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I figured I would post an update to my very own program as I am now approaching the final weeks of my residency. I can genuinely and boastfully say that I think Cook County (Aka John Stroger Hospital - but nobody who actually works there calls it that) is one of the best residency programs in the country (at least what I can speak of in regard to 4-year programs). There is a great exposure to almost all fields of OMFS (besides cosmetics), our Orthognathic program has gotten so heavy we schedule patients’ surgeries 6 months to a year out, and our implant experience has truly evolved.
In short, we do plenty of everything to the point that our interns are placing single teeth implants in clinic, and cutting Leforts & Genios in the OR, including doing minor path cases on their own with an attending (all of our interns this year have cut multiple Leforts and several have cut genios). Generally, the vibe at our program is that our attendings don't cut, if there's an intern and a senior in a double jaw, the intern and the senior will be cutting while the attending supervises (or scrubs out). Dare I say with the increase in 1st years/interns in our program since I first started, there is even a semblance of work life balance (if such a thing exists).
We likely have the highest ratio of dedicated block time to resident spots in the country. We have 5-6 days of block time a week between our three sites (3 days at Stroger Tue/Wed/Thu, 2 at Provident Mon/Fri, 1-1.5 at Masonic (Tue).
My favorite part of County is the vibe and laid-back environment. We are not a snobby entitled establishment, and if that is what you're looking for this isn't it. Our attendings have an open-door policy and will never not explain a procedure or answer a question. We all get a long together, and enjoy a lighthearted atmosphere with good old ribbing on our attendings. Dr Emmerling likes to spoil us with meals, coffees and lunches (I think there’s an expectation to pay it back after graduation).
Let's start with some background, CCH is located in the middle of the Chicago medical district, right off 290 highway, which is at the entry to downtown Chicago. We're situated across the street from RUSH, and UIC Hospital/medical school; and a 5 minute walk away from UIC Dental school (and the Pink line stop at Paulina). Most interns/1st year residents choose to live in the medical district, of which there is no shortage of options. Others choose to live in West loop/South loop where there are more bars and restaurants, some choose to live a little further away (lakeview/lincoln park, oak park etc).
We rotate between a few sites but only cover call at one site at a time, so you're never driving between sites. As a senior resident you're basically only responsible for call at the main site (CCH).
Program needs: We are actively recruiting 1-2 full time attendings, as a County hospital we could always use more ancillary staff/floor nurse coverage. We have one Panorex & 1 CBCT/Pano and are in the process of upgrading our machine within the next 2-3 weeks.
Current setup:
1-4yr/ 1-6 yr, planned for adding a third resident very soon, the only limiting factor right now is attending coverage.
Medical school for 6 year is through Rosalind Franklin university, and commences after completing 1st year. This is a relatively new change (we're sending our second resident off to med school now), but generally after 1st year you join as a M3 and continue till graduation, to be followed by Gen surg years and off service rotations.
Non-categorical interns:
The number of interns generally varies from year to year, this current year we've had 4, in addition to our 2 categorical 1 st years, for a total of 6 1st years/interns. For the past 3 years all of our non-categorical interns have matched into their #1 positions. We do not discriminate between categorical & non-cats, they all take the same amount of call, and share responsibilities equally, and do the same procedures both in clinic and the OR.
Research Intern:
For the second year in a row we have a research intern who can help residents with their publications /data collection while also getting their name on publications to help improve their chances at matching. This is a non-clinical position so they do not participate in the call pool or clinic activities.
Residents are expected to submit at least one paper for publication before graduation, there is certainly ample ideas to go around and attendings are happy to help with this, and the research intern is invaluable for this.
Call:
Dentoalveolar call 365 days a year from CCH/Stroger, the ED is very good at weeding out the garbage, you may get paged every now and then asking for a clinic appointment for a sub-acute dental issue, but the general consensus is dental pain is not an emergency, and we have a blanket no extractions in the ED policy. So if you have to go in for something it's usually a Submandi or a vestibular abscess that needs drainage.
Trauma call: 40% of days roughly, we cover the majority of calls, shared with ENT and plastics. OMFS covers all days ending in "1", "2", "6" or "7". We pride ourselves on seeing our consults and have gotten the best consulting service awards multiple years in a row. We do not place arch bars in the ED/close reduce fractures (we hardly ever place them these days). Face call is anything from frontal bone to skull base/mastoid, including soft tissue and ears.
