Q & A

 

Q: Do you learn more from didactics or shift work, or is it a good mixture of both?
A:

Our residency program emphasizes experiential learning:

  • Shift Work: Residents gain hands-on experience during 12-hour shifts in a collegial environment. Unique pathologies and supportive attendings enhance learning.
  • Didactics: Weekly sessions and resources like Tintinalli’s and the ROSH review question bank support academic growth.
  • Simulation Facility: High-fidelity simulations refine critical skills.
  • Flexibility: Residents balance shift work with at-home study, ensuring a comprehensive learning experience.

 

Q: Could you expand on the TECHS simulation lab?
A:

The TECHS center is a high-fidelity simulation lab that replicates real-life emergency scenarios:

  • Skill Development: Interns practice intubations, central lines, and other critical procedures during their first month.
  • Teaching Opportunities: Residents lead simulations for medical students, enhancing both teaching and technical skills.

 

Q: How often are you evaluated, and how are evaluations conducted?
A:

Residents receive regular evaluations:

  • Shift Evaluations: After every shift, attendings complete an evaluation form.
  • Annual Reviews: Faculty advisors conduct face-to-face annual reviews to discuss overall performance.
  • On-Shift Feedback: Attendings provide real-time feedback during shifts when possible.

 

Q: How are the relationships and teaching moments with your attendings?
A:

Attendings foster a supportive and educational environment:

  • Journal Club: Monthly gatherings at attendings’ homes to discuss emergency medicine research.
  • On-Shift Learning: Residents work closely with attendings in the doc box, encouraging real-time teaching moments.
  • Approachability: Attendings are accessible both on- and off-shift.

 

Q: If you are on another service, do you still attend didactics?
A: Yes, Thursday morning didactics are protected educational time. Exceptions are made for night shifts to ensure compliance with duty-hour regulations.

 

Q: How is the feedback between residents and attendings? Is there a formal learning hour?
A:

Feedback is integral to our program:

  • Didactics: ACGME requires five hours of weekly didactics.
  • Shift Evaluations: Residents receive feedback after every shift.
  • Advisor Meetings: Quarterly meetings with faculty advisors and biannual evaluations with the PD/APDs ensure continuous improvement.

 

Q: Is there a deadline to take step 3? 
A:

Yes, Step 3 must be passed to proceed to PGY3:

  • Deadline: Scores must be submitted by February of PGY2.
  • D.O. Residents: Passing Level 3 is sufficient for D.O. residents.

 

Q: Do you have a resident mentoring program?
A:

While there is no formal mentoring program, residents benefit from:

  • Faculty Advisors: Quarterly meetings with assigned advisors.
  • Peer Support: Seniors are approachable and provide informal mentorship.

 

Q:What kind of non-clinical responsibilities do residents have outside of shift hours?
A:

Non-clinical responsibilities include:

  • Didactics: Five hours weekly on Thursday mornings.
  • Journal Club: Monthly sessions.
  • Simulation Center: Monthly training.
  • Administration Training: A dedicated month in PGY3 to learn departmental operations.
  • Scholarly Activity: Residents complete a performance improvement project and engage in research.

 

Q: Can you talk about didactics and what it generally looks like?
A:

Didactics are comprehensive and interactive:

  • Schedule: Thursdays from 7 a.m. to noon.
  • Content: Includes simulations, grand rounds, M&M sessions, and oral board practice.
  • Simulation Training: High-fidelity cases and oral board prep tailored to each year of residency.

 

Q: During residency, do you get an advanced wilderness life support certificate?
A:

Yes, AWLS certification is part of the curriculum:

  • Timing: Obtained during orientation month in intern year.
  • Optional Certification: Residents can pursue AWLS instructor certification in later years.

  

Q: How do residents get feedback?
A:

Feedback is provided through:

  • Shift Evaluations: Online forms completed by faculty.
  • Advisor Meetings: Quarterly meetings with faculty advisors.
  • PD/APD Evaluations: Biannual reviews for in-depth performance discussions.

 

Q: What board prep initiatives do you have in place, and do you anticipate any upcoming changes?
A:

Board prep is a priority:

  • Resources: Free access to Peer and Rosh Review question banks.
  • Focus: Didactics emphasize test prep in the months leading up to the ITE.

