO was pretty dead set against moving there. So down it went.

6. Utah: I rotated here and really enjoyed my month. Really fun people, good focus on education, could not really be in a nicer location. In the end it was also far from family, and it's a young program that still seemed to be finding its place in the overall hospital scene. I know some residents in other departments at the U and it seems from their experiences that there's an overtone of 'residents are here to work' instead of 'residents are here to learn.' I figured out on the interview trail that this distinction was important to me. I don't think that was true in EM there at all, but you do have to do your off-service rotations. This could be off, it just seemed that some of the other programs I saw had a bit more to offer me in the end. Despite that, I would be more than happy to train there, and I'm sure I'd get a great education, if that's how things go.

7. Georgetown: Dr. Love (the PD here) was actually the one who drew my attention to the point mentioned above, that you want to go somewhere that you're not just a cog in the wheel of the hospital but that your education is primary. He has such a well-defined, clear vision for his program. It was really inspiring. I'd be really happy to train here, in theory, but the logistics were just not going to work for me. COL was way too high, you have to drive to locations that aren't near one another in crazy DC traffic, etc. I was kind of bummed I couldn't easily make this one work for us. We'll figure it out if match brings us there, but it'll be a challenge.

8. UVA: I definitely loved Charlottesville and the residents I met. I went here after I was at G'town and I wanted to take that program and move it to Charlottesville. The PD here is new and just wasn't a great salesman. I don't doubt they have a great program, but he did a lot of handwaving and literally saying 'blah blah blah' during his PPT and I felt like I didn't get a sense at all of what he was offering. That said, I'm sure I would be happy here and I certainly loved the scribes program.

9. Rochester: Definitely a strong program, nice people, good COL, strong research, but SO wouldn't budge on location.

That's all she wrote. Bring on 3/17!!

 

[okdynasty1]

Happy residents. 8-9hr shifts but sometimes shifts went over. 22,21,19 shifts per year. Emphasis on trauma, critical care, and peds. Rotate through several hospitals with Washington Hospital as the main teaching hospital. PD is extremely friendly and does an excellent job of selling the program. Not a completely young program but also not totally established so they are very open to resident feedback and infact expect you to do a QI project. Chair of this program feels that Gtwon is a top 25 EM program. Attendings love to teach here even so much as if there is a procedure or something you would like to see to help your education while your on a shift, the attendings will watch your patients while you can go do that. The program is implementing a an ENT, optho and OMFD where you go to clinics and do consults intern year. Washington Hospital as new renovated ED. Seems like a great place if your looking for balance between academics and community and if you want training in trauma, critical care, and peds. Overall program is looking for residents who want a balance between academics and community and are eager to improve this program. Also great place if your interested in policy and mass disaster medicine.

 

[Emurgency]

How do the residents feel about the paper charts? Seems like Gtown and WHC (+/- childrens?) all use paper charts with a computer system for labs/images, which is a bit concerning to me. Any thoughts/comments?

Also - are there any plans to convert to EMR any time soon?

 

[EMquest3]

How do the residents feel about the paper charts? Seems like Gtown and WHC (+/- childrens?) all use paper charts with a computer system for labs/images, which is a bit concerning to me. Any thoughts/comments?

Also - are there any plans to convert to EMR any time soon?

IIRC they are moving to EMR. No one wants to take the monetary hit for not moving to EMR coming in the next year.

 

[Emurgency]

IIRC they are moving to EMR. No one wants to take the monetary hit for not moving to EMR coming in the next year.

do you remember when they are moving to EMR? Was it a 'oh yeah we'll definitely get an EMR at some point' or 'we are going to EPIC in July' ?

 

[b-real]

How do the residents feel about the paper charts? Seems like Gtown and WHC (+/- childrens?) all use paper charts with a computer system for labs/images, which is a bit concerning to me. Any thoughts/comments?

Also - are there any plans to convert to EMR any time soon?

I don't go to either Georgetown or GW, but as a resident I hate electronic health records. It's great for looking up PMH, but slows me down considerably when I'm seeing patients. I would love for my hospital to be a combo of T-sheets and electronic ordering/PACS. Much easier to chart on paper.

