Wayne State University/DMC (Sinai-Grace) Residency Reviews

Discussion in 'Emergency Medicine' started by docB, Nov 22, 2008.

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  1. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    I was asked to post this review:

    OVERALL: heavy path/trauma, little evidence based medicine/academia, heavy push to see more and more patients but get less and less teaching, malignant atmosphere, poor didactics, 20-21 shifts per month often staying over to dictate and catch up, poor nursing/facilities & unstable economy
    RESIDENTS: 12 per yr. mix of local and out of state
    SHIFTS: 20-21 (10 minus days of the month) 10 hr shifts that often exceed that in order to dictate (yes we dictate every pt encounter) all your charts, very little time to read
    FACILITIES: ER is run down, small cubicles double bunked, small trauma room, shortage of computers where all orders and test reviewing is done, equipment such as otoscope lights/heads often not working, lecture room is small, cant see or hear lectures well
    NURSING: the worst nursing care and attitude imagineable in the ER (where obviously most time is spent), very good nice respectable nurses on off service rotations esp ICU. what few good nurses are in the dept are leaving or have left due to poor nursing mgmt. professionalism and morale is very low!
    SCUTWORK: lots of scutwork and baby sitting in the ER, ive pushed pts to cat scan, started my own IV, foleys. you are constantly having to chase down labs that never got sent, drips that were never hung, etc.
    TRAUMA: hands down tons of trauma and the best part of this residency but trauma isnt everything and certainly doesnt make up for the vast deficiencies of this program. dont get me wrong i love the trauma, but most of us will end up in a community setting where we wont see a lot of trauma or if you do work in a trauma center trauma surg pretty much runs the show. however we are the exception here as trauma sits back and watches. besides trauma codes are very cookbook and algorithmic
    EMS: we answer every ems radio call which can get very taxing and annoying at times because the detroit ems is such a mess they only have one radio and they call our ER for med control to relay ems traffic to other surrounding hospitals so your constanly playing call around on top of seeing 20-30 pts.
    CURRICULUM: standard curriculum i think. you have more ED months as you get more senior. you dont do any medicine floor months which is really nice, this is off set by more ICU time which is rough but you learn a lot on your ICU months.
    FACULTY: very hit and miss, most are clinical and you wont learn evidence based medicine here. you often get "thats just the way we do it here" a lot. most are litigation paranoid so you will order everything under the sun with no basis behind it. if you take too long to get a good history and physical your "too slow" and need to step it up to get your "numbers up". this is the mentality here. and realize the attendings get paid based on productivity (number of pts seen) so of course they are wanting you to see more and more. most of us have no problem with that because when we are attendings you want to be efficient and be able to see many patients, but when it cuts into teaching and doing a good job, i draw the line!
    DIDACTICS: protected lecture time 5 hrs per week, mostly resident presentations which is fine, but there is little EM faculty discussion or expansion of the topic, off service specialists do come in which are nice, tox/trauma/cardiac conferences are held periodically on a rolling annual basis which can be good. it seems this yrs lectures are better than lasts but we will see. i do like the practice oral board cases we do monthly for senior residents
    CAMARADERIE: our class gets along great but this is the exception. there is much tension among most of the senior residents esp with the ones gunning for chief. some of the seniors complain about the interns and they just started and have caused a bunch of problems among the interns.
    ATMOSPHERE: lots of politics here. overall malignant atmosphere
    LOCATION: good or bad whatever your take is. training wise lots of advanced path, indigent care, trauma, etc. living/social wise another story. the weather is horrible, the economy as you know is the worst in the country, socially not the greatest city either. in fact with the auto industry in flux a lot of us are worried about the ripple effect here as the majority of the working pts are in some way tied to the industry and if they go under we will likely lose hospitals, physicians, patients, etc. not to mention the detroit med center is not in a very stable financial situation anyway so we are all a little nervous right now.
    ADVICE: talk to residents at each program you interview at. ask for names, emails, etc. talk to several residents to get a consensus. dont just believe the ones that take you to lunch or give you a tour. they can be biased and reluctant to give you a candid view as it would be pretty obvious to the admin who told those candidates things. so if a program is reluctant to give you additional names of other residents not involved in the interview process be cautious! i was warned by residents when i interviewed here, but just thought they were typical over worked and underpaid residents but i wished now i would have listened more.

    good luck and do your homework/research!!
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  3. RxnMan

    RxnMan Who, me? A doctor? Moderator Emeritus 7+ Year Member

    This is a review sent to me by a SDN user who interviewed there and wishes to remain anonymous. I am posting it verbatim as a service for the SDN community.

