The more I learn about growing grapes, the more I see the similarities of tending grapes and attending residents.  Because vineyards (and residencies) are very long lived, site selection, soil preparation, vineyard design and plant selection should be done carefully. 

Site selection:  There are numerous site considerations when starting a vineyard including air drainage, water drainage, soil characteristics, soil depth, orientation, and length of growing season.  I planted north/south rows on an east facing slope with deep loess soil.

When starting a new residency, it is important that the local environment is supportive.  The EM-RRC looks for things like patient volume, patient acuity, procedure numbers, the qualifications of the faculty, competent program leadership, a strong didactic program, and administrative support.  We were fortunate to have everything needed for the original accreditation.  Our recent 5 year full accreditation validates that our site is pretty good.

Soil preparation:  The best time to amend the soil is prior to planting.  After soil testing, I added lime, rock phosphate, humate, and earthworms to the soil.

There are a lot of clinical sites that have the patient volume and acuity to support a residency, but the ‘soil’ may not be fertile.  Years before starting our residency, we had to prepare the Dean, the other departments and the EM faculty regarding what it takes to provide fertile ground for resident education. 

Trellis selection:  Grapevines cannot be grown satisfactorily without some sort of support system.  The reasons for training vines onto a trellis include: maximizing light interception, minimizing disease pressure, and developing a strong straight trunk.  There are several trellis systems described, and I choose the Scott Henry trellis system to control vigor and maximize light exposure.  http://www.henryestate.com/trellis.asp

The support and training systems of the 120+ EM residency programs are varied.  Medical students search for the training programs that best support their needs.  We have worked hard to make our training program supportive of the needs of our residents.

Plant selection:  The first year of planting, I chose an American cultivar named Cynthiana (unless you are from Missouri where it is called Norton).  I chose it because it is disease tolerant.  http://wine.appellationamerica.com/grape-varietal/Norton-%7C-Cynthiana.html

The second year I chose a French American cultivar named Brianna, because it is very cold tolerant.  http://www.macscreekvineyards.com/wines.php?id=23

The third year I took some risk and planted two European varietals that field testing had shown promise for southeast Nebraska.  Most people are familiar with Riesling but not with Lemberger. http://www.germanwineusa.org/home_cellar/varieties_lemberger.php

When we started the residency, we looked for the most ‘disease tolerant’ residents to start the program.  Now that the program is established, we are able to take more risksJ.

Training:  It takes about 3 years to establish a vine on a trellis, and about 5 years before it is full fruit bearing.  The first year you do your best to protect the plant by watering it, putting it in a grow tube, and gently tying the shoots in an upright position hoping they make it to the bottom wire of the trellis.  The second year you prune it back to 3 buds and hope it grows enough to form cordons on the trellis wires.  The third year, you prune it again, and let it bear some fruit.  By the fifth year, it is full fruit bearing.

I think this is a pretty good description of residency training, passing boards and starting your practice.  The pruning process of residency training may seem painful at the times, but without it you will end up looking like a grape bush instead of a grape vine.

Harvesting:  After hours of working in the vineyard throughout the growing season, it’s hard to describe the feeling of the grape harvest.  This year we harvested 1200 pounds of grapes, but with in a few years the vineyard should yield about 10,000 pounds.

Sometimes it’s hard for residents to see the hard work and personal sacrifice the faculty makes to train, (at)tend and prune them.  It was also hard to describe the feeling of seeing our first group of residents graduate last June, and start to see them bear fruit this year as they pass their boards and start their practice. 

Our senior class will soon be graduating.  The will be working in Nebraska, Wyoming and Washington.  They were a great class and we had fun pruning them.

This year we increased our class size to seven, and had a great match.  We will soon be welcoming new residents from Nebraska, North Dakota, Illinois, Missouri, Iowa, and Wisconsin

One major change in the Department this year was the establishment of basic science research program led by Dr Paul Tran.  We obtained bench space and recruited a PhD scientist, Dr Yu-Long Li.  He is currently recruiting two post docs.  The research emphasis will be in the areas of baroreceptor regulation, and limb ischemia/reperfusion.

We said goodbye to two faculty members who moved for family reasons.  Dr Seifert, former head of the Nebraska Poison Center, took a similar position at the University of New Mexico.  Dr Longwell went back to Austin, Texas.  We will miss them both.

We hired three of our graduates.  Drs Jones, Spiegel and Asher will be working mainly at our freestanding ED.  After they get their feet wet, they will spend some time supervising residents at the main ED.

Our ED family had another ‘fruitful’ year.  Among our residents, Drs Jones, Asher, and Schroeder had babies this year.  Among our faculty, Drs Larsen, Bott, and Oakes have had or soon will be having babies too.

If you are looking for a well prepared ‘site’, with good ‘support’ and ‘training’, I hope you consider applying to our program this year.  We are looking forward to many good ‘harvests’ to come.

Robert L. Muelleman, MD, FACEP
Professor and Chairman
Department of Emergency Medicine

Please click on the dates below to read the previous letter from the Chairman.
2003          2004          2005          2006          2007