importance of trauma exposure during residency

[Mista Suprane]

i'm an MSIV applying for the match this year.

several of the programs i am seriously considering (cwru, uchicago, to name a couple) are not level I trauma centers. how important is this experience during residency? i know that i will be more likely to sleep through the night on call, but as someone who is specifically considering a CCM fellowship and/or a career in academia, how will the lack of experience in this realm impact my future goals, realizing that perhaps my best chance at a fellowship would be at the institution where i do my residency, and that a lot of ccm research is trauma related?

should i weigh this heavily, lightly, or not at all?

any help from other med students, residents, attendings is much appreciated.

thanks.

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[Noyac]

I'm not real sure how important it is for you but I was sure glad that I was at a level1 during my residency. Personally, I would choose a Level 1 program over one that was not.

You are not in a residency to sleep during your call nights, at least I wasn't.

 

[ZA_Gasman]

The bulk of our on call work is trauma related, as we are at a major Level 1 ATLS certified centre. There is a hell of a lot to be gained from managing massive trauma victims, from the point of view of damage control surgery, massive transfusion, triage, and postoperative management. We also, unsurprisingly do a brisk trade in relook laparotomies. On a weekend night, it is unusual not to have 2 theatres running major trauma for at least some part of the night. Trauma is like OB, we may not like it, but is is part of the job, and part of the learning experience, so seek it if you can.
Just my two cents

 

[usnavdoc]

i'm an MSIV applying for the match this year.

several of the programs i am seriously considering (cwru, uchicago, to name a couple) are not level I trauma centers. how important is this experience during residency? i know that i will be more likely to sleep through the night on call, but as someone who is specifically considering a CCM fellowship and/or a career in academia, how will the lack of experience in this realm impact my future goals, realizing that perhaps my best chance at a fellowship would be at the institution where i do my residency, and that a lot of ccm research is trauma related?

should i weigh this heavily, lightly, or not at all?

any help from other med students, residents, attendings is much appreciated.

thanks.

I also interviewed at a few programs that didnt have trauma. They would generally make excuses saying that you learn the principles through other means. But honestly what it boiled down to was this. What is the upside of chosing a program without trauma. There is none. I wouldnt even consider a program that didnt have trauma.

 

[Mista Suprane]

What is the upside of chosing a program without trauma. There is none. I wouldnt even consider a program that didnt have trauma.

i don't think there is an upside either. looks like a weakness in training. but it is interesting to note that some major academic training programs (supposedly preparing you for a career in academia), such as BWH, UChicago, CWRU, Columbia, do not have in-house trauma. perhaps they send you somewhere for a trauma month or two? is this enough? or do you need to have the ability to handle it at 2AM every time you are on call?

i'm just wondering what would help me along more as a budding academic anesthesiologist/CCM doc- a powerhouse academic program lacking in-house trauma, or a not-as-highly-regarded program with trauma - because unfortunately my interview invites are not full of too many programs with both.

 

[GasEmDee]

i don't think there is an upside either. looks like a weakness in training. but it is interesting to note that some major academic training programs (supposedly preparing you for a career in academia), such as BWH, UChicago, CWRU, Columbia, do not have in-house trauma. perhaps they send you somewhere for a trauma month or two? is this enough? or do you need to have the ability to handle it at 2AM every time you are on call?

i'm just wondering what would help me along more as a budding academic anesthesiologist/CCM doc- a powerhouse academic program lacking in-house trauma, or a not-as-highly-regarded program with trauma - because unfortunately my interview invites are not full of too many programs with both.

For an academic career, go with the powerhouse programs. You probably will get exposure to trauma at affiliated hospitals. Programs like BWH do not produce deficient anesthesiologists.

OTOH, doing residency at a big-name institution has several important benefits if you are interested in an academic career
1. contact with the big-name faculty in the field
2. exposure to cutting edge research
3. while brand name is not important in private practice, it is a somewhat important in academic careers.

Look into the details of each program and make sure to ask the respective program directors. I'd be amazed if there were no exposure to trauma, but if that were the case, i'd definitely pause and reconsider.


