metronome

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I love the Bay Area and am thinking about it highly for the top of my rank list. But I can't help but wonder: what does the future of the Bay Area residencies look like? Specifically what does the emergence of a program like UCSF, destined to become a powerhouse of academic EM, mean for the future of Highland (Alameda County/Oakland)?

I rotated at Highland earlier this year and felt like the interns I met were perhaps not as strong as the older residents and couldn't help but wonder--is this what the future holds? Highland has such a stellar reputation and I had such a great time rotating there. But I've heard that the UCSF residents are super-strong and will likely continue to be so. Is Highland going to suffer for this?
 

gramcracker

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I rotated at Highland earlier this year and felt like the interns I met were perhaps not as strong as the older residents and couldn't help but wonder--is this what the future holds?

Well, yes. We're interns. By our very nature we're not nearly as strong as our older colleagues.

Highland will continue to be a great program, and so will UCSF. Go where you think you'll be happy. That is so much more important.
 

notdeadyet

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Specifically what does the emergence of a program like UCSF, destined to become a powerhouse of academic EM, mean for the future of Highland (Alameda County/Oakland)?
Do you really envision floods of ambulances racing across the Bay Bridge to SF for the sake of their residency program? Your concern would be more valid if a new academic powerhouse was setting up shop in Oakland.

Also, I think that the new residency program is only a big change for EM residency applicants. For SF residents, it's business as usual. SFGH is the City's only Level 1 trauma center and has had a great ED for a long, long time. It's had top notch residents rotating through there for a good while too. I don't think you're going to see traffic diverted or much of an impact to the man on the street because of the new residency program. SFGH ED was top notch before the residency was even formed.
 
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metronome

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Perhaps I'm putting too much stake in an isolated incident...And clearly an intern is an intern is an intern. No offense. In my comparison I was drawing on my experience during the didactic sessions there where I heard a few questions that caught me by surprise--they seemed very basic and perhaps what I would expect from a student with less experience than me, not a resident (even a first year resident) at one of the most well-reputed EM program in the country. It just made me start wondering as was well quoted:

"Also, I think that the new residency program is only a big change for EM residency applicants. "

This is exactly what I'm asking--will Highland be able to continue to draw the same caliber of residents that they have in the past? Will its residency program suffer because of UCSF's rising star program in the same area both with regards to faculty and residents?

I see it going two potential ways: that the Bay Area will simply now have twice as many superstar residents with two awesome programs OR it will be the same number coming to the area and now Highland and UCSF will be fighting over them, in which case I simply worry that Highland may lose that battle as my albeit limited experience suggests...
 

notdeadyet

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This is exactly what I'm asking--will Highland be able to continue to draw the same caliber of residents that they have in the past? Will its residency program suffer because of UCSF's rising star program in the same area both with regards to faculty and residents?
If UCSF took every applicant Highland wanted, Highland would still have another set of nearly-as-qualified replacements. It's one of the most competitive programs in the state.

Regardless, I think that Highland and UCSF are going to attract a slightly different applicant. Highland is one of the best examples of a typical County program, while I think UCSF will look more like a great example of the typical Academic program. Highland and USC LAC are more likely to be competing for the same applicants rather than UCSF.

And at the end of the day, it's the Bay Area. Neither program will have a tough time getting great apps because so many incredibly qualified folks would kill to get to (or back to) the Bay.

I wouldn't sweat Highland anytime soon. Stanford might be another story...
 

Poncho

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...I wouldn't sweat Stanford either. Overall, pulling our residents out of SFGH will be a good thing for our program. Our junior and senior residents have staffed SFGH for more than decade. Even with the new program we were invited to stay but we decided to phase our residents out and repatriate them primarily to Santa Clara Valley Medical Center, our other Level I county trauma center in San Jose. Having rotated at both SFGH and Valley, I strongly feel that Valley has a better ED experience. >ED 90,000 visits, lots of adult and peds trauma, burn center, huge immigrant population, aeromedical transport, and much higher medical acuity than SFGH.

Between Stanford which is also a Level I adult and peds trauma center and the Valley, we see >5,500 trauma activations split among 36 residents. Pulling our residents out of SFGH will cut down on the commute and allow us to staff the rest of our ED's better. It doesn't seem to be hurting our applications which are at their highest levels ever. We have an awesome intern class who will be the first class not to rotate at SFGH.

Even though we offer a solid county and trauma experience, we are a different type of residency the Highland (which is a great program), and are probably more similar to the UCSF-SFGH program because of our academic center experience and opportunities. Plus we have an excellent community component at Kaiser.

However, in contrast we are a three year program with the flexibility of an additional 4th year as a fellow (academic, EMS/disaster, wilderness medicine, international, cardiovascular, medical simulation, create your own). This puts us more in competition with other solid three year programs in California like Harbor-UCLA and UC Davis plus other academically oriented three year programs across the country.
 

roja

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I think you have your answer fairly clearly. Often the emergence of a new program, or a change in a long standing program create many questions for applicants.

You should not judge any program by an isolated experience with interns. Even the best intern in the country is still an intern. I have been working with the Highland R2-R4 and they are stellar. They will continue to be stellar.

The three bay area programs are all each very different. They each have thier own personalities. They are all excellent programs.

Luckily for those of us in the bay area get to draw on all these strenghts together. We have joint events with the various programs and the faculty from all the programs know each other well.

There is nothing to fear at all. Interview at each program and figure out which ones meet your needs and personality the best.
 

docB

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Perhaps I'm putting too much stake in an isolated incident...And clearly an intern is an intern is an intern. No offense. In my comparison I was drawing on my experience during the didactic sessions there where I heard a few questions that caught me by surprise--they seemed very basic and perhaps what I would expect from a student with less experience than me, not a resident (even a first year resident) at one of the most well-reputed EM program in the country.
It's also important to note that it's appropriate for interns to ask seemingly simple questions because that's what they're there to do. That's the time to make sure that you fully understand the basics. Med students go out of their way to avoid asking what they think are simple questions and frequently to everyone else's dismay try to use questions to seem well versed. Ask any upper year and they'll tell you they'd rather answer innumerable stupid intern questions than clean up the mess made by someone who was ignorantly forging ahead.
 
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