Q & A

Please see the link below to the prior Question and Answer sessions from previous interviews. 

Best regards,

Dr. Radosveta Wells - Residency Program Director, Texas Tech University Health Sciences Center El Paso

Q: Do you learn more from didactics or shift work, or is it a good mixture of both?
A: We are an experiential based residency here. The shifts are 12 hours but the environment is positive and collegial. From nurses to consultants, we learn a lot. We get unique pathology that allows for experiential learning on shift. However, we are also a great simulation facility, but we do not have to simulate a lot of cases because we see it in real life. You learn from seeing patients which means that it depends on the effort you put in afterwards and how much review of the cases you do at the end. You are always on with both the senior and attending. On shifts you are not overwhelmed and able to also take some time to learn. Even with the 12 hour shifts, residents can still have time to study at home and learn there as well. Use whatever works for you and you have time for!

Q: Could you expand on the TECHS simulation lab?
A: According to current residents at our program, the TECH center was the most impressive aspect. We have high fidelity simulations and use this unique opportunity to ensure that our residents see the full range of pathology.  We are able to synthesize very accurate depictions of what you will see in the ED in real life. 

Q: How often are you evaluated and how are evaluations conducted.
A: After every shift, you send a form to the attending you worked with to be evaluated. There is also an annual review with your faculty advisor where they go through how you are doing overall face to face. Additionally, every shift is an opportunity to do face to face evaluation with the attending if time allows.  

Q: How are the relationships and teaching moments with your attendings?
A: We are very close with our attendings and have great relationships. Every month we hold a journal club at a different attending’s house over dinner to discuss the latest research in emergency medicine. Our attendings are very approachable both on and off shift. On shift we sit in the doc box with our attendings and other residents which provides a great opportunity to ask questions and have teaching moments based on the patients currently being seen.

Q: If you are on another service, do you still attend didactics?
A: Yes. For our residents, Thursday morning didactics are a protected educational time. However, there are certain services that when you are on nights you are excused due to not being able to attend didactics between two night shifts to ensure no duty hour violations.

Q: How is the feedback between residents and attendings? Is there a formal learning hour?
A: ACGME requires 5 hours of learning for didactics every week. Every shift is an opportunity for feedback. Residents have evaluations done on every shift. Additionally, residents have an advisor who they meet with every 3 months. And every resident meets with APD or PD for evaluation twice every year.  

Q: Is there a deadline to take step 3? 
A: You must pass it to proceed to PGY3.  Scored must be back by February of your PGY2. 

Q: Do you have a resident mentoring program?
A: Although we have no formal mentoring program between residents, each resident has a faculty advisor they meet with consistently. Our residents have felt that their seniors are always open and available to them. By not having one-to-one assigned mentorship, they feel there is the opportunity to reach out to senior residents with their same interests. 

Q: What kind of non-clinical responsibilities do residents have outside of shift hours? Also, what training do residents get in administration, legal matters, insurance, billing, and contract related topics?
A: In regards to non-clinical duties, we have didactics 5 hours a week on Thursday mornings, journal club once a month, EMRAP once a month and one simulation center session a month. In the PGY3 year, we have a dedicated month to administration so our residents can become more familiar with the mechanics and operations of the department. Also every resident chooses a performance improvement project they can use to delve deeper into a topic of their choosing.

Q: Can you talk about didactics and what it generally looks like?
A: Each year we spend 8 to 9 months out of the year doing simulations. Every Thursday from 7 a.m. to noon is protected time for didactics, regardless of service you are on. Twice a month, we join the trauma service for grand rounds. We also do M&M sessions, but they are very benign, non-accusatory and very useful. For simulations, we have a full sim center – a multimillion-dollar facility. We do sim cases of ACLS/PALS and also weird cases that are very unique with important learning points. We also get oral board practice, and some of the people who designed our oral board prep have actually helped to make national oral boards in the past. Complexity of cases increases each year, but oral board prep begins first year of residency during sim. 

Q: During residency, do you get an advanced wilderness life support certificate? I have researched a lot of programs and to my knowledge you are the only ones? Is it optional training or is it incorporated into the program?
A: While in residency you as a required portion of the curriculum you will become AWLS certified. It is optional if you want to continue on to get your AWLS instructor certification.  

Q:  How do residents get feedback?
A:  “Residents receive feedback each shift by an online evaluation completed by faculty. They also have meetings with their assigned faculty advisor several times a year. All residents meet twice a year with the PD/APDs for thorough mid-year and end-of year evaluations. There is also plenty of on shift case-by-case feedback provided.”

Q: What board prep initiatives do you have in place and do you anticipate any upcoming changes?
A: We spend 9 out of 12 months each year preparing for boards. For the written board, we provide resources such as peer or rosh review free to residents with mandatory assignments that are a part of the asynchronous didactics curriculum. Also during the last couple of months before the ITE our didactics switch to test taking mode to best prepare our residents.

