"Wine to me is passion. It’s family and friends. It's warmth of heart and generosity of spirit. Wine is art. It's culture. It's the essence of civilization and the art of living." Robert Mondavi
In the 2007, the year we graduated our first residency class, this letter reflected on the similarities of tending grapes and training residents. Things like site selection, soil preparation, vineyard design, varietal choice, pruning techniques, canopy management, and harvest are good metaphors for developing a residency program and training residents.
As we prepare to graduate (harvest the fruit of our/their labor) our 10th residency class (69th resident), I would like to use the process of turning grape juice into wine as a metaphor for the years it takes from being a residency graduate to develop into a master ED clinician.
After harvest, the grapes are put into a crusher de-stemmer and pumped into a vat. As the name implies, the machine removes the stems from the vines, and partially crushes the grapes in order to let the grape juice begin the winemaking process in the vat. To be board certified in emergency medicine, you must not only graduate from an accredited EM residency program, you must pass the qualifying (written) exam. Preparing for and taking this exam may feel a little like being crushed and destemmed. About 90% of EM residency graduates pass the qualifying exam on their first attempt. The graduates from our program have performed even better.
The next step is pressing the grapes. In the case of some white wines, this happens almost immediately. For most red wines, the juice stays with the skin for hours to days before the mixture is pressed, and the juice is separated from the seeds and skins. If a graduate is successful with the qualifying exam, they earn the right to participate in the certifying (oral) exam. Preparing for this exam, and spending a half day at the Marriott O’Hare handling 7 simulated cases may cause a little press-ure. The majority of EM residency graduates (as have our graduates) pass this exam.
Then the fun of winemaking begins. Depending on the quality of the grapes, some adjustments to the acids or sugars need to be made. Yeast selection can be important too. The fermentation process that turns grapes into wine is magical. Some wines are best enjoyed immediately, some continue to improve in the bottle. The patient care experiences after residency often result in adjustments to practice style. Filling gaps in knowledge with CME and maintenance of certification activities also contribute toward becoming a master clinician. The rate of progress varies, but at some point, most reach the stage of master clinician.
It has been also been magical to watch our graduates’ progress in their emergency medicine careers. To our knowledge, all are still practicing emergency medicine. With this graduating class, we will have 24 former residents practicing in urban and rural Nebraska, 17 in eight surrounding Midwest states, and 28 through the rest of the country. If they are not already master clinicians, they are well on their way. At least four are medical directors, four have leadership roles in their residencies or fellowships, and three have roles as EMS directors. Please keep us posted on your progress.
This year we continued our clinical growth. In addition to seeing nearly 60,000 patients at Nebraska Medicine this year, we will start staffing the Bellevue Medical Center ED in July, 2016. As always, our faculty have stepped up to the challenge. Our new clinical faculty recruits are: Drs. Brozek, Hanson, Krause, Madden, and Welters. We are also excited that Dr. Welniak will be returning as the residency’s Assistant Program Director after having completed a two year education fellowship in New York.
Our match went extremely well this year. With a record number of over 600 applicants for our nine positions, we are looking forward to welcoming our new group from medical schools in Kansas, Missouri, Nebraska, and Texas.
I am very proud of our 10th graduating class. We were fortunate to retain four of our graduating residents, Drs. Brozek, Hanson, Krause and Madden, to help start the clinical practice in Bellevue. Dr. Habrat will do an EMS fellowship in New Mexico, and Dr. Warchol will do a Health Policy fellowship in Washington DC. Dr. Boosalis will start a clinical practice in Omaha, and Dr. Howe in Des Moines.
Our faculty and residents were fruitful in other ways this year. Drs. Barksdale, Ernest, Zeger, Campos, Corrick, Hall, Howe, Inglish, Madden, and Osborn all had new additions to their family this academic year.
I remember when I interviewed our first class of residents, I mentioned the only thing we didn’t have to offer is a tradition. I asked them to help start the tradition. After 10 graduating classes, I love the tradition we have developed. The residency has exceeded my expectations.
I am thankful to the former (Drs. Wadman and Hoffman) and current (Drs. Barthold and Branecki) vineyard managers, as well as the former and current faculty who have worked so hard in the vineyard over the past 10 years. Although the ‘pruning’ process may have been difficult at times during training, the vintages continue to improve.
Robert L. Muelleman, MD, FACEP
Professor and Chairman
Department of Emergency Medicine