    Sinai Grace (Detroit, MI)

    Pros: Tons of trauma, very busy urban ED.

    Cons: You work your tail off for the lowest pay I came across.

    Impression: I felt during my interviews that they think they’re the poop and you should feel lucky to even be allowed to interview there. I was really rubbed the wrong way here. We also had to pay for our own drinks at the pre-interview social (not a big deal, it was just awkward when we each got a $5 bill for our beer).
  4. RxnMan

    RxnMan Who, me? A doctor? Moderator Emeritus 7+ Year Member

    See more here.
  5. emclark


    Sep 15, 2011
    Anybody have anything positive to say about this program??
  6. EMDO

    EMDO Chief Resident 5+ Year Member

    Jan 15, 2011
    Yeah. I trained in Detroit and I know and have worked with several people in various specialties that have trained at Sinai, as well as DRH. They were all excellent, well trained docs.

    I never rotated at Siniai, but I did a couple rotations at DRH and I feel I am better off for it. Both hospitals are in the some of the worst parts of Detroit, and both are known for being tough places to train. I can definitely see why there may be some disgruntled residents there, but anyone graduating from those programs will be tough as nails.

    As for Detroit being a horrible place to live, I think that is totally ridiculous. First off, the vast majority of residents in the area live in one of the many outlying cities within a 20 minute drive of Detroit proper. And if you can't find anything fun to do in the area you got serious issues. There are great restaurants, a nice downtown, 3 pro sports teams, and about every band on tour stops off in the area. It may not be New York or Paris, but it is far from the hell on Earth it is made out to be.

    The whole point of residency is to get good training, and that typically involves having your butt kicked for a few years. I would think that most people going into EM would want to train in the city that was the poorest, the most violent, and had roads covered with oil slicks.
  7. Deuce Doc

    Deuce Doc Communityist 5+ Year Member

    Oct 19, 2011
    Sinai Grace
    .Residents: Tough to say. I met very few. Only two came to the dinner and there was not a whole lot of presence during interviews. The couple that I spoke to seemed like nice folks. I spent way more time talking to applicants though, with fairly mixed results..

    .Lifestyle/City: I'm told that none of the docs actually live in Detroit as much as the surrounding suburbs/towns. I did not get mugged on my way to the interview. The residents work 17, 18, and 16 nine and a half hour shifts per block..
    Curriculum: This place is no joke. They say it has the highest acuity, volume and most penetrating trauma in Detroit. They also do 6 months of ICU time. It sounds like most of the ED teaching can't happen during the shift because folks are working too hard. The problem is, I think due to rapid turnover and inadequate staffing, some of the residents' work is doing the jobs normally performed by ancillary services. I didn't get a great sense for the quality of conferences, but I believe they are protected on off-service months. If you want to learn by doing, this place might suit you well. These guys are giving away procedures by the end of intern year because they have too many. I interviewed at another place where they don't get enough live chest tubes--that will not be a problem here. They are dictating their notes to transcriptionists currently, but may be moving to dragonspeak.

    Facilities: Old-style, cramped ED. Honestly, not the greatest workstation setup, but the some residents seemed to prefer the close quarters. At some other programs, where isolated, large rooms have replaced curtains and chaos, some people seem to miss the old-style setup.