 

Q: How is the faculty-to-resident ratio in your program? Do you have repeated shifts/weeks with the same faculty?
A:

Faculty schedules are independent of residents’:

  • Variety: Residents work with multiple faculty members, gaining diverse perspectives.
  • Learning Opportunities: Exposure to different practice styles helps residents develop their own approach.

 

Q: Can you tell me more about the journal club and what it entails?
A:

Journal Club is a monthly event hosted by attendings:

  • Content: Residents present and discuss 2-3 articles relevant to their rotations.
  • Support: Ph.D. research faculty assist residents in analyzing articles.

 

Q: How much time do you spend with students?
A: Students typically work with senior residents during shifts. Qualified residents can also pick up extra shifts to teach MS1 and MS2 students at the medical school.

 

Q: Do you feel the faculty and leadership are receptive to resident concerns?
A:

Yes, faculty and leadership are highly responsive:

  • Example 1: Residents raised concerns about not seeing COVID-19 pediatric patients in the children’s hospital ED. Within two days, the issue was resolved.
  • Example 2: Residents were not getting enough intubations during the internal anesthesia rotation. Faculty arranged an offsite rotation at Texas Tech in Lubbock, TX, significantly increasing intubation opportunities.  

 

Q: What is the responsibility of the emergency department and hospital for treating both legal and illegal immigrants?
A: The ED treats all patients equally, regardless of immigration status. Social workers assist with post-discharge prescriptions and follow-up care for patients unable to afford them.

 

Q: How is it for residents to learn to speak Spanish?
A:

Learning Spanish is highly encouraged and supported:

  • Supportive Environment: Nurses, staff, and fellow residents are always willing to help.
  • Resources: Translator iPads with 24/7 access to multiple languages are available.
  • Progression: By the second year, most residents can conduct patient interviews in Spanish.

  

Q: How many residents do you have that don’t fluently speak Spanish?   
A: Most residents do not speak Spanish fluently when they start. By graduation, they are comfortable conducting patient interviews in Spanish.

  

Q: How do you deal with Spanish-speaking patients during time-critical situations such as trauma?
A:

The program ensures effective communication:

  • Translator iPads: Readily available for all languages, including Spanish.
  • Support: Faculty and staff who speak Spanish assist as needed.
  • Gradual Exposure: Interns are not expected to handle critical Spanish-speaking cases independently at the start.
  •  

Q: How does getting patients from Mexico affect how you manage their care? Do you incorporate Spanish into your curriculum?
A:

The program provides extensive exposure to Spanish-speaking patients:

  • Equal Care: All patients are managed the same, regardless of background.
  • Spanish Curriculum: Medical Spanish is introduced during orientation and reinforced throughout training.

  

Q: Are there any formal programs for students to learn/practice Spanish or certify bilingual?
A:

While there is no official certification, the program offers:

  • Orientation Month Training: Focused on functional medical Spanish.
  • Immersion: Daily practice with Spanish-speaking patients helps residents improve quickly.

 

Q: How is medical Spanish integrated into your program?
A:

Spanish is integrated from the start:

  • Orientation Month: Training focuses on medical Spanish for history-taking and physical exams.
  • Supportive Patients: The patient population is kind and encourages residents to practice Spanish.

Q: How many patients per hour do residents see?
A:

There is no strict requirement for the number of patients residents must see:

  • Intern Year: Typically, around one patient per hour.
  • PGY2 and PGY3: Patient load varies depending on the department's busyness.

 

Q: How many patients do you have to pick up as an intern?
A:

There is no specific requirement for the number of patients interns must pick up:

  • Autonomy: Interns are given significant autonomy with their patients.
  • Support: Attendings and senior residents are always nearby to provide assistance.
  • Teamwork: Emergency medicine emphasizes collaboration and teamwork.

 

Q: Does the rule of the 80-hour work week apply?
A:

Yes, the program adheres to ACGME guidelines:

  • Emergency Medicine Rotations: Capped at 60 hours per week.
  • Off-Service Rotations: Follow the 80-hour work week rule.
  • Additional Rule: Residents cannot work more than five consecutive days.

 

Q: How is the acuity at the hospital, and how are traumas run with surgery?
A:

The hospital is the only Level 1 trauma center in the region:

  • Patient Population: Includes critically ill patients from El Paso and Cd. Juarez.
  • Trauma Management: EM is responsible for airway management, while other medical patients are handled independently.
  • Collaboration: The program has a strong relationship with the surgery service.

