Residencies with multiple sites

[han14tra]

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I'm curious to see what others think about this. Which type of residency would you prefer and why? I'm especially interested in seeing how Attendings and Residents feel about this.

Choice A: All training is at one site (except for a 1 month community EM month). The main site is both a busy pediatric and adult trauma center. There is a built in Children's Hospital.
Choice B: You work at 3+ EDs (perhaps one is a VA, one is a women's and children's hospital, one is inner city, one is academic, one is community).

 

[dotcb]

Personal preference, but I think it's wise to get county (trauma), tertiary, community, and peds. If there's a hospital that has that all wrapped into 1 (i.e.. the only hospital in town), that might be fine.

 

[Arcan57]

Personal preference, but I think it's wise to get county (trauma), tertiary, community, and peds. If there's a hospital that has that all wrapped into 1 (i.e.. the only hospital in town), that might be fine.

Multiple training sites are good for different patient populations, but as long as you are seeing the a diverse enough population at the central hospital it's probably ok. Of note, a lot of inner city hospitals don't have a large nursing home population which will make up a large percentage of many community jobs. The other thing to consider is that if you're having to learn 4+ EMRs your efficiency is going to be shaky for a week or two after every transition.

 

[StevieStud]

variety is the spice of life.

Oh, and remember most jobs are out here in suburbia where nursing homes, kids and mva are more common than the knife and gun club and boarding winos of the typical inner city training hospital.

 

[RustedFox]

variety is the spice of life.

Oh, and remember most jobs are out here in suburbia where nursing homes, kids and mva are more common than the knife and gun club and boarding winos of the typical inner city training hospital.

I went to a residency with three different sites. It was the best.

I didn't realize that until like, not that long ago (sic). Maybe just after I graduated.

I think back to those three different settings:

One was an academic setting, where things got done a certain way. And that was it. Suck it, if you didn't like it. Turf battles, all day long. "I get to do this! I don't want to have to do THAT!" was the order of the day. Every day. It just depended on what end you were on... that month.

One was "community general", where things got done in a different way, and... it made waaay more sense. Fewer people quibbled over how much work they "had" to do, because... they "wanted" to do it. After all, this patient is here for a reason. Lets get 'em better.

One was "urban nasty", where things were a complete free-for-all. It was lunacy.

I learned how to operate within three different medical records systems. I learned how to dictate, how to "T-sheet", and how to use EMR.

By the end of it, I knew exactly how I did, and how I didn't... want to work, and when I was done.... ...

I found a job in line with my wants/needs.

Its as simple as that.

Maaan, I'm so glad I saw as many faces of EM as I could by the time I was a graduating senior.

I thought about this for awhile.

(...)


Public Service Announcement:

I know that there's a number of folks out there on this forum that "know me well" on here. I've been hangin' 'round here since I was an MS-3, near-six years ago. I got some buddies out there on the forum that know what I mean when I say certain things, and they're supportive, or not... when they shouldn't be. Thanks, amigos.

I know that there's a lot of detractors of mine out here on this forum that "know me well" on here as well. They tend to be younger than me; on the order of intern/2nd-year or MS-3/4.

Guys: I'm telling you this - I'm not trying to be a d!ckhead to frustrate you, personally. I get creative and illustrative with my arguments because... I made those same thought-errors and "rookie mistakes" that my predecessors did, and I want to warn you of them. I was the dumb@ss that "didn't listen". I paid dearly for my mistakes. I had some sweaty times as a student, as a resident, and even as an attending (admittedly, I'm only six months in).

Listen to Veers, McNinja, docB, dchristimi, southernDoc, Quinn, Jarabacoa, and the rest.

I wish that I listened more.

Trauma is overrated. A lot. Get over it.

Medicolegal knowledge is of supreme importance. It is better to win the war before the battle ever begins; especially if you don't like being sued. Also: pssst... the best way to not be named in a suit... is to not p!ss off your patients.

There aren't "tiers" among programs. No. There are rockstars from Podunk general, and zeros from Cinci and Denver. Its "the match". It isn't homecoming, where the prettiest girls are in the homecoing court, and you'd love to have them on your arm, because... that's cool.

Know how to operate many different medical records systems, but know EMR the best; soon, it will be the only game in town. Actually.... forget anything that's not EMR if you're a👎 MS 3/4 right now.

Don't get hung up on your pediatric Central American Global Health Elective Month Opportunity at Ballsnack General Medical Center and "have" to match there. 99%.... you'll never do that again. Ever.


You get the idea. Goodnight, all.

 

[deleted109597]

Echo above, sort of.

I don't know the best way to get the diverse experience RustedFox got without actually working at that many places in residency.

I do know that if you rotate through a ton of hospitals (read: more than 2), then a significant portion of your residency isn't learning medicine, or even learning anything useful (like where the best coffee is). A large part of showing up at a new place is: a) how do I order things here, b)which nurses can I trust, c)who admits what, d)which order do we consult services, e)bull**** highschool stuff.

However, I believe a large component of the reason many people change jobs after a couple years is because they have no experience in places other than academic tertiary mecca hospital (except for maybe moonlighting, but even fewer BC/BE people go work at rural hospitals). So if you don't have the community process down, learning it after residency is sometimes tough. Consults shouldn't start with "I've got a 65 year old here with cough x3weeks, etc...". It should be "hey, I've got this patient of yours here with pneumonia, can you admit him."

So I think getting exposure to each type of environment is important, but rotating after each month would be tedious. And, for the record, no place in the real world is ever like a peds hospital. Those places are bat**** crazy.

 

[DreamingTheLive]

I went to a residency with three different sites. It was the best.

I didn't realize that until like, not that long ago (sic). Maybe just after I graduated.