    Interview Day: Definitely among the most serious interviews that I had—it definitely felt like a job interview, rather than the typical get-to-know you kind of feel. My application has some shortcomings and I was definitely made to answer for them by each of the faculty (not just one hard-nosed person). Nothing about it was in any way hostile or unfair, but you should know going in, that you are still proving yourself..
    Summary: I was very impressed with the program director and her commitment to resident education. She even took some residents to Haiti for disaster relief for the hurricaine. . The thing that bothered me about this place was that every resident felt compelled to start his opinion with "well, we work really hard, but…" This was unusual on the trail. I am certain that lots of other places I interviewed demanded hard work, but typically the first thing out of the resident's mouths was how much they loved it. While I think that there is a certain street cred that comes with going to a tough residency like this one, but there is no learning in suffering, and I think I will want a more balanced approach to the facets beyond moving the meat.
    Last edited: Feb 22, 2012
  8. Forte007

    Forte007 2+ Year Member

    Feb 26, 2012
    - residents are really friendly and seem like fun people to hang outwith
    - program director really cares about the residency
    - tons of trauma
    - residents and interns report directly to the attending
    - fast track run by PAs (u don't have to deal with HA, F, etc)

    - random shifts (not grouped)
    - residents look over worked
    - detroit
    - seems like more work less teaching
  9. RandomChaos

    RandomChaos 2+ Year Member

    Nov 21, 2012
    Residents: 12 residents a year. Unfortunately was unable to attend social due to travel issues. However, met 6 residents during the interview and all of them seemed happy and very approachable.

    Alumni: All over the US. Send people to fellowship, academics, you name it. National recognition very good for getting a job.

    Facilities: Currently incredibly run down and bare bones ED. For the busiest trauma center in Detroit cant believe they only have 2 tiny trauma rooms. But general ED is very countyesque, curtains as only divider, lots of patients in hall. However this will all change come next year when new ED opens and is supposed to be twice the size and with 4 trauma bays.

    Peds: Technically level 2 for Peds but was told they get tons of level 1 peds cases cuz theyre the closest. Was told that PICU away at childrens was a bad rotation due to lack of autonomy

    Trauma: Its the busiest in detroit

    Faculty: Growing. Recently picked up a Board Certified US guy, BC International guy, as well as a BC Research guy. PD seems to really care about improving program. Constantly changing the program for the best. Very involved in ACEP and will go to bat for you if you bust your ass, and it seems like she has some pull with hooking you up post residency.

    Curriculum: Lots of Critical Care time. 1 month of internal medicine. Hospital is run by former ED docs which are now higher up administration so off service months are solid. EM residents come across as strongest residents of hospital.

    Patient Pop: Blue collar working class. About 9% uninsured. Most patients are medicare. 86% of patients are medicine complaints, 23% Pediatric patients. Tons of advance pathology with very sick people

    Location: North Detroit, very slummy run down neighborhood. But very separated from Ford and DRH so they get the worst patients and dont have to share. Detroit not really as bad as everyone makes it out to be. Very pretty city, but does at times feel like a ghost town with lots of abandoned buildings

    Overall: During the interview everyone seemed very honest and forth coming about strengths and weaknesses of program. Great place to train if you dont mind being pushed and busting your ass. With new U/S, research, and international opportunities plus the new ED opening and such an extensive alumni network I think this program will be one of more competitive programs in the years to come. The EM residents are def the strongest in the hospital and have the most responsibility, I really feel like you would come out of here as a rock star, and it shows with the extensive alumni. Has a feel very similar to Christ in Oak Lawn.
  10. Dr.Evil1

    Dr.Evil1 Senior Member 7+ Year Member

    Dec 6, 2004
    Myrtle Beach, SC
    I believe that the initial review posted here is very misleading, posted by someone who does not match with the program.

    I trained at Detroit Receiving (2008) which is the sister program to Sinai. My best friend was a chief resident there (2009). Sinai does have poor facilities which are (apparently) changing. You will work hard there. They are busy and are not the kind of place where you all gather around a patient and have the subspecialist give a presentation about the interesting case that was sent in from the other side of the state. Sinai has a 29 min guarantee to see a physician from patient arrival which does pressure you to have to actually pick up extra patients.

    If you are going into EM with a plan for future grand academics or are someone who is always looking for that next needle in the haystack then this is not the place for you. If you are a self-motivated, hard worker who wants a chance to wade through the muck of the sickest patients with the most pathology you can imagine then this is the place. You will get excellent experience and I guarantee that you won't be scared by anything you see after graduation. You will learn by seeing at Sinai. Melissa Barton is a very passionate woman and cares greatly for her residents. She will assure that you are a great ED doctor when you graduate.

