swaamedic said:
I would be a little concerned about the volume of penetrating trauma/ assult patients at SLC, unless the residents rotate elsewhere for trauma. I'm sure the volume of orthopedic trauma might make up for this though.
I have no evidence to back up either statement though.
Okay folks -
I have tried to stay out of this thread and let people speak their minds, but now that pure speculation is going on, I feel like I must share my feelings about all of the comments. Sorry about the long post that follows.
First, no one should get dinged for honest feedback, including Aloha Kid and anyone else with real experience in my ED. In fact, I really think this is a great forum, and wish SDN had been around when I was trying to figure out how to choose a specialty and a residency.
Second, any program that isn't ready to do continuous self evaluation and tell you the truth (or see the truth themselves) about the pros and cons of their own program is a program that is not commited to continuous improvement, and I don't know of any program like this. I feel very strongly that the RRC for emergency medicine is very diligent about ensuring a quality residency experience at any approved EM program in the country. No program is perfect, and although the RRC is very particular about which programs are approved and who stays credentialed, there are some real differences between programs.
Okay, here goes my comments about each of the things that has been said in prior posts in this thread:
1. Growing pains - Oh yeah, we will definitely have them. It is impossible to anticipate all the things that may go wrong, so I expect we will run into unforeseen issues. My job is to foresee as much as I can, head it off at the pass, establish relationships with people who can help solve our issues when they arise, and make sure that I get early feedback from residents and others involved about what is going right and wrong in order to nip any problems in the bud before they get out of control. It takes a special person to be interested in coming to a brand new residency. The rewards of such an experience will be immeasurable, but the responsiblities will also be much greater than what is expected of a resident at an established residency.
2. Attending Teaching - I think this is incredibly valuable feedback, and I plan to share this comment with all of my colleagues. Currently, the attendings in the department are the only people in the ED (except for the 3 months out of the year when the med students rotating through are planning careers in EM) who are specialists in emergency medicine. Our volume is too high for rotating residents and students to see all of the patients in the ED and then present them to attendings. So, attendings are responsible not only for staffing cases with residents and students, but also take care of patients primarily. This is a LOT of work, and switching between teaching mode and patient care/moving the meat mode is incredibly difficult. I am looking forward to the future when EM residents are seeing the majority of patients in the ED, and we can all spend our time teaching.
I agree that there are some attendings in my department who have spent a lot of years without being involved in an EM residency program, and there will definitely be growing pains for them. There are also a lot of young faculty who have come from excellent programs and have faculty experience with a number of excellent EM residency programs. I can confidently say that all of the attendings in my department are very excited and committed to making whatever changes in our practice style are necessary to provide the best environment for our residents.
3. Trauma - Anyone who interviewed here will already know the scoop about this. The major trauma experiences for at least the first few years are planned for LDS hospital. This is another level one trauma center that is a major part of the program, and there is a much more involved role for the EM resident right from the start. We are actively working with the trauma surgeons at the U. of Utah (we are part of the same department and have very good relationships) to develop a more active role for our own residents, but it will definitely take a few years of experiencing what an EM resident has to offer before we make major headway. Presently, it is very difficult for the EM attending to make any headway as far as rotating intern/med student involvement with trauma in the department. You can imagine the looks we would get if we walked up to the trauma team and said "excuse me, the future ophthalmologist and I will be doing all of the procedures on this patient, you guys can have the next one." Part of what it takes to make headway with a trauma team is a physical presence and the manpower to follow through. Once we have EM residents in the department, and residents that the surgeons have worked with and can trust, that relationship will blossom and trust and responsibility will follow.
4. Salt Lake and its culture - Definitely an outdoor paradise. Amazingly beautiful place to live, lots of people who play in the outdoors and care about preserving it. So much great stuff to say about living here that I won't bother wasting the time doing it.(Except that faculty ski day was yesterday and we played in 12 inches of fresh powder at Snowbird!)
5. Diversity - The population here is definitely different than a lot ofother places, and this was a big fear of mine when I came here from San Francisco. Yes, there are a lot of white people here. There are also a lot of very interesting subcultures, lots of whom come from all over the world, partially because of the success of Mormon missionaries who serve two year missions all over the globe. There is also a large and growing latino community, so large that the ED has 24 hour Spanish interpreters. However, it would definitely be misleading to try to convince anyone that you will see the same diversity that you would see in bigger cities throughout the U.S.
6. Mormons - Yes, Salt Lake is definitely the mormon equivalent to the Vatican city. I am not mormon, and look alternative. I have not been hassled by anyone since I moved here, and the mormons that I know are very tolerant and wonderful people.
However, this is definitely a red state, and can be very frustrating if you lean left politically. As for alcohol and caffeine, although people who are LDS do not drink alcohol or caffeine, the rest of us are still accomodated. There is a full service Starbucks in the hospital next to the ED that is open 24/7/365, and a healthy coffee house culture in SLC. There are also a number of excellent brew pubs and bars/lounges/clubs throughout the metro area.
7. Volume of penetrating trauma and assaults - Penetrating trauma here is of a very different kind than many places (think ski poles, tree branches, self inflicted GSW's and hunting accidents). That being said, decision making in penetrating trauma is very different than decision making in blunt trauma. I came to SLC from San Francisco General (only level 1 trauma center in San Francisco county and city) by way of Highland (well known knife and gun club), and feel qualified to comment on the differences. Many times, the end result of penetrating trauma is going to be a trip to the OR, whereas decisions in blunt trauma are not always so clear, and the diagnostic decisions can be more difficult to make. I think you need to be exposed to both, but if I had to choose one over the other, I think it is much more difficult to learn to make good decisions in the blunt trauma patient than the penetrating trauma patient. If you feel that your residency and trauma experiences will not be complete without the presence of a true knife and gun club than we would be a poor choice for your residency. We do have access to a lot of young people who believe they are invincible in their pursuit of the perfect outdoor experience, and don't understand the need to wear a helmet, use an avalanche beacon, get off the mountain when the lighting strikes around them, etc... and all of them who suffer significant injuries will end up in one of the three level one trauma centers in our area (U. of Utah, LDS hospital, Primary Children's Hospital), all of which are ED's our residents will rotate through.
I hope this post does not sound defensive, but I do want to let those of you who have not been out to visit us know what we are about and what kind of experiences we have to offer.
You can read more about the program and about each of us by checking out our website at
www.uuhsc.utah.edu/emresidency
Susan Stroud, MD
Associate Program Director
University of Utah
