There are elective opportunities for interested residents at Gallup Indian Medical Center (GIMC) and Northern Navajo Medica[a][b]l Center (NNMC) during 3rd year. GIMC is located in Gallup, NM, ~130 miles west of Albuquerque. GIMC serves as a receiving hospital for other Indian Health Service (IHS) facilities in the Four Corners area and is a Level 3 trauma center. NNMC is located in Shiprock, NM, ~210 miles northwest of Albuquerque. The Center for Rural and Tribal EMS, led by faculty member Chelsea White, MD provides continuing education and medical direction to the many of the Tribal EMS agencies in New Mexico (https://emed.unm.edu/crte). Tribal EMS providers can be the only health care providers within several hours drive in certain areas of the reservations.

Our beautiful surroundings in New Mexico are certainly one of the draws for many of our residents and faculty (see “Do I have to rock climb to match at UNM” below). This also overlaps with “What is Life in ABQ like?”. In short, faculty and residents enjoy the terrific weather that New Mexico offers--and many socialize by being outdoors for a variety of activities, including running, cycling, climbing, camping, fishing, and skiing. 

New Mexico has a very long, rich cultural history to learn about. The earliest known inhabitants in New Mexico stretch back to ~11,000 BCE with the Clovis people (artifacts found near Clovis, NM) to more recent ancestral pueblo and Mogollon cultures. There is a vast number of historic archaeological sites to visit including Bandelier, Chaco Canyon, and Mogollon. In more recent history (meaning the past 500 to 1000 years!), New Mexico was inhabited by many different indigenous peoples (now represented by 23 different federally recognized tribes in NM). More recently, the Spanish came to New Mexico in 1598 (from New Spain, now (old) Mexico) creating the oldest capital in (now) the US in Santa Fe (still the capital!). Other peoples have since come to New Mexico, making Albuquerque a diverse city within a minority-majority state. With all this history, there are countless places to explore. See https://www.newmexico.org/ for more information and ideas.

The food culture in New Mexico is also unique. New Mexican cuisine while related to Mexican food, it is distinct--with a focus on the New Mexico chile (our state question is “Red or Green?”). In addition to New Mexican food, nearly all other cuisines can be discovered around the state. Santa Fe offers a large number of higher end restaurants. We encourage you to investigate it when you can! (For more casual browsing from a distance, try nmgastronome.org for a list of restaurants and cuisines around the state.) It’s also hard to mention eating in Albuquerque without noting its craft beer scene. It has exploded over the last decade as one of the top states in the country for craft breweries per capita - but maybe more importantly, a high density of award-winning brews!

New Mexico is also a major artist hub with many galleries in and around the Albuquerque and Santa Fe areas. Albuquerque is a hotspot in the nation for urban art and has one of the oldest public art programs in the country with organizations like Los Muros de Burque passionately spreading the word. Art crawls are a fun way to spend time with family and friends. Santa Fe hosts several major art festivals every year, including the International Folk Art Market, Indian Market, and the Traditional Spanish Market. 

In addition to art, New Mexico has a vibrant local and regional live music scene, heavily latin-influenced, but the global influence is embodied in the annual ¡Globalquerque! world music celebration. Even if you are not into opera, tailgating with a cross-section of Santa Feans in your jeans or a ball gown, seeing the last rays of sun through the back of the open-air stage, followed by a world premiere by renowned opera singers is a fairly unparalleled experience.

The Albuquerque International Balloon Fiesta in early October is a site like no other. For one week, the skies over Albuquerque are filled with hot air balloons. Mass ascension events can have over 500 balloons in the air.  

We have a crew of faculty and residents who are ardent knitters. One of our residency grads, Bronwyn Wilson, has a terrific following on instagram. Check her out! (https://www.instagram.com/casapinka/)

For sports enthusiasts, Albuquerque’s 310 sunny days per year make it a great place for year-round participation or spectation. Many residents and faculty are already ardent supporters of NM United, our new USL pro soccer club who played their first games in the 2019 season. There is also pro baseball, pro indoor football, minor league soccer, and pro basketball starting in 2019. The UNM Lobos also have several worthy teams to follow, including Division 1 football, Men’s & Women’s basketball and Women’s soccer. We have the largest covered BMX facility in the world, hosting pro BMX riders from around the world. 

And for those with children, there are a ton of great ways to entertain and educate kids in Albuquerque, with a world-class zoo, botanic garden with a G-scale railroad and castle, museums, aquarium, parks, open-spaces, urban and foothill trails, indoor climbing gyms, skate parks, and family-oriented festivals & outdoor concerts. 

