"What is the role of the emergency medicine residents in trauma care?"

"Who directs other ED resuscitations?"

"Am I going to be exposed to a significant number of pediatric emergency cases?"

"Is there adequate sonography exposure?"

"Is there graduated responsibility as you advance in PGY?"

"When was the program's last ACOEP inspection and was the program ever on probation?"

"Why should I go to a four year program, when I could go to a three-year allopathic program?"

"Is the Emergency Department operating under the Department of Emergency Medicine?"

"What are the relationships with the other services?"

"What is it like to work in the emergency department?"

"Who has the final say when admitting patients?"

"What is the relationship like between the residents?"

"What is the relationship like between the attendings and the residents?"

"What is the workload like?"

"Is there any support for you and your family?"

"Will I be able to meet the residents in the program?"

You should be offered the opportunity speak to the program’s residents, without the presence of faculty. There are some questions can really best be answered by residents. This opportunity generally presents itself during the interview day. Be wary of a program where the opportunity does not exist. It usually means that residents are not encouraged, given the opportunity or just not committed to the program.  During the interview day, we always set aside time for the candidates to meet informally and interact with our residents.

"What is the role of the emergency medicine residents in trauma care?"

This is a very important question. Our senior EM residents have the role of Trauma Team Captain while the junior EM residents perform the technical procedures. In many ED’s a “turf war” exists between the surgical and EM teams for directing trauma codes, even though the entire process takes place in the ED. Some institutions divide the responsibility by day of the week or by the month. Since emergency medicine physicians always need to be prepared for whatever comes through the door, it is the EM physicians and residents who should direct the cases. If your patient requires an invasive procedure such as a central line or chest tube, make sure that is going to be in your scope of practice, not consulted out.

What about medical resuscitations? Who manages the airway? For example, is anesthesia or respiratory routinely called to intubate patients? The EM residents take the airway and run the resuscitations in our ED.  Emergency physicians are the experts at handling the emergency airway. It is one of the most important things we do in our practice and we need to be skilled at it.

"Am I going to be exposed to a significant number of pediatric emergency cases?"

At Good Samaritan, we have a dedicated pediatric emergency department that sees the highest volume of children of any pediatric emergency department on Long Island.  We are also staffed with one of the largest number of pediatric emergency medicine fellowship trained physicians in one institution in the U.S.  We place a strong emphasis on pediatric clinical education. Adequate exposure to pediatric emergency medicine is essential. Rotations of acceptable quality and frequency ideally in a dedicated pediatric ED is the optimum route to exposure.

"Is there adequate sonography exposure?"

In Emergency Medicine, ultrasound is a modality that is becoming indispensable in the care of ED patients. It is even tested on the emergency medicine board exams. In our ED, we have two portable ultrasound machines, a portable echocardiography machine and a full-time 24hour-a-day / 7-day-a-week dedicated ED sonographer with their own machine. In addition to ultrasound applications of focused assessment of trauma patients and central line insertion, residents can perform their own bedside scan and then confirm their diagnosis real-time with the formal sonogram in the ED ultrasound suite. We provide regular lectures and practical sessions in addition to the routine clinical applications.

"Is there graduated responsibility as you advance in PGY?"

The more experience and skill that residents obtain, the more proficient they become at independently assessing and rendering treatment. Graduated responsibility over the course of a residency program is required to produce competent self-sufficient emergency physicians. A program should have clear defined goals for their residents and just as importantly a defined method of ensuring residents meet those milestones to continue advancing.

"When was the program's last ACOEP inspection and was the program ever on probation?"

The American College of Osteopathic Emergency Physicians inspects all osteopathic emergency medicine residency programs. Programs are granted an accreditation endorsement of one to five (five years is the maximum for programs where no deficiencies are discovered) at which point they are due to be re-inspected. If significant deficiencies are discovered, a program may be placed on probation. Programs on probation risk losing their accreditation.

• We were last inspected 2006
• We are fully accredited
• We received the maximum years of accreditation for a new program

Allopathic EM residency programs follow essentially the same format with accreditation and inspections carried out by the ACGME’s Residency Review Committee (RRC).

