Top EM Programs: According to GARP

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A little different spin on my usual 2 cents on this subject:

I moved to NYC when I was 21 years old because I had a degree in art/sculpture and thought, to be the best I'd better go to where I believed the best artists would be...New York City. What I found there was a bunch of crazy, fun, intelligent screwballs and a lot of crack and armed robbers. It was a blast. I lived in a big loft in the ghetto and worked doing special effects, got drunk a lot and hung out with some great friends.

What I also found was that the art scene was just about who you knew, who's ass you kissed, and how far you would be willing to go to be famous. It was totally subjective. I mean, what do you base good art upon? We were all making crazy, abstract crap. I liked my friend's work, and they liked mine. But it was really just because we knew one another and supported each other.

If you go to a school that produces great musicians, like Juliard, it doesn't make you a great musician. It just means they thought enough of you to believe you had that potential. You could be a colossal failure anyway. If you go to a school who produces nobel laureates, well, then you could also say that there was something about you that accomplished people recognized and gave you a chance. Also, you could still end up being mediocre by those high standards.

EM residency programs do the same thing. There are academic programs that stress research, so they have the potential to produce EP's that may be in the forefront of research. On the other spectrum there are community programs that stress the ability to be a strong clinician and run an organized E.D., and these have the potential to create top clinical physicians. And there is everything in between.

What we do as human beings is try to associate ourselves with something that we feel will define us. For many young physicians, (and I have to say here that I believe it starts as something younger people tend to do more) this means hoping to be associated with a "big name" program. Part of it's intention may be to affirm to one's self the need for something greater than simply having had the intelligence and guts to finish all these years of training. It goes to a deeper sense of need for glorification, attention, and one-upsmanship. That's what all these lists some of you seem to need so desperately appear to be for, at least in my opinion.

That being said, I don't think that is necessarily an all encompassing feature. If I were more into research, or simply a quicker study, or maybe even more intelligent, I might be more inclined to be at an institution offering more didactics, or be full of people who could recite the newest articles at the drop of a hat. But I am not. And I know myself very, very well. I've had success and I've had failure. I'm smart enough, but I'm no intellectual. Some of you are, and you should be where you're stimulated, challenged, and where you'll learn to be what you imagine yourself to be.

Me, I'm the blood and guts type. I used to be a boxer, and I'm not a surgical fighter. I got hit, a lot. But I gave it back more. That's what I like about my program. It's not so pretty doing what it does all the time, but it gives as good as it takes. It's fun, it's often bloody and gutty, it's making a little more of a name for itself research wise (so what says I), and I'm already feeling good about being able to run a shop that sees close to 100,000 patients/year. I'm terrible with rashes. I often forget to order things and have to add them on later. But I can tube anyone. I can get any kind of line that's needed, with or without ultrasound guidance, and get it quickly enough to not have to turn it over to the ICU resident to do.

I may not be prepared to walk into Cook County tomorrow and not fall on my face, but I feel I'm going to be good enough to pick myself back up and would be rolling along with the best of them in a few weeks. And I know I could muddle my way through a busy night in a rural ED without panicking. That's all I want from my training. That's all I need from my training. I was lucky enough to find the fit for me.

If you get into a "top program" good for you. If you get into one that isn't on anybody's list good for you too.
 
ER-ER-Oh said:
A little different spin on my usual 2 cents on this subject:

I moved to NYC when I was 21 years old because I had a degree in art/sculpture and thought, to be the best I'd better go to where I believed the best artists would be...New York City. What I found there was a bunch of crazy, fun, intelligent screwballs and a lot of crack and armed robbers. It was a blast. I lived in a big loft in the ghetto and worked doing special effects, got drunk a lot and hung out with some great friends.

What I also found was that the art scene was just about who you knew, who's ass you kissed, and how far you would be willing to go to be famous. It was totally subjective. I mean, what do you base good art upon? We were all making crazy, abstract crap. I liked my friend's work, and they liked mine. But it was really just because we knew one another and supported each other.

If you go to a school that produces great musicians, like Juliard, it doesn't make you a great musician. It just means they thought enough of you to believe you had that potential. You could be a colossal failure anyway. If you go to a school who produces nobel laureates, well, then you could also say that there was something about you that accomplished people recognized and gave you a chance. Also, you could still end up being mediocre by those high standards.

