Linda Regan, MD, FACEP, is the program director at Johns Hopkins Department of Emergency Medicine Residency Program. She shares the unique programs and resources available at her program.
What sets your program apart from others?
The Johns Hopkins Emergency Medicine Residency program is a unique 4-year program that offers residents the opportunity to develop into superb clinicians capable of caring for patients in any environment and allows them to immerse themselves in a focused area of specialization in their final year of training. Our clinical training spans three unique hospitals: a 1,000-bed, Level I trauma, academic, tertiary referral center; a 420-bed, Level II trauma center; and a 200-bed community hospital. Residents receive the benefit of varied training environments and are able to make a difference with our diverse patient populations. After developing a core foundation in EM, our final year offers specialized training in a Focused Advanced Specialty Track. This FAST year provides an equivalent experience to many of the 1-year fellowships we offer. For 2-year fellowship training programs (eg, International EM), we encourage our residents to structure their fourth year similarly to the first year of the fellowship so they can receive credit for this time and complete their formal fellowship training in one year after graduation.
The following FAST areas are available:
- Administration/Leadership
- Critical Care
- Disaster Medicine/Austere Medicine
- Emergency Medical Services/Tactical Medicine
- Global Emergency Services
- International Emergency Medicine
- Medical Education
- Observation Medicine
- Palliative Care
- Pediatric Emergency Medicine
- Research
- Science of Healthcare Delivery
- Social Emergency Medicine
- Toxicology
- Ultrasound
Can you address how the EM/Anesthesia track developed? What are the advantages of such a pathway?
At Johns Hopkins, we are always looking for ways to improve EM training and predict the future landscape of EM. The mission of the Combined EM/Anesthesia residency program is to raise the quality of health care delivered in any type of ED by developing unique, dually-trained physicians capable of using their merged expertise to address key and critical challenges affecting both local and national populations. As front-line health care providers, EM physicians are integral to processes that seek to respond to many of the crises our nation is currently facing. For example, with a push toward preventing readmissions – which frequently occur for pain-related complaints – and keeping more patients out of the hospital and out of the ICU, we need innovative approaches to meet these challenges. By developing physicians uniquely capable to support ideas such as ED-based ICUs, opiate-sparing methods of pain treatment, and remote or austere hospitals that might rely on a single physician to staff the ED to the OR to the ICU, the combined EM/Anesthesia program is an exciting 6-year program that offers board eligibility for both specialties. Additionally, the combined training offers graduates the opportunity to enter any anesthesia-based fellowships (eg, critical care) that are not available across many programs to categorical EM graduates.
What prompted JHU’s transition from a 3- to a 4-year program, and what are the advantages/disadvantages you have seen from the change?
After more than 30 years as a 3-year training program, we accepted our first class of residents into a new 4-year program in 2008. With the vision of producing leaders in education, research, and the increasing number of subspecialty areas within EM, we decided to expand the training program to include an embedded fellowship within the fourth and final year of training. My thought process has always been that if you don’t know what your options are, it is a lot harder to consider them all equally. Our 4-year curriculum allows us to not only expose residents to what an academic career would be like both clinically and academically, but also provide important training for our residents who are interested in developing a niche within our field. When our residents select to focus their FAST on 1-year fellowship equivalents, (eg, medical education or ultrasound), they have an experience equivalent to the fellowship they would complete if they joined us after completing a standard EM residency. Because many EM fellowships are non-ACGME fellowships, we can provide an equivalency certificate for our graduates to present to their new employer when they complete residency. This has 100% contributed to many of our graduates graduating from our program and entering leadership positions within both academic and community sites as Ultrasound Directors and EMS Medical Directors, to name a few. In addition, the fourth year reminds us all that becoming an excellent bedside teacher takes skill and practice. We work with our residents so they can learn and practice how best to run a busy department while supervising junior residents and students.
Since becoming a four-year residency, we have absolutely seen a change in the type of medical student applicants to our program and we have been thrilled to see abundant academic productivity from our residents – many of whom choose to pursue academic careers after residency.
What salient points of a 3- vs. 4-year program would you tell medical students to consider?
There is no right answer to this question. Both 3- and 4-year programs graduate excellent EM physicians. In short, medical students should consider what they want to do and where they think they want to do it. We all know geography is a huge factor for students considering residency programs and for residents considering their post-residency career. If they know they will likely be entering a market where all of the programs they may want to work at are 4-year academic jobs, they should seriously consider a 4-year program, as many 4-year programs do not hire 3-year grads at our main sites without fellowships!