Q: How is faculty to resident ratio in your program? Do you have repeated shifts/weeks with the same faculty?
A: Our faculty have their own schedule independent of ours. They work either 8 or 12 hours shifts. Often, you will work with more than one faculty on a shift. There is no guarantee when you will work with the same faculty again. This gives you the opportunity to learn different things from different people since everyone has their own practice style. This also gives you the opportunity to begin to develop your own practice style.

Q: Can you tell me more about the journal club and what it entails?
A: In regards to the journal club, an attending will host this once a month session in their home. We go over 2-3 articles presented by residents based on what rotation they are on and what literature is most current or relevant. We have 2 PhD research faculty on staff that the residents who are presenting can meet with to help them better discuss the article in regards to its validity and value.

Q: How much time do you spend with students? 
A: Usually, students work with the seniors on the shift, however if you qualify you can pick up extra shifts to teach MS1 and MS2s at the medical school

Q: Do you feel the faculty and leadership are receptive to resident concerns?
A: Yes, recently we had an issue that the residents couldn’t see COVID-19 pediatrics patients in the children’s hospital ED. We compiled our complaints and approached the faculty as a unified opinion and within 2 days the issue was resolved. Another example, previously our anesthesia rotation was internal, but the residents were not getting enough intubations. The faculty were able to set up an offsite anesthesia rotation at Texas Tech in Lubbock, TX. Now our residents are getting 3-4 times more intubations on that service. They are very good at listening to us and enacting changes very quickly.  

Q:  What is the responsibility of the emergency department and hospital for treating both legal and illegal immigrants?
A:  “We treat everyone who comes to the ED.  We do not have information about patients’ immigration status.  Our social workers help us with post-discharge prescriptions and follow up when patients cannot afford those.

Q: How is it for them to learn to speak Spanish?
A: If you have an interest in learning, it really isn’t an issue. Many of our nurses and staff speak Spanish and are always willing to lend a hand. Other residents will also help out if needed. If no one is around to help or you are trying to communicate very nuanced details, we also have translator IPads for our ED with 24/7 translation in any language. For most residents by the time you start your second year of residency, you can complete your own patient interview in Spanish. Since about half of our patients are Spanish speaking only, you get a lot of practice.  

Q: How many residents do you have that don’t fluently speak Spanish?  
A: The majority of resident’s don’t speak Spanish fluently. Initially many don’t speak much Spanish at all, but by the time they graduate they are comfortable doing their own patient interviews in Spanish.  

Q: How do you deal with Spanish-speaking patients during time critical situations such as trauma? 
A: There is an iPad that we can carry to each patient’s room that has not only Spanish, but every language and they are readily available. We do not expect our interns to be the sole providers during critical cases from the beginning. Our interns are never thrown into having to learn Spanish and deal with critical Spanish speaking patients all at once. Also, many of our faculty and staff speak Spanish and can help.

Q: How does getting patients from Mexico affect how you manage their care? Do you incorporate Spanish into your curriculum?
A: One strength to our program is the exposure you will have to a Spanish speaking population. All patients are managed the same regardless of their background. We offer residents an initial course in medical Spanish at the start of residency and throughout training you will continue to get Spanish exposure. Those who are not interested in learning Spanish probably will struggle in our program and may not be a great fit here.  

Q: Are there any formal programs for students to learn/practice Spanish or certify bilingual?
A: At the start of residency, during orientation month, we have a program that focuses on functional Spanish, such as how to get through a patient interview etc. While being in El Paso, TX, everyone’s Spanish tends to grow exponentially. We do not have an official certification for Spanish, but if you put in the effort you will become comfortable. Our patients also appreciate when you take the time to try to connect with them in their native language. Many of our patients also understand and even speak some English, most visits will have a combination of the two languages. 

Q: How is medical Spanish integrated into your program?
A: Spanish is first integrated into orientation month for everyone regardless of Spanish background. It is designed to help with medical Spanish, such as getting a pertinent history and conducting a physical exam. The patient population is very kind here, when they see you trying to speak Spanish, they will help and encourage you! 

Q: How many patients per hour do residents see?
A: There is no strict requirement for how many patients to see. 

Q:  How many patients do you have to pick up as an intern?
A:  There is no particular number of patients that you are required as an intern to pick up. You are given a significant level of autonomy with your patients with lots of help by both the attending and your seniors nearby if you need it. Emergency medicine is all about teamwork.

Q: Does the rule of 80 hour work week apply?
A: ACGME EM sets the rule at 60 hours a week on service. Off service rotations you adhere to the 80 hour work week. There is also a strict rule that you can not work more than 5 days in a row.

Q: How is the acuity at the hospital, and how are the trauma run with surgery?
A: Our hospital is the only Level 1 trauma center for the region. We have many very sick patients from both the El Paso and Cd. Juarez communities. We have a great relationship with our surgery service. In trauma situations, we are responsible for airway management. We handle all levels of medical patients independently.  

Q: What has it been like to transition from PGY2 and PGY3 and in what ways are you learning to run a department instead of just seeing patients? 
A: During PGY2 you spend more time with patients, during PGY3 you spend most of the time in the zone with patients who are moderately critical and have some autonomy to practice what it would be like while still having an attending to fall back on. When there are multiple residents, the PGY3 is responsible for the intern and general flow of the zone which helps our residents to learn about ED management.  