    I now work in a busy community hospital in South Carolina. I am involved in hiring people to join our group. I would look very favorably at a graduate of Sinai and would not hesitate to hire them.
  11. CTRadAid

    CTRadAid 5+ Year Member

    Feb 25, 2010
    PRO: You can hang out with me in CT while I try to squeeze morbidly obese patients through the scanner.

    CON: We're understaffed and I will make you help me move 200kg patient onto the scanner.

  12. SoyMilk

    SoyMilk 7+ Year Member

    Nov 14, 2007
    The West Side
    Wow this is pretty damning
  13. kmb1908

    kmb1908 7+ Year Member

    Dec 27, 2008
    Any new reviews?
  14. pixma747


    Oct 30, 2014
    I rotated here as a student this year and live in Detroit. That first review definitely does not accurately depict the current state of the Sinai Grace residency. While some of the issues mentioned are still true, things these days aren't as bad as depicted.

    Location -
    Located in an average neighborhood of Detroit, with all the Detroit issues. Tons of trauma rolls in here, the attendings claim more than any other hospital in the state. While you probably won't want to live across the street from the hospital, I never felt unsafe walking to my car or in the hospital (security is good). There's plenty of good places to live within 10-20 min away (including places INSIDE the city of Detroit). The Detroit Receiving/Wayne State area (Midtown) is on a huge upswing and is a very trendy place to live these days, as is Corktown and downtown. The DMC is also part of the Live Midtown incentive, which gives DMC employees/residents $3500 to rent a house/apt over 2 years, or $20,000 towards the purchase of a house/apt in Midtown. (Check out http://www.livemidtown.org/incentives). The same deal applies for the Detroit Receiving program and also Henry Ford. If you can't bare to live in the big bad city, there are also nice suburbs within 20 min of the hospital as well (Ferndale is my favorite).

    Facility -
    As for the facilities, the brand new ED is now open. The OP was right about the old ED, it was a **** hole. The new one is actually a lot nicer than most of the other ED's that I've rotated at and seen on interviews. It's really big, all private pt rooms, 4 huge trauma bays. My biggest complaint is that it's so big now it takes a while to walk from the far module to the trauma bays. There's pictures and video of the new department here: http://www.sinaigrace.org/New_Construction_Projects. The rest of the hospital is in pretty good shape and many areas have also been recently updated. The ICUs are all brand new. I would say the worst part about the hospital is the food options (one cafeteria and one sorry coffee shop, both with mediocre hours of operation)

    Patients -
    Lots of poor patients who are un/under-insured with no PCP. Like many EDs, lots of people come in with non-emergent complaints (and many times via EMS). However, there is a whole separate urgent care area staffed by PAs and one attending that's open every day. Residents do not even rotate through that area as far as I know. The patients in the main area are often very sick, lots of admissions and ICU admissions. Crazy trauma comes in (lots at night) as well as super sick medical patients. You'll see everything and do everything (EM runs all traumas).

    Residents -
    Lots of really nice residents, good to work with, only had one that I didn't like very much. They did often have to stay over after their shifts for quite a while finishing notes. Overall, they definitely are worked hard at the program.

    Faculty -
    There's a lot of really great attendings here who teach very well and are pleasant to be around. However, there are a few that seemed very burned out. The hospital has such a huge patient volume that it's tough for them to find time to teach, although more than a few go out of there way to do it. You'll definitely be learning more by doing at this program (which may or may not be a good thing, depending on how you learn). Overall, the faculty is pretty young, a lot of new grads from Sinai and other Detroit programs.

    Other staff -
    The nurses and nursing assistants are stretched very thin here. The other hospital I rotated at had twice the amount of nurses for the same amt of patients, plus ample nursing assistants. This workload occasionally results in residents having to do some nursing tasks, like starting an IV or drawing blood, but this is not a daily occurrence. Supposedly, Sinai Grace is actually the most profitable hospital in the DMC system and it sometimes seems they do that by keeping their staff numbers low [just conjecture on my part].

    PD -
    So the current PD is stepping down and the assistant PD is moving up. I never worked with the new PD, but I've heard really good things about him.