The call schedule has been very light, averaging 5-6 calls a month, with 2-3 trauma days, which is quite light. Call is home call, and the ED is pretty good at not paging at 3 AM (they'll wait a little bit unless it's urgent). on that note our ED/Trauma bay is fabulous and are pretty good at managing most facial lacerations/injuries on their own. They really only consult for complex lacerations (vermilion border, eyelid, involving duct/structures); depending on who's covering they sometimes also manage intra-oral lacerations, meaning there's a lot less seeing silly cuts in the middle of the night.
Rarely will you ever spend the entire night seeing consults but it can happen on rare occasion, although we don't have post call days, our team is usually large enough to accommodate sending tired residents home (without needing to ask to leave).
Sites:
Cook County Hospital: Main site and hospital, clinic home- extremely heavy dentoalveolar clinic, mainly intern and 1st year run, but staffed with the seniors/chiefs. This is the only site we do our dentoalveolar sedations/implants. You never know what walks through the clinic doors, for basic infections to benign path that has been brewing for years, to acute malignancies. Certainly a clinic where you learn your medical skills very quickly due to the degree of unhealthy/medically complicated patients that walk through. It is a safety net site, so you see people turned away from everywhere else, including prisoners. It is NOT a point and pull clinic, and we usually schedule patients for a second visit for the procedures unless there is an infection/medical urgency.
OMFS operates their own service and admits patients, our census isn't terribly busy as the hospital environment tends to favor sending patients home earlier, 97% of orthognathics are discharged the next day. Average patient list is usually between 1-3 patients depending on what comes in from trauma/ED or OR admissions.
The trauma that comes in is varied and robust, this is a Level 1 trauma (the only one in the medical district) that receives transfers from the nearby hospitals (RUSH, UIC, Mt Sinai) and as far out as Indiana. We usually get somewhere between 2-5 mandible fractures a week depending on the season (trauma in Chicago is very seasonal, coming to a crawl in the colder months and picking up quickly once it gets warm). We get a fair amount of mid face/ZMCs and the occasional Lefort 2/3, with obviously plenty of nasal bones and orbital floors. (more on numbers later).
The hospital itself is relatively small compared to some other medical centers, but that means that we don't spend days traveling from one ward to another. Our clinic is directly beneath the ORs with easy quick convenient access. Given that it's a county hospital funding is lacking in some areas, which essentially translates to no custom plates here (with the exception of custom TMJ joints).
At CCH malignancy is managed primarily by ENT, although our attendings are adjunct ENT faculty and help with their cases, we do still participate in tumor board and can certainly scrub in to these cases if you would like to.
Provident Hospital: Sister hospital under the CCH umbrella, currently only used as a OR site/surgicenter, we do most procedures there from simple dentoalveolar/cysts to orthognathics, admissions here are to a hospitalist (usually for 23 hr obs at most). We do NOT cover call at this site, if there's something that needs to be seen they transfer it to Stroger or send to clinic.
Illinois Masonic Hospital: A new addition to our program in the past few years, this is essentially a attending private practice that feeds the OR there. It's a dedicated 1st year/intern rotation (part of a 3 month rotation block). When the intern is there they only cover that site, getting 1 on 1 time with attendings both in clinic and OR. As this practice has grown there have been good cases coming from there ranging from trauma (this is also a Level 1 trauma site), cancer, orthognathics, TMJ and reconstructive. This is seen as a elective rotation for seniors, and a great opportunity to get more exposure as a primary surgeon in some cases. Generally the attendings will ask if any of the seniors are interested in doing whatever case is happening, and if not the intern on rotation there is expected to be the primary surgeon (in some cases attendings will tell seniors NOT to go to these cases as they're more suitable for an intern).
Case load here include some benefits not available at stroger including ability to use custom plates for recon/trauma/orthognathics, going one on one with attendings under the microscope for micro vascular, and taking lead on neck dissections.
As mentioned earlier seniors are not responsible for call at this site, and interns staff consults directly with attendings.
Secondary sites/rotations:
RUSH (Plastics) - Generally this was a senior rotation initially instituted to help get orthognathic experience, along with craniofacial experience with Dr. Tragos, given now that our numbers no longer need supplementing this has become an intern rotation to introduce them to the craniofacial world and orthognathics. Additionally Dr. Tragos has left RUSH and joined county, and will be establishing her craniofacial practice here; allowing residents to continue to work alongside her even when off rotation.
Christ Hospital (Pediatric Anesthesia)- An excellent rotation during second year that gets dedicated pediatric anesthesia experience. During my rotation there I did over 70 pediatric anesthesias alone, besides what you do during anesthesia at county (CODA requirements is 50 cases 12 or under).
