This review is for the Oregon Health & Science University (OHSU) Emergency Medicine residency. In disclosure, I am an intern at OHSU. Last year I didn't see any reviews on SDN and figured I would post one since I now know much more about the program. As with all reviews mine is an opinion, so buyer beware. I'll start with an overview, detail the three year schedule, talk about the student rotation and interview process, then give some final thoughts at the end.
Overview
OHSU is an academic tertiary care 3-year emergency residency. The emergency program is a full department and well respected and strong within the university. The program is also one of the oldest in the country. 10 residents per year are accepted. The ED is somewhat lower volume than many training programs. This is balanced with the fact that residents rotate among several hospitals in Portland during residency. Also, there are only 2-3 residents and one student on the adult side (covering two pods). Basically, there are plenty of patients to see. It can be slow in the morning (department half full or so), but does get busy in the afternoon and evening. The ED places a large emphasis on customer service which is something you probably won't see at county programs. This means that there is a usually short wait times and rapid patient flow. There's a full capacity protocol to move boarding patients upstairs. Like everywhere boarding is a problem but almost all patients leave within a shift. None of the sign-out to me then I sign-out to you then I get the patient back the next day stuff that you see at some county programs.
The faculty is a mix of recent grads from around the country (almost all fellowship trained) and big-wigs in the field. One of the former presidents of ACEP is on staff as well as authors' of Emergency Ultrasound and Clinical Procedures in EM.
At the University, there's a mix of tertiary care patients (ie neutropenic fever), run of the mill stuff, and the underserved (homeless, drug OD, etc). There is no dedicated county hospital in Portland, unlike many of urban areas in California. There are two adult areas, an obs unit, and a peds area. The ED is certainly one of the nicer ones I visited on the interview trail. Almost all patients have individual rooms at the University. There's a central work station for the nurses and physicians. There's a call center for paging which saves tons of time. Residents have phones so the call center will page for you, then call you back on the portable phone. The VA is a little more old school (open bay) but has a dedicated physician work room and overhead pages you. There is absolutely no scut work like drawingblood cultures, wheeling pts to CT, etc.
Interns spend split their ED time at OHSU, the VA, and community sites. The VA has its own flavor. The patients are predominantly male and have great bread and butter pathology. There is a hallway for non-acute patients (ambulatory, no chest pain) and open bay for the acute side. PAs help with the hallway patients and you usually only see the acute patients. The nurses in the ED are nice and helpful, contrary to what I've heard about other VAs around the country.
Traumas are split with surgery. EM always does the airway. In Oregon, anesthesia does come to Level 1 traumas, but they defer to the ED staff for initial management. The secondary survey is usually done by the surgery team, but EM residents rotate on that service. Contrary to popular belief, there's plenty of trauma in Portland. Sure, it's not inner city Detroit, but residents feel comfortable handling trauma during the 3 years.
In regards to push back from other services, the ED has admitting privileges for internal medicine. You don't have to sell your admission. If they need to come in, it's a done deal. The only hassle I have seen is when a patient has involvement with multiple teams. They might try to push the admission on each other, but all you have to do is get them on the phone with each other.
I've heard negative feedback about perceived procedure opportunities at OHSU. All I can say is that my fellow co-interns have needled chests, intubated, put in chest tubes, given tpa for strokes – all in the first month of residency. I did two LPs in the past two days. Also important to know that interns get to work with sick patients right off the bat. There's no working low acuity for a year and then graduate to the acute side like some programs. In my first month, I've managed a massive PE, burn patient, NSTEMI, hyperkalemia, among others.
Conferences start at 7am on Wednesday with trauma conference. This is put on by the trauma service and reviews a few trauma cases. There's a learning point discussed with an evidence based approach for each one. Sometimes it's mainly surgically focused, other times ED management is the topic. This hour is also optional for ED residents. At 8 am, an EM M&M takes place, usually led by a senior resident. This is interactive and non-confrontational. The 9 to 11 hours are usually lectures put on by attendings and residents. At 12pm, there's usually a grand rounds or joint EM-peds, EM-IM, EM-rad conference. Also, the chief residents meet frequently with the residents to hear feedback/give advice, etc. Once a month, peds is the main topic for the conference day. Also, simulation is frequently done. There's a dedicated sim lab on campus which EM uses frequently. Attendings and nurse practioners (who run fast track) staff the ED during conference so everyone can go.