 

[HolyWowBatman]

Georgetown/Washington Hospital Center

PROS: happy residents and fantastic PD; Love the focus on pediatrics, critical care, and trauma (and residents rave about these experiences); the best composition of rotations at any program I saw and awesome 3+1 curriculum with tons of fellowship opportunities; great mix of hospitals and pt populations-- tertiary/complicated pts at Georgetown hosp., county and trauma pts at Washington hosp. center (by far the biggest hospital in DC and the city's major trauma center), and integrated peds at Children's National (and additional peds community months w/PEM docs); high pt acuity and can see the sickest pts from day one; seems like lots of procedures to be had here; pgy1s get lots of 1 on 1 time with attendings (big emphasis on teaching here) while pgy3s get to "run" the ED; program seems energized/growing (just added a sports med fellowship) and lots of support for residents

CONS: EMS here seems so-so since DC Fire/EMS has internal issues (though the hospital's helicopter service is supposed to be really busy and residents can fly); DC seems cool but it's expensive and the salary here is on the lower side given the COL; traffic is a pain and some of their community sites can take +40mins to get to depending on traffic (residents say it's worth it though)

 

[Primum non noce]

HI all,
Currently a third-year osteopathic medical student, was trying to set up audition rotations and GT caught my eye. I was curious as to how open they are to osteopathic applicants (i've taken the USMLE) and any information that you may have in regards to board scores ( cutoffs, averages, weight of Step 1 vs Step 2).

Thanks!

 

[rocketfrog03]

Hi, since it's been a few years since the last major review, can someone familiar with the program (preferably a current resident or recent grad) give an update? Specifically on the following questions:

• Is the average number and length of shifts still 22/21/20 x 9-10h for PGY-1/2/3, respectively? Is there enough time to pursue academic/professional/extracurricular interests?
  
  
• Based on the GT website, the ED is divided into colors with a separate urgent care section. Does this mean shifts are stratified by acuity (e.g., “trauma” shift or “resuscitative” shift), or is the entire spectrum of pathology seen on each shift? In other words, is trauma only seen during concentrated blocks of training or throughout the entire residency experience in the ED?
  
  
• Which team runs the trauma? Is it an alternating schedule with the surgery residents? Who does the procedures (intubations, chest tubes, resuscitative thoracotomies, etc), is it shared with anesthesia/surgery residents based on odd/even days or MRN numbers? Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?
  
  
• Is there frequent commuting between site locations outside of the dedicated training blocks?
  
  
• Is there an EMR? Is it Epic quality or a horrendous excuse for a computer program? Is there still paper charting?
  
  
• How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).
  
  
• Is the environment family friendly? What percentage of the residents are married, have children?

Thank you for your help and time, it is greatly appreciated!

 

[TheBlueBlazer]

Kinda figured one of my other colleagues was going to jump in and do this, but I'll help out. I'm one of the current seniors.

• Is the average number and length of shifts still 22/21/20 x 9-10h for PGY-1/2/3, respectively?

Basically. We're scheduled 9's, the new team comes in at 8, I average about 9 1/2​

• Is there enough time to pursue academic/professional/extracurricular interests?

If you want to do it, we'll help you do it. Seems like everyone manages to find their own "baby" or two over the course of things​

• Based on the GT website, the ED is divided into colors with a separate urgent care section. Does this mean shifts are stratified by acuity (e.g., “trauma” shift or “resuscitative” shift), or is the entire spectrum of pathology seen on each shift?

This will take a little explanation... So at both WHC (most of our ED time) and GUH (1-2mos/yr), it's an attending and resident that work together one-on-one, for the most part. At Georgetown, it's all-comers together, adult and peds, all acuity, just pick up the next chart. At WHC, it's adults-only, and things are a little different. Yes, there is an urgent-care sort of section that we work 1-2 shifts/month at, though it is frequently quite busy, and sometimes things can trickle over onto the main side. There are 3 teams - red, green, and blue. The three teams are basically the same, patients are distributed evenly, and high-acuity patients are rotated between the 3 teams. 3rd years only work on the blue team, sometimes with an intern so we get experience in the supervisory role. Sometimes 2nd years work on this team as well with just the attending. This team covers trauma airways as well. When things get really busy, the reality is that the charge nurses will tend to lean on the senior-led team because they know that they can. There are no resus shifts, though resus is offered as an elective, and is a pretty popular one. During these shifts, you basically act as a resus consultant during busy hours. There is plenty of acuity and pathology to go around, and it doesn't infringe on anyone's learning. Since not every team is always covered by a resident, and sometimes there are residents from other specialties, the attendings are often really appreciative of the help.​

• In other words, is trauma only seen during concentrated blocks of training or throughout the entire residency experience in the ED? Which team runs the trauma? Is it an alternating schedule with the surgery residents? Who does the procedures (intubations, chest tubes, resuscitative thoracotomies, etc), is it shared with anesthesia/surgery residents based on odd/even days or MRN numbers? Are there any emergency procedures that EM residents are not allowed to do (RSI, thoracotomies)?

Yes. Again, it's bit complicated. WHC is the city's major trauma center, and most trauma that comes in is funneled to Medstar, our separate area of the ED that is basically the trauma bay and the receiving area for our helicopter transfers in for NSGY, Cardiac Surg, Acute Care Surg and the like. You rotate on the trauma team as an intern, and are on even playing-field with all the other folks who rotate through for procedures. Third year, you circle back through trauma, but a weekend at a time during ED months, serving as a team leader, trading running things with the senior surgery resident. We do a dedicated month during second-year up at Shock Trauma in Baltimore. The ED manages trauma airways all the time. In terms of procedures, things get spread around, usually via whoever is there while the s*it is hitting the fan, and it hits the fan a lot.​

• Is there frequent commuting between site locations outside of the dedicated training blocks?