EM residency programs do the same thing. There are academic programs that stress research, so they have the potential to produce EP's that may be in the forefront of research. On the other spectrum there are community programs that stress the ability to be a strong clinician and run an organized E.D., and these have the potential to create top clinical physicians. And there is everything in between.

What we do as human beings is try to associate ourselves with something that we feel will define us. For many young physicians, (and I have to say here that I believe it starts as something younger people tend to do more) this means hoping to be associated with a "big name" program. Part of it's intention may be to affirm to one's self the need for something greater than simply having had the intelligence and guts to finish all these years of training. It goes to a deeper sense of need for glorification, attention, and one-upsmanship. That's what all these lists some of you seem to need so desperately appear to be for, at least in my opinion.

That being said, I don't think that is necessarily an all encompassing feature. If I were more into research, or simply a quicker study, or maybe even more intelligent, I might be more inclined to be at an institution offering more didactics, or be full of people who could recite the newest articles at the drop of a hat. But I am not. And I know myself very, very well. I've had success and I've had failure. I'm smart enough, but I'm no intellectual. Some of you are, and you should be where you're stimulated, challenged, and where you'll learn to be what you imagine yourself to be.

Me, I'm the blood and guts type. I used to be a boxer, and I'm not a surgical fighter. I got hit, a lot. But I gave it back more. That's what I like about my program. It's not so pretty doing what it does all the time, but it gives as good as it takes. It's fun, it's often bloody and gutty, it's making a little more of a name for itself research wise (so what says I), and I'm already feeling good about being able to run a shop that sees close to 100,000 patients/year. I'm terrible with rashes. I often forget to order things and have to add them on later. But I can tube anyone. I can get any kind of line that's needed, with or without ultrasound guidance, and get it quickly enough to not have to turn it over to the ICU resident to do.

I may not be prepared to walk into Cook County tomorrow and not fall on my face, but I feel I'm going to be good enough to pick myself back up and would be rolling along with the best of them in a few weeks. And I know I could muddle my way through a busy night in a rural ED without panicking. That's all I want from my training. That's all I need from my training. I was lucky enough to find the fit for me.

If you get into a "top program" good for you. If you get into one that isn't on anybody's list good for you too.
Click to expand...

Great Post
 
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This has generated some strong opinions on the program director's listserve. but all the responses share something in common:

The best program for one individual is not the best for another.

The writer of this list is almost certainly both right and wrong at the same time. Whether he/she is right or wrong is dependent on the reader.

Unfortunately, all of us who advise medical students, can only give you the information we have, and we get just as much bad info as you do. At the end of the day, the rumor mills and opinions can hurt you or help you, but you owe it to yourself to do your legwork and learn about each program based on your visit to that program - and not from what we (or your classmates) tell you.

Good luck!
 
Side note - I attended the AAEM Midwest Regional Medical Students Symposium on Emergency Medicine last week - and THIS POST was mentioned several times by different PDs. Seems like the post has created quite a stir among PDs, but more interesting to me was the fact that a bunch of PDs actually are reading SDN!
 
Flopotomist said:
Side note - I attended the AAEM Midwest Regional Medical Students Symposium on Emergency Medicine last week - and THIS POST was mentioned several times by different PDs. Seems like the post has created quite a stir among PDs, but more interesting to me was the fact that a bunch of PDs actually are reading SDN!
Click to expand...

I'm not surprised at all that a bunch of PD's read SDN. They read it whether they admit it or not. At the very least, there is someone in the residency leadership that reads SDN. They are better then you think when it comes to figuring out who people are here too, trust me. :) That PD listserve is the real deal too with SDN threads mentioned a lot (from what I hear), so watch out!
 
A stir??? For all applicants, I would not recommend choosing where to interview because of a list (and a confusing list at that) that someone arbitrarily posts.
Here are a few simple rules:
-Pick an area or region where you may want to be (if you are adventurous, go all over). I assume this part is done already.
-Talk to you advisor, program director, etc about which programs may be right for you
-Most importantly, Go Interview! You won't really know where you want to go until you visit the ED, talk with the faculty/residents and see the area.

On a side note, I echo the sediments of the Chicago attending regarding all of the chi-town programs. I interviewed at all but 1 program and to me the top tier programs include Christ, Northwestern, and U of Chicago (none of which were featured on this top 10 list), all with a different flavor. In reality, all of the Chicago programs are very strong; it is a desirable market that attracts many impressive candidates.
 
