Riley Grosso, MD, is the program director of the Emergency Medicine Residency program at Case Western Reserve University/University Hospitals in Cleveland, OH. Read on to learn more about the unique training experience that sets this program apart and the many opportunities and benefits EM residents are exposed to, as well as some ways applicants can stand out during the Match process.
What sets the program at UH apart from others?
This is my second year as program director, but I've been around the program now for almost nine years. It was my first job after residency, and so I've watched it grow over the past nine years. The thing that's always stuck out to me is how dedicated the faculty are to being good clinicians. Around the country it's not unusual for people to want to be good doctors, but their dedication to continuing to develop their clinical acumen even as attendings has really stuck out to me. They have an ability to focus on their education mission or their research mission, whether that is ultrasound, sports medicine, or critical care, while still prioritizing their clinical skills as a group of skilled physicians. As the program director, that's an amazing thing to have a bunch of educators who want to be really, really good clinicians in the department while maintaining their passion for education and for the specialties of emergency medicine. They are on all the special interest committees and do great work in those specialties but still show up and practice strong clinical medicine.
What is your perspective on benefits of a three-year versus four-year emergency medicine residency?
This is a particularly hot topic at this exact moment as we await the ACGME's decision. I trained in a four-year program, and I had a great experience training there. At UH, I train three-year grads, and they are phenomenal doctors. So, I think it can be done well both ways, I don't think that there's a one size fits all. The ACGME may decide that the future EM physicians do need more of a one size fits all with four years of training, and if that's what the experts think, then I'm fine with that. But my three-year grads are phenomenal doctors. At the end of their three years, their clinical skills and interests are strong, and they are excellent at taking care of patients. So, it's more about what kind of learner you are that may determine if you need the fourth year of instruction. Do you want a little more time to explore the subspecialties, or do you want to have your education more streamlined into those three years? At the end of the day, it depends on the learner and their preferences.
Do you have any perspective about what sort of changes UH would make to their residency training curriculum if the transition to a four-year residency is implemented?
We're ready for that change if or when it comes. We've been open to the change since it was announced, although we're currently a three-year program and that would be a big change in how we think about like what we do with that fourth year. Is it focused on volume of patients? Is it focused on learning the supervising aspect a little bit more than we already do? That's already part of our program, so it would just involve extending the amount of experience our residents can get. For us, all of the experiences that the ACGME is also going to put into this change - the toxicology rotation, the EMS rotation- we already have in the form of what we call our passport. The passport is a way for us to get our residents experience in all those niches that the ACGME has now identified in this upcoming change as important for emergency medicine. We will have to bulk some of them up and make them into rotations or scale them a little bit depending on the requirements the ACGME puts out, but we're lucky that our residents already spend time in many of these suggested curricular additions. I honestly am super excited about the changes. I picked this specialty because it's full of a bunch of people who said “We're ready for whatever comes down the pipe and we're ready to adjust to whatever changes come.” So we're going to be capable of changing quickly and adjusting, safely but quickly. This is just another opportunity to show that flexibility of emergency medicine across the country.
What's something that students might not know about your program?
Our program is based in Cleveland at main campus, an academic center, but our residents truly get the breadth of all the different types of emergency departments that exist through UH community and rural hospitals. Truly, one of our hospitals has a horse stall that the patients can park their horse and buggy at to go in and get cared for. Our residents have the experience of doing rural medicine during some of our rotations, community medicine in a couple of our community sites, and then we have the academic center in the city. So, our residents get experience across the breadth of emergency medicine in a way that I don't know is obvious when you just look at the website and see that we are based at the Cleveland Medical Center.
Has the change to ResidencyCAS affected how UH decides what applicants get interviews, and is there a specific range that UH looks for in USMLE or COMLEX step 2 or level 2 scores?
There's no specific score range to interview at UH since we have a holistic review of each applicant. Your score obviously plays into that review, but other things we're looking at are what you have done in your off-time and what is your life story and life experience. Our residents identify the values the program holds and guide what we want in the residents that are coming up. We use those values to then do a holistic review to look for residents and medical students that uphold those values throughout their life. Score is not unimportant, since we have to make sure residents can pass boards and we have the baseline knowledge we need to take care of patients well. We've interviewed multiple people this year with step one failures that managed to rebound on step two since that shows us a story of someone who has worked to improve or overcome a challenge in a very tangible way. If you have failed the step one exam, then we really want to talk about that on interview day. Ideally, we would want to be able to have an intelligent conversation about why it happened and why we think we might be able to overcome it with the right support. Additionally, it's hard to look at an application without a step two score, so we like when applicants have taken step two when they start to apply since that gives us more insight into the complete picture of the applicant.
How do you value research experience on an application? Is it a must have, good to see, or just contributes to the whole picture of the applicant?
I think it contributes to the whole picture of the applicant, and it is definitely good to see if it is research that is meaningful to the applicant. I would love an applicant who does research who can talk passionately about the subject they researched or the methods they use to research. The same thing applies to volunteer experience or other life experience included on the application. There is no must-have or favorite type of experience we're looking for, but I want it to be longitudinal and deep. Experiences where you learned lessons, where you were mentored, where you got experiences in and around the patient populations that we will care for in the emergency department or the health care system. These will always give us a better impression than 20 experiences where you showed up for a day and volunteered but didn’t feel strongly about the experience.
For your current residents, do you like them to pursue research while they're there? Is that part of the curriculum?
The ACGME requires a scholarly project, so we leave that up to our residents as far as the depth they want to pursue that project. If you're absolutely headed towards the community and research is not in your career interests, a case report is totally fine. However, if you are really interested in pursuing research projects, we have a robust research division with multiple research nurses and coordinators as well as a couple faculty who are really focused on that. A lot of our residents interested in research will pursue research electives and do longitudinal research projects with our faculty members. We are happy to have residents who are anywhere along the spectrum of research interest.
Does UH have any opportunities to explore global health for residents?
We just hired a recent global health grad who is revamping that currently. We've always had an academic component of global health through a faculty member who teaches global health through a lens of infectious disease and emergency medicine, largely focused on emerging infectious diseases. Our new addition this year has recently finished fellowship and will help us grow the practical side of getting to countries to do the work. The locations that national or international global health organizations are focused on are often very logistically challenging to get residents to, so this practical focus will be helpful in being able to get our residents involved. Currently we have a couple of residents going to Peru, Gambia and a couple other places this year. We just want to make sure we're doing it as safely as possible and getting residents both a meaningful experience in a place in a way that is safe for them.
What attributes or experiences have made applicants really stand out to you in the past?
There are multiple applicants we've interviewed this season that I would love to train. I believe that’s what is special about emergency medicine, the people who gravitate towards it just tend to fit the personality of what we are looking for. We're really looking for students whose applications show resiliency and humility, and who can talk eloquently about equity and what equity means to them in the emergency department. We ask the same questions of every candidate, and a lot of the questions we're asking are getting at those things. Experiences that can show me those types of qualities really can vary a lot. For example, demonstrating that you started a project and saw it through to the end shows me that you have some resiliency, because it's not easy to finish projects as a medical student. If you ran a clinic with multiple responsibilities, it shows me you probably have some humility. It is always very evident to me when residents or medical students are passionate about things they have on their resume. When we ask them about these experiences, their faces change, the tone of their voice changes, the way they talk about the experience is so different. We love to see that during the interview process, and that is the sort of thing that will really make an applicant stand out.