Procedures/Trauma in different residencies

[The White Coat Investor]

I remember going around and interviewing and wondering if I would get enough procedures. Now that I've finished a year of residency, I'm curious if it's true what I was told, that you get plenty everywhere. Any other new PGY2s out there that had to keep track of their procedures? Are your numbers about the same as mine, significantly more, or significantly less?

RRC Residency requirements for 3 years are:
*Bedside ultrasound 40
*cardioversion 10
*central venous access 20
*Chest tube 10
*Conscious sedation 15
*crico-surg 3
*Dislocation reduction 10
*Intubation 35
*laceration repair 50
*lumbar puncture 15
*medical resuscitation, adult 45
*medical resuscitation, pediatric 15
*splint 20
*trauma resuscitation, adult 35
*trauma resuscitation, pedi 10
*vaginal delivery 10

My personal numbers after first year are:
*Bedside ultrasound 45
*cardioversion 3
*central venous access 14
*Chest tube 7
*Conscious sedation 9
*crico-surg 4 (all animals)
*Dislocation reduction 13
*Intubation 43
*laceration repair 80
*lumbar puncture 21
*medical resuscitation, adult 22
*medical resuscitation, pediatric 1 (yea, I'm a little worried about that one, there just aren't that many really sick kids out there.)
*splint 23
*trauma resuscitation, adult 32
*trauma resuscitation, pedi 8
*vaginal delivery 15
abscess ID 16
Anthrocentesis, knee 1+++
art line 17
Arthrocentesis 1+++
Dental block 1
Digital block 17+++++
fiberoptic 3
Intraoss line 2
Laryngeal mask airway 4
nail removal 2
peritonsillar abscess aspiration 3
Regional block 4
Spinal anesthesia 2
swan-ganz cath placement 1
Toe nail removal 3

Also, our 33 residents saw 4400 trauma codes this year. How does that stack up with other places?

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[DrQuinn]

My numbers are pretty similar to yours... I dont' have my official numbers yet but we're pretty close in the big ones (intubations, Central Venous Access, deliveries). I think I"m a big higher in traumas and medical resus's though, but that's because I did one month of trauma and was the ONLY EM resident on during my EM months (beauty of being a new program). When I get my official numbers this month I will post.

Good thread though!

I dont' have any cric's though, not even on animals, just the fake model at ATLS. I have had about 3 pedi resus's, and lots of pedi trauma resus's.

Q, DO

 

[EMIMG]

This is the approx totals for me after a 3 year residency. I know that there are some of my classmates with more than me (they were just magnets). I know one of my classmates did 4 ED thoracotomies (2 of which were bilateral).

Intubations - 131
A-lines 24
EJ IVs 42
Femoral Central Lines 112
IJ Central Lines 28
Peripheral IVs 418
Subclavians 26
Vag Deliveries 26
LPs 41
*Adult Medical Resuscitations Directed 273
*Adult Medical Resuscitations Participated 215
*Pediatric Medical Resuscitations Directed 14
*Pediatric Medical Resuscitations Participated 27
*Adult Trauma Resuscitations Directed 115
*Adult Trauma Resuscitations Participated 124
*Pediatric Trauma Resuscitations Directed 22
*Pediatric Trauma Resuscitations Participated 19
(*These are the patients that are placed in our resuscitation/trauma room, not necessarily the ones that were mistriaged to the back that are sicker than dogs that we run in the main ED area).
Chest Tubes 14
Transvenous pacers - 5

As for the 4400 trauma codes, are these totals, or are some of these double counted (i.e. you see them and count them but another resident sees them and counts them as well). And, are these all traumas that come in directly as traumas, or are these some that you will later consult the trauma service on?

 

[Jeff698]

Thanks so much for starting this thread. As I'm looking at programs, this is a big question for me. From a lifestyle standpoint I (and most especially my wife) would like a smaller program but I worry that I won't get adequate experience.

Take care,
Jeff

 

[roja]

I think close. we track all our procedures on a computer with the exception of off service rotations.

I have a few more in some and a few less in others. (some I couldn't even keep track of like digital blocks..)

bedside u/s =200
intubations= 55
deliveries =10
central lines= 20

 

[The White Coat Investor]

I think close. we track all our procedures on a computer with the exception of off service rotations.

I have a few more in some and a few less in others. (some I couldn't even keep track of like digital blocks..)

bedside u/s =200
intubations= 55
deliveries =10
central lines= 20

Yea I didn't keep very good track of digital blocks or U/Ss. I know I didn't get 200 U/Ss, that' s really good for one year.

EMIMG 418 peripheral IVs? What's up with that? The other thing I still haven't figured out is what counts as a medical resuscitation or a trauma resuscitation. I've only been counting as medical those who go to the ICU. For traumas I only count the "trauma reds" and "trauma whites" and not the "trauma greens." As far as the 4400, those are the trauma reds, whites, and greens brought to our facility in the last year.

 

[roja]

I just checked my u/s. I am at close to 300 at the close of 1st year. Of course, I intend to do an u/s fellowship so I have done a bunch, in that vane. I am trying to get my 850 for RDMS prior to starting fellowship.

I don't even count peripheral IV's as a procedure. Nor small stuff like paronychias, etc. I try to remember to but in NGT's and abscess I&D's but I often forget....

 

[Scrubbs]

I'm starting to feel really stupid for not tracking my procedures better. I almost never keep track of trauma's and codes... I've been in a million this year, but didn't even think to write 'em down. I've mostly kept track of central lines, tubes, deliveries and so on. Lacs and digital blocks??? No way Ultrasound is luckily kept track of by our department... we have to enter all scans for Q&A. No clue how many I've done.

Oh well... I'll do better with the paper work this year I guess

 

[Apollyon]

Ah 4400 traumas, not trauma codes. I was think that Arizona is a nasty place, if 12 people every day were coming in traumatically dead.

Oh, did you go to births on your peds block? Dry/warm/position/suction/stimulate counts as a pedi resuscitation.

 

[EMIMG]

As for the peripheral IVs...yes, that number is correct. I typically would do them in the resuscitation/trauma rooms while I was tending to the patients. It is a billable procedure for our physicians if done by a resident vs. a nurse. In addition, we went through a time period where nursing was short-staffed. You can wait for your bloods to be drawn, or you can go do it yourself. Also, if there were not patients to be seen for a couple of minutes, and there was nothing to do, and IVs needed to be done, as part of the team, you would see to it that it would be done.

The deliveries were done on my Ob-Gyn block.

Pediatric resuscitations were only counted in the ED....none from the warming, stimulating, suctioning of NICU.

As for the trauma/medical resuscitations...counted any that came into our resuscitation room. Whether they were pronounced, admitted, transferred, etc. Not just ICU players. Did not count any trauma consults we had...just the ones where the trauma team was activated from the start of the situation.