EM Residency at Iowa

EM Residency at Iowa

By Marcus Toral

Welcome back to Vital Sign's new interview series with residency program directors here at the University of Iowa! For our second entry in the series, I sat down with Dr. Michael Takacs, the Director of the UIHC Emergency Medicine (EM) Residency Program. The EM Residency here at Iowa is a 3-year ACGME-accredited program that offers trainees the opportunity to work with a rapidly growing and diverse patient population. Uniquely, this program is the leading Rural EM program in the country, gives residents access to a Sports Medicine Fellowship at a Big 10 school, offers a comprehensive Wilderness Medicine Course, and allows third-year residents the opportunity to serve as flight physicians in Iowa's 25-year-old Air and Mobile Critical Care Services Program. With that, let's dive right in! 

Marc Toral, Editor-at-large: Hey, Dr. Takacs! Thanks for meeting with me. I'm excited to learn more about our EM program here. To start, could you tell our readers who you are and how you became interested in EM?

Dr. Takacs: Hi Marc! I'd be happy to. As you've mentioned, I'm the director of the University of Iowa EM Residency program and a Clinical Assistant Professor in the Department of Emergency Medicine. Initially, I think my interest in EM was sparked after serving as a volunteer fireman—5 years in total—so I'd been around the other side of acute care for a while. When I was in medical school, the television series 'ER' was in its heyday, and I honestly think that attracted a lot of people to EM. Really—We see this big swell of people from that generation. The field has grown steadily since the 1970s, and there are more programs and applicants year after year. Personally, what really drew me into EM was the challenge of solving problems and working to figure things out with only a limited amount of information; it's so exciting to make a correct diagnosis and find the best possible treatment for patients' most acute problems.

MT: Very cool. How many applicants does your program interview?

Dr. Takacs: We have 9 positions in our program, and we're looking to expand to 10 in the next year or two. To fill these spots, we typically plan to interview about a hundred. Looking at the applicant statistics, we've noticed an interesting shift—5% less graduates are applying to EM, but those who do apply are applying to 15% more programs. Also there are 8 new EM residency programs, so the number of interviews was a just a bit higher this year.

MT: Interesting. Typically, how many applications does your program receive?

Dr. Takacs: We get about 430 applications from US medical schools, and 70% are male and 30% are female. This sex distribution is pretty representative of the specialty nationwide. Even though there are more male applicants, we work to be very accommodating for women interested in our program. In fact, we have great diversity in our program here, and I think that's because we're a warm and welcoming group—definitely a family-friendly program. About two-thirds of our residents are married by the time they graduate, and of those that get married, about half have kids during residency. Honestly, I think this is something that's true of all residency programs at Iowa. They definitely tend to be more supportive of families, and I think that's something that makes this a special place to train.

MT: Personally, EM is a field that's appealed to me for a long time. In fact, it seems like it's been a popular pick among my classmates. How many applicants from Iowa will your program usually receive?

Dr. Takacs: Let's see...this past year we had 17 students from Iowa apply. That's pretty typical of the number that we see—usually around 15.

MT: Is there any preference given to University of Iowa medical students applying as internal applicants?

Dr. Takacs: Well, we interview all Iowa applicants, guaranteed. Besides that, there's some preference if we've gotten to know them and think they'd make a good addition to our program. So, yes! There's some built-in preference. For applicants, I'll admit that there's definitely value in seeing a different way of doing things, but on the other hand, when you stay at the same institution you can continue building on the relationships and projects began in medical school. This can help streamline things like finding mentors and setting up research projects. Our faculty has been very involved in medical school education, and there is an EM interest group here on campus. In general, most of the students that want to stay here can stay here. I truly don't think there are any 'bad' EM programs. Each program has its own little personality, and applicants should find where they feel most comfortable.

MT: What are you looking for in applicants to your program?