We do a month at Shady Grove Hospital in MD as first and third years for peds, PICU 2nd year and PEM 3rd year out at Inova Fairfax in VA. We do a community month 3rd year at a choice of a couple spots. Basically all of it is going against traffic if you live in the city, and for me was about a 30 min drive. They provide an apartment for our Shock Trauma month so we don't have to commute to Baltimore.​

• Is there an EMR? Is it Epic quality or a horrendous excuse for a computer program? Is there still paper charting?

At GUH and WHC we have Cerner Firstnet for all our order entry and our labs and imaging, but we chart on paper still. And I LOVE it. We use Epic a couple off-service places, and Cerner others, but I'll take my paper charts any day of the week. We have a pretty decent document/lab/rads management program for organizing historical stuff that keeps the paper from getting too onerous.​

• How is the scut work for EM and non-EM months (e.g., transporting own pts to CT, obtaining vitals).

Nonexistent in the ED unless you look for it. Off-service rotations you never do any of those specific things, but you do scut-y paperwork stuff the same way as anyone else on the service would​

• Is the environment family friendly? What percentage of the residents are married, have children?

As far as I know, it's friendly. People have taken time off to have kids. The kid/coupled ratios fluctuate pretty significantly from class to class, but kids is roughly 10ish% right now, and married/LTR is probably 50ish%.

Other things to consider - COL isn't as horrific as people make it out to be, and is doable, but yeah, it's pretty expensive. Traffic also isn't as bad as it's made out to be, especially if you pick the right places to live. We get A LOT of peds experience, and our 1-on-1 attending:resident is pretty unique and gives tremendous opportunities to learn, and our faculty is incredibly diverse in training and interests. We're not hierarchical at all, and you're seeing the same acuity of patients as seniors and interns, just the oversight/autonomy and numbers change as you progress. Our patients at are sick as crap. WHC is the quintessential urban ED, though we have a ton of resources that are not typical of county-type places. Multi-system pathology is the norm. GUH has a ton of sick pts, but they are more your Onc, Neuro, and Hepatic/Transplant variety. At WHC we went Dilaudid-free in the ED except in rare circumstance, which is nice. Our weekly conferences are protected and are a great mix of our faculty, who are often folks who wrote textbook chapters on the things they're talking about, experts from other specialties, and the big names on the lecture/podcast circuit.

PM me if you have any other specific questions, I'd be glad to help.​

 

[jendc08]

How did you go dilaudid free???

 

[hoot504]

BlueBlazer,

Could you elaborate on why you love the paper charting?

 

[TheBlueBlazer]

How did you go dilaudid free???

It just got taken out of the pyxis. We can still get it, we just have to have a nurse physically walk down to the pharmacy for it. That is not going to happen on a regular basis, leading to the "sorry, we don't have it in the ER. you can either have morphine now or you're going to have to wait a while for dilaudid." People who will wait are obviously not in 12/10 pain, and when people are in legit severe pain, we're quick to reach for fentanyl. Most people opt for the morphine, even the ones with "allergies" and our nurses have gotten more comfortable with more substantial doses of morphine where it's appropriate. Word has gotten out around town that you're not going to get dilaudid when you come to our ED, and the number of chronic painers we see has decreased substantially, at least anecdotally.

BlueBlazer,

Could you elaborate on why you love the paper charting?

It's just faster and easier for me. We don't use T-sheets, we have a VERY carefully crafted note to maximize billing and medico-legal documentation. I don't have to click through 45 screens, can easily start charting in the patient's room without being obtrusive and rolling in a computer. I can often have half a chart done before I leave the patient's room while still being able to pay attention to them and have them feel like I'm doing so as well. We use EMRs like epic or cerner at other off-sites, and I'm half as fast, though I do concede that with more familiarity it might get quicker on that end with more macros and dot-phrases and whatnot. Obviously, scribes change things completely, and EMRs completely do away with the legibility issue of paper charts, but if given a choice, I would choose our system any day.

 

[rocketfrog03]

Thanks so much for your update!

 

[Hoya_EM]

Another current resident chiming in, overall I'm very happy here and I think our training is terrific. I'll add a bit to what's been said by BlueBlazer and update some outdated info in some older posts.

