High Volume and hands on EM Programs

[masterb]

I was wondering if people could rate EM Programs based on sheer high

volume and high volume trauma seen + broad range of pathology (I know this may sound utopic). Also looking for programs that allow their residents to get procedural and team leading experience, i.e. not mere bystanders (I've seen the bystander effect at a top notch academic intensive care department where a bedside tracheotomy is performed by a fellow - who botched it up - and 7 people are watching her do it, I'd rather be the one learning to do the tracheotomy w/ faculty guidance as I near the senior part of residency no?)

 

Please see the blogpost (august 1 and 5 postings) below to get a better understanding of what I want to avoid, I am trying to get a sense of programs to explore:

 

http://drcouz.blogspot.ca/2007_08_01_archive.html

[rogerroger]

I was wondering if people could rate EM Programs based on sheer high

volume and high volume trauma seen + broad range of pathology (I know this may sound utopic). Also looking for programs that allow their residents to get procedural and team leading experience, i.e. not mere bystanders (I've seen the bystander effect at a top notch academic intensive care department where a bedside tracheotomy is performed by a fellow - who botched it up - and 7 people are watching her do it, I'd rather be the one learning to do the tracheotomy w/ faculty guidance as I near the senior part of residency no?)

 

Please see the blogpost (august 1 and 5 postings) below to get a better understanding of what I want to avoid, I am trying to get a sense of programs to explore:

 

http://drcouz.blogspot.ca/2007_08_01_archive.html

 

 

 

I think most would find it difficult to rate EM programs. Firstly, you can only at most rotate through a few during med school and you match into only one. From my limited experience with a few Canadian EDs via med school electives and residency I feel like all the programs are more similar than different.

 

Some places emphasize research more than others, others emphasize certain aspects of EM more, such as ultrasound, sim etc. But at the end of the day your experience in the ED will be more or less the same. Some off service rotations will probably vary in quality depending on location. But you will spend a vast majority of your time in the ED so the experience there is what counts the most.

 

The beauty of emerg is that it is the specialty for first line, hands on, high acuity. You also for the most part work one on one with staff. From day one the focus is slanted towards this type of learning. Just off the top of my head, during my last shift, which happened to be pretty busy, I ran two arrests, reduce a fracture, placed a line and did an LP. This is pretty much emerg bread and butter and such opportunities are probably rarely in short supply regardless of program.

 

It is very hard to rate programs based on the criteria you suggested. How much you like a program really boils down to your own interests within emerg, how much you like a location and how well the program fits your personality and learning style.

[masterb]

Thanks rogeroger, that is actually very helpful.

[Bede]

If you want hands on, go to a smaller center up north.

[rogerroger]

If you want hands on, go to a smaller center up north.

 

From the stand point of residency training, hands on is only one part of the story. Volume, acuity, academic resources etc. are important too. It is about striking that balance.