Program Highlight: Arrowhead Regional

Q+A with Dr. Carol Lee, EM Program Director at Arrowhead Regional Medical Center

Interviewer: Cynthis Wong (CUSM)

Accessible Text Version

What is the one thing that you would like students to know about your program?

One of the common misconceptions about our program is our location. People think we’re up in Lake Arrowhead, but we’re actually in San Bernardino County Medical Center. We’re close to Riverside county, LA county, and Orange county. ⅓ of our residents live in Riverside county, ⅓ in Orange county, and ⅓ in San Bernardino county. We’re accessible and closer to LA county than people recognize. We’re relatively new to ACGME, as we were accredited with them about 3 years ago, but have been an established residency since 2004. We’re also now participating in VSAS starting this month and will welcome people to come and rotate with us to see the program for themselves! Last but not least, we have a total of 32 residents.

What sets your program apart from others?

ARMC, being a county hospital, has a very high patient volume and acuity (>100,000 visits), without a lot of other competition from other in-house residency programs. For example, there is no anesthesia residency program, so our trainees do all our airway procedures. Furthermore, ARMC’s trauma volume is high due to the size of San Bernardino county and there aren’t many other local trauma centers besides Loma Linda. Our program is also differentiated by the relationship our residents have with other departments. Our residents are very independent and capable in terms of how they work within the ED, and trauma surgeons are heavily dependent on our EM residents. Our residents also work closely and are in good relationships with multiple teams within the hospital, particularly IM residents, and anesthesia attendings, leading to further enhancement of training. Lastly, there are only six residency programs in the hospital, meaning you get a lot of one on one attention and patient experience. We also have our own EMS fellowship. EM residents rotate through every service and know everyone with the hospital including NICU.

What are you most proud of in your residents & program?

We are proud to train amazingly well prepared and competent residents. Medical directors frequently call with positive feedback regarding our residents and for future recruitment as they had a great experience with prior residents. Furthermore, our residents learn how to handle pretty much everything, ranging from pediatric cases to running a full blown code. Our residents learn how to run the show when they come here.

How would you describe the culture amongst your residents, faculty, and program as a whole?

We’re very lucky to have an amazing group of residents that work well together, are supportive of their PD, and are always willing to volunteer when needed and help out. Every interview season, I have a surplus of people willing to get involved and do interviews, host tours, etc. It’s just one of the many instances that the residents show that they’re always willing to help, within the hospital, and outside their hospital duties.

What is the general breakdown of practice environments (academic, community, county) at your program?

Most of the residency takes place at ARMC’s emergency department, which is a county environment, but our residents have the option to rotate at different areas for other experiences. For example, our residents can rotate at Loma Linda for pediatric EM, Riverside county for anesthesia, and other community hospitals for community medicine experience. They are multiple electives available as well. We even had one fourth year resident who went to Dubai for a rotation. There is a possibility to do research, ultrasound, EMS, or critical care training as well as other electives.

What do you find are the benefits for your residents in the timeline of your program (3 vs 4 year)?

Our program is a four year program. The first 2 years of our program is all clinical. But the benefit of an extra year is having extra time to do research, electives, and having better training which leads to better job opportunities. Our residents come out highly respected and recruited because they are able to devote the extra time to being truly prepared for their field after residency.

Do you anticipate any future plans/changes in the program within the next couple of years?

As an institution, ARMC is continually looking to expand and develop its programs. We recently opened a new medical school, California University of Science and Medicine, and are excited to have new third year students coming in. We’re also looking into opening up a cardiothoracic program in the near future, and expanding the ED by 50 beds. Lastly, we are moving towards becoming a level 1 trauma center, applying to become a higher level stroke center, and opening an adolescent psychiatry program.

What opportunities to explore fellowships do you have at your institution?

Being an ACGME accredited residency, our graduates can go on to any fellowship they choose including pediatrics, toxicology, and EMS. We have EMS and U/S trained faculty at our institution.

What kinds of opportunities for research exist?

We have a very active research department, with one of our faculty being a leader of the research and grants office. The EM department works closely with the trauma team for research projects. For our residents, our requirement is scholarly activity, which doesn’t necessarily mean desk or clinical research, but something that broadcasts knowledge beyond department. For example, our residents can do patient safety projects, grand rounds, etc. based on their interest.

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[Included in our O4 newsletter. Editor: Tiffany Fan]