Good luck

 

[JP2005]

mista suprane...just come to hopkins for training

you'll be a SUPERSTAR

 

[iron]

One of last year's applicants pointed out the dichotomy of trauma or transplants. I went to one of the big academic names for residency but got little trauma experience. Even at our affiliated county hospital, not much was happening -- not enough motorcycles? ATVs? Guns? I did however do a dozen or so liver transplants during residency.

Now I am at Level 1 trauma center. I wish I had more trauma experience as a resident. Transplants were fun and demanding but the reality is you are more likely to need trauma experience than transplants. Even at transplant centers only 4 attendings or thereabouts are on the transplant team.

Go someplace you'll be happy and where you can be confident of your skills when you graduate.

 

[The_Sensei]

Trauma is just access, fluids, and blood products; no big deal. I didn't get much "trauma" experience per se as a resident and yet I am the greatest anesthesiologist currenly in practice!

 

[Noyac]

Trauma is just access, fluids, and blood products; no big deal. I didn't get much "trauma" experience per se as a resident and yet I am the greatest anesthesiologist currenly in practice!

Your Right

 

[militarymd]

My 2 cents on trauma....

1) get the tube in....
2) if you can't.....the trauma surgeon will do it for you
3) get venous access
4) if you can't....the trauma surgeon will do it for you
5) get invasive monitors
6) if you can't....the trauma surgeon will do it for you...or you just skip it
7) give plenty of volume (blood, fluid, etc.)
8) if you can't...the perfusionist running the RIS will do it for you.

More rewarding and challenging for me to see the patients in the unit after the OR.

 

[Noyac]

My 2 cents on trauma....

1) get the tube in....
2) if you can't.....the trauma surgeon will do it for you
3) get venous access
4) if you can't....the trauma surgeon will do it for you
5) get invasive monitors
6) if you can't....the trauma surgeon will do it for you...or you just skip it
7) give plenty of volume (blood, fluid, etc.)
8) if you can't...the perfusionist running the RIS will do it for you.

More rewarding and challenging for me to see the patients in the unit after the OR.

Damn Mil, you got some good trauma surgeons. Or at least they are the average. Me, I gotta do it myself. These guys aren't bad surgeons but I am better at getting access and airways by far.

 

[militarymd]

Damn Mil, you got some good trauma surgeons. Or at least they are the average. Me, I gotta do it myself. These guys aren't bad surgeons but I am better at getting access and airways by far.

I was referring to Trach's a la Baltimore Maryland's Shock Trauma routine.

And I'm pretty damn good at central access....but I gotta give it up...when you need a cut down.

 

[Noyac]

I was referring to Trach's a la Baltimore Maryland's Shock Trauma routine.

And I'm pretty damn good at central access....but I gotta give it up...when you need a cut down.

Yeah, I know you were talking about trach's and cut downs for that matter.

 

[Sammich81]

i don't think there is an upside either. looks like a weakness in training. but it is interesting to note that some major academic training programs (supposedly preparing you for a career in academia), such as BWH, UChicago, CWRU, ColumbiaQUOTE]

Mil, Noyac, all y'all...as people actually out there and evaluating fresh out of residency people, is CWRU a well-respected powerhouse?

I ask b/c I liked it there, but also really liked Pitt and well...I'm not sure if I liked MGH but it was sorta tempting for the name. They did a great job selling themselves...the feeling I got was (picture people beckoning with crooked fingers): "Join us. Join us. We will make you powerful. We will make you the best."

I just want to come out well-trained and marketable. With the boyfriend in Cleveland and marriage plans in the next year or two, however, would also like to not wind up divorced.

 

[Noyac]

i don't think there is an upside either. looks like a weakness in training. but it is interesting to note that some major academic training programs (supposedly preparing you for a career in academia), such as BWH, UChicago, CWRU, ColumbiaQUOTE]

Mil, Noyac, all y'all...as people actually out there and evaluating fresh out of residency people, is CWRU a well-respected powerhouse?

I ask b/c I liked it there, but also really liked Pitt and well...I'm not sure if I liked MGH but it was sorta tempting for the name. They did a great job selling themselves...the feeling I got was (picture people beckoning with crooked fingers): "Join us. Join us. We will make you powerful. We will make you the best."

