philly area programs

[endra]

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hi everyone,
i am finally trying to sit down and rank all of my programs. i am making a spread sheet. i only applied in the philadelphia area, but there are some questions which i have not found to be on residency websites and/or forgot what they said during interviews, and was hoping someone from each program could answer.

a) schedule in the ED and during off months, as in how often on call, how many shifts and of what length on average, how many weekends off, vacation.

and

b) admitting privileges

the programs are: upenn, drexel, einstein, temple, jefferson, christiana, and umdnj, st. luke's.

if anyone could answer that would be great. thank you so much.

 

[jaeida8]

Temple

During ED months, 1st years do 10 hour shifts, 2nd and 3rd years do 8 hour shifts. Generally, the schedule works on an 8 day cycle. 6 on, then 2 off. The shifts follow a circadian rhythm so you will work 2 days, 2 middles and then 2 nights (7-5, 1-11, 9-7 for interns, 7-3, 3-11, 11-7 for upper levels).

The exceptions are that you may have some Peds and yellow zone (lower acuity) shifts mixed in so you may have a lighter schedule (less or no overnights) during those weeks. The blocks are 28 days and you work between 20-22 shifts depending on the schedule. Weekend days off during ED months are variable. It depends on what template you are on- it can be from 0-6.

Off-service call months (all blocks are 28 days)

Intern year:
Medicine- Q4 call, 4 days off
RICU- Q4 call, 4 days off
Trauma- Q3 call, 4 days off
OB- 3-4 overnight calls, weekends off

2nd year:
Burn ICU- Q3 call, 4 days off
SICU- Q3 call, 4 days off

3rd year:
Trauma- Q3 call, 4 days off

Interns get 2 weeks of vacation throughout the year plus 1 week during the holidays (either Christmas or New Year's)

3 weeks of vacation plus 1 week during the holidays during 2nd and 3rd year.

As far as admitting, we have admitting privileges so it is not difficult to admit people we believe need to be admitted.

 

[EMCC]

St. Lukes

a) In the ED, all 10 hours shifts (except on Grand Rounds days--8 hours). As an EM-1, you work 21 shifts per month; 19 as a 2nd year, and 17 as a 3rd year. You are "guaranteed" 1 weekend off each month, with more weekends the further in your training you are. The shifts start at staggered times during the day; following the circadian rhythm is attempted, but not always successfully followed...
You have one month rotations as a 1st year--IM, MICU, SICU, surgery, elective
You have 1/2 month rotations as a 1st year--radiology, psychiatry, anesthesia
Call averages q4 on each off service rotation; you do roughly 3 nights (9p-7a) a month in the ED

Couple of other "notes"--in each month, ~20% of the patients you will see are Peds, so no dedicated Peds ED month at our institution (You do one month at St. Chris in philly to make the RRC happy). The last few hours of your shift are in fast track, so you are out of the ED within 20 minutes of your shift ending--unless you want to stay late...

b) admitting privileges...we don't admit our own patients...BUT, we rarely get a hassle for admissions... The hardest part of admissions is dealing with the IM residents saying the patients should be admitted to the hospitalist service and not to them. They still end up taking them after huffing for a few seconds on the phone. THE MOST IMPORTANT THING--we have "bridging orders" at our hospital; which means that we call for admission, the medical guys accept the patient, and we "bridge" them up (cursory orders: M/S tele, dx, IV fluids, page Dr. SoandSo when pt. arrives on the floor). The end result is that most patients are out of the ED within 4 hours (including waiting room time and further studies). Beds get turned over, and more patients are moved in to be seen...So, you never get sign out on a patient you signed out...

Ask any other questions or just PM me...

 

[endra]

for the two of you, thanks so much for replying with such detail! def a big help-- for the rest of the programs-- please keep it coming!!

thanks!

 

[antiveggies]

Christiana (PGY1, so i may mess up some of the 2nd/3rd yr stuff)

ED months interns work 16, PGY2 20, PGY3 18 shifts/month which are a mix of 8-12hrs with 12s on weekends (gives us more weekends off 👍). We do a month of dedicated Peds EM as interns at AI Dupont, and 2nd/3rd yr we work a few shifts at AI Dupont each month - we also see a good amount of peds on a daily basis at our main site.
Interns do a dedicated month of nights, and PGY2/3 do 6wks of nights. That allows us to only work 1-2 overnights per month the rest of the year. 🙂


Off service Call months
Interns
Trauma - 6 or 7 calls, 4 days off
MICU x2 - we have a night float/short call system. short call stays till 7pm, nite float is 7p-7a. we do 7 short calls each month, and 1 wk on night float each month. we have 2 MICU months intern year. 4 days off
CICU - like MICU schedule
the other off-service are no call 😎

PGY2
SICU - like trauma, 6-7 calls, 4 days off
PICU - i have no idea lol

PGY3
nada

we get 3wks vacation, and you can have 1 additional vacation week to attend a conference. over the holidays if you are in the ED you get either christmas or new years off (5-7days i think). off service depends on where you are

admitting - we just put a call out through our clerks so we arent stuck on the phone with some office, then the admitting doc calls back and the clerk lets us know when the admitting is on the line. getting pts admitted has never been an issue for me. we have a good medical community who generally respect our judgement, and we dont have many admission battles. we have a spreadsheet of all the PCPs in the area, and it tells us if they admit their own or use the hospitalist services (2 main groups) which also helps speed the process along. no bridging orders, they either give orders via phone to a nurse or the residents come down pretty quickly. the only time we have to do much after someone accepts the admission is when the hospital is full - then we keep an eye on them and continue to manage pts as needed while they hang out in the ED.


final words of advice - like everyone says, go with your gut. if you base this decision solely on hours/vacation and a spreadsheet you may end up somewhere you dont want to be. pick the place that feels right, and that you can see yourself being happy. good luck

 

[SJBX]

How are the sexual assaults handled at the Drexel program (since most of the training is done at Catholic Hospitals)?

For that matter, since Jefferson gets so many sexual assault cases, do the residents get bogged down treating those victims or do they have SANE nurses?

 

[jazz]

How are the sexual assaults handled at the Drexel program (since most of the training is done at Catholic Hospitals)?

For that matter, since Jefferson gets so many sexual assault cases, do the residents get bogged down treating those victims or do they have SANE nurses?

this info is a few years old so take it with a grain of salt.

sexual assault victims in philly are brought to 2 hospitals (jefferson and i think episcopal in north philly (affiliated with temple)) for the rape kit.
thus, the other residencies see very little sexual assault cases.
at jefferson, at the time, the 2nd year er resident saw all the rape cases and it did seem to take a lot of their time (especially when they got the case during a busy shift) based on sheer amounts of paperwork and documentation.

never heard of SANE nurses in philly.

as for drexel, the experiences of dealing with sexual assault cases are encoutered at mercy fitzgerald and st christophers.
the reason you get sexual assaul cases at mercy fitzgerald is b/c it's in darby county and thus the pts don't go to the 2 hosptials in philly. mercy fitzgerald is a catholic hospital -- i don't know what they do in terms of providing post assault "morning after pill"
st christophers is a children's hospital and gets their share of sexual assault cases.

so at jefferson i think you see more than your needed share of sexual assault and at the other programs you may only see 1-2 over your entire time but that's probably enough. doing a sexual assault exam/kit isn't hard, it's just a lot of time and documentation...

truthfullly it's so much better (for the victim) if a SANE nurse does the exam b/c they do it all the time, have more time to spend with the victim, and is so much less rushed than an ER attending...