Dr. Takacs: Good question! As you might've guessed, I get asked this all the time during interviews. For me, I look for students who take ownership of their own education, give back by volunteering, and get involved in different community activities. An ideal applicant for our program shows commitment to medicine and to the specialty. The residents that do well are committed to EM—they look to improve the program and teach other residents, and most importantly they look to make the ER a better place for our patients. We look for students who will become those types of residents.

MT: Could you tell me a bit about how your program is structured?

Dr. Takacs: We have a 3-year program here. About 90% of EM programs are 3-year, and 10% are 4-year. When EM started as a specialty in the '70s, there was a debate on the length. Ultimately, it was decided that programs could choose to be either 3 or 4 years. Our program is unique because we have plenty of built-in elective time, so residents can really tailor their education toward what they would eventually like to specialize in, such as critical care, sports medicine, or emergency medical services, to name a few. Residents can take electives in those areas, and if they decide to go on and do a fellowship, they are well-prepared. There are two 4-week electives in the second year, and two 4-week electives in the third year. These allow residents to decide what they like, explore whether they'd like more training in a subspecialty, or rotate at a community hospital to get a feel for rural medicine.

MT: It sounds like you offer a good variety of training opportunities to your residents. Recently, I've learned how ultrasound training is becoming more and more useful in the ER—does your program offer any opportunities for training in this?

Dr. Takacs: Yes! We offer a 4-week elective dedicated to ultrasound training. Ultrasound training is very popular in EM residency programs, and this is a really common elective for our students to choose at some point during their training here. Some people consider the ultrasound as the future replacement for the stethoscope! I don't go quite that far—but I certainly see that it's just as valuable as a stethoscope in making the best diagnosis.

MT: Do residents do research electives?

Dr. Takacs: Yes, residents can use a 4-week elective period to work on a dedicated research project in their area of interest with a faculty mentor. However, all residents, whether they do an official research elective or not, are required to do an academic project as part of their training. This is a requirement of the Accreditation Council for Graduate Medical Education (ACGME). Some areas that our residents have done research on recently include: the effectiveness of text message-based follow-up for ER patients, the treatment and management of sepsis, the improvement of healthcare in very rural areas, the improvement of inter-hospital patient transfers, and the reduction of harmful binge drinking in college students.

MT: That last one's a hot topic here, huh?

Dr. Takacs: Ha! It was a real hot topic back in 2008, 2009, and 2010. Back then, there were new initiatives by the University of Iowa and Iowa City to curb harmful binge drinking. We were able to see college-aged students in our ER and ask if these measures were reducing harmful alcohol-related harm—turns out, they were!

MT: Something you mentioned earlier was how EM tends to be one of the more male-dominated fields. I know that there are many women still interested in EM for a variety of reasons—what advice would you have for them, and other women applying?

Dr. Takacs: I would say that even with a higher percentage of men in the field, there's plenty of opportunities regardless of sex. In general, supportive mentorship is very important. At our program, we have about 5 or 6 women faculty , and they are great mentors and resources for our community.

MT: Let's end with some general advice for current students applying or getting ready to apply—what would you tell them?

Dr. Takacs: I'd give two main pieces of advice. First, some people identify early on what they want to do for residency. I think that's generally good. At the same time when they do their clinical rotations, they should really focus on keeping an open mind and thinking about where they fit in best. People do change their minds, and you really can't know until you experience it. Second, when you do finally make a commitment to a specialty, I think that finding a good mentor is very important. EM is a relatively competitive field, and it is good to have a mentor who understands your own unique challenges. This way they can provide the right advice for your fourth year, any away electives, and potential research projects.

MT: Great. Well, thanks for taking the time to chat and give us information about your program, Dr. Takacs! I'm sure we'll have some readers who will definitely appreciate your insights as they consider applying to EM!

Dr. Takacs: My pleasure!

To learn more about the Iowa EM Residency Program, see their website.

You can follow Dr. Takacs on twitter.

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