Program Director Interviews, Match, Medical Students

Program Director Interview Series: Todd Berger, MD | EM Residency Program Director at Dell Medical School - The University of Texas at Austin, Austin, TX

For this month’s addition to the Program Director Interview Series, we chatted with Dr. Todd Berger to learn about the Dell Medical School at The University of Texas at Austin Emergency Medicine Residency.

What sets your program apart from others?

There are so many great programs out there. At UT Austin, we have outstanding attending to resident ratios to really maximize the amount of one on one time attendings spend teaching and supervising residents. We are a multi-institutional training model to help residents be prepared to work in any setting upon graduation. We have a focus on leadership training by building in early exposure to an extensive array of career paths in EM leadership, and then give residents opportunities to meet role models and have mentors to guide them on a pathway to success during and after graduation. We have really strong opportunities around Public Advocacy, ED Administration, EMS, and Pediatric EM. And because of our residency culture and small class size, our residents are a tight family who really take care of each other and the program.

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

With a 4 year program, another year of experience is always a plus, although you'd get that same experience in a 3 year program and then practicing as an attending for a year. If you are going to attend a four year program, you should ask what extra are you getting out that additional year. Is there a research year or an on-line Master's Degree? If that is in line with your career goals, then it's a great opportunity. If it's just to see more patients and gain more experience, you can do that as an attending. Our 3 year grads have had no problems with job placement, including academic jobs, after graduation.

What is something students may not know about your program?

What's really been lost with virtual interviewing is the personal interaction. As I mentioned above, our residents are so close and tight knit. Even during this latest winter storm, they were driving each other and taking each other in when homes lost power and water. They're a family and I love watching our alumni stay best friends for life. I'm really proud of them every day.

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

We don't use a cutoff score or ERAS filter. Our applicant screening process is: good doctor (SLOES from EM residency based rotations) > good person (common values with us on your CV and Personal Statement) > good academics (class rank/quartile, clerkship grades, scores). Not to completely avoid the question (there are programs that filter), the national average for an EM matched candidate is USMLE 234/247, so a 230+ is competitive for EM. Similarly, a COMLEX of 600+ is competitive. Your mentor should have a candid conversation with you about application strategy based on your scores, grades, CV and performance in EM rotations.

What kinds of opportunities for research exist? Do you look for residency candidates with research experience?

Every program is going to have a different set of values. While we have a good research program to support clinical (not bench) areas of inquiry, our values are around community service, organized medicine leadership, school involvement, administrative experience, EMS and advocacy.

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

We do not have a global health program. We have a number of faculty mentors who make this part of their career, and they regularly take residents on trips with them. Residents get two elective blocks (one each in PGY 2 and PGY 3 year). Many residents use this opportunity to explore global health months.

How does your program address wellness?

We schedule some wellness events such as a welcome picnic, resident weekend retreat, wellness days, journal clubs, etc. And our residents are scheduled to work 18 shifts including 2 weekends in a 28 day month so they have time to explore professional development and leadership opportunities. But the residents are a family who really take care of each other well. They are a very happy group. There is rarely a week that goes by that the residents and their significant others aren't getting together socially between shifts.

What are you particularly proud about your program?

Easy question--the residents. They are so great and they come here to change the world and take care of our community. They leave a major impact when they graduate and go on to amazing careers as leaders in EM.

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

Someone who is willing to work hard (the patients deserve that) and is teachable. And someone who is willing to get involved. We want residents to get involved in our ED, hospital, university, organized medicine, advocacy work, etc. We want residents who want to come here and learn to be a great clinician, but also want to be what I call an ED Doc Plus. Our job is to show you all the ways you can take your career towards a path of leadership, and your job is to stay hungry to be involved. We look for a track record of involvement and leadership on applicant's CVs, statement, MSPE, etc.

For students lacking EM academic advising, what are your recommendations?

Get a virtual mentor. Whether you use a formal service such as the ones through SAEM and EMRA, or you meet a mentor by emailing program leadership at a neighboring program, EM is competitive and you'll need a mentor. You can have a career mentor in EM, but you should also have a well informed application mentor, who should be someone who is currently in EM residency program leadership. Also, attend the various medical student forums around getting into a residency put on by EMRA, SAEM and some of the state level ACEP chapters. Our program website has a long section on EM residency advice starting from making your fourth year schedule all the way through to making your rank list. Start here (Emergency Medicine Residency (utexas.edu)) and then click on 'application details,' and then click on 'read our application guide.'

What are some ways that COVID affected your program?

Our ED volumes are down. We have had to restructure to meet the pressures of a declining volume. I was able to put together a task force of some systems thinking residents and faculty, and we focused on our core educational philosophy (great attending to resident ratios, all residents present directly to attendings, etc) and really create a new system focused on enhancing our teaching mission and our resident's patient experiential learning. Our new schedule started in January, and the feedback has been great. Our residents report they are getting more teaching and supervision, and they are seeing more patients, more critical care, resuscitations and procedures, and our faculty are reporting that they have more time to teach and supervise than ever before. Adversity brings challenges, and it has brought our residency family closer, but it also created an opportunity for us to really enhance our teaching mission.

Should the 2021-2022 applicants pursue OSLOEs and LORs to supplement the single traditional SLOE?

We really don't read the other letters--they don't really offer any objective data and the accountability just isn't there. The current recommendations are two EM SLOEs from two EM rotations (one home and one away, or two away if you have no home EM residency program), with audition rotations resuming in August. We expect applicants to be respectful of fellow students and stick to no more than two EM rotations.

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