 

Q: What has it been like to transition from PGY2 to PGY3, and in what ways are you learning to run a department instead of just seeing patients?
A:

The transition involves increased responsibility:

  • PGY2: Focuses on patient care and building clinical skills.
  • PGY3: Residents manage moderately critical patients and oversee the flow of the zone. They also mentor interns, preparing them for ED management.

 

Q: Is it a graduated responsibility model, or can first-years see the sickest of patients with supervision as well?
A:

Yes, the program follows a graduated responsibility model:

  • Training: After ATLS and other training, first-years can manage sicker patients with supervision.
  • Support: Seniors and attendings are always available to assist.

 

Q: Are there any problems getting enough procedures?
A:

No, there are ample opportunities for procedures:

  • On-Service Rotations: Faculty ensure residents get hands-on experience.
  • Off-Service Rotations: MICU and SICU rotations provide additional procedural opportunities.

 

Q: How are traumas run? Who leads? Does EM take the airway?
A:

Trauma management is collaborative:

  • Airway Management: EM always manages the airway.
  • Level 1 Trauma: Co-run with the trauma surgery team, with EM taking the lead on airway and trauma taking the lead on other aspects.
  • Other Trauma Levels: Managed by EM unless a consult is required.
  • Rural Rotation: Residents gain additional trauma experience in Artesia, New Mexico, with 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:

Yes, residents are well-prepared:

  • PGY1: Introduction to trauma management begins mid-year, with shadow shifts in the resuscitation zone (R zone).
  • PGY2: Residents manage 2-3 R zone shifts per month, handling trauma bays and critical rooms with attending support.
  • Graduation: By the end of PGY2, residents feel confident managing trauma cases independently.

 

Q: What is the sign-out culture of your program? Do all patients have to have a disposition prior to you leaving?What is the sign-out culture of your program? Do all patients have to have a disposition prior to you leaving?
A:

The program has a supportive sign-out culture:

  • Flexibility: It is acceptable to sign out patients without a final disposition.
  • Timing: Sign-outs occur at 6:45 a.m. and 6:45 p.m.
  • Collaboration: Residents help each other reassess patients after sign-out.
  • Procedures: Residents avoid signing out procedures unless the oncoming resident agrees to take them.

 

Q: What EMR system does your hospital use?
A: The hospital uses Cerner as its EMR system.

 

Q: Can you talk about the unique pathology and unexpected events you see due to your border location?
A:

The hospital’s proximity to the U.S.-Mexico border brings unique cases:

  • Examples: Falling trauma from border wall jumps, submersion injuries, advanced surgical complications from Juarez, TB, neurocysticercosis, black-tar heroin abuse, wound botulism, and malaria.

 

Q: How much autonomy do you have when it comes to procedures?
A:

Autonomy depends on the resident’s experience and faculty comfort:

  • Goal: Residents quickly become comfortable performing procedures independently.
  • Support: Faculty are always available for assistance when needed.

 

Q: Do you get admitting privileges with medicine?
A:

Yes, the ED has the authority to admit patients:

  • Collaboration: Hospitalists and teaching teams rarely push back on admissions.
  • Efficiency: Consultants often allow residents to text them, speeding up the process.

 

Q: You say that first-year residents have decision-making. What do you mean by that?
A:

First-year residents are encouraged to develop their decision-making skills:

  • Process: Residents see patients, formulate plans, and present them to attendings for feedback.
  • Support: Faculty and senior residents are always available to answer questions.

 

Q: For a med-control cardiac arrest call, who makes the decision to stop CPR? The resident or attending?
A:

After five supervised med-control calls, residents can make decisions:

  • Supervision: Attendings are always nearby and calls are broadcast in the resuscitation zone.

 

Q: What is the relationship with SANE nurses in your department?
A:

The program has a strong relationship with SANE nurses:

  • Availability: SANE nurses are available 24/7.
  • Collaboration: All management occurs in the ED, ensuring seamless care.

 

Q: Do you have any midlevel providers in your ED?
A:

Yes, midlevel providers play a supportive role:

  • Responsibilities: Triage, fast track, and relieving residents during didactics.

 

Q: How much time do you spend charting after shift?
A:

The goal is to complete charting within the 12-hour shift:

  • Initial Adjustment: New residents may take up to an hour after shifts to finish charting.
  • Efficiency Tools: Dragon (talk-to-text software) significantly reduces charting time. 

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: We look at everyone in a holistic approach. We value diverse 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.
 
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: 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!