In the latest installment of our PD Q&A series, we are highlighting the Stanford Emergency Medicine Residency program. We spoke with the current PD Dr. Sara M. Krzyzaniak about what makes their program unique and what they look for in potential residents.
What sets your program apart from others?
I would say the two primary things that distinguish our program are the clinical experience and ability to develop a niche within EM.
Clinical: We pride ourselves on training clinically excellent physicians, and we do this through several ways. We have three sites where our residents rotate to expose them to the breadth of EM: Academic, County, and Community. Our primary training site, Stanford Healthcare, serves a very diverse population from both a socioeconomic as well as ethnic/cultural standpoint. We are fortunate to have very supportive ancillary services to support the needs of our population, from 24/7 social work/case management to a Substance Use Navigator. Our residents also get a robust exposure to Critical Care including during the newly-added 2-week CVICU rotation. On this rotation, residents manage patients on ECMO and become very facile in complex cardiopulmonary physiology. Finally, we integrate the residents’ shifts at our Pediatric ED and County sites so that there is longitudinal exposure to both of these clinical sites.
Niche Development: We pride ourselves on helping residents identify and develop a passion within EM, and we know that having a niche is a solid strategy for preventing burnout. Some of our residents develop a clinical niche (e.g. Critical Care) while others develop a non-clinical niche (e.g. Social EM, Research, Innovation). We are able to support residents in developing their niche through extensive elective time starting in their intern year, financial support for away electives, and robust mentorship from our experienced faculty.
What are the benefits of attending a 3 vs. 4 -year EM residency program?
I trained at a 4-year program and then was faculty at a 3-year residency program for 8 years before becoming PD at Stanford’s 4-year program, so I’m well-acquainted with the challenges and opportunities of each format. We know that residents are making a commitment when they join a 4-year program, and we in turn are committed to ensuring that extra time is high yield. It gives us an opportunity to spread out our 22 weeks of elective for longitudinal niche development and support academic interests and career exploration opportunities. We also are able to really lean into the graduated responsibility model so that by the fourth year, our residents are supervising 3-4 learners at a time and overseeing up to 28 active patients. This prepares them to step into a busy clinical practice where they are the supervising attending for a team of doctors, nurses, and advanced practice providers. Finally, we know that EM is increasingly complex, and our specialty looks very different than it did when it first became a specialty in 1979. EM physicians must be adept in managing new technologies, novel treatment strategies, and caring for a more complex patient population whose needs extend beyond just their initial medical concerns. The four-year model allows residents to further develop their skills and become even more proficient doctors.
What is something students may not know about your program?
One thing that surprises people is just how diverse our patient population is. We draw patients from all over the Bay and Northern California (20% of the patients admitted from our ED come from >50 miles away!); 63% of our patients are Hispanic, Asian, or Black; and over 150 languages are spoken in our patient population. We have a large Spanish-speaking population and are fortunate to have 24/7 Spanish interpreters dedicated to our Pediatric and Adult EDs. Many of our patients experience food and housing insecurity, and we do a lot of work on shift to ensure we are helping patients meet their basic needs. Our Social EM group works closely with our Substance Use Navigators to ensure our patients with substance use disorders are connected with community resources, and we are able to initiate medication-assisted treatment in the ED for many patients.
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?
We recognize that standardized tests do not accurately reflect student or physician performance, and we do not use score cut-offs in screening applications.
What kinds of opportunities for research exist? Do you look for residency candidates with research experience?
There is no shortage of research opportunities at our program! We have 13 unique fellowships with faculty to support scholarly projects along with countless other faculty areas of expertise. Just a few examples of recent resident research are high altitude research in the peaks of Nepal, strategies to connect patients with primary care, and using artificial intelligence to predict the need for organ support in patients admitted to the ICU from the ED. Competitive applicants will have some amount of research experience. It does not necessarily need to be within EM, but we like to see that an applicant understands the scholarly process.
Do you have opportunities to explore global health at your institution?
We have robust global health fellowship and faculty who support residents to use their away elective time during their four years. In the past 2 years, we’ve had residents complete electives in Rwanda, Namibia, South Africa, Costa Rica, Peru, and Nepal. Our Global Health faculty have strong relationships not only with other departments at Stanford but also internationally to support multi-disciplinary and multi-institutional endeavors which opens a lot of doors for our residents.
What are some qualities that your program looks for in applicants?
We take a holistic approach in reviewing applications, which for our program means that we read every application from start to finish. We want to recruit a class with diverse backgrounds and interests, so there is not a one-size-fits-all framework for a Stanford EM resident. In general, we look for residents who will come to our program and engage in the myriad opportunities that are available, which means finding applicants who are excited to develop a niche in EM. Sometimes applicants have a clear vision for what their ultimate career will be, while others come in as a “pluripotent stem cell” and are excited to explore several pathways before honing in on their niche.
Can you describe any attributes and qualities that make applicants stand out?
We understand that applicants take many different journeys on their way to residency. One thing that always stands out is excellence, whether it is in academics, sports, music, advocacy, or a prior career. We know that anyone who achieves excellence in one aspect of their life can apply that same commitment to excellence to their training and become a successful physician. Beyond excellence, we look for applicants who share our department values of leadership, innovation, diversity, discovery, and service.