In this month’s addition to the Program Director Interview Series we got to chat with Jordan Spector, MD to learn about the BMC EM Residency Program. Dr. Spector tells us more about residency in New England.
What sets your program apart from others?
Boston Medical Center (BMC) hosts a 4-year training program in emergency medicine, the first EM training program in New England. Our hospital and our ED serve a diverse, multicultural population that otherwise has limited access to health services and is a ‘county-style’ ED affiliated with a large tertiary (and in some cases, a quaternary) medical center. As such, our residents get the experience of managing a busy, high acuity ED within the infrastructure and alongside the expertise that only a large, academic medical center can provide. Training in the busiest Level I trauma center in New England, our EM residents supervise the care of every trauma and critical care patient that presents to our ED. Utilizing a graduated model of responsibility across training, our residents can master EM core content and develop their skills in code leadership and multi-patient management, all of which we see as imperative for independent practice in our specialty. Along with the excellent clinical training, every member of our team seeks to identify, articulate, and address the social determinants of health, with a consistent effort to address health equity on behalf of every single patient in our ED, every single day.
What are the benefits of attending a 3 vs. 4 year EM residency program?
There are many outstanding EM training programs in the US, both of the 4- and 3-year variety. Our four-year curriculum provides space and breadth to learn in a number of different care-venues, from our own ‘safety net’ ED to a number of community ED affiliates serving different populations (with different patterns of pathology), as well as rotations in a number of critical care units, and two separate pediatric EDs (BMC and Boston Children’s Hospital). Ultimately though, I don’t think it’s accurate to think of a four-year program as simply a ‘three-year model with an extra year’. Through a variety of curricular provisions and across the 5 months of elective time we offer, the BMC EM residents have opportunities to explore academic interests, to work on longitudinal projects, and to attend and give presentations at regional & national meetings. For those interested in a career in academics, the four years at BMC provides excellent preparation, and we send graduates every year to competitive fellowship and faculty positions all around the country.
What is something students may not know about your program?
Boston Medical Center is the successor to the old Boston City Hospital. Boston City was the first municipal hospital opened in the United States, back in 1864. As the country’s first hospital built specifically for the care of under-resourced and vulnerable communities, our original charter and institutional mission has been to address and improve health equity for all of our patients, for over a century. In the ED, we have had a number of unique programs, established decades ago, programs that provide unique personalized services to our patients suffering from substance use disorder(s) and/or experiencing homelessness, as well as programs to connect-with and treat our patients suffering traumatic injuries, utilizing a trauma-informed model. As applicants seek out programs truly dedicated to the work of health equity and social justice, they should note that BMC has been working within this space, tackling these challenging issues for generations. And we are constantly examining our own curriculum and systems and practices in the direction of equity and justice.
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?
Our program has not historically placed much emphasis on standardized test scores amongst our applicants, as we are keenly aware of the literature that demonstrates such practice may perpetuate inequity and hinder diversity. The USMLE Step 1 change to pass/fail will have negligible impact on our process, frankly. This year, as every year, we will continue to use our holistic application review process to identify those candidates who have done the work or espouse the ideals that align with our program’s stated values of; 1) commitment to mission, 2) resilience in the face of challenges, 3) growth mindset, and 4) ability to assimilate into our team.
What kinds of opportunities for research exist? Do you look for residency candidates with research experience?
The mission of our residency program has always been to provide some of the best clinical training in the country. But we have worked for many generations to offer opportunities for a variety of scholarly skills as well. We have a nice infrastructure for those residents interested in research, with a number of research associates and assistants on staff, as well as biostatistician support. Our residents have historically done a great deal of research in population health, point of care US, medical education, and global health. In recent years, our current array of faculty and residents have focused a great deal on issues related to diversity and inclusivity, with ongoing efforts to examine our own clinical and administrative practices, through the lens of antiracism. Any scan through our recent graduates and faculty will demonstrate we’ve produced a number of grant-funded researchers as well as national committee chairs and leads.
Do you have opportunities to explore global health at your institution?
Many EM residents at BMC have an interest in Global Health, and we have sent a number of our residency graduates off to global health fellowships after completing their residency training in recent years. Historically, members of our faculty have helped organize and supervise a few annual programs that provide international opportunity for residents to get involved in an extant project. But we also have had many residents who cultivate their own project, who bring some expertise prior to their time in residency and continue those global relationships, during their elective months and such. The opportunities to pursue international opportunities were unfortunately limited during the COVID-19 pandemic, but I am pleased to relay that our institution has just announced that international work will be made possible once again in the coming months!
What are some qualities that your program looks for in applicants?
Our program has articulated a number of values that we think are essential ingredients to success as a resident in our program, values as enumerated in question 4 (above). We are looking for applicants who share a dedication to caring for vulnerable and marginalized populations. We are committed to recruiting a diverse group of residents (the literature is clear! Diverse teams function better!). Especially in current times, we see the effort of caring for our high-needs community, without stigma, with a tireless focus on equity and inclusivity as the central mission of our work. We are looking for applicants who share these ideals - who are prepared to help us reflect on our own systems and practices as we strive to make a positive impact - both for the patients we serve in our ED, and for the learners we welcome into the BMC EM training program.
Can you describe any attributes and qualities that make applicants stand out?
Again, as above — commitment to our ideals. It’s hard work caring for a community with limited resources, and any applicant that applies to our program must know that they will work hard here. But that’s OK - our patients deserve it. And it is this very model that consistently ensures that 100% of our graduates are outstanding clinicians. That’s not hyperbole, the clinical training is outstanding. I hear this from department directors across New England every year, as they clamor to hire our new graduates. In addition, we are a group that really values one another’s attributes and one another’s company. We specifically arrange our department staffing and shift hours to align resident schedules and give our group ample opportunity to learn from one another on-shift and to lean on one another at other times. I encourage anyone reading this to reach out to anyone you’ve ever known that has trained at BMC — it’s a special place. Everyone who has ever worked here knows the heart of BMC. I often say that to work at BMC is to remain in touch with some of the ideals that attracted people to medicine in the first place — the focus on service and the altruism. If you are applying to EM this year, definitely check out BMC!