Written By: David Jolley, MD, FAAP;
PEM Fellow PGY-5
August 5, 2014
Dr David Jolley authored an insightful and honest review of the program based on his 1st year fellowship experience. The review will highlight program strengths and shortcomings to guide future applicants attempting to narrow their search for the most compatible program based on their goals and interests.
What Makes UNM PEM Fellowship Unique
Pediatric Emergency Medicine is a Division of the Department of Emergency Medicine, NOT the Department of Pediatrics! This means we have a much closer relationship with the General Emergency Medicine Physicians than is typical for a PEM program! One of the biggest complaints I heard on the interview trail is that PEM fellows spend their adult months in an unfamiliar place with an unfamiliar system, working with unfamiliar attendings, taking care of low acuity patients.
Here you spend your adult months working side by side with people you work with on a regular basis in a system you know. You are put in a very active resuscitation bay as the only training physician (don't worry, you have an attending) taking care of high acuity adult patients. Those with heart attacks, strokes, sepsis, or trauma patients! You learn what the adult months are designed for: how to stabilize and ship a critically ill adult patient! And instead of being overwhelmed with this for four long months, your only full month is in your first year, followed by one shift a month for the next two years! We still have a good working relationship with the Department of Pediatrics which has all of the major subspecialties so you have access to pediatric expertise. We are included in the teaching of both the Pediatric residents and the general Emergency medicine residents and you work side by side with both groups and will get to know them well! Within the Department of Emergency Medicine there are amazing opportunities with Disaster Medicine, Emergency Medical Services, and Wilderness Medicine. These groups are housed within the same department (and building!) and if you have interest in these areas you can definitely get involved! Our EMS and Wilderness programs also have their own fellowships with educational opportunities galore!
I have kept data on all the procedures I've done or seen in the first year of my fellowship (these are all on real patients and do not include the simulated procedures like DPL, additional cricothyroidotomy's, and field amputations). Choose this link: Procedures 1st Year to view. Choose this link Diagnoses 1st Year to view the variety of patients I saw. Enjoy!
We do not have an active cardiac surgery or diverse transplant group. This means we don't see many heart surgery or transplant patients, so of you really like these, you will not see that many of them here. We get a handful of coarctation patients and kidney transplants, but without an active group these are few and far between. We also have very few sickle cell patients due to the elevation, but have an active hematology and oncology group. We also do not have a PICU fellowship, so the fellow experience for that month still needs significant work as we don't have a solid role there yet. The PICU experience here is currently pretty laid back without many high acuity surgeries, but plenty of severe medical and trauma patients and attendings who enjoy teaching.
As this is a young fellowship, the directorship actively listens and responds to the fellows with monthly meetings and has already added an excellent ultrasound and orthopedics rotations within the last year based on our requests! They have added a weekly curriculum at our recommendation, including assigning another faculty member specifically for this task. We have three simulation centers on campus which we use to teach the residents and are just starting simulation specifically for the PEM fellows. We get amazing experience in the Pediatric Emergency Department with a diverse group of patients with interesting patient problems.
We are an active Level 1 Trauma Center. You will notice we don’t have a trauma month in our curriculum. This is because we see these patients on a daily basis mixed in with all of our other patients. The most severe trauma patients we see in the Resuscitation Bay, a location just down the hall (no really, like 100 feet) from the 12 bed Pediatric ED, yet we have the capability for caring for them in the Pediatric ED if necessary.
We have plenty of opportunities for procedures. We do many procedural sedations, laceration repairs, and draining abscesses on a regular basis. I have done two chest tubes in the year I’ve been here and seen three more (real patients). I’ve seen a cricothyroidotomy (real patient) and done several myself in the simulation center. I was able to practice field amputations on cadavers in the anatomy lab during my EMS month, and I get to intubate on a regular basis.
In case you are interested, the department is also supportive of fellows who want to get a Masters of Science in Clinical and Translational Research at the University of New Mexico during their fellowship.
So while we're still experiencing some growing pains, the educational opportunities are great here at the University of New Mexico. I highly recommend that you consider this as a place of training!