Q: Is it a graduated responsibility model or can first years see the sickest of patients with supervision as well?
A: Yes it is a graduated responsibility. After ATLS and other training we allow residents to take care of patients who are sicker as long as they are comfortable with it. There is always a senior and attending there to help.  

Q: Are there any problems getting enough procedures? 
A: No, there are plenty of opportunities to get procedures done. If there are procedures to be done, our faculty are great at making sure we get them.

Q: How are traumas run? Who leads? Does EM take the airway?
A: In the ED, EM always has the airway. Anesthesia does respond to level 1 trauma but waits outside of the room. The EM attending is in the room for support, questions and assistance if needed. Level 1 trauma is co-run with the trauma surgery team. EM jumps in first for the airway and then the rest is co-run with trauma taking the lead. Because we rotate with the surgery department on SICU months, which is a month of SICU days intern year and a month of SICU nights 2nd year, we tend to split trauma procedures with them depending on what side of the body you are standing on. Any other trauma level is your patient unless you call for a consult. We also have a great opportunity to run any level of trauma on our rural rotation in Artesia, New Mexico, where there is single EM coverage and a general surgeon. 

Q: Since your program is the only level 1 trauma center within the region, do residents feel experienced with managing trauma by graduation?
A: Definitely yes! You begin to get an introduction during the middle of your PGY1 year when we begin to pick up patients in the most acute resuscitation zone (R zone). There is always a PGY2 or PGY3 nearby to help. At the end of PGY1 year, we have shadow shifts with the resident in the R zone to learn how to run that zone. Starting PGY2 year, you begin to have about 2-3 R zone shifts a month where with the help of an attending you manage 4 trauma bays and 12 critical rooms independently. About half way through PGY2 you begin to feel comfortable managing these cases. You are well prepared by the time you graduate.  

Q: What is the sign-out culture of your program? Do all patients have to have a disposition prior to you leaving?
A: It is totally acceptable to sign out a patient prior to final disposition. We sign out at 645 am & 645 pm. If the patient comes in at 615 no one expects a full work up prior to sign out. Everyone in our program is very open to helping each other out. Someone can always be reassessed after signout. The only thing we try not to do, is sign out procedures unless the oncoming resident wants them.

Q: What EMR system does your hospital use?
A: We use Cerner.

Q: Can you talk about the unique pathology and unexpected events you see due to your border location?
A: UMC is less than a mile from the main bridge crossing to Juarez, this brings a lot of unique pathology. Some unique things are falling trauma from people trying to jump the border wall, submersion injury in our canal system, advanced surgical complications due to getting surgery in Juarez, a fair amount of TB, neurocysticercosis, black tar heroin abuse, wound botulism.

Q: How much autonomy do you have when it comes to procedures? 
A: This is very dependent on you and how much the faculty is comfortable with you and how long you have worked together. The goal is for every resident to quickly become comfortable doing procedures independently. That being said, the faculty are always around if you need additional assistance.  

Q: Do you get admitting privileges with medicine?
A: At our hospital, our ED has the decision to admit. We usually do not get any push back from our hospitalists or teaching teams. Once the consultants get to know you they usually tell you to text them and this speeds up the process tremendously.

Q: You say that first year residents have decision making, what do you mean by that?
A: As a first year, you will go see your patient and formulate your own plan. Then you will present your patient and plan to the attending who will provide feedback and recommendations. Come with a plan and be prepared to talk through it. If you have any questions, the faculty and other residents are always able to answer questions.

Q: For a med control cardiac arrest call, who makes the decision to stop CPR the resident or attending?
A: After 5 supervised med control calls, residents are able to attend the med control calles. However, the attending is always nearby if we need assistance and the call is broadcast over the speaker in the resuscitation zone.

Q: What is the relationship with SANE nurses in your department?
A: All management happens in our ED and we have a great relationship with our SANE nurses.

Q: Do you have any midlevel providers in your ED? 
A: We do have mid level providers. They are usually responsible for triage and fast track. They also help to relieve the residents during didactics.  

Q: How much time do you spend charting after shift?
A: The goal is to be done at the 12-hour mark and go home. When you first start residency it sometimes takes an hour after shift to finish charting. Dragon (our talk to text program) helps a lot and makes it much quicker so you no longer have to stay after. 

Q:  What are the unique and distinctive aspects of the program?
A:  “In El Paso, we have a unique opportunity to work with very appreciative underserved patients with limited financial resources. Working on the border provides the opportunity to see conditions not commonly seen elsewhere in the US. Our residents speak very highly about the cheap cost of living and good work-life balance. Being on the border, our patient population speaks predominately Spanish. Our residents appreciate the opportunity to work on gaining Spanish proficiency in residency, if they don’t previously speak Spanish.”

Q: At what point in your residency did you feel comfortable having a patient encounter in Spanish?
A: It is completely dependent on you. El Paso is a very unique place in that you will be immersed in Spanish from the moment you get here. During your orientation month in residency, you will have an opportunity to work on and grow your medical Spanish. Also on shift, if you put in the work and not get nurses to translate or use the formal translator technology when it is safe and appropriate for your patients to do so, your Spanish will grow each day. If you choose not to put any work into it, then you will go through residency without ever being comfortable using the language.