I think back to those three different settings:

One was an academic setting, where things got done a certain way. And that was it. Suck it, if you didn't like it. Turf battles, all day long. "I get to do this! I don't want to have to do THAT!" was the order of the day. Every day. It just depended on what end you were on... that month.

One was "community general", where things got done in a different way, and... it made waaay more sense. Fewer people quibbled over how much work they "had" to do, because... they "wanted" to do it. After all, this patient is here for a reason. Lets get 'em better.

One was "urban nasty", where things were a complete free-for-all. It was lunacy.

I learned how to operate within three different medical records systems. I learned how to dictate, how to "T-sheet", and how to use EMR.

By the end of it, I knew exactly how I did, and how I didn't... want to work, and when I was done.... ...

I found a job in line with my wants/needs.

Its as simple as that.

Maaan, I'm so glad I saw as many faces of EM as I could by the time I was a graduating senior.

I thought about this for awhile.

(...)


Public Service Announcement:

I know that there's a number of folks out there on this forum that "know me well" on here. I've been hangin' 'round here since I was an MS-3, near-six years ago. I got some buddies out there on the forum that know what I mean when I say certain things, and they're supportive, or not... when they shouldn't be. Thanks, amigos.

I know that there's a lot of detractors of mine out here on this forum that "know me well" on here as well. They tend to be younger than me; on the order of intern/2nd-year or MS-3/4.

Guys: I'm telling you this - I'm not trying to be a d!ckhead to frustrate you, personally. I get creative and illustrative with my arguments because... I made those same thought-errors and "rookie mistakes" that my predecessors did, and I want to warn you of them. I was the dumb@ss that "didn't listen". I paid dearly for my mistakes. I had some sweaty times as a student, as a resident, and even as an attending (admittedly, I'm only six months in).

Listen to Veers, McNinja, docB, dchristimi, southernDoc, Quinn, Jarabacoa, and the rest.

I wish that I listened more.

Trauma is overrated. A lot. Get over it.

Medicolegal knowledge is of supreme importance. It is better to win the war before the battle ever begins; especially if you don't like being sued. Also: pssst... the best way to not be named in a suit... is to not p!ss off your patients.

There aren't "tiers" among programs. No. There are rockstars from Podunk general, and zeros from Cinci and Denver. Its "the match". It isn't homecoming, where the prettiest girls are in the homecoing court, and you'd love to have them on your arm, because... that's cool.

Know how to operate many different medical records systems, but know EMR the best; soon, it will be the only game in town. Actually.... forget anything that's not EMR if you're a👎 MS 3/4 right now.

Don't get hung up on your pediatric Central American Global Health Elective Month Opportunity at Ballsnack General Medical Center and "have" to match there. 99%.... you'll never do that again. Ever.


You get the idea. Goodnight, all.

Baller.

 

[glorfindel]

Agree with what's been said above; given the OPs options I'd choose Choice B.

There are so many valuable things to learn in residency that aren't medical. Most of these are administrative and systems-type stuff that I think you can learn more quickly if you're going to multiple sites in residency.

That said, I think it's absurd to think that you're going to learn everything you need to know as a resident. The best part of our job is that it does take a while to master it -- certainly longer than 3 or 4 years.

As soon as I feel like I've got everything mastered, I'll get bored and quit without any hesitation whatsoever.

 

[FSU2013]

I went to a residency with three different sites. It was the best.


Listen to Veers, McNinja, docB, dchristimi, southernDoc, Quinn, Jarabacoa, and the rest.

.

First off, thanks to all of those listed above and many others that are unnamed. Your contributions are invaluable.

Second, would you have any reservations about going to a one hospital program? I interviewed at one program that had a community, county and academic center and thought that was ideal for training, but I really loved two programs that only trained out of one hospital. Both treated what appeared to be a wide cross-section of the city.

Thanks again.

 

[bartleby]

Great thread. Agree wholeheartedly with the multi-site theory. If you only work in an ivory tower you are going to be lost when it comes to the job search and will have a steeper learning curve when you're finished.

 

[bad virus]

I hate to say it because its so crude and because I like the fox a lot . . . But Dang it Fox, you created a circle jerk.

 

[RustedFox]

Second, would you have any reservations about going to a one hospital program? I interviewed at one program that had a community, county and academic center and thought that was ideal for training, but I really loved two programs that only trained out of one hospital. Both treated what appeared to be a wide cross-section of the city.

Thanks again.

I would have no reservations about a one-shop program.

 

[Mighty Mouse]

i personally like the 1 hospital training.

but the answers given above are a bit broad. the multiple sites are fine if they are within a reasonable commute (as defined by whoever is ranking that place).

my residency had all off-service rotations in the hospital, and we did a smattering of off site community months (1 15 minutes away and the other 30). totally fine. but if the drive had been 45 minutes to an hour....and it was more months than not in my training....different ball game completely.

 

[gan911]

variety is key. you'll never get a feel for how you want to work in the future if you don't get exposed in residency. There is never one place that is able to provide you everything in the world - you'll have sleepless nights as an attending if you don't get comfortable with every situation.

the drive? it blows, but whats 1 month of hard work for a little calm later in life?

 

[tkim]

My program had a county/trauma center, an academic medical center, a peds hospital, a busy suburban community hospital, and a rural/critical access hospital. The practice of medicine is very different, obviously, at each place. I agree that the first rotation at each new site was a kick in the balls/new kid in high school for the first two weeks, but after that you got exposure to the different environments and you could form an opinion on what you liked best.

The common practice of people in the waiting room for 8-10 hours, no primary, no insurance, no followup, at the county is vastly different from the suburban setting where Press Gainey is a swear word, and there are actually pillows for patients. Since the majority of grads go to work in the community, if you can't/won't toe the customer service line, you are gone.