Pros&Cons of being the first class of a brand new EM residency?

[deleted709753]

I got an interview invitation to a brand new program (Valley Health in Las Vegas) that I’m excited about. It’s in a location that I prefer.

Are there any former or current residents on here that were part of their first graduating residents class? Can you please tell me the pros and cons of your experience?

I did an away rotation at a residency that just graduated its first class, and the PD there talked about how the residents in their first class got an unusually high number of procedures just because they were no other residents to take their procedures.

I currently have >10 interviews, both east and west coast. I will have options to rank more competitive programs higher on my list. But I’m legitimately excited about this interview and I’m looking for arguments both for and against. Thanks!

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[gamerEMdoc]

My first and foremost advice is always go where you will be happy and don't worry about everyone elses opinion. But since you asked, these would be the positives/negatives I think of off the top of my head:

Positives:
- Procedure numbers
- Being able to be part of building and shaping something that will grow based on your experiences/feedback

Negatives:
- The unknown of how the faculty are to the residents
- The patient volumes you may be expected to see in the ED since you don't have the same safety net of senior residents above you
- Some rotation hiccups and potentially poor off service experiences while the iron out the kinks and fight any turf battles with other fields

 

[Fox800]

Turf battles. Fighting with admitting teams and other services because "that's always how we've done it".

 

[Tenk]

@RustedFox I summon you!

I was but a mere medical student when our school started an EM program but I got to hang with the first class a lot and I felt like they got a lot of attention and proper training. There were definitely some changes that I saw happen throughout the years but they were mostly just doing some rotation here instead of there.

 

[RustedFox]

I was one of the O.G.s at my program.

PROS: Lots of good teaching. Little interference from off-service residents. First crack at procedures.
CONS: Some rotations will totally suck and be generally worthless, and you're the guinea pig that brings this to light.
(our month of Ortho was largely clinic-based, and was pretty worthless, as was an outpatient peds month. Our SICU month got canned
altogether after the surgical folks didn't play well in the sandbox)

 

[House911MD]

I was one of the O.G.s at my program.

PROS: Lots of good teaching. Little interference from off-service residents. First crack at procedures.
CONS: Some rotations will totally suck and be generally worthless, and you're the guinea pig that brings this to light.
(our month of Ortho was largely clinic-based, and was pretty worthless, as was an outpatient peds month. Our SICU month got canned
altogether after the surgical folks didn't play well in the sandbox)

I see you are an attending now. How do you feel things ended up in the end for your class training wise? Even with the hiccups do you feel like you were adequately training by the time you graduated or did you and your peers have to do some extra work on your own (that would not otherwise have been required at an established program) in order to get where you needed to be?

 

[RustedFox]

I see you are an attending now. How do you feel things ended up in the end for your class training wise? Even with the hiccups do you feel like you were adequately training by the time you graduated or did you and your peers have to do some extra work on your own (that would not otherwise have been required at an established program) in order to get where you needed to be?

I felt finely trained by graduation. No difficulty transitioning to community practice.

 

[Rendar5]

Provided you are not a scut monkey expect a closer relationship with your attendings than usual with more 1:1 instruction early on and be able to meaningfully shape your residency program but also expect potentially worthless rotations and lots of background politics (which hopefully won’t affect you too much) as services not used to residents have to learn to function with them and with your faculty. You will actively change and help grow your residency program.

 

[SamtheWise]

Would not do it if you could match anywhere else.

Granted, I don't know the specifics of your situation, so you may be very tied to the location, but, I would not do it. I guess more procedures is a pro, but honestly I get tired of doing some procedures and it's nice to have other people to punt them to. How much benefit do you get from doing every scalp lac in the department vs seeing more patients vs finishing up your notes and going home on time?

Pros: more procedures(?), you're in an EM program

Cons: more procedures(!), unknown relationships with off service residents and admitting services, untested and unrefined off service rotations, unclear expectations of the ED resident in the department, looking at the website it looks like this program has no academic affiliation, no alumni network, super desirable jobs will likely be harder to get as you are not a known quantity like a resident from a previously established program, and the 'faculty' are likely community ED physicians with no fellowship training and less of a commitment to academic emergency medicine.

Basically would think very hard before going to a brand new community emergency medicine program

 

[Listen2Savage]

I'm ranking a new program numero uno

Am I crazy?

Being the first class kind of excites me.

 

[Fox800]

I'm ranking a new program numero uno

Am I crazy?

Being the first class kind of excites me.

Probably.

 

[Listen2Savage]

Probably.

500 × 281

 

[emergentmd]

Unless the area is where you need to be, I would not. Wayyyyyyy to much variables. Wayyyyyyy to much promises that will not be kept. Wayyyyyy to many outside influences that has not been vetted and out of control of the EM program.

Imagine buying a house.

House #1 (known program with good history) - You get to go in the house, talk to the current owner, make sure everything works. Schools, area, neighborhood had many years of history.

House #2 (new) - Realtor tells you that the house is beautiful, school is top notch, neighborhood is hip and sought after. The house is in the city you want. Only catch is you can't go into the house, you have no clue what the neighborhood will be, they won't even tell you the address. Just the promise that it will be in your sought after city.

Who is picking house 2?

 

[Apollyon]

Who is picking house 3?

I don't know. Tell me about it. Or, maybe, were you referring to #2?

 

[Holy Rattlesnakes]

What about new 3 year program vs. older 4 year program?

 

[GeneralVeers]

Being from Vegas area my advice would be to not rank highly any program in this city except the official UNLV program. The other two programs are CMG residencies, and won't have a lot of procedures, varied pathology or good teaching. At the end of the day though, a residency spot is a spot so do what you have to do.