What efforts towards diversity and inclusion is the residency program making? 

We consider this a top-down effort that begins at the institutional level with hiring decisions, policies, financial support and cultural norm setting, proceeds through departmental hiring with some of the same considerations, and then learner recruitment. Of course this all happens concurrently but without support from the top is very difficult to accomplish. After 30 years with one of our emergency physicians at the helm of the institution as the HSC Chancellor / Dean of the SOM and Executive Vice President, the institution is splitting those two functions apart and currently hiring for both. Last year the institution hired two women in top leadership. Kate Becker came in as UNM Hospital CEO and has been an energising force for UNM hospitals, and our new University President, Garnett Stokes, has been busy with outreach around the state. Diversity and inclusion has been one of the strongest considerations in our ongoing selection of the new EVP. At the departmental level, our chair has set social justice and diversity as our primary goal for the next 5 years. Cameron Crandall is one of our senior leadership as longtime Vice Chair for Research and also serves as the Associate Vice Chancellor for HSC LGBTQ Diversity, Equity, and Inclusion and JP Sanchez joined our department in July as our Vice Chair for Diversity and Inclusion. Dr. Sanchez is a national leader in diversity and we are really looking forward to working with him to shape our departmental efforts. At the program level, last year we began considering our recruitment process in terms of effect on diversity. This is an ongoing process, and one which we hope will wrap up this year, although this recruitment season has thrown a wrench into that. So we are trying to systematically address diversity among our residents, but also plan to continue to work closely with Drs. Sanchez & Crandall and our other institutional resources to include education efforts, culture components, and communication encouragement.

The most established career tracks are EMS, Critical Care, and Wilderness Medicine. Each of these tracks pairs residents with a faculty mentor in that field and provides for adjustments in the standard curriculum to allow for a deeper exposure within a particular subject. For example, Critical Care track residents rotate in the CVICU as opposed to inpatient cardiology during their HO2 year, EMS track residents can opt to trade their dedicated Ultrasound month for a dedicated EMS month as HO2s. In the past, residents have also combined track experiences or designed their own career track experiences in Ultrasound, Disaster Medicine, Administration, Education, Toxicology, and Pediatric EM.

Albuquerque is a diverse, livable, mid-size city with a low-cost of living, and unbeatable access to the outdoors. There is a vibrant and growing food and brewery scene in Albuquerque. Many residents live within walking or biking distance of the hospital. The average rent in Albuquerque for a 1 BR is $922/mo as of July 2020, but with roommates or a partner you can pay significantly less. Housing prices in Albuquerque are so affordable that it's not uncommon for residents to buy a home. 
Outside of Albuquerque, Santa Fe is an hour-drive with its renowned arts and cultural scene, Taos is 2½ hours through some of the most scenic driving in the country. New Mexico has dozens of state and national parks, cultural monuments, and beautiful outdoor recreation areas.

https://www.visitalbuquerque.org/
https://www.newmexico.org/
https://youtu.be/ZzRLNZFBV0w
https://youtu.be/LwHFYwB5SJA
https://youtu.be/Btx-DfE8-Io

We’ve described a lot of what Albuquerque and New Mexico have to offer above under “What types of social activities do your residents, staff and faculty engage in?”.

Each class year is assigned its own Assistant Program Director to oversee the needs of learners along their progression through residency. We also have a Resident Professional Development Director who is a non-clinical faculty member and meets with all residents to help them develop their Individualized Learning Plan early on and is also available for continued advisement. Each HO1 is assigned an HO3 resident mentor before their arrival in order to provide guidance[f][g] and help with the transition to residency. Additionally, Career track residents are paired with a faculty member in their field of interest. And there is a deep field of faculty with a variety of professional interests who are happy to share those interests with residents.

New Mexico is a minority majority state with 47% of the state population identifying as Hispanic, 9.4% Native American, 2.1% Black, and 1.4% Asian. The department strives to have a workforce that represents the communities we serve. % female faculty / leadership? Faculty & resident involvement in diversity initiatives / programs? This year’s intern class did widen our color spectrum a little, although didn’t do much for the gender split. 
Cam will pull diversity stats from ERAS data. Can also do some basic stats on faculty.

