Jake Freudenberger, MSIII, University of North Texas Health Science Center - Texas College of Osteopathic Medicine
EMRA MSC Southwest 1 Regional Representative
This month our Program Director Interview Series turns to the West. We spoke with Ryan Kirby, MD, Program Director at John Peter Smith Hospital (JPS) in Fort Worth, Texas, about what’s on offer in the Lone Star State.
What sets your program apart from others?
I truly believe that there are not any bad programs out there. The ACGME ensures through accreditation that you can become board eligible and have the skills to practice by graduating from any EM program. When you begin to look at what sets programs apart, I think the applicant needs to have insight into what type of learner they are and in what type of environment they will thrive. Our program combines repetition, exposure, and pathology in a way to challenge residents at each stage of their training. The volume at JPS exceeds 125,000 annually with EM residents actively managing all types of patients, both medical and those that need our Level 1 trauma capabilities. Due to our location and the population we serve, the residents get exposed to a wide variety of pathology and disease.
What are the benefits of attending a three- vs. four-year EM residency program?
EM residency is a challenge at any length. The constant evolution of medicine and the expanded duties of an emergency physician offer lifelong learners the opportunity to develop their practice over time. Training in a three- or four-year format is truly a personal choice. There are definitely pros and cons to each. Knowing what you ultimately would like to do upon completion of training may help guide that decision. If you have an academic interest or would like to take advantage of some of the specialty tracks offered in EM, a four-year program is likely a good fit. Having completed a four-year program myself, I personally believe the sweet spot is somewhere around 3.5 years. Now leading a three-year program, I encourage the residents to take ownership of their area of responsibility earlier in training and start developing an understanding of departmental flow and resource management.
What is something students may not know about your program?
I think we continually hear that JPS is “new.” The program actually gained accreditation in 2009. I think we have recently done a better job of having a presence in regional and national events.
What range of USMLE/COMLEX Step 1 scores do you look for in an applicant for the program?
We typically look at the data that is available every year from the National Residency Matching Program (NRMP) that shows average scores of candidates who matched into EM. This helps guide our expectations and ensures we are aligned with the competitiveness of the specialty.
What kinds of opportunities for research exist? Do you look for residency candidates with research experience?
Our research opportunities exist in the context of translational research. We are part of a larger network that allows us to have access to over one million ED visits annually. Each year, our residents and faculty participate in abstracts at SAEM, ACEP, and the Texas College of Emergency Physicians (TCEP) conferences. We were fortunate to have multiple publications accepted last year. The ability to do bench work is limited, but we have partnerships with the University of North Texas Health Science Center and Texas Christian University if that is of interest. Regarding candidate experience, it helps that students have exposure to research prior to matriculation but it is not a requirement.
Do you have opportunities to explore global health at your institution?
We looked specifically at this question a year or so ago and had to decide what we wanted as a program. My belief is that true global health opportunities come in the form of a sustained presence within a region that upon completion leaves the infrastructure, knowledge, and ability to continue without external support. I felt as though many global health initiatives are truly probably better characterized as medical tourism. To be genuine in our efforts, we do not have the size or total number of residents interested to undertake a sustained global health mission at this time. This is something I’d like to explore, perhaps joining with another program in the future. Currently, we have international and rural rotations that are in place in Hawaii and developing in Africa and Australia. These will give residents the opportunity to observe and practice international medicine.
What are some qualities that your program looks for in applicants?
I think our program is looking for the “teachable” student, like every other program. In practice, that often translates into the student who is humble and hungry for knowledge. So many of the skills that you need to be successful as an emergency physician are derived from your ability to communicate and relate to your patients. I think one of the best quotes I’ve heard is that “Nobody cares how much you know until they know how much you care.” The applicant pool for EM continues to increase, with all applicants having a fairly high degree of academic success. What really sets people apart is their interest in doing more with their time in residency and recognizing that these three years will be the foundation for a career of service.
Can you describe any attributes and qualities that make applicants stand out?
I think most applicants get mixed advice on what to put on their ERAS application. I know we enjoy seeing previous work experience. Transitioning to residency from being a full-time medical student can be challenging. This can sometimes be a person’s first “real” job. Entering the workforce in an apprentice-type capacity can be a learning curve. Having prior job experience can be a plus. Additionally, jobs that involve customer service or interacting with people demonstrate some of the skills we mentioned above.