In this month’s addition to the Program Director Interview Series, we got to chat with David Barnes, MD, to learn about the University of California Davis Emergency Medicine Residency. Dr. Barnes tells us more about residency in the beautiful Golden State.
What sets your program apart from others?
Truthfully, EM programs have more similarities than differences. We all share common curricular DNA, and the fact that most programs are in good standing with the Review Committee suggests that we all hold ourselves to very high standards. I’ve said for years that there are no bad EM programs, but there are definitely important differences in culture, experiences, and opportunities at each program that make some a better fit for certain applicants. I recently surveyed our residents about this very question. Overwhelmingly they indicated the culture, sense of community and family, the learning environment and exposure to high acuity patients, and our faculty as the best and most distinguishing features of our program. The sense of community and family here is palpable. Residents watch out for each other, support each other, help each other…they live, work, and play together. From watching each other’s dogs or kids, to camping and skiing, it really is a community. We have tremendous pathology at UCDMC and across our academic affiliates—medical, trauma, pediatrics, geriatrics, mental health—which allows our residents to develop a tremendously versatile skillset. We’re an integrated military (Air Force) program comprised of civilian and active duty Air Force residents. We train in 7 hospitals, 6 emergency departments, 5 health systems, and across 4 different EM practice models (academic, HMO, fee for service, and VA). Our residents learn from over 250 EM faculty and have access to care for over 500,000 patients each year (collectively across the 6 EDs). And the UCD EM faculty are amazing. They are world-class educators across the spectrum of EM practice and research, many fellowship-trained, all committed to mentoring, educating, and supporting our residents as they develop towards independence. That faculty retention is extremely high at UCD says so much about the health system support, department leadership, and culture.
What are the benefits of attending a 3 vs. 4 year EM residency program?
There are advantages and disadvantages to both formats, and more than once it’s been declared—unequivocally!—that the ideal program training length is 3.5 years. This debate goes back decades, and despite countless opinions, I’m not sure it’s ever been settled. We’ve always been 3 years. We graduate top-notch emergency physicians who go on to fellowship, community practice, or are deployed to active duty Air Force posts. They go on to become leaders in the specialty, leaders in their departments, medical directors, program directors, EMS medical directors, and more. Every program will tell you something similar though. In my opinion, the differences are mostly minor/subtle, and whether someone chooses to train in a 3- or 4-year model is mostly one of preference. In a 3-year model, there’s less time for electives and less time to explore some of the peripheral aspects of our specialty. Learners on a steeper part of the learning curve may perceive the pace of learning as too fast. A 3-year format allows for a time benefit for those aspiring to fellowship after residency, and there’s definitely a financial motivation to the 3-year model as residents start receiving full salary and benefits one year earlier while also having one less year of loan deferment or forbearance and the accumulating student loan interest. This will appeal to certain applicants. 4-year programs offer a way around some of the limitations of the 3-year format—more time for electives, more time to explore hidden curricula, more time to explore and even gain experience and preparation for fellowship—but it comes at a cost of more time, more loan interest, and delayed gratification.
What is something students may not know about your program?
A lot of our residents have tattoos. ;)
What range of USMLE/COMLEX Step 1 scores do you look for in an applicant for the program? Or alternatively, how do you feel about the change to pass/fail Step 1 grading?
I’m a bit mixed on this and look forward to seeing how the change plays out over the next few years. On one hand, I support holistic application review and we’ve incorporated holistic review principles into our selection process. There’s a tendency to use objective scores like step 1 to screen out applicants with no consideration for other strengths and attributes they may bring to a program. Just like no one is defined by a single attribute, quality, success, or mistake, using a single score from a single exam taken on a single day seems arbitrary at best and unfair at worst. On the other hand, the exam is a pretext for other objective assessments taken throughout one’s medical career, and programs have to have some assessment of a candidate’s basic medical knowledge. It may not be the best assessment, but it is a standardized and psychometrically validated one. So, we’ll see how the next few years go.
What kinds of opportunities for research exist? Do you look for residency candidates with research experience?
UC Davis Emergency Medicine is one of the top 5 NIH-funded Departments of EM in the country. Our faculty is comprised of world-class researchers who study everything from trauma to pediatric critical illness, stroke, intracranial bleeding, TXA, sex and gender disparities, troponin assays, violence and firearms, airway management, and more. Like all programs, our residents complete a scholarly project. With guidance from our Scholarly Project Oversight Committee, residents are mentored in any number of projects, including traditional IRB-approved research projects, for which they receive to support our research staff and our student EMRAP program.
Do you have opportunities to explore global health at your institution?
Yes! In addition to having a global health fellowship and four amazing GH faculty, we have a resident track called “Global Health Area of Distinction”. For interested residents, this optional curriculum runs concurrently through all 3 years of training. It is comprised of Global Health rounds (akin to journal club with a focus on GH issues), additional learning opportunities, opportunities to complete a global health elective experience in the PGY2 and PGY3 years, and a mentored Capstone project on a GH topic.
What are some qualities that your program looks for in applicants?
Our program aims fall into three domains: clinical skills, professionalism, and humanism. To those ends, we find that residents who excel in our program are not just clinically talented but also have outstanding interpersonal skills; are growth-oriented, humble, and compassionate; demonstrate outstanding leadership and teamwork skills; bring a strong work ethic; commit to problem solving; take their role as physicians seriously, but don’t take themselves too seriously; contribute to a larger community that is the residency family and Department of Emergency Medicine; and share a desire to advance patient care outcomes through the delivery of evidence-based, safe, effective, and equitable care.
Can you describe any attributes and qualities that make applicants stand out?
We look at each applicant holistically. Applicants who are well-balanced across all the different aspects of their application tend to bring the most to the table.