SolidGold said:
I'm not surprised at all that a bunch of PD's read SDN. They read it whether they admit it or not. At the very least, there is someone in the residency leadership that reads SDN. They are better then you think when it comes to figuring out who people are here too, trust me. :) That PD listserve is the real deal too with SDN threads mentioned a lot (from what I hear), so watch out!
Click to expand...

so what can/should I do? I'm too freaking transparent! :scared:
 
BKN said:
same thing I wrote 2 years ago. guard your anonymity!
Click to expand...

Or give up on the concept all together and just assume everyone knows who you are anyway.

I obviously don't attempt to hide who I am but, even if I did, I'd assume that anything I posted could pop up in an interview with someone 20 years from now.

Welcome to the ever-present internet. Don't count on annonymity. Anywhere. Anytime. You'll be much safer that way.

Take care,
Jeff
 
Yeah people do read this stuff. People who make impact your career. You have two choices:
(1) make yourself TOTALLY anonymous, as if you are hiding from the FBI (never mention your sex, age, location, hobbies, taste in TV programming or wine, or hair color).
(2) Be as open as you wish, but assume that everything you ever write will be read by everyone who could ever matter to you.

The internet as a whole, and SDN specifically, are too big and well known and easy to search now to play semi-anonymous.
 
Hard24Get said:
so what can/should I do? I'm too freaking transparent! :scared:
Click to expand...

:laugh: Sometimes I think SDN may have helped me match at my #1.

As long as you don't talk trash about a program, I don't think anybody really cares...you have no worries though, if I remember correctly from my following of the interviews thread, you've got a bunch of them and at some great places too, congrats!
 
I'm in the same boat. I feel that if you say it (internet or otherwise), you better have the b*lls to own up to it. Needless to say I have lots of SDN folk say "hey, TysonCook, I love your purple hippo" etc. It was brought up at least 5+ times at different programs by PD's, so I know fo sho that the PD's are around.

Hope all is well, TysonCook (yes that's me!)
 
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TysonCook said:
I'm in the same boat. I feel that if you say it (internet or otherwise), you better have the b*lls to own up to it. Needless to say I have lots of SDN folk say "hey, TysonCook, I love your purple hippo" etc. It was brought up at least 5+ times at different programs by PD's, so I know fo sho that the PD's are around.

Hope all is well, TysonCook (yes that's me!)
Click to expand...

I'm not a PD, but I love your purple hippo too. I'd hit it.
 
There was talk of your purple hippo when I interviewed there, it's huge.
 
SolidGold said:
I'm not surprised at all that a bunch of PD's read SDN. They read it whether they admit it or not. At the very least, there is someone in the residency leadership that reads SDN...
Click to expand...
All of the PDs (EM and otherwise) I've spoken to either read and post at sites like SDN or Scutwork, or they want to know more so that they can read and post there. :laugh: They genuinely want to know what we think about training and what we want to see in a program.

Hard24Get said:
so what can/should I do? I'm too freaking transparent! :scared:
Click to expand...
Janders said:
...(2) Be as open as you wish, but assume that everything you ever write will be read by everyone who could ever matter to you...
Click to expand...
I agree. I don't give much away, but I also don't post anything I would be embarassed to own up to. (You shouldn't be worried H24G!)

With "Top Prgram" lists always popping up, I'm surprised that this one is somehow special. Though Er-Er-Oh's posts make me think, and I appreciate that.
 
Here is a list that was compiled from the FAQ on this forum. This has not been created with my own input in any way but simply collected from past posts. I wanted to put this here to show the differences from the OP and demonstrate the wide array and number of programs that are considered exceptional. This list is not exhaustive and has more of a tendency to leave out good programs than include mediocre ones. I am excited to interview at some on this list and some not on this list and find my own personal #1 place.

In somewhat regional order:
UCLA-Harbor, USC, Highland, UCLA-Olive View, UC-Davis, OHSU,
Pittsburgh, Indiana, Hennepin, Vanderbilt, Denver, Cincinnati, Arizona, Maricopa, UNM, Cook County, UIC, UNC, Carolinas, Orlando, Emory, Jacobi, Bellevue, Christiana, Penn.

The list could really go on and on....
 
makesomerheum said:
Here is a list that was compiled from the FAQ on this forum. This has not been created with my own input in any way but simply collected from past posts. I wanted to put this here to show the differences from the OP and demonstrate the wide array and number of programs that are considered exceptional. This list is not exhaustive and has more of a tendency to leave out good programs than include mediocre ones. I am excited to interview at some on this list and some not on this list and find my own personal #1 place.

