Pediatrics exposure in EM residency

[drdrtoledo]

Hello all,
Applying for the match this year. I was hoping for some advice on which programs have especially strong pediatric training/exposure. I am looking at the east coast and mid west but would welcome any standouts elsewhere. So far I've been told that Indiana, Maryland, and Arizona are good spots for peds. They are the only programs offering combined EM/Peds so I would imagine so. Anyone out there have other programs they can recommend? Is it really a good idea to apply to the hospitals that have fellowhips? Thanks.

AT

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[NinerNiner999]

We do over 7 months of combined pediatrics during our three years, plus we are the regional pediatric level I trauma center, making the peds exposure a little too much at times (of course, I'm more adult-oriented anyway). I think we are right on par if not more comprehensive than the average program as far as peds exposure.

 

[USCDiver]

(of course, I'm more adult-oriented anyway).

Oh come on! We both know that isn't true (wink wink nudge nudge).

 

[Seaglass]

We, also, have a total of over 7 months Peds exposure and are one of the 5 level one peds trauma centers in NC. Of course that is really a useless designation.

 

[wthomp03]

Check out Stony Brook. We are the only level I in the county with no pediatric trauma centers, so almost all of the kids come here. We also don't have a dedicated Peds ER, so we are seeing peds pts everyday (I would guess I see 2-4 kids on average per 12 hr shift) and not just during dedicated peds months. Our PD is Peds EM fellowship trained, so we get a great deal of peds teaching. We also do a 1 month rotation at a peds ER in the city. I feel totally comfortable with peds pts, even really sick ones.

 

[bulgethetwine]

We, also, have a total of over 7 months Peds exposure and are the only level one peds trauma center in NC. Of course that is really a useless designation.

Wrong. Carolinas, Duke, Pitt County Memorial and University Baptist are all Level I designated EDs, both adult and pediatric.

To avoid a debate, check the facts here:
http://www.facs.org/trauma/verified.html


For what it's worth, when I was interviewing, I placed a premium on choosing a place with robust pediatric experience. Now, I'm not so sure it was important. Deep down, I wonder if I was emphasizing it in my personal statement/interview because I really wanted it that way, or I thought it would make me a stronger condidate?

My experience with pediatrics so far is that, as much as the pediatric people hate it, the stereotypical phrase "adult medicine for little people" isn't really far from the truth. Of course this is a catch phrase which is inflaming to pediatricians because it diminishes the unique challenges of their specialty, but I would argue that most of the unique challenges arrive when you're dealing with floor pediatrics -- it is here where the biggest differences in terms of disease and pathology come into play. In the pediatric ED, the vast majority are either things run very similar to the adult side (trauma protocols, for example) or are related to stuff that could easily be handled by an average primary medical doctor.

There are certianly important things to know -- different anatomy of children, for example, and first presentations of 'common' pathology like seizures, hypoglycemia, etc. I'm just not sure we should be in a pissing contest about which residency has the most pediatrics with the implication that more=better doctor.

 

[FoughtFyr]

To avoid a debate, check the facts here:
http://www.facs.org/trauma/verified.html

To start a debate, realize please that ACS is not the "only" manner in which trauma centers are designated "Level I". Many states have their own criteria under their EMS acts (e.g., Wisconsin) as do some cities with "home rule" (e.g., Chicago) and the USDOT used to also provide the designation. So, it is entirely possible for there to exist more than one "only Level I" in a given area.

As for Peds experience, here at Mayo (NOT an ACS Level I TC currently, but definately a State Level I and a major tertiary referral center for both trauma and medical) you do a month of dedicated Peds ED shifts during your intern year. After that month is complete roughly 20% of your shifts when assigned to the ED will be in the Peds ED. We also do a month of PICU as second year residents (acting as seniors in the unit). all in all, lots of good peds experience. Once again, the RRC does regulate the amount of pediatric exposure you will have so all of the EM residencies should get you to a fairly decent comfort level with peds. And EM based peds EM fellowships are easy to comeby after residency if you remain so inclined.

- H

 

[beyond all hope]

When I was interviewing, I thought the strongest Peds exposure was at UIC (Univeristy of Illinois at Chicago). All of their ERs are mixed adults/peds, plus they do seperate Peds ED months and 2 months of PICU.

Look for places with mixed Adult/peds EDs, or ones that mix Peds with Adult shifts. Just doing a month each year in the Peds ED is not enough.

 

[Homunculus]

My experience with pediatrics so far is that, as much as the pediatric people hate it, the stereotypical phrase "adult medicine for little people" isn't really far from the truth. Of course this is a catch phrase which is inflaming to pediatricians because it diminishes the unique challenges of their specialty, but I would argue that most of the unique challenges arrive when you're dealing with floor pediatrics -- it is here where the biggest differences in terms of disease and pathology come into play. In the pediatric ED, the vast majority are either things run very similar to the adult side (trauma protocols, for example) or are related to stuff that could easily be handled by an average primary medical doctor.