Q: What kind of natural disasters are there in El Paso and what type of type of training experience do you have for them?
A: We are actually very fortunate as El Paso does not really experience any natural disasters such as tornadoes, hurricanes, or earthquakes. We do however still have disaster drills and other interprofessional drills often. Some of our residents have helped out with local marathons and events. 

Q: What are some unique community health problems to El Paso?
A: El Paso, TX is directly on the border with the city of Juarez in Mexico. Each day you will be practicing border health due to the patient population. You will see many unique pathologies not commonly seen in other parts of the United States.  

Q: Are there any community outreach programs?
A: In many ways, being the county hospital, we are already helping the community on a daily basis by serving our medically underserved and often financially disadvantaged patients from both El Paso and Juarez. For those looking to do more, there are many opportunities to volunteer in the El Paso community. We have several low cost/free medical clinics in the El Paso community that are always looking for residents to volunteer.  

Q: What brought you to the El Paso program specifically?
A: For some residents it was location, and some wanted to be in a county hospital and level 1 trauma center for training purposes. We are the only level 1 trauma center in about a 300-mile radius. The weather also brought people here; it's always sunny, and you can always be outdoors. There is no state income tax in Texas, and El Paso has a very reasonable cost of living. El Paso is a perfect mix between city and outdoorsy areas. Hiking trails are close, and a couple of hours drive to other outdoor adventures, such as skiing or climbing. El Paso is still big enough to have Top Golf, an international airport, and other amenities such as indoor skydiving and other things you will find in larger cities. The people here are so grateful and really spoil the residents and doctors. They are very appreciative of the services we provide. We hardly ever get a “bad” patient or difficult patient like other locations. It makes it easier for us to take care of them. A lot of our graduates come back as faculty to either pick up shifts part time or stay and work here: That's how great El Paso is. 

Q: How is life generally in El Paso? Did you find there was anything tough or difficult to adapt to? How is the housing situation?
A: El Paso is a good city to live in. Although it is not LA or Chicago, there are many big city amenities such as Top Golf, indoor skydiving, and shopping. However, it still has a small town feel! There is no real traffic oftentimes our residents will live about 20 miles away from the hospital and still make it within 25 minutes. Also, unlike a big city, there are many outdoor recreational opportunities nearby such as skiing/snowboarding in the winter in Ruidoso or Cloudcroft New Mexico which is less than 3 hours away. Year round, there is also hiking right here in El Paso. The cost of living is incredibly affordable, you can rent a nice 3 bedroom house in a great neighborhood on the westside (where real estate is more expensive) for about $1200. Texas has no state income tax, so other than federal tax the salary you see is the salary you make. We also have a good airport for cheap connecting flights.

Q: How often do you get snow in El Paso?
A: We get some light snowfall about 4-5 times a year, but the snow usually always melts by the afternoon. It looks beautiful on top of the Franklin Mountains. It is hot most of the time and winters are very mild. If you are interested in snow, there are ski resorts about 3 hours away in the mountains of New Mexico. You can get a little bit of everything within a reasonable drive by living in El Paso.  

Q: Do the El Paso public schools have a dual language program for kids and, if so, is it very difficult to get into?
A: Dual language programs are readily available in our public schools. They are relatively easy to get into as well.

Q: What is the relationship between residents and ancillary staff (nursing, phlebotomy, transport, etc.)?
A: We have fostered a great relationship with our staff. There are a number of staff meetings with the charge nurses and other staff where residents can voice any concerns. We are required to attend a few so that we can also learn their thought processes. During your intern year you get to spend some time with either charge nurse or triage and get to experience what that entails. Through this, you get a better idea of why things are done the way they are and how orders are taken after input and the process behind it. This allows the residents to have a close and very smooth and more understanding relationship with the staff. You always have a nurse, paramedics, and techs that get their work done and help the residents in an efficient manner. We help each other out and we work together as a team.

Q: When medical errors happen, do you feel supported and what resources are there for residents?
A: There is always good follow up afterwards, and there is always faculty that will support you throughout. Even if it is off service there is always good proactive feedback. There is a private room, docbox, where you can also go back and get one on one feedback and learn what went wrong and how to prevent it from happening again. There is also a dedicated time during procedure day to address what went wrong.

Q: What is the schedule / work life balance like?
A: “Every month you can pick 5 days off; if you work 2 months back to back you can request 8 days. Every Thursday from 7am-noon is protected hours for education. Each month is split up so you will have 2 weeks of days and 2 weeks of nights. If you have 2 months back to back you can request 1 month of days and 1 month of nights. 

Q: Can you comment on the shift times?
A: Our shifts are 12 hours from 0700-1900 and 1900-0700. We also have an internal moonlighting shift that is from 1200-2400 that you can do as a 2nd year in good standing.