The most established career tracks are EMS, Critical Care, and WIlderness Medicine. Each of these tracks pairs residents with a faculty mentor in that field and provides for adjustments in the standard curriculum to allow for a deeper exposure within a particular subject. For example, Critical Care track residents rotate in the CVICU as opposed to inpatient cardiology during their HO2 year, EMS track residents can opt to trade their dedicated Ultrasound month for a dedicated EMS month as HO2s. In the past, residents have also combined track experiences or designed their own career track experiences in Ultrasound, Disaster Medicine, Administration, Education, Toxicology, and Pediatric EM.

New Mexico is a minority majority state with 47% of the state population identifying as Hispanic, 9.4% Native American, 2.1% Black, and 1.4% Asian. Among the patients we see in our ED, 52% are male, 48% are female by sex designation at birth; 48.3% identify as cisgender women; 46.3% cisgender men; and, 1.2% identify as transgender or gender non-binary (4.2% declined to state). Most identify as straight (81.0%) followed by bisexual (1.6%), gay (1.1%), lesbian (1.2%) and other (0.9%) (14.2% declined to state). Overall, 6.2% identify as a sexual or gender minority. About half (49.9%) identify as Hispanic/Latino. About 60.1% identify as White/Anglo, 16.4% as American Indian/Alaska Native, 4.2% Black/African American, and 1.2% as Asian (about 16% declined to state). Most patients identified English as their spoken language (86.7%) and 11.1% identified Spanish. The mean age of our patients is 34.8 years (SD 22.2 years) (median 34, IQR: 17 to 52). Twenty-five (25%) are under 18 years old and 10% are 65 and older. 
In 2019, the median number of visits per patient was 2 and the interquartile range was 1 to 6 (mean, 5.2 visits per patient per year, one patient had 332 separate visits).

UNM Hospital serves several important missions, including acting as the only Level I trauma center for the state, the only NCI designated cancer center, academic medical center, and as the safety net hospital for the Albuquerque Metropolitan area. We see a large number of trauma patients per year, including both blunt and penetrating trauma. Many of our patients come from neighboring areas of Colorado and Arizona. Common chronic medical conditions that are disproportionate among our patients include diabetes, hypertension, alcohol use disorder (and related downstream health conditions such as alcoholic liver disease), substance use disorder (notably opioids and methamphetamine). A significant percentage of our patients have hepatitis C while our population of patients living with HIV is relatively low. 

We have a significant homeless and unstably housed population. Fortunately, we have a fantastic staff of case managers / social workers dedicated to the ED from 8 am to 11:30 pm 7 days a week. 

We have excellent services available to the homeless community, including Albuquerque Healthcare for the Homeless (https://abqhch.org/) and Heading Home (https://headinghome.org/). In addition to our own primary care services offered through our family medicine and internal medicine programs, UNM has strong partnerships with several federally qualified health centers (FQHC) (e.g., First Choice Community Healthcare(https://www.fcch.com/) and First Nations Community HealthSource (https://www.fnch.org/)) to provide continuity of care after discharge from the emergency department.

We have always put an emphasis on well-rounded applicants. Although we have relied on traditional metrics such as Step scores and US training for the initial selection of applications for closer review, we have considered involvement in community and other projects, research, and diversity of work experience to be valuable attributes.

We do have a brand new Housestaff Diversity Council (first meeting Aug 2020) which is still organizing their focus for this year, but has great support from GME and institutional leadership. The Associate Dean of GME, Gena Dunivan, sits on this council. We also have a Health Sciences Office for Diversity, Equity and Inclusion with a mission to train providers who can reduce health disparities by reflecting the state’s diverse population.

We’ve had individuals participate in various community discussions/activities around these issues, our new departmental discussion agenda, our chair setting this as the primary priority for the next 5 years. Our Learning Environment Office has taken an institutional lead on this as well, hosting sessions for faculty and GME learners such as “Suggested Practices for Facilitating Conversations about Race, Ethnicity & Racism”.

We do not generally consider applications with a Step 1 score less than 210. Given the changes in Step 1 scoring, we will likely change this cutoff to Step 2.

No! Access to the outdoors is one of the things that draws many people to New Mexico. Many of our residents enjoy different types of outdoor recreation (and it makes for great recruiting pictures) but outdoor prowess is by no means a prerequisite to matching at UNM or enjoying life in Albuquerque. But we have been known to make converts out of indoor-oriented interns!

In addition to salary and health insurance through BlueCross/Blue Shield, UNM EM residents receive reimbursement for Step 3, Membership in SAEM and EMRA, a subscription to Rosh Review, over $700/yr in food money, and $600 in CME money that can be used for study resources, medical equipment or electronics[h][i]. We also encourage scholarly involvement and leadership and support these endeavors through travel funds. The institution has arranged a partnership to provide primary care for GME learners through LoboCare clinics if they do not have a separate PCP, and all interns are expected to participate in a short counseling session so they have a mental health contact for themselves or for a colleague in crisis.