PCRF Palestine rotation: This was a yearly rotation for one resident before COVID that recently got restarted, I had the opportunity to travel to the west bank with the PCRF (Palestinian child relief fund), with one of our volunteer faculty where we do a lot of Cleft lips/palates, and orthognathics, occasional TMJ/Benign path with surgeons from all over the world. A great opportunity to learn different techniques and work in a challenging environment.
In short, we do plenty of everything to the point that our interns are placing single teeth implants in clinic, and cutting Leforts & Genios in the OR, including doing minor path cases on their own with an attending (all of our interns this year have cut multiple Leforts and several have cut genios). Generally, the vibe at our program is that our attendings don't cut, if there's an intern and a senior in a double jaw, the intern and the senior will be cutting while the attending supervises (or scrubs out). Dare I say with the increase in 1st years/interns in our program since I first started, there is even a semblance of work life balance (if such a thing exists).
We likely have the highest ratio of dedicated block time to resident spots in the country. We have 5-6 days of block time a week between our three sites (3 days at Stroger Tue/Wed/Thu, 2 at Provident Mon/Fri, 1-1.5 at Masonic (Tue).
My favorite part of County is the vibe and laid-back environment. We are not a snobby entitled establishment, and if that is what you're looking for this isn't it. Our attendings have an open-door policy and will never not explain a procedure or answer a question. We all get a long together, and enjoy a lighthearted atmosphere with good old ribbing on our attendings. Dr Emmerling likes to spoil us with meals, coffees and lunches (I think there’s an expectation to pay it back after graduation).
Let's start with some background, CCH is located in the middle of the Chicago medical district, right off 290 highway, which is at the entry to downtown Chicago. We're situated across the street from RUSH, and UIC Hospital/medical school; and a 5 minute walk away from UIC Dental school (and the Pink line stop at Paulina). Most interns/1st year residents choose to live in the medical district, of which there is no shortage of options. Others choose to live in West loop/South loop where there are more bars and restaurants, some choose to live a little further away (lakeview/lincoln park, oak park etc).
We rotate between a few sites but only cover call at one site at a time, so you're never driving between sites. As a senior resident you're basically only responsible for call at the main site (CCH).
Program needs: We are actively recruiting 1-2 full time attendings, as a County hospital we could always use more ancillary staff/floor nurse coverage. We have one Panorex & 1 CBCT/Pano and are in the process of upgrading our machine within the next 2-3 weeks.
Current setup:
1-4yr/ 1-6 yr, planned for adding a third resident very soon, the only limiting factor right now is attending coverage.
Medical school for 6 year is through Rosalind Franklin university, and commences after completing 1st year. This is a relatively new change (we're sending our second resident off to med school now), but generally after 1st year you join as a M3 and continue till graduation, to be followed by Gen surg years and off service rotations.
Non-categorical interns:
The number of interns generally varies from year to year, this current year we've had 4, in addition to our 2 categorical 1 st years, for a total of 6 1st years/interns. For the past 3 years all of our non-categorical interns have matched into their #1 positions. We do not discriminate between categorical & non-cats, they all take the same amount of call, and share responsibilities equally, and do the same procedures both in clinic and the OR.
Research Intern:
For the second year in a row we have a research intern who can help residents with their publications /data collection while also getting their name on publications to help improve their chances at matching. This is a non-clinical position so they do not participate in the call pool or clinic activities.
Residents are expected to submit at least one paper for publication before graduation, there is certainly ample ideas to go around and attendings are happy to help with this, and the research intern is invaluable for this.
Call:
Dentoalveolar call 365 days a year from CCH/Stroger, the ED is very good at weeding out the garbage, you may get paged every now and then asking for a clinic appointment for a sub-acute dental issue, but the general consensus is dental pain is not an emergency, and we have a blanket no extractions in the ED policy. So if you have to go in for something it's usually a Submandi or a vestibular abscess that needs drainage.
Trauma call: 40% of days roughly, we cover the majority of calls, shared with ENT and plastics. OMFS covers all days ending in "1", "2", "6" or "7". We pride ourselves on seeing our consults and have gotten the best consulting service awards multiple years in a row. We do not place arch bars in the ED/close reduce fractures (we hardly ever place them these days). Face call is anything from frontal bone to skull base/mastoid, including soft tissue and ears.
The call schedule has been very light, averaging 5-6 calls a month, with 2-3 trauma days, which is quite light. Call is home call, and the ED is pretty good at not paging at 3 AM (they'll wait a little bit unless it's urgent). on that note our ED/Trauma bay is fabulous and are pretty good at managing most facial lacerations/injuries on their own. They really only consult for complex lacerations (vermilion border, eyelid, involving duct/structures); depending on who's covering they sometimes also manage intra-oral lacerations, meaning there's a lot less seeing silly cuts in the middle of the night.
