Match, Program Director Interviews, Advising, MSIII, MSIV

Program Director Interview Series: Tiffany Murano, MD, FACEP | St. John's Riverside Hospital

This month, the Medical Student Council spoke with Dr. Tiffany Murano, Program Director at St. John's Riverside Hospital Emergency Medicine Residency, about applying for EM residencies and opportunities at Riverside. Please read on for Dr. Murano's advice and insight.

What sets your EM residency program apart from others?

Let's start with the obvious—St. John's Riverside Hospital's Emergency Medicine Residency (SJRH-EMR) will be a new program in a newly ACGME-accredited institution. Almost all physicians can say they graduated from residency, but very few can say they were graduates of the first class from a residency. In addition, SJRH-EMR will be the first emergency medicine residency program in the Hudson Valley region of New York! Currently, there are no EM training programs between New York City and Albany—a 150-mile distance. Our program will fill in that gap!

The SJRH-EMR is unique for the New York City Metropolitan Region. The residents will be engaged in three unique hospital environments: a large community hospital in Yonkers, an urban county hospital in the Bronx, and a rural/suburban 5-bed single coverage ED in Dobbs Ferry. Given that SJRH has only one other training program (Internal Medicine), there will be no other residents competing for EM procedures. In fact, the EM residents will have the opportunity to perform all procedures themselves. This will be instrumental for our residents to become strongly prepared to practice emergency medicine no matter where they go after graduation.

What is something students may not know about your program?

Location, location, location. Depending on which direction you travel from the main campus, in 20 minutes you can be in the heart of Manhattan or in one of Westchester County's 50 parks with nearly 18,000 acres of open space, miles of trails, and scenic views. This means you can go mountain biking, hiking, or kayaking in the morning and then be down on Broadway watching a show within 30 minutes. With the combination of the beauty of Westchester County and the extraordinary range of New York City activities, there is no shortage of fun, excitement, and adventure.  

And speaking of location, the main hospital sits on the palisades overlooking the Hudson River, so each floor of the hospital has breathtaking views. In one direction, you can see the new Tappan Zee Bridge under construction; in the other direction, you can see the George Washington Bridge.

But don't let the beauty fool you. The ED patients have a high acuity and we see a wide variety of medically ill and injured patients. 

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

I was in your shoes at some point and remember the pressure and stress that goes into taking these standardized exams. I understand that an isolated performance on an exam may not be truly reflective of a candidate's ability to become an outstanding resident. The board scores are only one element of many factors that are taken into consideration when we are evaluating applicants. While we do consider board scores to be important, we are committed to looking at every aspect of the candidates who apply to our program to make sure we ultimately have residents who are a good fit. We do not have a minimum number for board scores; however, we will require the all applicants have passing scores for USMLE/COMLEX Steps 1 and 2.

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

Research is an important component to residency training, but it is not a requirement for applying to our program. All residents will be required to complete a scholarly project during their residency training. Scholarly projects include a variety of activities, such as original research, case reports, review articles, textbook chapters, and development of an educational module (such as those published on MedED Portal). We will encourage and support all of the residents' participation in research and scholarly projects that are interesting, meaningful, and exciting to them. Not only will we be fostering an environment in which our residents grow clinically, but academically as well. Our faculty has expertise that covers a broad range of niches within emergency medicine, and they are enthusiastically awaiting residents who are willing to pursue such interests.

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

EM physicians have been a tremendous part of global health initiatives. We feel that global health experiences during training play an instrumental role in developing a resident who has a strong interest in pursuing International Medicine as a niche. As a newly developing program, we do not currently have a global health program. However, those residents who wish to engage in a global health experience during their residency training will have support and mentorship from the program and the institution. 

What are some qualities your program looks for in applicants?

We are looking for highly motivated applicants who are eager to participate in new projects, activities, research, or teaching. Active learners entering residency who work hard and take ownership of their training are the ones who will eventually become the future leaders of emergency medicine. Our residency maintains these values, and we hope to develop a successful academic culture.

