Program Director Interviews, Match, Medical Students, MSIII, MSIV

Program Director Interview Series: Sandra Najarian, MD | EM Residency Program Director at Case Western Reserve University/MetroHealth Medical Center/Cleveland Clinic, Cleveland, OH

In this month’s addition to the Program Director Interview Series we got to chat with Sandra Najarian, MD to learn about the CWRU/MetroHealth/Cleveland Clinic Emergency Medicine Residency Program. Dr. Najarian tells us more about residency in the 216.

What sets the CWRU/MH/CCF EM residency program apart from others?

We are a unique, dual training site program. MetroHealth is a county hospital, Level I trauma center, and Burn Center for northeast Ohio, and the Cleveland Clinic is a world renown, tertiary referral center. Our combined patient volume is well over 160,000 patients per year. The MetroHealth Emergency Department also manages Metro Life Flight, which is one of the largest, hospital-based aeromedical transport systems in the country. We have an academic affiliation with Case Western Reserve School of Medicine. Both MetroHealth and the Cleveland Clinic have free-standing Emergency Departments so residents are exposed to county, tertiary, and community hospital settings. The range of pathology is truly astounding!

What are the benefits of attending a three- vs. a four-year EM residency program?

Attending a 3-year or 4-year EM residency is a matter of personal preference. There are benefits to both. You can get excellent clinical training in both types of programs. A 4-year program can afford you some extra time to explore specific aspects of your career or to continue to do research. We are a 3-year program, and our curriculum is designed to prepare our graduates for independent practice. Our residents are well-prepared to manage an ED with high acuity patients. Residents have the option to develop a particular niche or an area of interest as well. Fellowship after residency is also available to further develop an expertise or specific niche. We have fellowships in ultrasound, EMS, clinical informatics, and addiction medicine.

What is something students may not know about your program?

We graduated our first resident nearly 30 years ago! We have graduated well over 250 residents who have gone on to have successful careers in academics and community EM. We have graduates who have become leaders within their institutions, whether they are program directors, medical directors, or heads of departments. Our graduates end up in all parts of the country; we even have a few alumni practicing in Canada. We keep in contact with our alumni, and our graduates recruit our residents into their physician groups. This year, we matched our first legacy resident!

What range of USMLE/COMLEX Step 1 scores do you look for in an applicant?

We do not have a specific cutoff for USMLE scores that we use when evaluating an applicant. We like to see an improvement in the Step 2 score over the Step 1 score. The USMLE scores are just a small part of the overall view of the applicant.

What kinds of opportunities for research exist for residents in your program? Do you look for residency candidates with research experience?

We recently established the Cleveland Center for Emergency Care Research and Innovation as a way to centralize all the great research that is being done at our institutions. Residents have opportunities to participate in research. Faculty are doing research in areas of basic science resuscitation, stroke, ultrasound, EMS, clinical informatics, and opioid safety, just to name a few. We are lucky to have many resources available to us between our two institutions and Case Western Reserve University School of Medicine. It’s certainly nice when applicants have had research experience, but it’s not necessary.

What are some qualities that your program looks for in applicants?

We are looking for motivated, bright, enthusiastic, hard-working individuals. We don’t expect you to know everything, but being ‘teachable’ and being able to adapt is also something we look for in applicants. Emergency Medicine has many great teachers and having the ability to learn from the different practice styles to develop your own style is important. Having a little bit of humility, compassion, and sense of humor goes a long way as well.

Alternatively, can you describe any attributes and qualities that make applicants stand out?

Applicants who have shown commitment and involvement in EM certainly stand out. Applicants who have a diverse background and interests outside of EM also stand out.

How has COVID-19 impacted training and how has your program adapted?

Other than our ED volumes being low for the first few months of the pandemic, COVID-19 has not significantly impacted training. We are fortunate to have simulation centers and cadaver labs at both MetroHealth and the Cleveland Clinic, and the residents benefit from this. When our residents rotating on anesthesia were not able to rotate in the operating room due to the lack of elective surgeries, we were able to bring those residents into the simulation center and cadaver labs to do airway training most days (with masks and distancing, of course). Now, those residents are able to make up their missed time on Anesthesia. Since our state reopened in May, we have been seeing increasing ED volumes, and now, it’s all the usual emergencies that we were seeing pre-COVID. Since March when the pandemic hit, our educational conferences have been virtual and have been well-received. Virtual conference has made it easier in some ways for faculty and residents to participate and attend. That being said, we miss seeing our residents in person at conference and hope to get back to ‘in-person’ conference soon, with masks and distancing, as our hospitals will allow. Small group sizes, masks, and distancing have allowed us to continue to have in person orientation (what we like to call our ‘Cornerstone course’) for our new interns in our simulation centers during this month of July. I’m proud of how well our residency has been able to adapt to and find creative solutions for our ever changing environment during this pandemic!

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