Rarely will you ever spend the entire night seeing consults but it can happen on rare occasion, although we don't have post call days, our team is usually large enough to accommodate sending tired residents home (without needing to ask to leave).
Sites:
Cook County Hospital: Main site and hospital, clinic home- extremely heavy dentoalveolar clinic, mainly intern and 1st year run, but staffed with the seniors/chiefs. This is the only site we do our dentoalveolar sedations/implants. You never know what walks through the clinic doors, for basic infections to benign path that has been brewing for years, to acute malignancies. Certainly a clinic where you learn your medical skills very quickly due to the degree of unhealthy/medically complicated patients that walk through. It is a safety net site, so you see people turned away from everywhere else, including prisoners. It is NOT a point and pull clinic, and we usually schedule patients for a second visit for the procedures unless there is an infection/medical urgency.
OMFS operates their own service and admits patients, our census isn't terribly busy as the hospital environment tends to favor sending patients home earlier, 97% of orthognathics are discharged the next day. Average patient list is usually between 1-3 patients depending on what comes in from trauma/ED or OR admissions.
The trauma that comes in is varied and robust, this is a Level 1 trauma (the only one in the medical district) that receives transfers from the nearby hospitals (RUSH, UIC, Mt Sinai) and as far out as Indiana. We usually get somewhere between 2-5 mandible fractures a week depending on the season (trauma in Chicago is very seasonal, coming to a crawl in the colder months and picking up quickly once it gets warm). We get a fair amount of mid face/ZMCs and the occasional Lefort 2/3, with obviously plenty of nasal bones and orbital floors. (more on numbers later).
The hospital itself is relatively small compared to some other medical centers, but that means that we don't spend days traveling from one ward to another. Our clinic is directly beneath the ORs with easy quick convenient access. Given that it's a county hospital funding is lacking in some areas, which essentially translates to no custom plates here (with the exception of custom TMJ joints).
At CCH malignancy is managed primarily by ENT, although our attendings are adjunct ENT faculty and help with their cases, we do still participate in tumor board and can certainly scrub in to these cases if you would like to.
Provident Hospital: Sister hospital under the CCH umbrella, currently only used as a OR site/surgicenter, we do most procedures there from simple dentoalveolar/cysts to orthognathics, admissions here are to a hospitalist (usually for 23 hr obs at most). We do NOT cover call at this site, if there's something that needs to be seen they transfer it to Stroger or send to clinic.
Illinois Masonic Hospital: A new addition to our program in the past few years, this is essentially a attending private practice that feeds the OR there. It's a dedicated 1st year/intern rotation (part of a 3 month rotation block). When the intern is there they only cover that site, getting 1 on 1 time with attendings both in clinic and OR. As this practice has grown there have been good cases coming from there ranging from trauma (this is also a Level 1 trauma site), cancer, orthognathics, TMJ and reconstructive. This is seen as a elective rotation for seniors, and a great opportunity to get more exposure as a primary surgeon in some cases. Generally the attendings will ask if any of the seniors are interested in doing whatever case is happening, and if not the intern on rotation there is expected to be the primary surgeon (in some cases attendings will tell seniors NOT to go to these cases as they're more suitable for an intern).
Case load here include some benefits not available at stroger including ability to use custom plates for recon/trauma/orthognathics, going one on one with attendings under the microscope for micro vascular, and taking lead on neck dissections.
As mentioned earlier seniors are not responsible for call at this site, and interns staff consults directly with attendings.
Secondary sites/rotations:
RUSH (Plastics) - Generally this was a senior rotation initially instituted to help get orthognathic experience, along with craniofacial experience with Dr. Tragos, given now that our numbers no longer need supplementing this has become an intern rotation to introduce them to the craniofacial world and orthognathics. Additionally Dr. Tragos has left RUSH and joined county, and will be establishing her craniofacial practice here; allowing residents to continue to work alongside her even when off rotation.
Christ Hospital (Pediatric Anesthesia)- An excellent rotation during second year that gets dedicated pediatric anesthesia experience. During my rotation there I did over 70 pediatric anesthesias alone, besides what you do during anesthesia at county (CODA requirements is 50 cases 12 or under).
PCRF Palestine rotation: This was a yearly rotation for one resident before COVID that recently got restarted, I had the opportunity to travel to the west bank with the PCRF (Palestinian child relief fund), with one of our volunteer faculty where we do a lot of Cleft lips/palates, and orthognathics, occasional TMJ/Benign path with surgeons from all over the world. A great opportunity to learn different techniques and work in a challenging environment.
