out of the ashes... academic vs county vs community?

[borderlineinCle]

Embarrassed to even re-hash this topic, but given that it's a new interview season figured might as well see what people are thinking Fall 2018.

I've been reading last year's EM applicant thread on how SDN'ers ranked different programs with Pros/Cons. Seems like most of the heavy academic program cons were "won't be well-trained" "won't be good at the bread and butter of EM" "too much consulting" etc. Whereas the county/community heavy programs some of the cons were "won't know how to manage medically/surgically complex patients as well".

Objectively, it seems like quite a significant amount of hubris for a med student (such as myself) to weigh in on what is good, well-rounded training and who is getting good, well-rounded training without going through the process....

I have to imagine location plays a factor, too.

I'm more excited by the academic heavy programs (and that's where most of my invites are so far), but wondering if I'll be missing something but not having more emersion into community / county? If I train academic, can I get a job at a university-affiliated county ED? etc.

I'm sure this is an annoying question for some, and I apologize. But I do look forward to hearing the sage advice from y'all.

Thanks!

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[GolfUSA]

I am an applicant this cycle considering this issue as well. At first I thought I just wanted to do community hospital work because I loved working as an ER scribe before Med school in this setting... But now with a lot of invites to academic institutions, I am thinking more seriously about these options. I hope that someone who has trained in a 4 year program or at a research heavy hospital and now works in the community can weigh in on whether they feel as prepared as their community trained colleagues in this environment.

 

[borderlineinCle]

I am an applicant this cycle considering this issue as well. At first I thought I just wanted to do community hospital work because I loved working as an ER scribe before Med school in this setting... But now with a lot of invites to academic institutions, I am thinking more seriously about these options. I hope that someone who has trained in a 4 year program or at a research heavy hospital and now works in the community can weigh in on whether they feel as prepared as their community trained colleagues in this environment.

Hoping we get some good comments, too. It's a bit unnerving when applying for residency and hearing people tossing around "you may not get great training at [X] environment".

 

[Petypet]

in order to graduate from residency they have to be certified so you will get good training anywhere. Small community programs tout, you get no competition for xyz, Big programs state they have the resources and numbers to train and get exposure to anything. I chose a research heavy program for its resources, opportunities, networking, and ability to see everything. IMO going to a hospital system that sees 250k patients between the sites benefits me, I see lvads, transplants, etc. Smaller community programs may not get depth of exposure, but at the end of the day you learn abc's and resuscitation, and sick vs not sick, which you will get anywhere. Personally, from a heavy research center with a lot of academics, I comfortably moonlight in the community as a 3rd year resident.

 

[miacomet]

They let PAs and NPs work in the ER. PAs and NPs don't even do a residency. You'll be fine.

I would look at lifestyle, program fit, geography, money (some places offer a 401k with a match) and where you will want to end up after graduation. If you think you want an academic job in the Northeast after graduation, apply to academic programs in the Northeast. If you want to live in Salt Lake, apply to the local residency and so on.

 

[borderlineinCle]

Thanks to both of you for replying, I greatly appreciate it!

in order to graduate from residency they have to be certified so you will get good training anywhere. Small community programs tout, you get no competition for xyz, Big programs state they have the resources and numbers to train and get exposure to anything. I chose a research heavy program for its resources, opportunities, networking, and ability to see everything. IMO going to a hospital system that sees 250k patients between the sites benefits me, I see lvads, transplants, etc. Smaller community programs may not get depth of exposure, but at the end of the day you learn abc's and resuscitation, and sick vs not sick, which you will get anywhere. Personally, from a heavy research center with a lot of academics, I comfortably moonlight in the community as a 3rd year resident.

This is great to hear. These are the kind that I'll be interviewing at for the most part (some county too that I'm excited about). You make great points that we'll all learn what is needed before graduating from residency. Good to hear that moonlighting in community from academic was a good transition for you!

They let PAs and NPs work in the ER. PAs and NPs don't even do a residency. You'll be fine.

I would look at lifestyle, program fit, geography, money (some places offer a 401k with a match) and where you will want to end up after graduation. If you think you want an academic job in the Northeast after graduation, apply to academic programs in the Northeast. If you want to live in Salt Lake, apply to the local residency and so on.

You know, that's something I didn't think about honestly. Really good point! That's how my list is currently set up based on most of those factors that you mentioned.