There's always a concern about autonomy at an academic center - both with EM attendings as well as other services. In my experience, autonomy is graduated at OHSU and as a senior resident you will be running one of the pods on your own in the ED. The attending will see each patient (on their own, after you unless a critical resuscitation where they will probably be in the room) but your plan is put in place. For example, an attending disagreed with my assessment in my first month of residency, but let me do what I felt was right. As an aside, beware of places where attendings are minimally involved. Remember that you are supposed to learn in residency. Trial and error with patients is an outdated model, dangerous for patients, and doesn't offer much learning for you. If that's what you want, skip residency all together after you are licensed and starting earning your own paycheck which will be a lot higher than a resident's salary. As far as other services, I can't comment too much on it since it is so variable. For example, with ortho, the ED team does simple reductions (shoulders, etc), but complex stuff will either go to the OR or the ED staff will run the conscious sedation while ortho does the external fixation/other procedure. You can always ask to be involved and services are pretty collegial with each other.
There are a few recent changes within the program. Ultrasound was added as a two week rotation during the second year. The ultrasound resident works one on one with a u/s fellowship trained faculty and essentially scans everyone in the department during that time. OB will be likely change next year. It's currently at OHSU and there's been some frustration with not getting enough deliveries since FM and OB are on service too. The rotation will likely be switched to a community hospital without other residents. Anesthesia by the way is at a community hospital and there are no residents to compete with. I don't know what the average # of intubations is, but one R2 I talked to said she got 70 tubes, including 15 peds, on her month.
Rotation Schedule:
EM I:
4.5 months at OHSU/VA/Peds ED. 2 additional ED months at community hospitals (Kaiser and Emanuel). 3 ICU months, one at a community hospital, one PICU, and one University MICU. One month wards, 2 weeks OB, 3 weeks Anesthesia (1 is peds only), 1 month Trauma. There's a little variability for each intern, b/c some do an additional Gen Surg night float in lieu of one of the community ED months. Essentially you spend half the year in the ED and half off service. ED shifts are mostly 10 hours as an intern. The VA is staffed mostly with interns so it's fun b/c you're working with classmates, get to see high acuity patients (the vets come in sick!), and have lots of autonomy (no Medicare CMS rules).
EM II: 10 months in the ED. Split between Peds (dedicated month plus intermixed shifts during adult months), OHSU, St. Vincent (community), one month back in the VA ED. Ultrasound and tox are two weeks each. 1 month SICU then you can put your pager away for good. 8 hour ED shifts. As an R2 at OHSU, you run one of the acute sides, splitting traumas with the other acute side usually run by an R3. You start to directly manage traumas and also psych patients (woohoo!) as an R2.
EMIII: 11 months ED (OHSU/Peds/St. Vincent/teaching month), 1 elective. You run Area 1 at the OHSU ED. All 8 hour shifts. R3s also have a dedicated teaching month without clinical responsibility. You help the med students and interns during shifts, give lectures, etc. Don't know too much about the elective, but some residents go overseas, work at mountain clinics at ski resorts, do research…
Notes: EMS is not a dedicated time period. There is a list of tasks to complete each year to fulfill the RRC EMS requirement. This includes some ride alongs, EMS meetings, acting as a paramedic, etc. I don't think there is a dedicated ortho month anymore. My take was that most programs haven't found that very useful since you are usually rounding on ortho pts rather than doing reductions. I'm also not sure about the exact shift schedule each month. I know residents usually get a 3 day weekend during an ED month. It seems most people work between 18-21 shifts a month. Residents get 3 weeks of vacation per year. Interns get an additional week at the end of the academic year. Traditionally, the intern group has done something together during that week (ie rent a house on the coast).
Last comment on rotations: OHSU is an off service light residency. You spend most of your time in the ED, particularly after your intern year. You will get 4 months in ICUs and one ward month. You can put your pager away sometime during your second year. You get to train at several community EDs which is a great strength. You will feel well prepared for the pace of community ED medicine. You will also be the only learner in the department so if something cool comes up, you're on it.