In somewhat regional order:
UCLA-Harbor, USC, Highland, UCLA-Olive View, UC-Davis, OHSU,
Pittsburgh, Indiana, Hennepin, Vanderbilt, Denver, Cincinnati, Arizona, Maricopa, UNM, Cook County, UIC, UNC, Carolinas, Orlando, Emory, Jacobi, Bellevue, Christiana, Penn.

The list could really go on and on....
Click to expand...

Well, that wasn't too bad. We made it 68 posts before a med student posted his/her own list (based on a survey of others posts no less). Clearly, another kid missing the forest for the trees.

No wait, your list is more better.

One. More. Time.

Your. Own. Personal. Fit.
 
Okay, here's one thing that confused me - someone posted that "this person from my school had gotten GW's highly competitive fellowship".

What makes a program better able to get people into a good fellowship? Is it the fame of the people there? The location? The programs? There's gotta be something.

What if you're the type of person that can generally fit in anywhere, how do you begin looking? What criteria do you go by?

Like I'm the perfect example, there are like 10 schools in the area I want to be in. That's the only criteria I've got (family), so now that that's done, I have no way of assessing which ones I should do an away rotation at besides the fact that "that sounds like a good school". It's really frustrating simply because I know that wherever I end up going for my away rotation I'm going to end up thinking "I wonder what this other school would have been like? Should I have gone there?".

Now if there was a more definitive list of which are the toughest to get into/best in some way possible (which there isnt), at least I'd be able to say "okay I'll start off at these two places for my away roations because they're subjectively considered the hardest to get into".

I may just be stressing (shelf in like a week), but there's gotta be some way for me to pick beyond walking there and going "okay I like this place".
 
the OP is obviously a troll.... 2 posts... are you kidding me? And no assistant program director would be stupid enough to think, let alone post this!
 
Okay, if an assistant PD is going to put his list up here I figured I better straighten things out and put the real list on here. First let me tell you who I am and list my credentials.
I am God
I created the earth.
I created mosquitos for my own wise puposes.
I created 3000 religions just to confuse the hell out of everyone.
And Lastly I created EM so really all you need is my list. I will do it regionally.
Kabul, Baghdad, Tel Aviv, Tehran, and USC
Heaven, Honolulu, and Christiana
Antarctica, Santa's workshop and Hennipen
Hell, Death Valley and Tucson.
Hope you all enjoy the list and stop praying for interviews, I really don't care.
Peace out;)
 
willlynilly said:
the problem with this list is that some poor sap of a student will take this as gold, no matter what disclaimers are put in.

students: go to a place (city) that you want to go to, and within that city, find the program whose personaity best suits you. that is the best program for you, period.
Click to expand...

If a medical student truly has his/her heart set on a career in emergency medicine and takes the word of only one person as to the best programs, he/she is either incredibly vapid or naive or worse yet, indecisive- and therefore, he/she probably does not belong in EM.

Deciding on a right residency program is like choosing a spouse- it requires a good deal of research and careful consideration. Nothing like buyer's remorse.

To the OP, your list is interesting and provides some food for thought. It would be more helpful for those considering posting a list of the best programs if there is some justification for why these programs belong on the best list-- what makes them special or superior in your view to the other programs in the region.
 
vtucci said:
If a medical student truly has his/her heart set on a career in emergency medicine and takes the word of only one person as to the best programs, he/she is either incredibly vapid or naive or worse yet, indecisive- and therefore, he/she probably does not belong in EM.

Deciding on a right residency program is like choosing a spouse- it requires a good deal of research and careful consideration. Nothing like buyer's remorse.

To the OP, your list is interesting and provides some food for thought. It would be more helpful for those considering posting a list of the best programs if there is some justification for why these programs belong on the best list-- what makes them special or superior in your view to the other programs in the region.
Click to expand...

I don't agree with the list either. But if you read the OP's post, he/she DID provide justification for the list as a whole (although not for individual programs). I'd be surprised if details were included about specific programs because, well, IMHO, there are probably some issues that an asst PD knows about that certainly a medical student wouldn't know, couldn't know, or doesn't need to know.