Y'all are great

 

[gro2001]

The idea that you won't be well trained or miss out on the bread and butter EM because you went to an academic program is ludicrous. Do you think academic medical centers are somehow spared from the pneumonias/appys/etc? Or that there are not enough of these cases to go around? Think about it for a second and you will realize how ridiculous this notion is.

As to which is better: you will get a lot of hedgy answers. We all know colleagues from all of these backgrounds that are excellent, so people are generally hesitant to trash some types of training. Also, everyone gets to do only one residency, so all evidence is anecdotal in this case.

That said, we all have our biases. My general bias is in favor of academic 4 year programs. This also happens to be the type of program I trained at. While all programs will get you the bread and butter and enough of everything to be a competent and well rounded emergency physician, not all programs will have a true dedication to teaching or allow you to develop a niche (now, the niche thing is more important for academia and can also be developed in fellowship, but that's a whole other conversation). Typically (but not exclusively), you see that more often at 4 year academic programs.

Overall though, I think geography and fit should play a far larger role than any other factor in selecting your residency. You need to be happy with the place and the people, everything else is secondary. To that end, I would disagree with the money aspect. Money is important, but the difference between having 401k matching vs not for 3 years of residency or a slightly higher salary is much less important that your happiness with geography and people.

 

[borderlineinCle]

The idea that you won't be well trained or miss out on the bread and butter EM because you went to an academic program is ludicrous. Do you think academic medical centers are somehow spared from the pneumonias/appys/etc? Or that there are not enough of these cases to go around? Think about it for a second and you will realize how ridiculous this notion is.

As to which is better: you will get a lot of hedgy answers. We all know colleagues from all of these backgrounds that are excellent, so people are generally hesitant to trash some types of training. Also, everyone gets to do only one residency, so all evidence is anecdotal in this case.

That said, we all have our biases. My general bias is in favor of academic 4 year programs. This also happens to be the type of program I trained at. While all programs will get you the bread and butter and enough of everything to be a competent and well rounded emergency physician, not all programs will have a true dedication to teaching or allow you to develop a niche (now, the niche thing is more important for academia and can also be developed in fellowship, but that's a whole other conversation). Typically (but not exclusively), you see that more often at 4 year academic programs.

Overall though, I think geography and fit should play a far larger role than any other factor in selecting your residency. You need to be happy with the place and the people, everything else is secondary. To that end, I would disagree with the money aspect. Money is important, but the difference between having 401k matching vs not for 3 years of residency or a slightly higher salary is much less important that your happiness with geography and people.

What an great, thoughtful reply! Thank you! Yeah I've been thinking about this a lot today and it really doesn't make that much sense. I think you're right. Instead of pushing to eventually make a rank list based on 'anecdote', I feel more comfortable based on geography and fit.

thanks so much!

 

[GonnaBeADoc2222]

I trained at the academic big house for 4 years and now I'm in the community.

I know that I had excellent training, especially in critical care. Saw more than enough bread and butter EM. I lost count of the number of intubations and central lines I did. I felt more than prepared upon graduation.

I do feel a little weaker in ortho - but I think unless you trained at a place w/o an orthopedics residency, you will feel this way too. Luckily, most of EM ortho is push, pull, splint, followup.

I agree that location / fit matter much more. 401k matching and minor variations in salary not so much. Not to ignite the 3 vs 4 year thing, but you should really try to go to a 3 year program. Academic niche is better developed during fellowship and if you have no interest in that, you should be allowed to go make money. 4 year programs exist so that departments can reduce midlevel coverage and save money by paying you 1/2 their salary while capitalizing on your high level of education and training compared to that of really any midlevel (give me a somewhat strong pgy2 (even some interns) over any midlevel, anyday).

Conversely, one of my colleagues trained at one of the classic knife and gun club county places (I won't say where). One day I said, "How many chest tubes did you do in residency? I bet you did over 100!" He sheepishly replied that he did "Three." I was shocked. Why? Surgery basically came down for every trauma and completely took over. Not that chest tubes are a very difficult or nuanced procedure, but three in four years? - come on.