Student rotation:
OHSU takes away students for Adult and Peds rotations. The student rotation does not offer as much autonomy as you might see at county programs. You will split your time at the VA and at OHSU. At the VA you will staff with attendings and sign your chart over to the attending who will likely just co-sign it. You can put in orders as well. At OHSU, you work with a resident which come sometimes be a little frustrating since they are busy and not always interested in or have time for teaching. OHSU has tried to remedy this with a dedicated teaching R3 who does not have clinical responsibilities. This will certainly help the student rotation.
You will have the opportunity to interview for the program if you are doing a rotation. This will save time and money later and give you some interview experience. OHSU is a little quirky about whom they interview. I talked with students interviewing at Harbor, Highland, and other top west coast programs. Some were not offered interviews at OHSU. I don't know why or what the interview committee looks for in particular. My advice would be that if you are really interested, an away rotation is a good way to guarantee an interview spot.
I have one other downside to the mention about the rotation. Since the really sick patients are usually managed directly by residents, students don't get the opportunity to see some of the high acuity pathology that comes in. It's important to know that as residents, you will get this experience even if you don't see it while you are at OHSU as a student. You also don't really get to see the richness of the community sites which is a great strength to the program.
Interview Day:
I interviewed during my rotation, so I can't really comment on the interview day. I know the dinner is usually held at one of the many microbreweries in Portland. I've heard from other interns that OHSU doesn't really sell itself as well as it could. I don't think they play up living in Portland because they want people to come who are interested in the program, not the town. This is contrary to many other programs that do a huge sales job for their geography.
You should know that OHSU does zero follow up after your interview day. They don't call anyone nor expect a call from you. You, of course, are welcome to let the PD know your intent but it won't affect your application.
Resident Life:
The camaraderie among residents is great. Lots of people are outdoor oriented and there's plenty of options in the Portland area for recreation. Attendings and residents are usually on a first name basis (it's hard to call some of the older attendings by their first name, but I don't think they really care). The nursing staff is very helpful. For example, if you're suturing they get everything ready for you.
Interns have an orientation month in July with lectures, reduced shift schedule, and merit badges (ACLS, ATLS, PALS, NRP). We hung out a bunch and got to know each other. There's also a yearly retreat for all residents. Everyone is excused from their clinical responsibilities and every other year the whole group goes rafting.
The group of residents is rather diverse. Some went straight through college to medical school, others have previous residency training. Most have significant others and a few of have kids. Numerous residents have had children while in the program.
I feel there's plenty of life outside the ED. In the summer, there's daylight after 9pm so you can work an am shift (7-3pm) and get a good hike/bike ride/kayak/run/whatever on a work day. Skiing is 1.5 hrs away and lasts year round. If you're a whitewater kayaker, there are world class rivers in every direction. There's plenty of road bike rides and mountain biking is just out of town. The coast is 2 hrs away. Hiking opportunities are fantastic – there are mountain lakes, the Columbia gorge, St. Helens, the coast range, all within an hour or two. It does rain a lot here in the winter but snow in town is infrequent. Portland has plenty of city stuff going on as well (you might be able to tell that I'm not a big city person so I don't know details too well).
My Conclusion:
The standouts for this program include the great teaching faculty, good mix of pathology, and opportunities to work in community EDs. The pediatric experience is also top notch with a brand new Peds ED and Peds fellowship trained faculty (from both EM and Peds background). Living in Portland is also fantastic. It's cheaper than anywhere in California too.
If you want to do academics in the future, plenty of the young faculty are involved in teaching research and have great tips to offer. OHSU offers fellowships in Peds EM (2 yr track), Tox, International, Admin, Education. EMS hasn't been offered in a while, but they are willing to put one together if you are interested (all of Oregon's big wig EMS folks are faculty). Ultrasound is not a fellowship, but is taught in the residency curriculum.
Most residents go into the community, usually in Oregon. Though recent grads have gone to Colorado, Kansas, Minnesota, Idaho, Washington State as well. Working in Portland EDs is an extremely tight market. As an OHSU grad, you will have a super advantage with local connections and also you may very well have rotated in that ED. I don't know of any residents going to super-trauma heavy, very urban EDs. For one, Oregon doesn't have any. Also, while residents feel comfortable at trauma, they are usually not doing it for 6 hours of their 8 hr shift. I personally see this as advantage, because trauma is very algorithm based. If you talk to senior ED staff in the community, they will tell you the elderly are the hardest to take care of. You will see plenty of elderly patients at the VA and OHSU so you will be very versatile after finishing.
You are welcome to contact me if you have questions about the program.