When I was an applicant on the interview trail the greatest differences I noticed been different programs were their pediatric, critical care, and trauma experiences. Our leadership spends a ton of time and thought curating our rotations/education in these areas:

Trauma/Burn
We have focused trauma experiences each year in addition to all the standard/community-type trauma we see every month in every ED we're at.
EM manages every trauma airway and we can start doing them as PGY2s.
-Intern year: month on the trauma service at Washington Hospital Center which is DC's major trauma and only burn center. We see a ton of penetrating trauma and most of our interns gets at least a few to many chest tubes and other random procedures are known to fall to down to the intern (ie I did half a clamshell on a patient in my month). We also see lots of burns.
-Second Year: month at Maryland Shock Trauma. We go there for the high-speed blunt trauma since there isn't much highway within DC proper.
-Third year: dedicated trauma senior shifts at Washington Hospital Center only during the busiest times (Friday and Saturday nights). Your only job is to run/manage what comes into the bays and do/teach procedures (you alternate these two roles with the surgery senior). Our relationship with the trauma service is really good and the majority of the trauma attendings like to teach. As BlueBlazer mentioned, lots of trauma procedures.

Pediatrics
We get about 6.5 months worth of peds both longitudinally and in month long blocks and through this we get to manage some really sick kids and do a lot of the common peds procedures (facial lacs, sedations, reductions, LPs, etc) as well as some of the less common (intubations, chest tubes, lines, etc).
-At Georgetown you'll see adults and peds mixed in together on every shift. I'd guestimate the amount of kids you can see during your shifts here over 3 years would equal 1 month of dedicated peds EM.
-Pediatric anesthesia at Georgetown
-Over your first two years you'll have scattered, longitudinal peds shifts (2 months worth) at Children's National whenever you are in the ED at Washington Hospital Center. All the pros/cons of being in a tertiary peds ED but unlike most places the fellows function as attendings so they staff cases with you rather than stealing them from you (though most of the time you staff cases only with attendings). You will see some peds trauma here and they have a high enough volume so you will get sick kids. We have a good relationship with them (the two hospitals sit next to each other as they share the same campus) and their PEM fellows do their adult ED time with us.
-3 dedicated months of community peds EM at two high-volume dedicated peds EDs with PEM-boarded attendings. This is really a highlight of our peds training as you see lots of bread and butter stuff, a decent amount of trauma, and a surprising amount of sicks kids in a community setting (which involves you doing more and consulting less). It's a great balance to learning in the tertiary peds environment.
-Month of PICU at Inova Fairfax (more on this below)
-You can also do up to 1.5 months in pure community EDs with peds mixed in with adults

Critical Care
We have multiple attendings with critical care training and they help foster a great CC/resus experience. The bulk of the actual ICU time is in the PGY2 year as this allows you to function more independently in the units. We get a number of dedicated resuscitation and critical care lectures, sim sessions, etc throughout residency and each second year class gets extra lectures in this area.
-MICU PGY1 at Washington Hospital Center: super high acuity here as you basically need to be intubated to be accepted onto the MICU service. You'll learn a lot about the vent and do some lines.
-While at Shock Trauma (PGY2) you round on all your team's patients in the SICU and if you're proactive you can learn a ton from the ICU fellows and attendings
-MICU as a PGY2 at Georgetown: very high acuity and lots of transfers in for complex medical problems. You function as an upper year and you do not pre-round/write progress notes as your interns do this. You help them out and are primarily responsible for evaluating/stabilizing new admits and doing procedures. You will do TONS of lines and procedures this month. You will also get the chance to put on your big boy/girl pants when you become the most senior MICU doc in-house on weekend nights (your attending and fellow take home call).
--SICU as a PGY2 at Washington Hospital Center: you'll be in a unit managing super-sick post-op heart patients (transplants, LVADs, etc.), along with trauma, neurosurg, and more bread and butter post-op patients mixed in. Here, too, you will have nights where you are the most senior SICU doc in-house for your unit and cross-cover the SICU across the hall (a dedicated trauma/burn unit).
-PICU as a PGY2 at Inova Fairfax: a busy 15-bed PICU at a hospital with a busy congenital heart surgery program. You will take care of post-op Glenn's, Fontan's, etc and get very comfortable with heart kids. You will also see a good mix of neuro and trauma patients in addition to the usual DKA, respiratory failure, and septic kids. Big bonus here is that there are no PICU fellows, meaning that any procedure on your patient is generally your procedure.

It was basically the quality of these three focus areas, along with the 1:1 attending:resident staffing in our EDs (which is an amazing thing), the really high patient acuity, the awesome ultrasound teaching, and the great procedural experience that made me want to come here and the program has delivered on all fronts. I continue to feel lucky to have matched here.

Feel free to ask or PM with any questions.

 

[Got Em]

Does anyone know if the schedule is based on a 4 week block or a whole month? (22x9, 21x9, and 20x9 for every 28 or 30 days?)

 

[actoutfit]

Our schedule is based month to month. So 22 shifts per month as an intern. 21 as 2nd year then 20 as 3rd year. Feel free to ask any questions.