I think back as to what made me choose my residency spot. Oh sure, I asked all the questions that Iserson's told me to ask, and all the questions that I gleaned from every little thread that was posted on SDN.

But at the end of the day?

1. I liked the geography
2. I liked the stuff that the people did on their time off (a surrogate for identifying "cool people" when I only had the benefit of an afternoon's interview).

And I wouldn't change a thing.
 
Just listing the programs by geographic region and noting that the OP is familiar with the docs/leadership at these programs without more information does not qualify as describing why he/she believes that these are the best programs in the respective areas- at least not in my book.

We are all more comfortable with what we know so I am not surprised that the OP believes that some of these programs are the best because he/she has had a chance to evaluate some of the grads from these programs and knows the leadership at some of these programs.

However, from a student's perspective, it is more useful to state why he believes these programs turned out stellar EM physicians other than the amorphous I know it when I see it. Each of us will generate our own lists based on our own personal criteria for what is the best program for us but it does help to have other people's perspectives so we can ask questions when we are on the interview trail and tailor our lists accordingly.

Was it some aspect of the curriculum? (i.e., do the EM residents run the traumas exclusively, or do they have increased elective time or a stent in administration)

Or if it is a leader in the field- what is it about that leader that makes them special.
 
vtucci said:
Just listing the programs by geographic region and noting that the OP is familiar with the docs/leadership at these programs without more information does not qualify as describing why he/she believes that these are the best programs in the respective areas- at least not in my book.
Click to expand...

<Sigh>

I guess your -back- button to get to the first post in the list is broken. I don't endorse the list based on even the OP's priorities, but here they are verbatim from his post.

OP wrote:

"It's based on what I know of the people who run them, the faculty (big emphasis on these first two points) the overall experience provided at the site (city, variety, acuity, etc), the quality of the parent institution, whether the program typically gets "top rated candidates" (ah! This is an enigma wrapped in an enigma!) and, where possible, takes into consideration what I know of their graduates. ....

he continues:

..."it reflects an ever-changing landscape and a certain degree of "diamond in the rough"-edness. I emphasize once again it is influenced heavily by the leadership at those institutions because they will not only steward you well during your 3 or 4 years, but are well poised to help you walk through many "open doors"..."
 
Scott & White......really? Nothing against the program, but I don't see how it fits your own standards.
 
My back button is far from broken.

I read the OP's post and would state again I would be interested in knowing what about the leadership at certain programs makes them stand outs. I have been involved in other fields besides medicine and there are a number of leadership styles. I am curious if the OP favors one over the others or if there is something in particular that makes him/her give the nod to the head of these programs.

Also, overall experience in terms of acuity/variety, top rated candidates-- these concepts can be defined in many ways- variety can be construed to mean ethnically/racially diverse patient population v. diverse pathology. I assume he means both but it never hurts to clarify. For top rated candidates, are we assuming top 25 med school and outrageously high board scores? What about the MD/MPH, MD/PhD etc with abstracts and papers up the whazoo etc. Top rated or best students might be seen differently by different programs and by the OP.

TraumaCheers said:
<Sigh>

I guess your -back- button to get to the first post in the list is broken. I don't endorse the list based on even the OP's priorities, but here they are verbatim from his post.

OP wrote:

"It's based on what I know of the people who run them, the faculty (big emphasis on these first two points) the overall experience provided at the site (city, variety, acuity, etc), the quality of the parent institution, whether the program typically gets "top rated candidates" (ah! This is an enigma wrapped in an enigma!) and, where possible, takes into consideration what I know of their graduates. ....

he continues:

..."it reflects an ever-changing landscape and a certain degree of "diamond in the rough"-edness. I emphasize once again it is influenced heavily by the leadership at those institutions because they will not only steward you well during your 3 or 4 years, but are well poised to help you walk through many "open doors"..."
Click to expand...
 
I have to disagree with the OP's Midwest rankings. I just left the number "1" program in the Midwest based on this person's rankings. Darn, I should have known this before I left!! Although I do consider it a good program, there is just no humanly plausible reason why Iowa would be ranked ahead of Christ Advocate, Indy, Metrohealth, UIC, or U-Chicago. I would love to hear the rationale behind this. I tend to think there is no actual rationale, and instead only rhetoric and a big joke played on those who think this person is actually an assistant D. On the other hand, I am excited to see my new program as the 5th best program in the NE. I somehow doubt there is any rationale behind this either unfortunately.
 
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