Christopher Fee, MD, Program Director of University of California San Francisco (UCSF)-Zuckerberg San Francisco General Hospital (SFGH) Emergency Medicine Residency Program, spoke with the EMRA Medical Student Council about applying for EM residencies and opportunities at the UCSF residency program. Read on for Dr. Fee's insights on the residency culture and highlights of the residency.
What sets your program apart from others?
Our program provides trainees with a wonderful diversity of training sites and patient populations spanning the multicultural, underserved, and trauma patients at SFGH, a mix of community and tertiary care patients at UCSF, and a range of community and tertiary pediatric patients at UCSF-Benioff Children's Hospital San Francisco. Our weekly didactics are developed with the learner in mind and maximize interactive small group discussions, brief targeted lectures, flipped classroom models, high- and low-def simulation sessions, cadaver labs, and independent interactive instruction. Our faculty have a broad array of expertise, including experience as editors of major EM journals, nationally recognized education leaders, well-funded and well-published health services and clinical researchers, leaders in global health, and dedicated bedside educators. While the UCSF/SFGH Emergency Medicine residency program began in 2008, the Department of Emergency Medicine has been training visiting emergency medicine residents for decades at both UCSF and SFGH.
What are the benefits of attending a 3- vs. 4-year EM residency program?
This is a very personal decision on the part of the applicant. My personal belief is that there is no "best" residency program, though there is a best for each individual applicant. As a general rule, 4-year programs allow trainees to take advantage of additional elective time to explore areas of interest to attain additional career development or shore up comfort/skills in perceived areas of deficiency. Many 4-year programs have developed longitudinal tracks within their curriculum that allow their residents to gain more expertise in a subspecialty area within emergency medicine.
We have such a track structure, and the tracks are called Areas of Distinction (AOD). Each of our residents must participate does so beginning in their R2 year (after sampling the various tracks as interns to see what they are all about). The AODs provide a framework for imparting didactic material, mentorship, and ultimately a scholarly project. Currently we have 7 AODs:
- EMS & Disaster Medicine
- Health & Society
- Medical Education
- Medical Toxicology
- Pediatric Emergency Medicine
- Research
- Ultrasound
What is something that students may not know about your program?
In addition to the AOD structure, there are several other features of our program of which students may not be aware.
Facilities: Over the past couple of years, we have opened 2 new hospitals and a Clinical Decision Unit. We have an entirely new medical center at UCSF Mission Bay, which includes the UCSF-Benioff Children's Hospital San Francisco with the only stand-alone Pediatric Emergency Department in San Francisco. A new hospital was built to replace the aging San Francisco General Hospital, now known as Zuckerberg San Francisco General (ZSFG). The new ED occupying four times the square footage of the old ED. The ZSFG ED is the only Trauma Center (Level I) in the City and County of San Francisco. A highly functional Clinical Decision Unit (CDU) at the UCSF ED run by EM that has helped to reduce crowding, unnecessary admissions, and improve our ability to provide patient centered care.
Resident Opportunities: Resident interested in advocacy can opt to participate in the ZSFG Training and Education Program for Underserved Populations (STEP-UP), a cross-residency collaborative that aims to improved training in care for vulnerable populations. Also, we have a very active and engaged Residency Diversity Committee committed to enhancing diversity within our program as well as in EM and medicine more broadly. At the national level, our residents and faculty have received numerous recognitions: 2017 EMRA Residency of the Year, 3-peat Sim Wars champions, ACEP National Emergency Medicine Junior Faculty Teaching Award, among others.
Fellowship Programs: We have multiple fellowship programs which enhance the training of our residents:
- EMS & Disaster Medicine
- Global Health
- Medical Education
- Medical Toxicology
- Pediatric Emergency Medicine
- Research
- Ultrasound
What range of USMLE/COMLEX Step 1 scores do you look for in an applicant for the program?
We do not use Step 1 scores to screen applicants for interviews, nor do we have minimum Step 1 scores under which an applicant would have little chance to match with us. We recognize Step 1 scores for what they are: a predictor of future performance on multiple choice tests (though the reality is that after you complete your residency training, you will have to take the ABEM Qualifying Exam as part of the board certification process, so test taking can't be entirely ignored). Rather, we use a holistic approach when reviewing every applicant. If an applicant had a poor performance on Step 1, but was otherwise a stellar student with a clear track record of leadership and professionalism, we will be interested. For example, we have matched residents who failed Step 1 who are among the best physicians and human beings that I know. However, if an applicant performed poorly on Step 1 and has other areas of concern (failed pre-clinical courses or trouble on clinical rotations, lapses in professionalism, etc), we are unlikely to invite them for an interview.
What kinds of opportunities for research exist? Do you look for residency candidates with research experience?
We don't specifically look for applicants with research experience any more than any other aspect of an applicant's file. Those with research experience should be prepared to discuss their role and what they learned through the process if they interview with us. Within our residency and institution, there are numerous opportunities for research. As noted above, all of our residents participate in our Areas of Distinction program and will participate in a scholarly project which may take the form of a research project. We are fortunate to have several faculty with successful research careers and experience in mentoring trainees, including within the domains of health services research, clinical decision rules, education scholarship, EMS, neurologic emergencies, pediatric EM, etc. Examples of resident projects over the past several years can be found here (http://emergency.ucsf.edu/content/areas-distinction). Residents may pursue additional elective research training through the UCSF Clinical and Translational Research (CTR) Pathway (http://meded.ucsf.edu/ctr).
Do you have opportunities to explore global health at your institution?
Our faculty recognize both the educational value to our residents and also the reciprocal value to both our Department and those sites that our residents, faculty, nurses, and pharmacists of global health opportunities. We have several current affiliations in place, including in Tanzania, Chiapas (Mexico), Saipan, and are working on others. We encourage our residents to participate in these opportunities (if they are interested) and guarantee each resident up to 4 weeks during their training. This limitation is related to the financial reality that resident salary and benefits are not covered when a resident spends time away from their primary training sites. Our faculty have generously set aside professional fees to support resident salary and benefits during these rotations. For those residents who wish to pursue further career development in global health to reduce "health inequities and disparities in populations throughout the world," UCSF offers training through the Global Health Pathways Program.
What are some qualities that your program looks for in applicants?
We look for applicants who are well-rounded and have a track record of leadership. It is our hope and intention to nurture our trainees throughout their residency, provide mentorship and opportunities for development, and provide EM and multidisciplinary connections for them to broaden their perspectives and influence. We want our graduates to continue to be leaders after they leave their training, whether in academia (research, education, policy), within their community practice, or within their community at large through engagement and advocacy.
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