?? to ask on interviews

[jonwilli]

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Have spoke with some residents who have been through it before and here are some questions to make sure you ask beside the standard benefits, shifts, call, off-service, etc. that you can find on emramatchguide.org:

1. What type of supervision by attendings and autonomy by the residents?
2. Moonlighting--how far away, when eligible, etc.?
3. Who runs the traumas/airways (seniors, interns, surgery, anesth, etc.?
4. Will you be eligible for certification in ultrasound upon completion of residency?
5. How long do critical pts tend to stay in the ED after admission? (Meaning how many ICU progress notes will you be writing)
6. Cost of living, which can make a huge difference with most programs paying about the same


Feel free to add some stuff you wish you would have asked or have heard besides the basics

 

[Seaglass]

Will you be eligible for certification in ultrasound upon completion of residency?

Except for RDMS, the certification that professional ultrasonographers obtain, there is no such thing. I venture a guess that no more than 2-3% of EM residencies will have RDMS certification as an option. Perhaps Roja or Dr. Ultrasound-from-Christiana-whose-last-name-I'd-rather-not-butcher-here would comment.

 

[roja]

Have spoke with some residents who have been through it before and here are some questions to make sure you ask beside the standard benefits, shifts, call, off-service, etc. that you can find on emramatchguide.org:

1. What type of supervision by attendings and autonomy by the residents?
2. Moonlighting--how far away, when eligible, etc.?
3. Who runs the traumas/airways (seniors, interns, surgery, anesth, etc.?
4. Will you be eligible for certification in ultrasound upon completion of residency?
5. How long do critical pts tend to stay in the ED after admission? (Meaning how many ICU progress notes will you be writing)
6. Cost of living, which can make a huge difference with most programs paying about the same


Feel free to add some stuff you wish you would have asked or have heard besides the basics

Many residencies will allow you to get ACEP level 1 and 2, however, this doesn't aide you a ton when you get out. You have to look at each hospital's accredidation process. Many hospitals require you to have 40 hours of lecture time and 50-100 scans... It is really variable. It takes a motivated resident to get RDMS, but it is very do-able, especially if you have an ultrasound friendly program.

Regarding ICU progress notes, I have no idea what these are... if a patient as been admitted to the ICU, then we do not write progress notes, the ICU team does.... if anything emergent happens, we handle it, because we are there, but no notes... perhaps this is not the norm.


I would add in:
1. security of benefits... make sure different hospitals aren't bidding on your contract, this can leave you high and dry without any insurance, etc.
2. Floor months- these are not required for the RRC and are often a sign of a department that has had to negotiate to get its program up and running.
3. Research- is there lots of it floating around?
4. are you scutting for other services or are you offservices geared towards the ED?
5. CME money.... is it every year? once during the residency?
6. Confrences- are they paid for if you present
7. mentality towards free time... some programs still have an old school mentality... work work work...
8. Think about the type of program you want....... a more traditional role or more modern.
9. Oral board prep

 

[ERMudPhud]

Regarding ICU progress notes, I have no idea what these are... if a patient as been admitted to the ICU, then we do not write progress notes, the ICU team does.... if anything emergent happens, we handle it, because we are there, but no notes... perhaps this is not the norm.


I would add in:
1. security of benefits... make sure different hospitals aren't bidding on your contract, this can leave you high and dry without any insurance, etc.

Hopefully it has changed but I remember a few years ago at Mt. Sinai if you had an ICU player the ICU fellow or senior resident would come down and right a consult note with all sort of useful suggestions that would finish with "Sorry, no ICU beds available. Please reconsult as needed"

As for the benefits, I remember when that was a problem in Denver andit was a big pain. It has since been corrected.

 

[roja]

Hopefully it has changed but I remember a few years ago at Mt. Sinai if you had an ICU player the ICU fellow or senior resident would come down and right a consult note with all sort of useful suggestions that would finish with "Sorry, no ICU beds available. Please reconsult as needed"

As for the benefits, I remember when that was a problem in Denver andit was a big pain. It has since been corrected.

That is truly frightening. We seem to have gone the other way.. we admit to ICU, wihtout the screen... It's up to the AC to downgrade and let the team know... Once the patients have been admitted, they are not our responsibility. Of course, since they don't hang down in the ED, we handle the emergencies... I tend to wait until I get the screen, just to help out... but still...

 

[peksi]

Except for RDMS, the certification that professional ultrasonographers obtain, there is no such thing. I venture a guess that no more than 2-3% of EM residencies will have RDMS certification as an option. Perhaps Roja or Dr. Ultrasound-from-Christiana-whose-last-name-I'd-rather-not-butcher-here would comment.

Seaglass is correct. First credentialling is a "hospital Issue" what that means is that you need to matriculate each hospital or hospital systems credentialling process unless there is an agreement such as when large contract groups have several hospital ED contracts in some states.

There are what are considered "Global Credentials" and "Line or Specialty Specific Credentials" for instance, in global gredentials EM physicians are generally credentialled and privleged to see patients, order medications,do CPR, Intubate, do central lines etc. But for some EP's & residents such procedures are line credentials and have specific criteria above your "residency training"

For most attending positions, both academic and private EM US is a "Line credential" that regardless of your previous training, regardless of if you were "credentialed" in your hospital as a resident or not you will likely need to matriculate and apply for such priviledges.


So what does this mean for applicants and the issue of RDMS....really not much. ARDMS is a credential that is availble to all physicians, and more EM physicians seek this than any other non radiology group, but it is not a mandate, it also is not a clear garenntee of skill set..I know some EPs who are RDMS with a skill set far less than what I would expect who do not know one end of the probe from the other. I have distinct criteria that my residents and faculty must meet...beyond a certain "number of scans" before I will reccomend them to the ARDMS to sit for testing.

I think it is important that you have a clear path to US education in the ED, that consultants value the skill set of those in the ED who perform US and that residents get the oppertunity to perform a broad array of EDUS during the residency. Credentialling should be available in your residency, but this is not an issue that will give you a gold card to carry with you everywhere, as these credentials, especially in EM US vary more widely than any other potetnail credential available for EM physicians in the United States and probably the world.

I support ARDMS certification for those who wish to have a recognized certification of a "knowledge set" after from my standpoint meeting a specific skill set, including image optimization, aquizition, interpretation etc. the kicker now is in order to sit for ARDMS you essentially need a "sponsor" who must be certified by ARDMS for you to sit for the exam (as of 1/1/05).

So remember US is a part of your education, not the point of your education,. Look for places that you like, can see going to work at and that will be a good fit. Evalaute the US component as you would any other component of the training, and for those who have a distinct interest in EM US then you can do some research into EM US and the active programs will likely be obvious to you.


Hope this helps.

Paul

 

[EMDrMoe]

8. Think about the type of program you want....... a more traditional role or more modern.

What makes up a traditional versus modern role? Thanks!

 

[roja]

I just found that on the interview circuit, there were definately programs were of a little more traditional 'old school' philosophy: towards rotations necessary (outside of RRC requirements), set up of lectures, numbers of shifts, relationships between attendings/residents.

Some are more progressive: shift in attitudes regarding what rotations make a strong EMP, progressive or alternate views on learning from confrence (not necessarily simply reading from tintinalli), attitudes towards attneding/resident relationships....