My point is, I don't think you can judge the caliber or type of training you'll get by lumping programs into baskets of academic vs community vs county. I think there are strong and weak performers in each. Yeah, there are standards that the ACGME uses to try to make all training "equal" but the ways some places get to those required procedure numbers is sometimes sketchy (yeah, simulation is good and all, but a sim chest tube doesn't replace a crash chest tube where you are throwing on a mask and gown in 20 seconds and the tube is in 60 seconds after that and there blood flying everywhere). And it's hard to figure this out I think. You have to find honest residents to talk to at the pre interview dinners etc and not just the ones who are all smiles and are there just to get brownie points so that they can be chief resident.

 

[MechEDoc]

With respect to my personal biases, here is my view. Train at a high level well-functioning academic center. You will pick up good habits, have a better understanding of what can be accomplished at a high quality facility, and be able to anticipate what options will exist for patients that you may someday need to be transferring from a distant and small hospital.

In comparison to my peers at trained at County/community hospitals I performed fewer procedures, I obtained more consultations, and generally felt less prepared for "getting in the trenches" and "moving the meat". However, I feel is much easier to pick up skills for "moving the meat" after residency than trying to pick up more nuanced, "ivory tower" approaches when you come from a rough-and-tumble training background.

Following my training I have worked at a number of facilities that have had residents. I do not necessarily feel that they picked up good habits nor have an appreciation for the level of care that could be obtained at a tertiary referral center. I feel that there is a place for all types of medicine, many problems do not need a fancy medical center, but you will be better served learning the nuances of well organized medicine by training at a well organized facility.

With respect to my peers that have come from more dysfunctional systems I have seen them be much more accepting of subpar care. This is not the kind of care that I want for my patients or for family. I think much of the acceptance comes from ignorance rather than a lack of dedication or professionalism.

With respect to 3 vs 4 year-long training programs I feel that a 3 year program is adequate. Get out and work as hard as you can and read as much as you can during your first year post residency. The biggest learning curves are the first year of residency in the first year post residency.

 

[borderlineinCle]

I trained at the academic big house for 4 years and now I'm in the community.

I know that I had excellent training, especially in critical care. Saw more than enough bread and butter EM. I lost count of the number of intubations and central lines I did. I felt more than prepared upon graduation.

I do feel a little weaker in ortho - but I think unless you trained at a place w/o an orthopedics residency, you will feel this way too. Luckily, most of EM ortho is push, pull, splint, followup.

I agree that location / fit matter much more. 401k matching and minor variations in salary not so much. Not to ignite the 3 vs 4 year thing, but you should really try to go to a 3 year program. Academic niche is better developed during fellowship and if you have no interest in that, you should be allowed to go make money. 4 year programs exist so that departments can reduce midlevel coverage and save money by paying you 1/2 their salary while capitalizing on your high level of education and training compared to that of really any midlevel (give me a somewhat strong pgy2 (even some interns) over any midlevel, anyday).

Conversely, one of my colleagues trained at one of the classic knife and gun club county places (I won't say where). One day I said, "How many chest tubes did you do in residency? I bet you did over 100!" He sheepishly replied that he did "Three." I was shocked. Why? Surgery basically came down for every trauma and completely took over. Not that chest tubes are a very difficult or nuanced procedure, but three in four years? - come on.

My point is, I don't think you can judge the caliber or type of training you'll get by lumping programs into baskets of academic vs community vs county. I think there are strong and weak performers in each. Yeah, there are standards that the ACGME uses to try to make all training "equal" but the ways some places get to those required procedure numbers is sometimes sketchy (yeah, simulation is good and all, but a sim chest tube doesn't replace a crash chest tube where you are throwing on a mask and gown in 20 seconds and the tube is in 60 seconds after that and there blood flying everywhere). And it's hard to figure this out I think. You have to find honest residents to talk to at the pre interview dinners etc and not just the ones who are all smiles and are there just to get brownie points so that they can be chief resident.

This is incredible, thank you! I'm feeling much better about my interview list now
Question: what types of questions do you think are the best to ask at the pre interview dinners to gauge some of these nuances of residency programs?

Also, I've talked a number of county people now. Why do they think / say that academic EM docs aren't trained as well? It seems like what everyone is saying here that that is not true, or a biased way of looking at things. maybe the grass always seems greener on 'our' side?

Thanks so much for taking the time to craft this great response!

 

[borderlineinCle]

With respect to my personal biases, here is my view. Train at a high level well-functioning academic center. You will pick up good habits, have a better understanding of what can be accomplished at a high quality facility, and be able to anticipate what options will exist for patients that you may someday need to be transferring from a distant and small hospital.