    Sinai is definitely not an easy place to train. However, the experience you'll get directly caring for patients is incredible and will surely prepare you for anything.
    kmb1908 and Zebra Hunter like this.
  15. woodhorse22

    woodhorse22 Member 10+ Year Member

    Jan 3, 2006
    I am a current 3rd year at Sinai Grace Hospital ED. It is definitely a tough place to train but you see a lot and learn a lot. The new program director is extremely receptive to resident's comments and they work closely to bring changes. You are the boss of the ED and you do everything. When you rotate through the ICU, the medicine residents look at you for help (putting lines in and running codes).. Nursing staff has improved significantly but there are always days when this is not true. Pushing patients to CT/Xray is not an issue anymore. Very strong emphasis on U/S now with the fellowship and everything. This place trains you to be efficient and if you can work here you can darn well work any where else. As far as shifts go, you work about 16-17 shifts a month as a 3 rd year. The scheduler is very flexible and you can nearly always make a switch as needed. Thursday conference includes a combination of Rosen presentations by fellow residents as well as lectures by outside physicians as well as faculty. Strong emphasis on oral board prep. Great relationship between residents of each class. Lots of activities to socialize with your colleagues (JC, big sib events, oral case evenings, etc).
    PM me if you have any question but the training I have gotten here has been amazing. I can tell you that coming out of a well known detroit program was very helpful on the job search. They really want you after you have trained here.
  16. DetEMED


    Sep 5, 2015
    I'm a current resident in this program. This program has changed in the last several years, as others have mentioned. The short version is this - you will work hard. Our style of training – seeing and doing everything - may not be for everyone. But when you graduate, you will be able to work literally anywhere and handle any patient with absolute confidence. There is no substitute for the clinical experience you will gain at this program. I’m extremely happy here. Interview/rotate here, and you'll find all the below to be true.

    RESIDENTS: I love the residents in my program. Senior residents emailed us immediately after matching with their cell phone numbers for any questions we had. Everyone here works extremely hard, is very well qualified, and does a great job looking out for other residents.
    LOCATION: Detroit is a great city back on the upswing. I've lived here for many years now and I love it. Many residents also live in the suburbs and love it there as well. Either way, commute to the hospital is 10-20 minutes. SGH itself is located in a pretty run-down part of the city; this is great for your training, but you won't be walking to work.
    FACILITY: Brand new ED; 59,000sq ft, 80 beds, 4 resus rooms. Brand new MICU and SICU with 20 beds each, located directly above the ED. Brand new radiology suites in the ED. Brand new front lobby for the hospital. All of these opened in 2014-2015. This is a Level 2 trauma center, which is irrelevant as Detroit EMS triages by location and not level (we actually get more level 1 EMS runs than any other Detroit ED). It does mean that you do your own optho exams, your own ortho splints/reductions, and your own ENT procedures. You rarely consult out for treatment. This is the main reason I chose the program over others. One logistics comment; SGH is part of the Detroit Medical Center. DMC Main Campus is a large, tertiary care center downtown. SGH is about 8 miles up the road.
    PATIENTS: More than 100,000 visits a year. In Detroit, we really do have some of the sickest patients in the country, and this is the primary reason I stayed here after med school. About ¼ of our trauma is penetrating trauma, (that’s a lot). It’s unlikely you’ll make it through August without seeing an ED thoracotomy. EM residents run all codes - med, peds, or trauma. EM residents perform all procedures anywhere in the ED or resus rooms with extraordinarily rare exceptions. Yes – this includes all chest tubes, thoracotomies, peds procedures, etc.
    FACULTY: Faculty is partially shared with Detroit Receiving Hospital downtown. Excellent, young, and interested in teaching. Will pick up charts if you get in over your head. Include two ultrasound attendings, two toxicology attendings, and at least one sports medicine, research, EMS, education, and palliative care attending. Some shifts are too busy for tons of teaching, and that is one knock on working here. You may get less teaching some days - but only because you're seeing more patients. You're learning either way.
    WORKFLOW: You will work incredibly hard in this program. There will be nights when you have to attend 10 resus codes and feel like you're in way over your head. You might stay 3 hours after your shift to dictate on those nights. 60-120 minutes is more typical. But you're seeing a ton of patients and learning a ton. Nursing staffing, which is commented on extensively in prior posts, is definitely a problem. But this has improved in the several years I've been involved in the program. You still need to line and lab your patients on rare occasions, but this is far less common than it used to be. It's important to know how to do these things yourself; however, some may see this as a drawback in this program. The upside, of course, is that if you train here you are prepared to practice everywhere. Not every ED has ideal staffing.
    CURRICULUM: One other drawback to this program is that the hospital has exceptionally strong EM and critical care, but other departments are relatively weak. I was concerned about this going in, but haven't found it to be much of an issue. You can find the curriculum online. A very wide range of electives are available as DMC is an enormous, tertiary care center. 5.5 months of critical care plus one month of ED critical care. Intern year starts with a 1 month block of orientation in the ED in which you work with a senior and attendings have a very strict no-stupid-questions policy. You attend every resus as an intern and are given first shot at nearly every procedure. I was well prepared when I had to lead floor codes in September of my intern year.
    ULTRASOUND: We have a killer ultrasound program. Two fellowship trained US attendings, 8 machines (5 of which are new in 2015), and with an US elective, you have the potential to easily complete 6 weeks of focused ultrasound training in your residency (or more). You will use the ultrasound multiple times a day in this program, and it will change your practice. We have Q-path coming online shortly and so our images will be reviewed by our US attendings. Both of our US attendings are fantastic teachers. Of 11 residents from the class of 2016, 4 of them are going on to US fellowships.
    DIDACTICS: Pretty good, and definitely not a waste of time. Hard to compare this as they're the only ones I know. Protected time on all rotations. Several quarterly didactic sessions in US, Tox, General Med, Med Ed, and Wilderness Med are combined with nearby programs such that you'll be going to these roughly once a month. We also have monthly journal club, case night, intern teaching sessions, and ‘mandatory fun event’ sessions which are well attended.
    PROGRAM LEADERSHIP: The new PD is excellent and one of the top reasons (along with patients, new facilities, and level 2 designation) that I chose this program. Will go to bat for you. Will be honest with you. Remaining leadership is fantastic as well and extraordinarily approachable. Well respected by residents.
  17. EmergMed2017