Q: What do the shifts look like? What are the hours?
A: We do 12-hour shifts. You can work five days in a row max. EM is capped nationally at 60 hours a week. At our program on your EM months, you can also get five days off in a row. A lot of residents take advantage of this time and either fly to go visit family or take a vacation. You spend half the month on days and half the month on nights. They like to keep the end of one month and beginning of the next month on the same schedule, so you end up doing a month of days and a month of nights. So, not too much flip-flopping.

Q: Are the attending schedules mirrored or do you have multiple attendings?
A: The attendings have some shifts that mirror the resident hours of 7-7, but there are also 8 hour attending shifts. 

Q: How are you able to balance wellness without sacrificing education during didactics? 
A: We reward ourselves with a Thursday morning off for wellness every 2-3 months because we are able to provide enough teaching on shift and will supplemental materials, such as Rosh Review and PEER, and have robust asynchronous didactics. Additionally, we have 12 hour shifts but that allows us to have more time off to be able to go visit our families and have time for ourselves as well. Also, if you like you can have additional learning opportunities during PGY2 and PGY3 if you qualify to pick up extra shifts with additional pay and learning opportunities under the license of an attending.  

Q: When was the last time you had two days off in a row?
A: Each month you are in the ED, you can request up to 5 days off in a row. Each month you have about 15 shifts of 12 hours. There is plenty of time off to do whatever you want. We hand off patients to the next team and do not keep patients till disposition. We work 7-7 and that’s it, wellness is a huge deal here. When you first start residency, some residents will stay late to finish charting, but you quickly adapt and no longer have to stay late. 

Q: How respected are the residents by attendings outside of the ED?
A: Other services attendings respect you. Across the hospital our residents are known as hard working with great attitudes. We always are there to help with the procedures and we are proactive, and the other services love that. 

Q: What do your spouses think of the residency program and El Paso?
A: They were able to find jobs and find friends in the community, and especially with co residents. They are happy about the 15 days/month work schedule. It makes a huge difference when you get to go home and know you don’t have to worry about anything and you get to be home. It is a big enough city where you can find anything you need. There are good schools for our children. We have a program for resident families to meet across specialties and our emergency medicine residency is very close. 

Q: Is there a support program for spouses?
A: We do have a program for spouses where they can meet other spouses from your department and also other residencies in the hospital. They are there to provide support and host activities. 

Q: How do residents feel about their work life balance?
A: They go out golfing and have plenty of time for family. The work life balance is amazing here. Everyone does a great job to prioritize resident wellness. The residents work 12 hour shifts and work hard while on shift, but when they are off they are off. Residents have friends in other programs that state they are over worked and have no time to relax and enjoy life with their family, friends, and co residents and faculty. On your ED months, you get 5 days off in a row to do whatever you want.  

Q: Where do residents usually live? Do they buy or rent? Any advice?
A: Due to the very affordable cost of living in El Paso, some residents are able to buy houses. Some house mortgages are close to what you would pay for rent here. Some residents live in luxury apartments with washer and dryer and cable, internet, and TV included for just $900 a month. The city is split into the east and west sides by the Franklin Mountains, and there are residents that live on both sides. Regardless of where you live in El Paso, everyone can be to the hospital within 20 minutes because of the hospital's central location and minimal city traffic. 

QHow do shift trades work at your program?
A: You may shift trade with your PGY level in the same zone. Under no circumstance can you work more than 5 ED shifts a week or violate duty hour restrictions. We also allow you to work extra shifts early within duty hour restrictions to buy time if you know you need time off in a certain month, such as for pregnancy.

Q: How are vacations and break times taken?
A: When you are on ED months you can get up to 5 days off in a row per month. Several residents have been able to go home once every other month. Also once a year, if you have back to back ED months you can get 8 days off.

Q: How is the ultrasound curriculum?
A: During residency there are two dedicated months of ultrasound. We have two faculty that are specifically certified in ultrasound and one is fellowship trained. As an intern you get a minimum of 100 scans and as a PGY2 you get 200 scans on that dedicated month. There are 3 ultrasound machines in the ED that anyone has access to. Oftentimes, our residents on ED shifts will grab an ultrasound machine and do the point of care ultrasound for their own patients.

Q: How is your critical care training and do you have dual trained faculty in critical care?
A: The majority of our critical care is usually done off service. Currently, due to COVID-19, we are doing a bit of multitasking by helping with the boarded COVID-19 patients. None of our faculty are dual boarded in critical care.

Q: Are there opportunities to work with EMS and/or Flight?
A: There are opportunities to work with EMS. One of our faculty, Dr. Baker, is the medical director for Border Patrol in the El Paso area. Many of our residents have interest in EMS, and two of our graduates from this year are pursuing EMS fellowships. Our emergency department is also medical control for the entire city. There are no opportunities for flight at this time. 

Q: How does your residency apply ultrasound to practice? Do most residents feel confident performing ultrasound? Does the simulation lab have the capacity to practice ultrasound? 
A: Ultrasound use is encouraged by all attendings. We have two faculty who specialize in ultrasound, including one who completed an ultrasound fellowship. During residency you have 2 months dedicated to radiology/ultrasound. These months give you the opportunity to work with these faculty one on one. Ultrasound is a skill, and like any skill the more you are willing to work at it, the more comfortable you will feel. Our simulation center has several different models for ultrasound practice.  

