In this month’s addition to the Program Director Interview Series, we got to chat with Albert Fiorello, MD, to learn about the University of Arizona - University Campus Emergency Medicine Residency. Dr. Fiorello tells us more about residency in the beautiful Grand Canyon State.
What sets your program apart from others?
One particularly unique aspect of our program is that residents will spend significant time in three different emergency departments, all of which are included in every EM block, throughout all 3 years. The University Campus hospital provides an academic experience with high volumes and high patient acuity. Banner – University Medical Center South Campus provides a community environment with lower volume and acuity. Lastly, there is a dedicated Pediatric Emergency Department where our residents rotate; we do not do dedicated Peds EM blocks, but prefer to integrate Peds EM shifts into every EM block. We think this allows our residents to be comfortable in all of these practice environments from early in their training to create extremely well-rounded future attending physicians.
We also provide our senior residents with the ability to act as a resuscitation captain. We have a senior resident on at the busiest time of day with the sole responsibility of getting involved with critical patients, major procedures, and wherever else they can be useful without needing to pick up patients of their own. This not only allows for all of the fun without the charting, but also gives our senior residents a fantastic opportunity to do a lot of teaching and mentoring for students and junior residents.
What are the benefits of attending a 3 vs. 4 year EM residency program?
First of all, I think this is a very personal question that each individual needs to figure out, and every program should be evaluated as a whole in regards to their fit, regardless of the number of training years.
With that being said, I am of the opinion that you can fit all of the training that you need in 3 years by eliminating “fluff” that isn’t as essential to EM. It is especially important to take care of sick patients for the entirety of 3 years starting in the beginning as an intern. We try to accomplish this by allowing our residents to take care of the sickest patients starting on day 1. Of course, we provide plenty of backup from many different sources, including our resuscitation captains.
What is something students may not know about your program?
Something that many students may not know about this program is that we are the busiest trauma center in Arizona. While Tucson may be smaller than Phoenix, Banner UMC Tucson hospital has an extremely large catchment radius and sees more trauma patients than any one center in Phoenix.
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?
Like many other programs, we take a holistic approach to our applications and do not utilize any score cutoffs. While above-average scores can certainly help an application, they are only one data point that we utilize and are not the end all be all of evaluating applicants.
With that being said, I am actually not the biggest fan of the switch to pass/fail Step 1 grading because I think that there will just be other parts of the application that gain more emphasis, and we lose an “apples to apples” comparison between applicants.
What kinds of opportunities for research exist? Do you look for residency candidates with research experience?
We have many different pathways for research involvement. Our ScholarQuest program is around 15 years old, and was actually redesigned last year to have three different possible tracks to choose from. There’s a standard original research track. In this track, everyone gets exposure to clinical research and every resident is involved with ideas that are created by residents. Strong points of this program include strong attending mentoring and projects that allow for completion within a reasonable time window for a working resident, approximately 1.5-2 years beginning to end.
We also have an educational development track as part of ScholarQuest. If there is a particular area of interest that someone wants to develop educational materials for, they can elect to develop curricula for our program in this field. One resident a few years ago was passionate regarding LGBTQ+ related healthcare and choose to analyze our existing curriculum, assess departmental understanding of current issues, and revamped our materials/programming to address any weaknesses that they found.
The last track relates to the development of clinical guidelines, utilizing Banner’s Clinical Consensus Groups. Within the Banner system, each specialty has a CCG that gets together monthly to assess clinical guidelines and develop evidence based order sets and pathways. These are applicable in large academic centers and small community centers alike, and our residents can fulfill their ScholarQuest requirement by becoming involved in this process, helping to develop clinical guidelines that can be used throughout the Banner Health network. One example of the work these committees can do is that we recently revamped the sepsis order sets and approach to sepsis for all of the Banner Health facilities.
In terms of applicants, again, we look into the whole applicant. Is this person committed to EM? Have they engaged with the field? Research is one way to do this, but certainly not a requirement.
Do you have opportunities to explore global health at your institution?
We do have many opportunities for global health, though this year because of the pandemic it has been difficult. Previously, would have 2-3 residents per year who would do something international during elective blocks. Past activities included clinical rotations, medical Spanish immersion, and other initiatives. We are hopeful for the coming year, however, with one resident currently pending approval to go to Italy later this year.
What are some qualities that your program looks for in applicants?
Self-motivation is something that is really important in residency due to changes from medical school in terms of scheduling your time and learning in addition to working full time. Additionally, we aren’t a hand-holding residency; we won’t assign specific readings or assignments but will provide a lot of resources so that every person can learn in the way that suits them best. In addition, we have large indigenous and Hispanic populations in and around Tucson, so we often look for people who are motivated to be involved with these certain populations.
Just as important, to me anyway, is what we are not looking for. We don’t want people who will only engage with the program between when they clock in and clock out for clinical shifts. We want people to be active in the program and make life-long friends. We believe that it is much easier to work with friends than colleagues, and we look for people with a similar mentality. We try to foster this from day one by starting in mid-June with 2 weeks of bonding and then having everyone work their first month in the ED with half the number of normal shifts. We want to give you a lot of time to get to know your other residents and facilitate the sense of community that I love about our program.