Urban Fourth Year Clerkships

[SuperflyMD]

I go to a school without an EM Residency, so I plan to do at least two away rotations next year. Hopefully, one will be in New Mexico, but I need help choosing a second. I want to go to a major city, prefferably one with several residency programs nearby.

I'm thinking about LA (King/Drew), Chicago (Cook County or Resurection), and New York (SUNY Brooklyn).

Any opinions on these, or other urban programs for 4th year rotations would be of great help.

Good Luck to everyone waiting for Match results!

Stephen

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[sweetfynesse]

I did an away rotation at Downstate this year, and absolutely loved the experience. Coming from a school with a brand new EMed residency, I felt it would be a good idea to do away rotations, as well. I chose Downstate, as well as Shands Jax.

At Downstate, students work 3-4 12 hour shifts per week to a total of 14. You also have one EMS ride. You will work the daytime shift for two weeks, and overnight for two weeks. On day one, you have a nice orientation and then everyone choses a letter to correspond to the pre-made schedules. You have two or three free changes (they do not have to be coordinated with another student) in your schedule, if you need to be off certain days, or just wanted to for whatever reason. And then you can swap with other students if you need to at a later date. The Program Coordinator is very helpful, just don't disturb her for stuff you can do for yourself. Seriously, I absolutely loved her. One night I stayed out drinking way too much, missed my a.m. shift, and she worked everythng out for me.

The ER is separated into PEDS, Critical Care, Med/Surgery, and fast track/treatment room. You will generally have equal time in all areas. In all areas, except Critical Care, you will be responsible for seeing your own patients, presenting them to a senior or attending, and then placing all orders (expect radiograghs or CT--only residents/attendings). In the Critical Care area you will work as a team when taking care of the patient. The team will consist of attending, senior, junior/or intern, MS4, and MS3. Here, you pretty much do whatever needs to be done to help out. I enjoyed this area the most. In every area you will pretty much be required to place all the IVs, start fluids, and wheel pts to xray/CT. You'll get used to this, and, not to worry, it's only 4 weeks, so you won't get tired of it. You also get to do all the sutures, staples, and splints on your patients. That's a big plus. The only bad thing is that you will likely never place a central line, chest tube, or do an LPs---only residents.

You'll defintely have time to enjoy the city. I did anyway.

They say the best way to increase your grade is to do extra shifts, but I didn't and the PD said Iwould have gotten an honors, except for the fact that my school is pass/fail...So, take it with a grain of salt. The best thing is to just work hard while you're their, and let people know that you are a visiting student that's interested in applying for EM. Interestingly, while you're there they will give you an advisor if you chose. This would be great for you since your school doesn;t have an EM residency. This advisor will stay in contact with you throughout your process.

Although, there isn't always time for bedside teaching, you will have 2-hours of mandatory lectures on Tues and Thurs mornings that are very helpful. Downstate is an incredible environment, not on to learn e-medicine, but also to learn what it is you want out of program. I would recommend everyone interested in emed to rotate through a county program. You'll work your butt off, but its just 14 days, an you'll gain so much.

Good luck, if you wanna know anything else let me know if I can help...

 

[edinOH]

I rotated at Metrohealth in Cleveland and loved it. It is an excellent program in a relatively big city (Big compared to what I am used to). In the end I ranked them number four but I would be very happy if I matched there. They have some very well known and well respected faculty there. You could get some good letters from some of the attendings. The PD is new but he is a pretty genuine guy from my experience. I was told by one of the attendings that he "knows how to write a good letter." I'm glad I got one from him... IN this respect a strong letter from a PD would be a plus.

Anyway, you couldn't go wrong with a rotation at Metro.

By the way I too am from a school without an EM program. I go to the University of Oklahoma.

 

[pinbor1]

Hi Stephen1 to answer your questions about chicago programs here is a basic overview of my knowledge concerning rotations at these sites.

Christ- very good experience, mix of suburban pts and pt's from the south side. Very busy ED, lots of autonomy, very good clinical reputation in chicago. Very busy trauma 1, good trauma elective

Cook County- also very good and very busy. I've been told that it is more primary care heavy when it comes to volume. New ED with lots of "toys", don't know how well integrated they are. Definitely could get some good letters. very busy trauma 1, good trauma elective

Northwestern- Higher fee for service than other ED's with rotations. I've been told that there has been much improved teaching in the last few years. Also trauma 1

U of Chicago- Haven't heard much, they have a flight program and I think you can arrange to fly, but not sure. ED is peds trauma 1, pt population is also pretty indigent. Covers southside as well as fee for service. Pretty good academic rep.

U of I- Chicago- Also a good clinical/academic program. Has three sites you can rotate at.
1. UIH- tertiary care, great teaching, will see both urban pt's and tertiary care pts in the ED
2. Illinois Masonic- urban community hospital- "yuppies, little old ladies, and puerto rican population, also a trauma 1, and big psych referral area for chicagoland.
3. Mercy- inner city ED experience, large indigent population south side, blue collar, and chinatown pt's. Pretty high acuity. Great teaching, very hands on.

Resurrection- two sites
Resurrection- Large polish population, high cardiac acuity, good teaching from what I've been told. Lot of UIC grads are attendings there.
St. Francis- Suburban Trauma 1, large hispanic population, don't know much else about it.

This is a quick, very general overview. If you have more specific questions feel free to ask. Good luck with your rotations. Also good luck with your UNM rotation; they have a great bunch of residents/attendings out there

 

[eemer]

If you go to a school with a community associated ED then spending a month at a county program is definately a great idea.

I did a month at Kings County (Downstate), which was so eloquently described previously. Obviously I enjoyed is, as county remained my top choice. I would like to add that there is bedside teaching at KCH, but you may need to ask for it. Also, the consulting services (like urology, ENT, etc) are generally open to teaching.

I also did a month at Charity in New Orleans. Another huge county program with incredible volume and lots of teaching. If I was able to move to New Orleans, charity would have been top of my list.

If you are going to a do a month at a county program, stay big. In LA, do USC, in chicago, go to cook, in NY you can choose between Jacobi and Downstate. you should also realize that county programs aren't for everyone, but the only way to know for sure is to try.