We are also looking for pioneering candidates with strong leadership qualities who are looking to be the founders of Westchester County's first emergency medicine residency program.

What are some advantages to applying to newer programs?

Newer programs give residents the opportunity to lay the foundation for the residency. With this being the second new residency program that I have a hand in creating (Rutgers New Jersey Medical School being the first), I can truly say this is a very exciting and rewarding opportunity. Because things are not set in stone, residents can be assured that changes and improvements can and will be made when necessary. In fact, residents are the key players in creating a program that meets all of the residents' educational needs.

 Also, residents will get to set the tone for the program. How Emergency Medicine and the Emergency Department are perceived in the institution will be set by the residents who are in that particular program. This is where the people who have great communication and leadership skills as well as a great work ethic will really thrive and make a tremendous impression.

What are some disadvantages to applying to newer programs?

New or newer programs mean there will be a few bumps in the road—especially for a brand-new program. This means there may be kinks to work out in some rotations, schedules, and the curriculum. The applicant who thrives on problem-solving will find this a really great opportunity.

In a brand-new program, there are no residents who are currently in training to talk to so an applicant will not be able to get a feel for what the “culture” of the residency is like. Also, until a program has its full complement of residents for all years, it will be hard to really ascertain how the residents feel about the entire curriculum and rotations. On the flip side, residents will get to create the culture for the residency. 

In addition, there are no established “cut-offs” or outcome data—that is, no known average USMLE scores, no pass rate for the boards, ITE, numbers of procedures, etc. So on one hand, applicants will not know where they rank among the current trainees and the success of the trainees once they graduate. This may not be so much of a disadvantage for the applicant who wants to blaze the trail and set the bar for years to come.

How do different stages of accreditation impact a program's ability to interview or rank applicants?

In order for an EM residency to achieve ACGME accreditation, a program must first submit an application and then have a site visit by an ACGME field officer. Once this is accomplished, the field officer generates a report and the EM Residency Review Committee (RRC) meets to review the application and will either grant or deny initial accreditation. Programs must have ACGME approval in order to be in ERAS.

We submitted our application in August, completed our site visit in October, and are currently waiting for the RC-EM to meet and review our application for initial accreditation. We are hoping to hear good news in January.

Applicants may only rank programs that are approved and are entered in the NRMP Match. However, applicants may want to interview and visit programs who are in the accreditation application process if it is a possibility that the program will be approved in time to enter the NRMP Match.

What advice would you give to someone who is considering applying to a new program?

A new program is not for everyone. There are applicants out there who favor a program that has longevity and has already established its reputation and curriculum. That is completely understandable, and if that is how you feel, then a new program is probably not the best fit for you. However, applicants who are creative and thrive on getting in on the ground floor will find that a new program will provide lots of opportunity for personal and professional growth.

New does not mean “not good.” Keep in mind that a new program that has been accredited by the ACGME has met the requirements for the high standards set forth for quality training in our specialty. I would advise applicants to closely look at the curriculum, self-reflect, and make a decision based on what they feel would be the best fit for them.

What factors should an applicant consider when deciding whether to interview at a program that is awaiting accreditation?

There is always the chance the program will not receive accreditation in time for the match. In that case, the program will obviously not be available for participation in the NRMP Match process. The program will have to be in close contact with the applicants in order to keep them apprised of any updates regarding its accreditation decision and status. In the case of medical students applying for residency positions, travel can be quite costly and interviewing at a program pending accreditation will be an additional financial burden depending on where the program is located. If the program is within close proximity to the applicant and travel costs will be low or minimal, then I would advise the applicant to go for the interview if there is sufficient interest. For those applicants geographically distant to the program, then I would suggest exploring the option of a Skype interview. This way, there is not a significant financial burden and the applicant will still have the opportunity to meet the program leadership. I will say that most program directors prefer a face-to-face meeting with applicants but are cognizant about the travel and finances that go with the interview process.

Interested in learning more about Emergency Medicine at St. John's Riverside? Check out the website or email the program administration at