There are certianly important things to know -- different anatomy of children, for example, and first presentations of 'common' pathology like seizures, hypoglycemia, etc. I'm just not sure we should be in a pissing contest about which residency has the most pediatrics with the implication that more=better doctor.

as a peds resident, i *mostly* agree. peds ED is very much (probably even *more* than adults) basic primary care stuff. ear infections, URI's, lacs-- run of the mill stuff. even codes can be braselow taped to make them more foolproof. the peds specific things that tend to be "not optimally managed" by adult ED's (in my experience) are specific subsets of the peds population-- heme/onc kids, NICU grads, short guts, metabolic disorders, sexual/physical abuse, CFers, Sicklers, neonatal fevers/ALTEs, etc. Most of these kids get good care, but it seems that the adult ED's tend to be more "what do i do next" when we get consulted. It's not a big deal-- after all that's why we're here. For me it's a comfort level more than anything, and the more peds experience docs have had with specific peds problems the more comfortable they seem to be about dealing with it quickly-- which in the end is what the ED world is all about-- speed and efficiency

i wouldn't totally base my decision on where to on peds exposure, but i would definitely consider it in the equation. i would also probably look less at their peds trauma level and more at their peds "complexity" level-- because as you said, peds codes are fairly straightforward.

--your friendly neighborhood trainwreck avoiding caveman

 

[pinbor1]

When I was interviewing, I thought the strongest Peds exposure was at UIC (Univeristy of Illinois at Chicago). All of their ERs are mixed adults/peds, plus they do seperate Peds ED months and 2 months of PICU.

Look for places with mixed Adult/peds EDs, or ones that mix Peds with Adult shifts. Just doing a month each year in the Peds ED is not enough.

Thanks Beyond all Hope. I'm a senior resident and I would have to agree that our peds exposure is excellent. We do two PICU months, one at UIH where you will take care of a number of cardiac patients, heme/onc, kidney, and small bowel transplants. We even had a hunter syndrome kid If I recall properly. In addition you get your usual bread and butter asthmatics. During this month, you take call on your own, no peds resident for back up. If you have questions you call the attending or the appropriate consultant. This can be nerve racking at first, but it's a great experience. In addition, we do Christ PICU another great experience. There you are on call with a peds resident, so you split the work. It is a little less autonomy, but it's nice to get input from peds residents on call with you. Both PICU are ~14 beds if I remember correctly. We also do two dedicated peds months. 1st year it is at UIH/Illinois Masonic. 2nd year is at either Children's Memorial or Wyler's at Univ or Chicago. In addition, we do some trauma months at Christ where we get additional peds exposure. I would have to agree that it is also pretty straight forward when running the peds code. I think the hard part is the emotional part of treating a kid.

I think our mixed adult/peds ED months which are basically all our ED months is the big sell. It is much more of a challenge taking care of sick kids at a non-trauma center, non-PICU hospital with ED nurses that don't regularly see sick kids. This is when you really need to understand your pediatric critical care. At Mercy, our inner city ED, I have taken care of a number of sick kids ranging from Asthma and Severe Dehydration to Closed Head Injuries with resulting bradycardia. One of my fellow colleagues had a 20 something week crack baby dropped off 3-4hrs post delivery blue and unresponsive. Mom delivered and left the kid on the floor while she was high on drugs. It are these circumstances, that truely test your nerves and skill level.

Peds is an important factor, and we all never get enough exposure. I agree with the posters above that peds should be a factor in your equation, but program fit is more important. Regardless, I hope I see you interviewing at our program. If you need a place to crash, I will happily offer my place.

pinbor1

 

[Seaglass]

Well I assume they are making these claims based on something. Maybe they're not.

 

[FoughtFyr]

Well I assume they are making these claims based on something. Maybe they're not.

The others may not be certified by the state as pediatric centers...

- H

 

[Seaglass]

Actually in doing more review of the subject it seems that bulgethetwine is likely correct and that our trauma surgeons are talking out their ASSES. I'll have to ask one next time I see them in the ER. I regret the error and will retract the statement.

 

[bulgethetwine]

Actually in doing more review of the subject it seems that bulgethetwine is likely correct and that our trauma surgeons are talking out their ASSES. I'll have to ask one next time I see them in the ER. I regret the error and will retract the statement.

Ah, what the hell, there's no need to retract -- afterall, the statement was qualified correctly: it's pretty much a "useless designation" other than bragging rights... and I think we'll leave the pissing contest to the surgeons!