In comparison to my peers at trained at County/community hospitals I performed fewer procedures, I obtained more consultations, and generally felt less prepared for "getting in the trenches" and "moving the meat". However, I feel is much easier to pick up skills for "moving the meat" after residency than trying to pick up more nuanced, "ivory tower" approaches when you come from a rough-and-tumble training background.

Following my training I have worked at a number of facilities that have had residents. I do not necessarily feel that they picked up good habits nor have an appreciation for the level of care that could be obtained at a tertiary referral center. I feel that there is a place for all types of medicine, many problems do not need a fancy medical center, but you will be better served learning the nuances of well organized medicine by training at a well organized facility.

With respect to my peers that have come from more dysfunctional systems I have seen them be much more accepting of subpar care. This is not the kind of care that I want for my patients or for family. I think much of the acceptance comes from ignorance rather than a lack of dedication or professionalism.

With respect to 3 vs 4 year-long training programs I feel that a 3 year program is adequate. Get out and work as hard as you can and read as much as you can during your first year post residency. The biggest learning curves are the first year of residency in the first year post residency.

This is super helpful too. Thank you for taking the time to write this! yes, I wan to be able to provide that high-quality, nuanced care regardless of where I practice one day. It seems like the academic EM programs from the *very little* that I've seen emphasize / value on-shift teaching, too.

I want to stay in academics after residency. I have a pretty extensive research background / publication record going into residency next year.
Do you think that 3 year + fellowship (at a 3 year program) carving out that niche as opposed to a four year program would make me a hire at academic centers?

Thank you!

 

[gamerEMdoc]

Echoing what was said above. There are community places that see insanely sick people with very little backup and get to do a ton of procedures. Academic places where you don't do nearly as many procedures. And vice versa. Each site is different. You can't make generalizations and lump them together as "community" vs "academic". Its all about volume, acuity, patients/hr the residents see, the amount of subspecialist backup that takes away procedures, etc. This is going to really vary based on the individual program.

 

[borderlineinCle]

Echoing what was said above. There are community places that see insanely sick people with very little backup and get to do a ton of procedures. Academic places where you don't do nearly as many procedures. And vice versa. Each site is different. You can't make generalizations and lump them together as "community" vs "academic". Its all about volume, acuity, patients/hr the residents see, the amount of subspecialist backup that takes away procedures, etc. This is going to really vary based on the individual program.

Thank you, gamerEMdoc! Question: what types of questions do you think are the best to ask at the pre interview dinners to gauge some of these nuances of residency programs?

 

[MechEDoc]

This is super helpful too. Thank you for taking the time to write this! yes, I wan to be able to provide that high-quality, nuanced care regardless of where I practice one day. It seems like the academic EM programs from the *very little* that I've seen emphasize / value on-shift teaching, too.

I want to stay in academics after residency. I have a pretty extensive research background / publication record going into residency next year.
Do you think that 3 year + fellowship (at a 3 year program) carving out that niche as opposed to a four year program would make me a hire at academic centers?

Thank you!

Following training I would recommend spending a significant amount of time in the community if you want to be a good academic teaching physician. It will give you perspectives and appreciation for where I would estimate 80% of healthcare in America is provided. This will make you both more resourceful, as well as able to better prepare future physicians.

With respect to asking specific questions I would not worry too much about it. Judge the program based upon the people you meet as well as the emergency department. If the emergency department look sloppy, something is probably wrong with the overall system. If the emergency department is well-run, you are likely going to find an overall well-run department.

Doing locums work, I usually know within minutes of starting work at a department how well it will run.

 

[MechEDoc]

Thank you, gamerEMdoc! Question: what types of questions do you think are the best to ask at the pre interview dinners to gauge some of these nuances of residency programs?

While this may be an excessive generalization you may wish to avoid programs at sites that are staffed by contract management groups. These sites typically have extreme focus on profitability and you will find compromised care and teaching.

 

[miacomet]

I think the academic vs county vs community debate really comes down to realizing exactly how broad a field EM is, and how differently it's practiced across the country. While most programs turn out competent docs, nearly all docs graduate with some weaknesses and some areas of strength. At one program you may do hundreds of chest tubes, at others maybe the strength is ICU experience. A community program will teach you more about the nuances of less highly-resourced practice and selling admits. Academics will expose you to all the zebras.