Q: What elective opportunity is available for the residents? Can someone speak about the elective opportunities available?
A: We have had residents go to many locations such as a pediatrics elective in Houston, TX; an elective that focuses more on hyperbaric and marine envenomations in Hawaii; rural EM in Alaska; an elective that focuses on wilderness medicine in Taos, NM; and we have an EMS rotation available here in El Paso, TX.

Q: How do you deal with Spanish-speaking patients during time critical situations such as trauma? 
A: There is an iPad that we can carry to each patient’s room that has not only Spanish, but every language and they are readily available. We do not expect our interns to be the sole providers during critical cases from the beginning. Our interns are never thrown into having to learn Spanish and deal with critical Spanish speaking patients all at once. Also, many of our faculty and staff speak Spanish and can help.

Q: How does getting patients from Mexico affect how you manage their care? Do you incorporate Spanish into your curriculum?
A: One strength to our program is the exposure you will have to a Spanish speaking population. All patients are managed the same regardless of their background. We offer residents an initial course in medical Spanish at the start of residency and throughout training you will continue to get Spanish exposure. Those who are not interested in learning Spanish probably will struggle in our program and may not be a great fit here.  

Q: Are there any formal programs for students to learn/practice Spanish or certify bilingual?
A: At the start of residency, during orientation month, we have a program that focuses on functional Spanish, such as how to get through a patient interview etc. While being in El Paso, TX, everyone’s Spanish tends to grow exponentially. We do not have an official certification for Spanish, but if you put in the effort you will become comfortable. Our patients also appreciate when you take the time to try to connect with them in their native language. Many of our patients also understand and even speak some English, most visits will have a combination of the two languages. 

Q: How is medical Spanish integrated into your program?
A: Spanish is first integrated into orientation month for everyone regardless of Spanish background. It is designed to help with medical Spanish, such as getting a pertinent history and conducting a physical exam. The patient population is very kind here, when they see you trying to speak Spanish, they will help and encourage you! 

Q: What kind of feedback are you getting from graduates from your program?
A: They say that they are all always well prepared after graduating. Some of the changes we had recently was due to feedback from the graduates. For example, our recent graduates felt that they were deficient in community and rural EM. We now have those rotations, and are receiving positive feedback.

Q: What are the most important characteristics you are looking for when granting interviews for candidates?
A: Hard working individuals. We want individuals who embrace the culture and the patient population here. Also, those who feel they will fit well and will be happy here. We are not interested in individuals who intentionally seek to outshine others, we want team players. We want people who are eager and ambitious to learn Spanish, although Spanish fluency is not a mandatory requirement. 

Q: Do you have a cut off for board scores?
A: No cutoffs, we have a holistic approach to reviewing applicants. However, if you have a history/pattern of difficulty with exams, then it will be hard for you in residency due to the nature of the specialty and difficulty of in-service exams.  

Q: What are all of the subspecialties and fellowships do the faculty have?
A: Please visit our website faculty page to learn more about each individual faculty's interests.  

https://ttuhscep.edu/som/emergency/faculty.aspx  

Q: What are your preferences in the selection process?
A: We have a holistic approach; there is not just one thing we look at. We look to see if the applicant meshes with us and what interest they have in our program. Usually, people want to be close to family, but our residents come from all over. The El Paso Airport is very accessible with direct flights to many major cities. 

Q: What is the biggest stress in your workday?
A: Emergency medicine is always stressful no matter where you go. The majority of our residents handle stress really well. We have a wonderful team and everyone is always there to help each other out. Sign out tends to be stressful because you are wrapping up your patients and making sure you have the most recent results to share. The resuscitation zone can be stressful at times, but the residents from the nearby zone always come and help out when they can. As an intern, being on off service rotation could be pretty stressful when the senior is asleep and you have to make the decision yourself, but they know you are an intern and learning and they will always be working with you to make sure you learn and become confident with treatments such as ventilation settings and starting pressors etc. It is a great learning opportunity.  

Q: What is in place to ensure that I leave this program/residency a strong physician? 
A: By national requirements put in place by residency accrediting bodies, you will get good training at any program. However, coming here you will not only become a competent physician, but you will also have a strong Spanish background and be prepared to practice rural medicine. During the course of our residency, you will have a few rotations in rural Artesia, New Mexico. We stay in touch with our graduates and are very responsive to their feedback. Also, we have a state-of-the-art simulation lab, oral board practice, and plenty of opportunities for resident feedback to help to make you the best physician you can be. Each year we score above the national average on the ITE. 

Q: What does Border medicine without borders mean? And what difficulties have you faced in order to practice border medicine?
A: In emergency medicine, you treat the patient in front of you regardless of their background. We have social workers that help us tremendously with all situations. A unique factor due to our location is that we have patients that are under custody of border patrol. This creates challenges such as availability for follow up and access to medications. We also have patients that come from Mexico by ambulance and we are able to provide them care as well. We have barriers of course, but with the help of social work we have been able to break them to care for our patients. 

