Medical Students, Advising, Match, Program Director Interviews

Program Director Interview Series: Paul DeKoning, MD | Dartmouth-Hitchcock Medical Center's Emergency Medicine Residency

Next up in our Program Director Interview Series is Paul DeKoning, MD, sharing details about the Dartmouth-Hitchcock Medical Center in New Hampshire. 

What sets your program apart from others?

We are an academic, tertiary, Level 1 Trauma Center in the middle of nowhere. I personally can’t think of a better place to live, train, and practice EM. At Dartmouth-Hitchcock, you will experience the full breadth of emergency medicine in a way you can’t anywhere else, from rural EM to specialized tertiary services and everything in between. You will spend the majority of your training at Dartmouth-Hitchcock Medical Center, situated in the wooded hills of Lebanon, New Hampshire. We are the state’s only Level 1 Trauma center and we serve an incredibly large catchment area that encompasses all of New Hampshire as well as parts of Vermont, Massachusetts, and Maine. You will experience inner-city Baltimore at Shock Trauma, community pediatric EM in Manchester, NH, and rural/community EM in Keene, NH, all while having the joy of living in the beautiful Upper Connecticut River Valley, where outdoor adventures await you right on the hospital property. Our patient acuity rivals that of any inner city: our Case Mix Index is the second highest in New England and in the top 5% nationally. Our admission rate and critical care rate is more than twice the national average. In addition, you have the opportunity to rotate at one of the many critical access hospitals that serve our referral network. You can do it all! Given the rural communities we serve, our vision is to change the face of emergency care in an entire region. The impact we are having is remarkable.

Additionally, this program prides itself on the close-knit family atmosphere that exists between residents and faculty. The greatest assets of this program—more than the training experiences, rotations, and other bells and whistles—are the people that comprise our resident and faculty bodies. They are truly amazing! This environment enables us to be highly-responsive to resident feedback in a continual drive towards curricular innovation and improvement. 

What are the benefits of attending a 3 vs. 4 year EM residency program?

I think it depends in part on what you want to be when you grow up and what your priorities are in the process. Our graduates practice in busy urban practice, academics, as well as more rural community settings. Our 3-year program has considerable flexibility that has enabled many of our graduates to launch into both academic and community careers. We have 2 elective blocks, which is relatively unusual for a 3-year program. This flexibility permits adjusting specific resident schedules in order to facilitate unique rotations that pave the way for fellowship training. Alternatively, residents can choose to rotate in Critical Access Hospitals in preparation for serving in rural areas after training. What do you want to do? We can help you get there.

What kinds of opportunities for research or social EM projects exist?

Depending on resident interest, opportunities exist for both traditional translational/lab research as well as bedside clinical research with faculty who excel in both realms.

Do you have opportunities to explore global health at your institution?

Yes. Many of our residents have used elective time to embark on international clinical experiences. Several of our faculty and graduates also have interests as well as connections in international and global health.

Can you describe any attributes and qualities that make applicants stand out?

The two most important things I look for in applicants, aside from the ability to do the work, are 1) wholeness and 2) a teachable spirit. In terms of wholeness, we champion the well-rounded clinician. If all you do is medicine, you won’t do it very well for very long and it is likely to end badly. You need to have stuff in your life that fills you up outside of medicine. It will actually make your medicine better. Yes, you still need to read, come to the conference, and study for the in-service. But, you need to be whole as well. Your patients (and loved ones) will thank you. Applicants who demonstrate a teachable spirit exhibit an internal drive to continually improve and learn from every opportunity. They are confident (without arrogance) in what they know but never assume they know it all. They view feedback and constructive criticism as amazing opportunities to humbly pursue greatness. Hard to describe, but like the color blue, I know it when I see it.

What is something students may not know about your program?

We have numerous faculty interests that fall under the umbrella of ‘Austere Medicine’ and we are in the process of developing an Austere Medicine Fellowship to join our EM Ultrasound Fellowship. Given our geographic location; faculty experiences in EMS, ultrasound, wilderness medicine, and search and rescue; a growing TeleHealth system; and other clinical and institutional resources, it just makes sense. Stay tuned!




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