Comments on: We’re Failing Our Residents: Training ED Docs for the Real W… : Emergency Medicine News

By: Residency programs do not prepare doctors for the real world « Help Medical Students

Fri, 19 Feb 2010 06:26:48 +0000

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By: Residency programs do not prepare doctors for the real world | FuN LivINg Lifestyle

Thu, 18 Feb 2010 17:47:14 +0000

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By: teach

teach — Thu, 18 Feb 2010 13:16:22 +0000

This is where medicine can learn from the education sector. Due to the fact, that only 50% of teachers remain in their field after 5 years, places of higher education are retooling their programs and adding year long externship/student teaching programs in both suburban/rural schools and inner city schools.
Although I am not in medicine, I believe this same concept may work. Residents could spend one rotation or more in a county hospital and the remaining rotations in the suburban/urban counterpart. If it would make for better doctors, and give residents a wider arrange of experiences.

By: edwinleap.com | Grand Rounds is up!

edwinleap.com | Grand Rounds is up! — Tue, 09 Feb 2010 06:49:17 +0000

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By: Hospitalist

Hospitalist — Sun, 07 Feb 2010 18:26:17 +0000

I work in a hospital that has no: neuro, GI, ENT. i know this and the ER knows this. Yet they call me to admit people for ERCPs and acute CVAs. Blows my mind.

By: WcT

WcT — Sun, 07 Feb 2010 16:38:02 +0000

I’m no expert, but I’ve had a chance to get involved in the GME aspects of the EM residency at my institution and this comes up alot. Part of the issue is findin precepting institutions that will take residents, and be anywhere in the area. One residency actually sends residents out of state for rural emergency medicine because they couldn’t find a hospital within an 8 hour drive that would accept residents at all.

By: Hueydoc

Hueydoc — Sat, 06 Feb 2010 14:00:40 +0000

I have worked in both Level 1 Trauma centers and small community hospitals. One thing I find funny is when I have to retake ATLS, it’s always at a big trauma center and the guys teaching it
( residents mostly) have no clue about the lack of support these hospitals have. “Involve the surgeon right away in the care of this patient”- my reply? “Uh- we don’t have one” leaves them speechless. You see a LOT of trauma in the small rural hospitals, whether you have the capability to treat them or not. No luxury of “call in the Trauma Team”- it’s just you and two nurses. The EMS? Sometimes just a volunteer EMS unit that splints legs with cardboard. Yes, they need to rotate the residents into the “real” world.
Two very different worlds indeed.

By: WhiteCoat

WhiteCoat — Thu, 04 Feb 2010 15:04:51 +0000

It may be a poorly worded sentence on Dr. Welch’s part, but there is no way on God’s green earth that any emergency physician sees 200 patients a day. That would amount to 20-25 patients per hour.
I split my time between low volume and high volume hospitals. I also find that at the low volume places, many primary care physicians and consultants have a low threshold for refusing patients and requesting that I transfer them. Trauma, possible strokes, new onset seizures, patients who need surgery but who have multiple comorbidities, HIV patients, dialysis patients – most get sent out. One doc doesn’t like accepting chest pain patients because “what am I going to do here if it’s an MI? We don’t have a cath lab.”
I’ve found that working in a rural environment makes one a better ED physician at the cost of perhaps not keeping up with the most current cutting-edge medicine breakthroughs. Depends upon how you apply yourself.

By: storytellerdoc

storytellerdoc — Wed, 03 Feb 2010 13:30:28 +0000

I agree…I work in a large hospital with every subspecialty available. However, our ER group has started providing coverage for some outlying smaller hospitals again, and we’re all loving it. You do practice a different kind of medicine when you are alone in the country.

I would like to make a point with Aggravated DocSurg. The same shoe you are placing on ER programs should also be placed on recent surgical programs. EVERYBODY gets an abdominal CT in our ER, when a surgeon is consulted. While we try to discern who may or may not need one, the minute a surgeon is called, one is ordered. The clinical exam has fallen behind, in some cases, the radiological exam. And like you, not all the older surgeions do this, but the younger ones–hell yeah! Some of the surgeons don’t even carry stethoscopes anymore…

Enjoy the day.

By: Guiac

Guiac — Tue, 02 Feb 2010 21:41:52 +0000

Unless EM residencies are extended to 4 years I just don’t see where the time is going to come from to teach all these additional skills.

Look at it this way, would you rather have your newly graduated EM resident faced with task of learning patient satisfaction, consultant satisfaction, and reassurance of non crucially ill populations or figuring out how to put in a central line, chest tube, resuscitate a floridly septic patient, etc. on the job(rare though that might be)? The former skill set, while frequently frustrating to learn, nevertheless doesn’t involve life and death.

Also I think the jobs taken by many residents straight out of residency just aren’t that great(a point made in the article about turnover of new grads). We all know that there’s a handful of nice “cush” hospitals that both pay well and are pleasurable to work at with good ED leadership. These places are well staffed and getting in requires a good resume and some networking. I think a lot of folks move on to greener pastures once they’re available.

DocSurg – In some ways you’re probably right, though I could argue that some of my surgical colleagues might have benefited from a little more time in the ED!