Q: Do you feel anything is missing from your residency? 
A: Pediatrics EM training here is not as strong as some of the other programs. You do not get scheduled Peds shifts unless you are PGY2. However, we have dedicated months of Peds in PGY2 and PGY3 so you may feel a little rusty since it is not early on, but in the end residents feel like they get enough pediatrics experience here. There is also an opportunity to do a 3rd year elective at a children’s hospital if you would like more exposure.  

Q: Are you open to DO or IMG students? 
A: As long as you take USMLE Step 1, we look at everyone in a holistic approach. We value diversity and experience as well. We have faculty who are DOs and faculty who are IMGs. Also, if you want to incorporate OMT into your practice, faculty is open to you practicing that way!  

Q: Outside of orientation month, what do you recommend an incoming intern do to be best prepared to begin residency?
A: First, figure out what resources you like to use to get quick access to essential information regarding emergency medicine. There are many great resources to work on fundamentals prior to residency such as EMCrit, RebelEM, EMRAP C3. There is also ALiEM’s resource: https://www.aliem.com/bridge-to-em/. Also, try to relax at the end of fourth year, you can study all you want but the first day of intern year will be stressful and a big jump. Take some time to focus on your wellness.

Q: How many SLOEs are required to apply?
A: No minimum requirement but not more than one EM SLOE, and as many Non-SLOEs as you have.  Not more than 4 LORs total.
 
Q: Do you have a cut off graduation date for IMGs?
A: No exact cut-off date but obtaining Texas Medical Board Permit-in-Training takes time, especially during the pandemic, so late graduation would be a significant obstacle which may preclude both IMGs and US graduates from ranking here.

Q: How regional is your selection for the program? I personally have no link to Texas, but  I am VERY interested in your program due to the emphasis on EMS and inclusion of medical Spanish. 
A: We are not regional in our selection process, we consider all applicants.  

Q: Can you speak to what you are looking for in residents, and who would not fit in in your program?
A: Being directly on the border, most residents graduate knowing medical Spanish and being able to perform their own patient interview in Spanish. Anyone thinking of applying here who is uninterested in learning Spanish would be a poor fit for our program and could struggle. Many of our patients are very kind and encouraging to new Spanish speakers; it is important to us that our residents care about our patients and their culture and language. We are looking for hard-working residents who want to be part of a team. People who will try to step on others to excel would not be a good fit for our program either. 

Q: How family friendly is this program?
A: Our program is very family friendly. Many of our residents have spouses and children. Those without families of their own have said they feel the program is one big family. 

Q: What is the greatest weakness of the program and what are we doing to strengthen or fix it?
A:  “We have a children’s hospital associated with our program, but we don’t see as many sick kids as bigger cities do. Some residents, particularly those interested in pediatric emergency medicine, would like more pediatric exposure. In the third year of residency there is an opportunity to do a pediatric rotation in (Dallas/Houston, he wasn’t sure) if you decide you want more exposure.”

Q: What do you believe is the greatest challenge for your program? How are you working to improve it?
A: The most recent issue we faced and actually resolved this week had to do with COVID-19 and our pediatric ED. Although our children’s ED is down the hallway from our main ED, they are governed by the children’s hospital which is separate from UMC. Recently due to COVID-19, there had been new restrictions placed on all residents rotating through the pediatrics ED that prevented our residents from seeing COVID-19 pediatric patients. This week we were able to resolve the concerns and return our residents to receiving the best possible pediatrics experience. From the time it was brought up as a unified complaint by our residents, it was resolved within days.  

Q: What is one thing you wish you knew prior to starting residency?
A: Residency is a huge adjustment with a large learning curve in both medical knowledge and how to work the ED system to best care for your patients. We have an orientation month in our residency to help you get acclimated that is a huge advantage. I had no real issues acclimating. Our residency program is extremely accommodating with great faculty that are very supportive. The program also does a great job with graded responsibility so you are always pushing yourself, but with lots of support to help you succeed.  

Q: I haven’t been offered an interview by your program, should I be concerned?
A: The short answer, no. Unfortunately this year has been challenging for both applicants and programs. We ask you to be patient, as many programs including our have not gotten through the entire process of reviewing applications and offering interviews.

Q: Are you happy as a resident?
A:  “Yes! Half of the residents have families and enjoy the time they have off to be fathers/mothers and husbands/wives. The other half use the time for hobbies and travel. We also have great benefits – health, dental, and eye are paid for without coming out of our salary. The cost of living is very affordable and residents are able to buy homes in nice neighborhoods on a resident’s salary.”

Q:  Is there a screening or cutoff number for USMLE or COMLEX step 1 score? There is no specific cutoff, we evaluate the whole application holistically.
A:
 “Though we do not have a hard cutoff, we typically consider candidates whose USMLE/COMLEX scores are within at least 1 standard deviation of average. However, we evaluate the whole application and value candidates with diverse experiences.” 