Past that, I think students should look at the philosophy of the program and the type of individual the program is trying to produce. At Hopkins, I want residents who will take advantage of the many opportunities we have to offer, and who want to explore the various possible career options that involve leadership, teaching, research etc. Four-year programs naturally have more time to devote to self-development and additional training experiences; this allows us to produce graduates with a niche focus, skills in clinical and non-clinical education, and a strong foundation in lifelong learning.
Lastly, students should remember there is no ONE perfect program for you. You will find many that you love. Trust your gut about where you feel you will fit the best.
What is something students may not know about your program?
I feel very strongly that residents should graduate knowing how to affect their local environments and should have the skills to make any ED they work in better. To that end, we have a very robust longitudinal QI program, run by our Associate Clinical Director. She developed the QI program as part of her FAST year, then joined our faculty and took on leadership of the entire program. All of our residents work in multidisciplinary teams with two residents from each class, an EM nurse, ED administrator and EM attending physician champion. During this 4-year longitudinal curriculum, residents learn about needs assessments, stakeholder involvement and getting buy-in. Most important, they learn that if something isn’t working, YOU have the power to take ownership and fix it! Since the QI program began, many of the resident-run projects have shown real demonstrable change in our EDs, positively affecting staff satisfaction, efficiency, costs, and – most important – patients.
What are you most proud of regarding JHU’s program?
I am extremely proud of the FAST program that we have developed and of the efforts our faculty, mentors, teachers, leaders, and – of course – residents have put into the development of our many specialty areas! We have 15 diverse tracks, many of which have been developed specifically based on an individual resident’s interest. I believe we have the most unique experiences to offer trainees – from ultrasound, where residents can graduate with RDMS or RDCS certifications and the skillset to take on an Ultrasound Director role to the International/Global EM FAST residents who work with leading faculty to engage in ground-breaking work that impacts international communities to novel and less well known areas, like the Science of Healthcare Delivery or Social Emergency Medicine. In the Science of Healthcare Delivery, our residents learn to broadly apply engineering and population health principles to challenges in healthcare delivery, with varied areas of focus such as clinical decision support, systems engineering, and health informatics. In the Social Emergency Medicine FAST, residents work to study the relationships between social issues and ED care while they develop and test interventions to address social determinants of health inequity. These last two FASTs are our most recently developed and resulted from pairing residents and faculty who shared unique interests and wanted to formalize opportunities for others to come in the future.
But there’s even more! We have had residents travel to placements at the WHO in Geneva, participate in multiple research projects in South Africa, develop online educational about pain management in the ED, develop stop gaps in our EMR to reduce unnecessary lab ordering, and work to develop violence interrupter programs in the ED. Many residents have worked with our Tactical Medicine FAST to participate in training with the multiple organizations to whom our department’s Division of Special Operations group provides medical direction, such as the U.S. Secret Service, the US Marshals, BWI Airport Fire Rescue, and the Maryland State Police Tactical Medical Unit. We even had a resident win a National Kidney Foundation Clinical Research Award!
Every year I am immensely impressed with the amount our residents can accomplish when given time, mentorship, financial support and structure. I am very proud of our residents’ dedication to making an impact on those around them locally, nationally and globally.
What range of USMLE/COMLEX Step 1 scores do you look for in an applicant for the program?
Though we do require completion of USMLE Step 1 for application, we do not have a score cut off. We consider all applicants regardless of their score – as long as they pass! I strongly believe that test scores do not necessarily reflect ability nor do they help us find the best applicants.
What kinds of opportunities for research exist? Do you look for residency candidates with research experience?
There is a multitude of opportunities for residents to get involved in research at our program. We have a robust research educational program run by the Director of Resident Research that involves online modules, meeting with our librarian, and learning how to ask good research questions. We have research presentations embedded in our weekly conferences a few times a year so that residents can see what their co-residents, fellows and faculty are involved in. In addition, all of our residents must complete a scholarly project as part of their FAST year and get to present their project at conference before beginning (you never know who will be inspired to get involved and help!) and again when it is completed. We do NOT require residents to do bench research or complete an RCT! We strive to help our residents understand that scholarship can take many forms. We want them to experience the value of mentorship, organizational skill, and creating clear goals for yourself in terms of productivity. Where they take that is up to them!
What are some qualities that your program looks for in applicants?
We look for applicants who have been involved. We want to know that our residents will be active participants in the program and join our team with enthusiasm. In our experience, past leadership or involvement in research, teaching, or community service predicts future involvement, overall. Our goal is to find applicants that will work hard to advance their personal growth and develop into the leaders of our specialty in the future.