I think it's very, very tough as a new attending to transition from one practice type to another, but nearly everyone does it and it works out fine. That having been said, I would recommend everyone try and do at least one community rotation. Most docs will work in the community at some point, and it's good to learn how to function with minimal backup.

 

[TheComebacKid]

Every year this topic comes up, and every year, I love discussing it with you all.

When I was a med student, the sexiest programs that were advertised the heaviest were the county programs. The LAC+USC type places, Cook County, Denver Health etc. I rotated at a county site that was advertised as a huge knife and gun club where the residents ran the show. To make a long story short, I ranked that program last. It's nothing against county training programs, overall the mission they serve is incredibly important, and the physicians were well trained, but I thought there was more BS at that program than was worth my time. I thought there were way more patients with coughs and colds, homeless patients looking for a place to sleep, than there were GSWs and chest tubes. Residents pushed patients to scanners, started their own IVs, the nursing was terrible. It wasn't for me.

I chose to go to a 4 year academic program in a city without a county hospital. I have all the trauma that comes with being a level 1 center in a violent inner city environment with tons of penetrating trauma, but we have resources including 24 hour social workers, competent nursing, and cool toys. I see all the bread and butter stuff I need, but I still got to work with the CT surgery attending to crash a patient onto ECMO because we have those resources here. I have amazing off service rotations with expert consultants, one of the best EM critical care experiences there are. I still get the satisfaction of serving the underserved and taking care of the indigent. We have all the fellowships in the world, experts in their respective fields, research opportunities, and a strong group of educational faculty. We have money to spend on whatever we want as a department. It's all in one package. This was the right fit for me.

We have weaknesses too. Like someone stated earlier, ortho experience, for a multitude of reasons, is more challenging in an academic center where you compete with ortho residents for procedures. I suspect this is a different experience at a community program where you are the only residency in house. That being said, I have done more chest tubes, central lines, intubations, REBOA, etc than I can count. When it comes down to training to get a high number of ortho procedures, vs a high number of intubations/lines/tubes, I'll take the latter any day. As EM physicians, as far as ortho is considered, you need to know how to perform procedural sedation, how to push/pull and splint. We are lucky that we have a community site that we rotate at that we make up some ortho experience there. But when it comes down to the number one priority for me it was managing the sickest patients and doing critical procedures. Our graduates have gone into the community where ortho follow-up happens the next day, so it's manageable.

If you like an academic center, I say go for it. I am at one (granted we have a county/hybrid feel), and contrary to what is depicted in the TV shows about the county cowboy EM doc, academics can give you all the opportunities and training experiences you need. Just keep in mind that every single setting has its weaknesses.

 

[gamerEMdoc]

Thank you, gamerEMdoc! Question: what types of questions do you think are the best to ask at the pre interview dinners to gauge some of these nuances of residency programs?

Not sure to be honest, I dont go to the pre interview dinners.

But, I do think guaging what procedures are common and what procedures the residents feel like they lack is important. More important though I think is getting a sense of how the residents get along and gel with eachother.

 

[southerndoc]

If it's RRC approved, you will get good training.

Remember, a lot of the community faculty trained at academic centers. Obviously they learned something in order to train the residents at a community program. I trained at a large academic facility and I'm core faculty at a large community program. I don't think my residency hindered me in one bit.

 

[RPedigo]

Just keep in mind that every single setting has its weaknesses.

I think that's basically the gist of it. Go with your gut and what you think your most likely anticipated practice setting would be. I trained at a county hospital (that has multiple community rotations) and got outstanding training. I have friends who trained at purely academic centers and got outstanding training. I have friends who trained at community sites and got outstanding training.

I'm currently faculty at a county hospital (the same one I trained at) and obviously my training environment has served me well. Did I get a lot of procedures and super sick patients? Yes. Did I see lots of liver transplant and LVAD patients or put people on ECMO? No. Is it important to have regularly seen that in residency? Depends on where you're working after residency. If you're working at a huge transplant / ECMO / LVAD center, yes. If you're working elsewhere, no. For me, getting lots of exposure to procedures and sick patients that we managed ourselves had more versatility for my anticipated career goals. Did we see each see 3 patients/hour in a slick high-productivity high-efficiency system? Not always. That said, I also moonlight in the community (as do our residents) and when they publish the productivity/length of stay data, the other residents and I are almost always in the top quartile for speed and productivity.