Q: Any unique benefits to the program being in El Paso, Texas, directly on the border?
A: Our hospital being so close to the border creates a very unique environment that is different from your typical underserved populations. We have American and Mexican ambulances that meet on the international bridge and then come to our ER. Being the only Level 1 trauma in the area, we also have individuals flying from southern New Mexico and western Texas. Our patients are great to work with and really appreciate the care they receive. Our program also puts a huge emphasis on wellness. The weather here is amazing with plenty of sunshine. The mountains of New Mexico are a great place to cool off with summer camping and snow in the winter. With plenty of outdoor activities close by, it is easy to stay active and helps relieve stress. Our airport is easy to get in and out of with a lot of direct flights all over the country. 
 
Q: Are there IMGs in your program?
A: Yes, we are both IMG and DO friendly. Currently, our program director and one of our chief residents are both IMGs. Please see our current resident and faculty profiles on our website to see the diversity we pride ourselves in.  
 
Q: Who would do well in your program?
A: People who are hard working, teachable, and receptive to feedback will thrive in our program. We also desire people who are humble, have a caring attitude, and are willing to serve our underserved patients with sensitivity and care. People who desire to be a part of the team, neither intentionally outshine everyone or hold others back, will do well in our program. 

Q: Is the program open to new ideas for community service?
A: Yes, of course new ideas are always welcome.

Q: Do you feel you will be prepared to take on a self-practicing role when you graduate?
A: Yes, we feel we will be prepared to take the next step and become attendings and physicians in private practice. It is always a big jump, but we are prepared.

Q: What social services do you have available in the department? Are they available 24/7?
A: We have the most competent, compassionate, and hard-working social workers. They are our angels. We have social work available 24/7. During daytime hours, we have a social worker dedicated to the emergency department. On nights and weekends, social workers are shared throughout the hospital. Being on the border, we get a lot of individuals who will be deported or are coming from Mexico. They help us find continuation of care for them. They also have been able to help with dialysis for patients across the border.

Q: Are there opportunities available for residents in advocacy and leadership during training?
A: Several residents have held positions in TCEP and participated at a state level in advocacy and leadership. We also have residents who volunteer to be a part of the house staff which is a very active hospital based organization with representation from all residencies at our university to bring issues up to our larger graduate medical education committee to ensure we are providing a great education at a university level.  

Q: How are residents part of efforts for diversity and inclusion?
A: Our population is very diverse compared to the general population and we get diversity from travelers and the military base. We also get emails for training in diversity and inclusion. Our residents come from all backgrounds. Check our current resident’s page for more information, they are a great and welcoming group!

Q: Where do the majority of residents end up after graduation? In community practice, academic medicine, pursuing fellowships, etc.?
A: Once our residents graduate many pursue community practice, but a large group have done other things as well. Some residents have been more research focused and are able to attain more prestigious academic positions. Such as, one of our graduates is currently a faculty at Harvard. Also in the past 10 years, two of the ACEP presidents have graduated from our residency. Some residents have become department chairs or started freestanding EDs. Some residents have pursued interests and fellowships in areas of global health, EMS, toxicology, and many others. Whatever your interest and career objectives, the program will give you the tools you need to succeed. There is elective time in 3rd year to pursue these interests, and you can even trade a month of PGY2 ED shifts for 3rd year elective time. We support residents in contract negotiation and job searching as well. Our alumni have visited to give advice and TCEP held a workshop recently to make sure our residents have the tools they need.

Q: Can you comment on what internal moonlighting is at your institution and how it works?
A: Our internal moonlighting shifts are additional shifts our residents can work with more independence and get paid extra. They get to do a little more than normal in the department by working in triage and doing other duties while still being protected under the attending license. They are open for PGY2s and PGY3s who meet certain criteria including ITE exams scores percentage and being up to date with medical records. There are also external moonlighting opportunities for PGY3s who qualify.

Q: What benefits are offered to residents?
A: We offer many benefits to residents. Our insurance benefits include:
Major Medical Insurance through Blue Cross Blue Shield (Resident + Family) with $0 cost per pay period, Dental Insurance through Blue Cross Blue Shield (Resident + Family) with $0 cost per pay period, Vision Insurance (Resident + Family) with $0 cost per pay period, Term life insurance: Resident - $100,000; Spouse - $10,000; each child - $5,000 with $0 cost per pay period, Long Term Disability: Resident - $1,500 monthly benefit with $0 cost per pay period, Workman's compensation, and Professional liability insurance. $0 cost per pay period means with each pay period, you pay ZERO dollars for major medical, dental, vision etc. for residents and family members. Just another reason why our program is the best program! Our professional benefits include: Subscription to PEER IX Review, Subscription to Rosh Review, Book allowance ($100 per year), One funded conference for each senior resident, Meals at University Medical Center- $210 bi-weekly stipend, Medical Spanish class, Set of EM books by Rosen & Barkin or Tintinalli, Dues for American College of Emergency Physicians (ACEP), Dues for Society for Academic Emergency Physicians (SAEM), Dues for Emergency Medical Resident Association (EMRA), Subscription to MD Challenger board review course, Salary conversion plan allows payments for tax-deferred annuities through payroll deduction, Lab coats with laundry service, and free parking!