Level 2 vs 1 Residency

[feelingfroggy]

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Just interested in everyone's thoughts on residency at a trauma two vs level one center. I know level one is better for those wanting to go into academics but will going to a level 2 really make that much a difference in job prospects?

 

[Apollyon]

Employers will be looking for EM-residency trained docs. If there is so much trauma, there would be a trauma team.

If there's so much trauma, and no trauma team, I would look elsewhere.

 

[Greenbbs]

Just interested in everyone's thoughts on residency at a trauma two vs level one center. I know level one is better for those wanting to go into academics but will going to a level 2 really make that much a difference in job prospects?

Trauma's not necessarily what sets us apart as docs. Trauma is extremely cookbook in nature. ABCDE, then let the surgeons take over. What will set you apart as an EM doc is the volume and breadth of illness that a particular ED sees on an annual basis.


Say Program X is world renowned for trauma, but the rest of the stuff that comes in isn't consistently all that exciting.

Program Y is strong in trauma, but their medical population blows everyone out of the water.

In my opinion, you're better off picking the hospital with the better depth of medical problems because that's what's going to set you apart from the others, because I feel that what sets us apart from other docs is being able to do the complex medical stuff rather quickly and efficiently. EM docs are charged with taking a bunch of crap and trying to find out if it's going to kill you or not. I'd rather know I'm comfortable diagnosing both run of the mill things and complex medical problems like mesenteric ischemia and AAA and Lemierre's, etc than know I can manage an airway and ship it off to the surgical team.

You're going to get trauma anywhere. But sometimes the biggest places aren't necessarily the best.

 

[AmoryBlaine]

I doubt there is any EM job anywhere in the US where major trauma accounts for more than 1% of your job.

What others have said is true. Trauma is a surgical disease. It's just like an MI or unstable vag bleeding -- you get the ball rolling but you need someone else to provide definitive care.

Furthermore the interventions that are helpful in trauma (chest tube, introducer line, needle thoracostomy, pelvic binder) are not very technically difficult. Honestly you will need more technical skill to repair a complex lac than you will to place a chest tube.

The other interventions (cric, thoracotomy) are ones that probably less than 10% of EM grads will really feel comfortable with no matter where they train.

You realize pretty quick in EM residency that you need to see alot more belly pain/chest pain/headache than major MVC...

 

[deleted65604]

I hated working at a level one trauma center. When the surgical team showed up, they would bring around 7 people during the day, and 2-3 at night. Combine that with the 3 ER residents, 2 med students rotating throught the ER, lab tech, 2 ER techs, 2 ER nurses, pharmicist, and 4-5 random gawkers, the trauma bay became jam-packed inefficiency personified.

It was WONDERFUL to run traumas in a small place and have the bare essentials as far as staff to actually be able to do the assessment yourself.

I think you would potentially learn trauma BETTER at a small place.

 

[Greenbbs]

I hated working at a level one trauma center. When the surgical team showed up, they would bring around 7 people during the day, and 2-3 at night. Combine that with the 3 ER residents, 2 med students rotating throught the ER, lab tech, 2 ER techs, 2 ER nurses, pharmicist, and 4-5 random gawkers, the trauma bay became jam-packed inefficiency personified.

It was WONDERFUL to run traumas in a small place and have the bare essentials as far as staff to actually be able to do the assessment yourself.

I think you would potentially learn trauma BETTER at a small place.

I couldn't agree more.

 

[Flushot]

I hated working at a level one trauma center. When the surgical team showed up, they would bring around 7 people during the day, and 2-3 at night. Combine that with the 3 ER residents, 2 med students rotating throught the ER, lab tech, 2 ER techs, 2 ER nurses, pharmicist, and 4-5 random gawkers, the trauma bay became jam-packed inefficiency personified.

It was WONDERFUL to run traumas in a small place and have the bare essentials as far as staff to actually be able to do the assessment yourself.

I think you would potentially learn trauma BETTER at a small place.

Thanks for your insight. I've been contemplating between a rural vs. metro location for 3rd year, and our school actually has an EM residency at the rural location. For me, I think the rural route might be better at the moment.