Every type of program has their own strengths and weaknesses, but it's up to the individual applicant to decide which of those are best for what they want.

 

[DrDrummer]

That being said, I have done more chest tubes, central lines, intubations, REBOA, etc than I can count.

You're training at an institution that has emergency medicine residents performing REBOA, and have done this more times than you can count?

 

[alpinism]

Agree with training where you plan to practice.

That being said I couldn't disagree more with the notion that you'll get quality training at every program.

The ACGME requirements are a joke and many items can be fulfilled by simulation and conference attendance.

You'd be surprised how many places are graduating residents who've never floated a pacemaker or drained a pericardial effusion.

Trust me you don't want your first time to be as an attending working alone at a community hospital with no guidance or supervision.

 

[TheComebacKid]

You're training at an institution that has emergency medicine residents performing REBOA, and have done this more times than you can count?

Yes, our EM residents are placing REBOA with the help of the trauma surgeons. If you can place a femoral arterial line, you have the skillset to place a REBOA catheter. I have placed it a handful of times. I misspoke when I said "more times than I can count" as I was primarily referring to lines, chest tubes and intubations.

There are other procedures that I am much weaker at, including hip reductions, and other various ortho procedures since our program has a strong ortho residency that we utilize heavily. That is probably a huge weakness for us that is well known at our program.

 

[Vandalia]

In my opinion it is like the benefits from taking an advanced anatomy class as an undergraduate, or perhaps the difference between ROTC and one of the academies in the military.

For the military example, an academy grad might be a little better prepared for his first couple of years of service as compared with an ROTC grad, but very quickly that advantage disappears. In the same way, the guy who took several anatomy classes might be a little better prepared for the first week or two of med school anatomy, but after a month or so there is no difference.

It might be possible to detect a difference between EM physicians based on their residency type in their first year or two, but after that, the difference disappears.

 

[TheComebacKid]

You'd be surprised how many places are graduating residents who've never floated a pacemaker or drained a pericardial effusion.

There are a very few EM attendings who are "comfortable" with draining a pericardial effusion. The unfortunate nature of our specialty is these life saving procedures that we are supposed to know how to do are very hard to come by in training.

Many of my coresidents have had the opportunity to perform rare procedures like resuscitative thoracotomy or pericardiocentesis, I have not had those same opportunities. You never know when you will get that chance to scoop up a rare procedure.

I have taken home the trans venous pacing kit and talked myself through how I'm going to need to do it, but unfortunately, it's possible that the first time I'll do it may be after I graduate. The reality of the situation is there is absolutely NO WAY for one residency program to train you for every single thing you will be faced with as a new attending.

 

[gamerEMdoc]

There are a very few EM attendings who are "comfortable" with draining a pericardial effusion. The unfortunate nature of our specialty is these life saving procedures that we are supposed to know how to do are very hard to come by in training.

Many of my coresidents have had the opportunity to perform rare procedures like resuscitative thoracotomy or pericardiocentesis, I have not had those same opportunities. You never know when you will get that chance to scoop up a rare procedure.

I have taken home the trans venous pacing kit and talked myself through how I'm going to need to do it, but unfortunately, it's possible that the first time I'll do it may be after I graduate. The reality of the situation is there is absolutely NO WAY for one residency program to train you for every single thing you will be faced with as a new attending.

I do agree with this. Some things are just rare. If you are lucky, you'll be in the right place at the right time. But I trained in a place with crazy high acquity and little backup. I work in a high acquity place now. I worked on my own for four years. There is still stuff I've never done. I've prepped for a crich several times, but never did one, because I've never not been able to get a definitive airway yet, even in the worst airway disasters like shotguns to the face, terrible angioedema, etc. I had my first emergent pericardiocentesis opportunity 8 years into my career. Some stuff just doesn't happen often. I had my only perimortem csection about 5 years out of residency. Some stuff just doesn't come around often.

If you interview at a place where residents struggle to get intubations/central lines, fracture/dislocation reductions, LPs, etc. That's scary, because that is the stuff you are going to do over and over again for the rest of your career. The rare procedures, that's just being lucky enough to be in the right place, right time IMO.