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Hey all, As there seems to be a lot of growing interest in EM PA residencies across the country, I just thought I'd start this to (hopefully) offer answers to any burning questions you guys have about EM residency in general or at Iowa in particular. Ask away! I'll edit this initial post to include all Q&A to make it easier on the reader. Who I am: Year-1 EM PA resident at the University of Iowa Hospitals and Clinics (UIHC); Graduated from South University - Tampa C/O 2015; formerly trained as EMT, paramedic. ***Obligatory disclaimer: I do not represent UIHC, nor the EM PA residency program there, nor any other part of the institution of the University of Iowa in any other capacity than as a resident learner and medical provider in the Emergency Treatment Center. All answers are based on my current knowledge, personal opinion, and/or cited references.*** Why did you choose this particular program? There's lots to love about the residency experience here: PAs are on equal footing with medical residents, the "your patient, your procedure" policy, high availability of attending faculty during your shifts, the well-organized administration, variety of electives (and option to create your own)... there's much more. However, far and away the thing that impressed me the most was the amazing faculty. It was apparent from my interview day onward... Easygoing, personable, humble, reasonable people; only ever as serious as they need to be; will often go out of their way to drop some knowledge on you. They inspire respect not out of fear or intimidation, but by their scope of knowledge and willingness to teach. Large egos are not in fashion here. Everyone is known by their first name or nickname. Since I've started, I realized this mentality has trickled down to the R2s and R3s as well; everyone is willing to help out. Other than that, moving to a small Midwest town has always been on my bucket list for some reason. Iowa City is a great little town too; full of great culture for its size, but small enough that I walk/bike to work every day. I probably couldn't have picked a better time either, with Hawkeyes having had a blowout season and the Iowa Caususes soon, I feel like I'm getting the quintessential Midwest experience. Do you feel you get enough slit lamps, chest tubes, intubations, ect. without having several off service rotations? I know procedures is the big question; personally I feel like I'm off to an adequate start after 3 blocks in the ED, and just now starting to get confidence in picking up patients that need these procedures. Also keep in mind this is (mostly rural) Iowa, and you're not going to see GSWs or similar trauma every night like you would in Baltimore or Philadelphia, although a good amount of MVCs. That said, each resident's mileage will vary; if you're procedure-hungry, you could probably expect to increase your numbers up to about 30% over mine (total guesstimate). So here's some numbers, keeping in mind this is a new PA grad, with 12 weeks in the ED so far, where I was the Primary on the procedure: 4 LPs, 4 paracenteses, 1 chest tube, 1 US-guided central line (fem), 0 intubations, 4 dental blocks, countless peripheral nerve blocks... and i haven't logged slit lamps but i'd say probably 5-6; I could have been doing many more slitlamps if I wanted. There's a dedicated ophtho room with slit-lamp setup here, and if you want to pick up all the ophtho patients for a night I don't think anyone would fight you for it. One thing definitely worth mentioning that often gets overlooked, we have 2 or 3 portable ultrasounds for bedside studies available 24/7, with linear, curvilinear, and cardiac probes attached. If you ever want to play around with ultrasound it's there. We use it all the time for peripheral IVs on tough sticks, checking for abscess/pockets, FAST exams... even some fancy nerve blocks. As cool as it is to poke prod and cut a patient, sometimes I feel that as a PA, the highest-yield learning during this residency won't be the procedures but my proficiency with ultrasound. But again, your mileage may vary. How is housing near the hospital? Housing nearby to the hospital is great, from what I hear. I actually live on the other side of the river in downtown Iowa City (which wouldn't be my first choice for a family) but there are many available houses for rent in the University Heights area that I think would work well for a family (and it's closer to the hospital too). Are they pretty bias about picking Iowa grass or would a person with FM/military medicine experience be given a good shot? I think any great candidate is given a good shot. That being said, Iowa has a fantastic PA program, and most of the residency applicants are graduates from there, so if you look at the numbers it may appear that they're heavily favored. However, I didn't graduate from there and I got in, and I didn't have to beg. Two of the three initial acceptance offers given for the latest class were to out-of-state candidates, one of those being a military-trained PA. So I would say everything considered, there's not a perceptible selection bias. What's your biggest dislike of the program? Honestly, I can't think of anything I dislike that would be particular to this program; I feel that any dislikes would be common to most if not all programs. I really tried to come up with something and I've started writing several different things here but erased them, because they didn't seem like they were real problems. Mostly just annoyances, ones likely to be encountered anywhere, and largely an issue that is outside the program's or ED's control. But if you want to know the ups and downs of something in particular I can try to help. Do you think that NOT being from an EM background hinders someone's chances? Hinders vs a candidate that has an EM background? I have to say yes; at a minimum, an EM background shows a proven interest and ability to handle the particular stresses that come with EM. I wouldn't let that stop me from applying though; I would just go wild on my EM rotations in PA school and do as much as possible there, and make sure to mention it during the interview. What's the hour work week look like - Any time for picking up additional shifts for supplemental income? During your ED blocks (which are the vast majority) you have about 45 hours (5 shifts x 9 hours) of scheduled work hours. However, amount of shifts can vary from week to week. Shift times also vary, from morning to day to overnight. Scheduling for the most part always puts your next shift equal or later in the day than your last, which is helpful. Also, it's rare to always have all documentation done before your shift ends. I'd say I work at least 1 additional hour per shift, often several hours if it's been a rough day. I finish my documentation before shift ends maybe 10% of the time. I will say I'm not the fastest documenter, but in general I would probably my numbers are a safe estimate. UIHC doesn't allow PA residents to pick up ad-hoc shifts as regularly employed PAs, at least last time I checked. I believe working at an outside facility is possible with permission, but don't quote me on that. How's the whole interview process, structure, day like? Similar to PA school. Morning presentations by faculty and administration, a tour of the ED, the resident's lounge and offices. Four or five 10-minute interviews by current faculty, then lunch. I will say one big difference between PA school and residency interviews is it's much more of a two-way interview, with them selling the program to you and you selling yourself as a candidate. I imagine PA school is so competitive that those adcoms don't see the need to do that. Did you apply w/o PANCE scores (or contingent on completing it correct?) Correct. I applied without having taken the PANCE, and even got my offer before I had my scores back. I'm not sure if having scores in-hand (or exceptional scores) is a factor in the selection process, but I'm anecdotal proof that they aren't required. But of course my acceptance was ultimately dependent on passing. (Continued below....)
Heyoo, I'm now into my 5th month in emergency medicine fresh out of school and there's one thing (among many) that my brain's not quite clicking on. When is it appropriate to have a patient sign out AMA versus just documenting the pros and cons of certain testing/treatments and discharging them to home. If you have a patient on coumadin sustain minor head injury and they refuse a CT scan, would you sign this patient out AMA or just document that you had a discussion at length regarding the importance of imaging and potential consequences of not getting a CT (disability/death)?? What about an elderly patient with multiple comorbidities with classic presentation of MI who's refusing all testing? Thanks for any clarification