I just want to come out well-trained and marketable. With the boyfriend in Cleveland and marriage plans in the next year or two, however, would also like to not wind up divorced.

It doesn't matter to me where you trained. What matters is your attitude, experience and skills. You wonder how we find out about these assets? Someone always knows someone that has worked with you. THis is a small community. Just about everyone we interviewed for our position we were able to check up on. These references, whether you are aware of them or not, weigh more than anything else.
Personally, if you want to be well trained, you need to go to a residency that doesn't have a **** load of fellows. I've said it b/4 and its true. Fellows take all the big cases. You need to finish residency being able to do everything from hearts to peds to trauma to OB to heads etc. YOu don't get this experience by watching fellows do these cases.

 

[Sammich81]

Personally, if you want to be well trained, you need to go to a residency that doesn't have a **** load of fellows. I've said it b/4 and its true. Fellows take all the big cases. You need to finish residency being able to do everything from hearts to peds to trauma to OB to heads etc. YOu don't get this experience by watching fellows do these cases.

What do you say to the programs (MGH, Pitt, CCF for example) who say--we have fellows but we do such high volume that it's ok?

vs somewhere like UVA, where there are no cards fellows so every single case goes the residents, although there are less of them.

 

[timtye78]

Here is what is important (In order):

1. match anesthesiology
2. complete residency unscathed
3. pass your boards
4. get a job
5. try not to get sued



I personally could not care less for trauma experience, and I do not plan on being somewhere with trauma when I am done.

....Am I dreaming? Here on OB anesthesia call, quiet pager....whats wrong?...

 

[Noyac]

Here is what is important (In order):

1. match anesthesiology
2. complete residency unscathed
3. pass your boards
4. get a job
5. try not to get sued



I personally could not care less for trauma experience, and I do not plan on being somewhere with trauma when I am done.

....Am I dreaming? Here on OB anesthesia call, quiet pager....whats wrong?...

I'll take trauma over OB any day. And it will be difficult to avoid trauma all together when you get out. Unless you are in a surgery center. There are always traumas in your area that will need to be stabilized before flying them off to the Level 1 center. Personally, I enjoy trauma surgery just not at 4am when most of them occur.

 

[iron]

"was referring to Trach's a la Baltimore Maryland's Shock Trauma routine"

One of our trauma surgeons trained at Shock Trauma. He's not very good. As in, dangerous. No one, including other surgeons, has respect for his skills. You can't depend upon surgeons to do everything. Know who you're working with.

 

[Noyac]

What do you say to the programs (MGH, Pitt, CCF for example) who say--we have fellows but we do such high volume that it's ok?

vs somewhere like UVA, where there are no cards fellows so every single case goes the residents, although there are less of them.

Thats hard to say if it is really the case. I would ask to see the numbers of cases the residents actually get and choose the program that gets the greatest numbers. Don't let them fool you in saying that the presence of fellows leads to better training. THats BS.

 

[Mista Suprane]

thank you all for your help...

BTW, I was told that BWH is a level 1 trauma center, just so no one reading this is misled.

Mil, Noyac, all y'all...as people actually out there and evaluating fresh out of residency people, is CWRU a well-respected powerhouse?

I would also like to know what people think about this, specifically for a person trying to get a position at a university...

 

[cchoukal]

I'm at the University of Chicago, one of the aforementioned non-trauma programs. We are, however, a level-1 center for peds trauma, but I don't know how much we really get. As mentioned, we DO advertise that "trauma experience can be gained in other types of cases." We do a fair number of emergent AAAs and liver transplants (seems like a couple per week), which cover a lot of the same issues as trauma management. In the past (not sure about now), we offered a trauma elective at Cook, one of the region's busiest trauma centers, but to be fair, the resident was on the trauma service (responsible for initial stabilization and on-going management), not performing the operative anesthesia.

You'd probably get a lot more trauma exposure if you matched at Cook, but it's kind of a dump program. Is it rare to have a program that is heavily oriented toward research AND offers a robust trauma experience? Not sure. My recollection was the UCSF, which probably publishes more anesthesia research than anyone in the country, gets a lot of trauma (at SF General). There may be others.