    Nov 20, 2016
    Hey guys. I've been on the site for years but made a new profile for anonymity. I'm a 4th year going into EM and I found these threads so incredibly helpful that I want to help contribute to keeping them up to date.

    I interviewed at DMC Sinai-Grace so I thought I would share my thoughts:

    • Trauma. Trauma. Trauma. I haven't been to another place during the course of my interviews where I think I would be better trained to handle trauma than here. EM runs all the traumas and does all the procedures for these patients. And based not their location we're told that they get lots of crazy, penetrating traumas. It just seems like a great place to learn
    • No hierarchy or graded responsibility between the different years. Sounds like it would be terrifying initially but I learn best by being thrown in and I think this would give me the opportunity to get proficient at treating these patients quicker. Felt like there was adequate faculty supervision but enough of a leash to feel like you're going at it alone
    • Detroit has a reputation (which is what allow you to have all these trauma patients and penetrating traumas) but the Downtown and Midtown areas felt like great, cool, young places to be. You can feel that the city is coming back and it seems like a cool time to get in there. I felt completely safe in both those areas
    • Faculty were great. I connected more with the faculty here than at almost any other place
    • 1 block of IM wards and 1 block of general surgery (with vacation built in so basically 2 weeks of gen surg). I just don't know why both of these are necessary especially since I imagine I would hate both of them. So that's pretty annoying.
    • Detroit is a really cool, young city but it's just so cold there. I'm a southerner so I don't know if I'd be willing to live that life for 3 years when I could get comparable training somewhere much warmer.
    • I just didn't vibe with the residents here. They are a little too mellow, most live in the 'burbs, and just don't seem like they're my people. They are perfectly nice and social though so I'm sure they would mesh with some people just fine.
    Overall, the program itself was great. I have almost 0 complaints (except for the dumb wards/surgery months). I think I would be a bada** ER doc if I went here. The only reason it'll move lower on my list is because of weather/location and not meshing well with the residents. Definitely top 5 though I think.

    Hope this was helpful! Happy interview season!

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