"Why should I go to a four year program, when I could go to a three-year allopathic program?"

All Osteopathic EM programs are four years in length as are approximately 40% of all allopathic EM programs. So the obvious question is why should you join a four-year residency when you can graduate after only three?

Advantages of a Fourth Year:

The foremost advantage is an additional year of administrative and clinical training. These graduates are exposed to a more comprehensive and in-depth training program. Additionally, they are generally more confident and more competitive applicants on the job market.  They have more time to refine their skills, are generally published more, and will have developed specialized interests during their residency. Make sure the fourth year curriculum however, offers additional training that interests you and provides the opportunity and format to explore your interests through venues like elective rotations.

Disadvantages of a Fourth Year:

If the fourth year is so important, why doesn’t the ACGME mandate that all of the allopathic EM residency programs restructure to that format? It has been left as an option to the programs. It really comes down to what you think. Is an additional year at a resident’s salary as opposed to a year as an attending physician worth it? The income always sounds good, but you are building the basis of your lifelong clinical practice style. Emergency Medicine is a field where expertise is needed in a large array of different specialties. Each applicant must ask themselves which program will provide them with enough training, skill and comfort to provide the best care possible to your patients and to limit medical errors.

"Is the Emergency Department operating under the Department of Emergency Medicine?"

Might sound like an obvious question, but some institutions do not have a Department of Emergency Medicine. In those instances, the ED operates under another specialty such as the Department of Surgery or Department of Medicine. In the latter, critical administrative decisions are made by people other than emergency physicians. Additionally, many resources may be scarce and must be shared with other programs / departments. At Good Samaritan, we are a fully accredited department with representation on the hospital’s medical board.

"What are the relationships with the other services?"

How well is the Emergency Department respected within the institution? Are there turf battles? Is there professionalism and respect between colleagues at both the attending and resident levels? Having full representation on the hospital’s medical board, our department is on equal footing with other departments and facilitates positive relationships and collegiality.

"What is it like to work in the emergency department?"

In general all ED’s are dynamic and exciting places. This is a great open-ended question as you may see some of the passion the people that you meet may have about the place in which they work.  You may also notice some of the controversial areas which are common in most  emergency departments.  The way in which the ED attempts to manage or corrects difficult situations can be most insightful. 

"Who has the final say when admitting patients?"

At Good Samaritan Hospital Medical Center, the ED has the final say.  At some institutions, if you decide a patient in the emergency department needs to be admitted, what happens then? Do you call someone from an in-patient service who comes to the emergency department, evaluates the patient, and maybe agrees or disagrees with your assessment.

"What is the relationship like between the residents?"

Your co-residents and interns become a very significant part of your life. If there is conflict and undue competition between the residents, this may be an environment that is not supportive and conducive to education. Residency involves a large commitment of time and hard work.  You need to be surrounded by people who interact well and are supportive of each other. During the day of your interview, you can get a feel for this. Often the best way is to do a rotation in the hospital to which you are considering.

"What is the relationship like between the attendings and the residents?"

One of the built in features of our program is to foster positive relationships between our residents and attendings.  These interactions include one on one mentor meetings, social events, and informal opportunities.  You should ask: Do they get along together? Do they have a good time together? Do they dislike each other? Are these the kinds of people that you are going to enjoy working with for four years?

"What is the workload like?"

Who makes the schedule, and is it fair and reasonable? Are you always so busy that you are completely exhausted and could not possibly have the time or energy to read? Is the patient load sufficient for you to develop procedural and clinical proficiency as an emergency physician?  At Good Samaritan we believe we have a comprehensive patient mix, with a reasonable workload, many interesting clinical cases but allowing enough time for academics and other interests. 

"Is there any support for you and your family?"

Residency is a full-time job and then some. No matter what field or institution you choose, you are going to spend a lot of time away from home. In our program we regularly organize special events where residents, their immediate families and / or significant others can participate. It gives a chance for the most important people in our lives to be included in our residency family. At Good Samaritan, we also foster relationships through regular individual resident meetings with a faculty mentor and Big Brother/Big Sister program, as well as general residency meetings where there is a forum to discuss issues which the residents would like addressed.