Harborview for away fourth year rotation ... ?

[Paws]

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So, I am thinking I might really be interested in doing EM. Maybe because this is the only residency forum that I read religiously? Hard to know. Probably, anyway. I feel like I should try and prove to myself if I really want to do this, plus gain some excellent experience.

I have heard that Harborview is a great place to gain experience as a medical student. Anyone else have any ideas about Harbor, or any other good ER's for fourth year rotations? I don't think I could afford a NYC or LA ER, because I am not too rich.

 

[NateintheED]

I'm assuming you're talking about Harborview Medical Ctr in Seattle. As a current resident in the only EM program in WA, let me share a couple things.

First, if you just want to experience the pathology, Harborview is a great place. They see all kinds of craziness.

BUT if you want to rotate at a place that practices real Emergency Medicine, Harborview is not that place. In fact, we residents were pulled from the ED there a few years ago because of the way the department is staffed with non-EM trained staff. Its still run very old school, with IM and Surgery staff and divided into medical and surgical areas, from what I'm told.

In my opinion, there are plenty of other places that see lots of pathology AND practice real EM (and will have real EM residents, etc.). And they're not in LA or NYC. Try looking around the midwest. Michigan has a couple great programs (UMich and Detroit Receiving), as do Cleveland (Metrohealth), Cincinnati, and Indianapolis, to name a few. And of course you can't count out any of the Chicago programs.

 

[Paws]

Thanks Nate, I appreciate the reality check here. I guess I really feel sort of clueless about 1) doing an away rotation, and 2) how to decide where to do it, and why.

I had heard pretty awesome things about the experience people at UW receive at the ER but I didn't really understand the politics of the situation. Thanks for the advice. 👍

 

[crewmaster1]

Coming from UW, having done Harborview....it's a great rotation for what we have available in the UW system (autonomy, busy, good stuff to see), but hell no, don't arrange an away rotation there. There are a million better choices where you will get to see tons of pathology and trauma, and actually have the opportunity to see how EM docs function in that setting. If you want to know why EM is a residency and we no longer staff EDs with medicine docs, then a rotation at HMC is great (examples include needing to consult out basic joint reductions/distal radial fractures because medicine attendings have no idea what to do with them, or paging "anesthesiology stat to the ED" numerous times overhead while a patient struggles in respiratory distress and medicine docs stand there wondering how to manage an airway). Nate's correct that the attending coverage is all screwed up. Your letter of rec. will come from Dr. Copass, the neurologist who is the ED director. While he is very well known in EMS, most EM docs/PDs can't figure out what the hell is going on up there and you will spend every interview explaining the politics and workings of HMC. They have now hired 3 new EM attendings to start working at HMC, but they are all new grads that were UW med students who I imagine Dr. Copass and all the medicine docs will work very hard to mold them into just what they want. Who knows, we will see. Either way, go somewhere else for all the work it takes to set up and away rotation and get a good, representative EM rotation with some EM letters of rec.