I also love the statement, "grow where you are planted," and think I will have to use that myself...very east asian!
The 90% of core emergency medicine is taught everywhere and most graduates of most programs will be 90% the same.
In any case, some of the differences that I see are as follows...
Evidence based practice
Every residency believes that they teach and learn evidence based care, but teh extent to which this is lived is quite variable. Residents graduate with different understandings of what is the workup for a given chief complaint or patient and some are evidence based approaches (of which there can be small variability) and there are approaches that are different because of logistical issues, or style issues, or for other factors.
Longitudinal Care experience
Residency education may come in the form of sheer patient volume or duration of patient encounter. By this I mean, that some environments provide extended time with each patient due to the logistics of that practice environment and although this decreases the total number of new patients that are seen by a given resident on a shift, it increases that resident's awareness of the disease over a course of time. For example, my residency has a very very expedient transit time and so I saw 27 new "critical" patients the other day on my shift. I spent roughly 1 hour with them before they were moved to their disposition. In another facility I trained at, I had seen roughly 7 new patients a shift, but worked with them for sometimes 8-10 hours (sometimes even took care of them on the next shift). This gave me an appreciation of needing to redose antibiotics, make many ventilator changes, and make treatment modifications. So, this is a key difference in the types of education that is offered in different institutions.
Ultrasound, EMS, Trauma, Peds, Wilderness, Hyperbarics
As was alluded to in a previous post, the specialty services provided by the EM physician may vary from program to program. The variance can be quite significant at times, and deserves detailed assessment. Granted, somethings, like Trauma is quite simple from the EM physician perspective, but Ultrasound (I am biased
, is exceptionally important!
Simulation
More and more, residencies are looking to incorporate simulation into the curriculum, but the manner in which it is done and the degree to which the residents feel it is a safe learning environment varies tremendously. The simulators themselves can vary tremendously from single models in a multipurpose room to entire buildings of simulation with every bell and whistle accounted for.
Access to Experts
Some institutions have experts consult such as Orthopedic Hand surgeons and others do not. For those motivated residents (again getting to grow where you are planted), having the specialist offers the chance to learn the most cutting edge, or sophisticated management of crucial injuries; whereas for the residents who choose to, it can be a crutch and prevent them from learning key elements of EM.
Another element of this, is that when considering our specialty there are clearly standout teachers such as Amal Mattu, Deepi Goyal, William Mallon, Slovis, etc. Certain institutions have clinicians like these or have connections with this level of educator and others don't; its not necessary, but sure makes learning the specialty of EM easier to have engaging, knowledgeable leaders such as these around you.
Surely, there are more differences, but I point at these as they are things that are important to me. Although all EM residents are well trained, there are clearly differences in the training from one institution to another. A motivated resident can compensate for many of these things and an underachieving one can still find a way to be less than impressive despite every advantage...so grow where planted (but look to be planted where you think you will grow best).
