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Program Director Interview Series: Nikolai Butki, D.O., MPH, FACEP, FACOEP | Program Director at McLaren Oakland Emergency Medicine Residency, Pontiac, MI

What sets your program apart from others?

I really need to emphasize: There is NO SUCH THING as a bad emergency medicine residency.  The ACGME assures that any program with ACGME accreditation has the requisite patient volume, access to procedures, structured education, engaged faculty, adherence to work hour limitation, evaluation mechanisms and attention to resident wellness to successfully train emergency medicine residents. So please don’t think that attending any specific program will ‘make’ you a good resident nor will any program inhibit your potential. The EM physician you become is 100% dependent on the effort you put into your residency.

With that said, we specialize in training community-based emergency medicine physicians. The department primarily serves the city of Pontiac, MI, an under-served inner-city population with many social determinants inhibiting access to medical care. Therefore, we see many patients in the ED with undiagnosed diseases at advanced stages. We also see high rates of penetrating trauma like one would normally only see at large, inner-city tertiary care institutions. We see these, however, with the institutional resources of a community-based hospital, meaning the ED physicians are responsible for consulting specialists after determining diagnoses, not with undiagnosed symptoms.

A community-based training program, we are also university-affiliated. We participate in the Michigan State University College of Osteopathic Medicine State-Wide Campus System (SCS).  The SCS provides monthly lectures by nationally-acclaimed speakers and multiple hands-on simulation skills courses such as OB Emergencies, Trauma Procedures, Dental, Difficult Airway, HAZMAT, Advanced Ultrasound-Resuscitation, Advanced Ultrasound-Procedures, Ventilator and Burn Management.

We also specialize in training clinician-educators. We developed the 15-Minute Lecture Competition curriculum where we train residents in the scholarly activity skill of lecture presentation. We also train residents how to perform bedside teaching, so they can effectively teach junior residents and rotating medical students. We also have multiple faculty with teaching appointments at medical schools, providing residents opportunities to teach at the medical school level.

What is something students may not know about your program?

I am the second program director in the history of the program. Michael Q. Doyle, DO, founded the program in 1976 and served as the program director until 2018 when he retired.

How do you feel about the change to pass/fail grading in USMLE Step 1 and COMLEX Level 1? How will this affect your rating of applicants?

Minimally, if at all. A high ABEM board passing rate is necessary to maintain ACGME accreditation, and future performance on standardized exams (like ABEM) is directly correlated to past performance on standardized exams (such as USMLE and COMLEX). For that reason, many programs highly value high USMLE and COMLEX scores to better ensure high post-residency ABEM pass rates.  While we do take board scores and board passing into consideration, board scores and board passing are not the most important criteria we use. We use a holistic evaluation of candidates, prioritizing performance on audition rotations.

What are some qualities that your program looks for in applicants? Can you describe some attributes that make applicants stand out?

We embrace diversity, meaning we enjoy any opportunity to train, work with and learn from people who are different from us. The only characteristic that all residents and attendings in the program share is a calling to serve an under-served, under-resourced population.

What resources are available at your institution to support research? Do you look for residency candidates with research experience?

Our resident and faculty scholarly activity is almost 100% designing, implementing, evaluating, and disseminating the results of resident and faculty quality-improvement/patient safety (QI/PS) projects. We feel QI/PS is a skill much more useful for community-based physicians than performing hypothesis-driven research.

We have multiple faculty who competed and are instructors in the AAMC Teaching for Quality (Te4Q) certificate program. And we have PhD statisticians dedicated to the program to provide guidance on study design, data collection, data interpretation and dissemination of QI/PS projects. Most projects culminate in dissemination, either peer-reviewed publication or poster presentation at conferences.

How does your program prepare residents for future careers in Emergency Medicine?

We allow senior residents in good standing (high in-training exam scores, professionalism and patient care skills) to moonlight independently. While the extra income is appreciated, the primary benefit of limited moonlighting in safe environments is to prepare residents for autonomous practice.

Can you describe the opportunities for trauma team training at your facility?

We are an ACS verified Level II trauma center. Residents complete a 1-month in-house Trauma Rotation with our busy trauma service. Residents also complete three months of in-house ICU, where the critical trauma patients are cared for. Most importantly, however, we do not have a general surgery residency. ED trauma management, including procedures, are performed almost exclusively unopposed by the EM residents under the guidance of the trauma team as part of their daily EM shift experience.

McLaren Oakland is a designated Percutaneous Coronary Intervention (PCI) center. Can you share its impact on EM residency training?

Huge. Becoming a PCI center has been a process in the making for almost a decade. We have always been the colloquial “trauma hospital” for the northern part of the county. With the ability to now perform PCI, the number of not only true STEMI patients but also critical cardiac patients presenting to our ED has exploded, providing even more critical patients to a fertile training ground for EM residents.

Have alumni from your residency program gone on to pursue fellowships? If so, which fellowships?

Recent graduates have gone on to pursue fellowships in ultrasound (x3), primary care sports medicine, education-simulation and telehealth.

How does your program support resident wellness?

We offer a lot of institution-sponsored initiatives. These include specific protected days off for all residents to perform bonding activities, hospital events, access to counselors, monthly resident forum meetings with the program director, semi-annual self-evaluations and institution sponsored critical incident debriefing.

But most of all, the culture of the program is that of looking out for one another. All residents in the program share a willingness to switch shifts or even entire rotations if a colleague is in need.  This perpetual culture of resident solidarity is the aspect of the program I am most proud of.



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