So our program is unique in that we have a bunch of different hospitals we rotate at. Probably 80% of our shifts are at the main center, which is a big Level I trauma center in an urban setting that gets a lot of penetrating trauma, like knife and gunshot wounds. And then we have a pediatric hospital we rotate at and it's kind of longitudinal throughout the curriculum. So you go there every like five or six shifts during your ED months. That helps so you don't just have a month in the winter where you see all kids with colds or a month in the summer where you see all the kids that fell off the handlebars; you get to see kind of the full breadth of pediatric care. And then we have a suburban center that has a little bit higher socioeconomic status, and a rural center was just added to our rotations this year. So as a third-year, you go out to one of our more rural settings. It has helped a lot of us in our career decisions because emergency medicine can be very different at a Level I trauma center after you leave and go to the community. Being able to get that experience helps to kind of inform you of what you're looking for in your practice.

So I had never been to Cleveland before my interview for residency, actually. And luckily, I was able to come for a couple of days around my interview back before you know, pre-COVID era, obviously. It's a great place to live. It's Midwest still. We get all four seasons. We've got the lake (Lake Erie) here, so you'll get some lake effect snow which is always kind of interesting. Iowa would get a good amount of snow, but here it can just randomly have a foot of snow come out of nowhere. So that has been interesting when you wake up at 7 a.m. and have to shovel the drive before you go into your shift.

It's different in that you can kind of choose. There's a little bit of a choice in how much work you want to do. So everything is how much you put into it is what you'll get out of it, especially in emergency medicine with the shift schedules. I have interest in the administrative side and operations side of emergency medicine which tends to create a lot of meetings outside of my shifts. This year, I became a chief resident and that adds a lot of meetings and a lot of scheduling and conference planning to my schedule.

Healthcare reform is basically debated every election cycle and it's such a hugely complex problem. Being in the emergency department, we are kind of at the frontline of a lot of the dysfunction of the current system, and knowing when you see a patient that a single hospital admission or even a single emergency department visit could be financially catastrophic for someone's future, it adds an extra layer of mental burden when you're making those decisions that I don't feel is fair for doctors to have to add on to their already complex decision-making process. Obviously, nobody has the answer to this problem either. It's been talked about for 20 years and I think 20 years from now, it'll still be getting debated.

Being okay with failing and using that as an opportunity to learn is the biggest part of medical school and residency. Here is an example... On all your rotations you're only doing the things that you're comfortable with and kind of sticking to what you know. Eventually, you'll get to a point where you have to know that next step and you're the senior member on the team. So if you don't stretch yourself and get yourself to the point where the senior members on your team can recognize where your current weaknesses are or where you kind of start to falter in your current knowledge, it's going to be hard for them to teach you. They'll keep saying “good job” because you did a great job in the labs. But if you never kind of commit to a plan and say, “Based on this lab, I want to do this,” they can't either correct you or say that you did a good job with that and keep pushing you to the next step. 

It is completely expected that you don't know the answers and it's okay to fail would be kind of the short version of the advice.