All UNM housestaff are able to join the Council of Interns and Residents, a subsidiary of 1199 SEIU. Membership is not mandatory, but the Union negotiates for all house officers. This year the union successfully negotiated a 3% salary increase for all post-graduate trainees, and a $40/month cell phone reimbursement. 

GME provides a generous benefit package, particularly in light of the relatively low cost of living the Albuquerque area affords. As a state institution, the malpractice coverage is very good. Disability and health insurance are covered, and residents are eligible for 15 days of vacation, 5 days of educational and 2 days of wellness leave annually. There are two weeks of institutional parental leave, and our program also allows additional combinations of sick leave, annual leave, or FMLA to extend that time. Scrubs and ID badges are provided by the institution, lab coats are provided by our department, there is a call room in the clinical department and a resident work room with sleeping facilities, snacks, coffee, computers with internet and dictation access in our academic offices.

We consider teaching an integral component of competent EM practice. Residents have graduated levels of teaching and presentation requirements as they progress through the residency. Beyond formal didactics, one of the things that makes UNM EM unique is the broad range of learners in our department and the opportunities for on shift teaching. In addition to medical students from UNM and visiting institutions, UNM EM also trains APP students, paramedic students and pararescue trainees from Kirtland Air Force base. 

What kind of resident does best in the program (may be interesting to get faculty and resident opinions on this one?)
From the Program Director (PD): I obviously get this question a lot. And have one perspective. And I think there are many ways to be “successful” as a resident, so many perspectives here are helpful. But from the PD perspective, I feel like other than the general “just be a rock star” advice, what makes this program unique is our blend of patient population, socioeconomic challenges, hospital niche in the community, and geographic setting. So that does create a personality/skills mix that will thrive. Everyone who goes into emergency medicine wants to serve everyone who walks in the door, that kind of comes with the territory. But at UNM, we look for residents who have a little higher commitment to underserved populations and are creative thinkers. Working in an under-resourced environment with a challenging patient population means that if you can think outside the box, initiate your own solutions, and have an extra dose of compassion for those who have a hard time accessing care for one reason or another, you will do well here.

Supporting our residents' families is critical to supporting our residents. Many of our residents have young children at home, we also have faculty members who had their children while they were residents here with us. 

If a resident or their partner is pregnant, the institution provides 2 weeks of parental leave and allows an additional 2 weeks of sick leave plus 2 weeks of annual leave or FMLA, which can be combined. The ACGME requires 46 weeks of training to get credit for an academic year. If a resident wanted to take more than 6 weeks of leave, their training would need to be extended and we would work with them to facilitate the completion of their requirements.

We seek to recruit and train a diverse group of emergency physicians with a range of interests encompassing all the different aspects of Emergency Medicine. We place an emphasis on those with a commitment to serving people in underserved communities. UNM EM is a recognized leader in fields like Critical Care, EMS, and Wilderness Medicine, and so applicants with interest in those fields tend to apply here, but interest or experience in those fields is by no means a prerequisite to a successful application.

We will consider applications from both DOs and IMGs. Given the number of applications we receive, and the overall competitiveness of our pool, it is especially important to have equivalent experiences (rotations, EM mentorship for letters, research, volunteer and work) for us to compare during the application process.. This can be a challenge for both of those groups depending on their education structures. So if you are an applicant that falls into one of those categories, it is especially important to make sure those experiences are included in your application.

We have a strong working relationship with all other services. We’ve been at this long enough and have enough high-level integration with other departments (dual-trained intensivists who work closely with surgical and medical colleagues in the ICU’s, department faculty with dual appointments like Anesthesiology, Pediatrics, and Psychiatry, trauma committees, other hospital committees) that we have good trust and communication with key departments. We share trauma team leader responsibility with the senior surgery residents, share the “procedure doc” role for traumas, and have primary airway responsibility in all trauma resuscitations.

Community involvement is the one of the founding principles of our program. Our residency program began in 1986 when we were a division of the Department of Family, Community, and Emergency Medicine. Since the beginning, and continuing on after we became our own department in 1990, we’ve highly valued our commitment to community involvement. Since the beginning, we have required a community project, in addition to the RRC-required scholarly and QA projects. This is not intended to be onerous as it only entails 20 hours of involvement in the 3 years of residency, and the intent is for our residents to have connections with whatever they consider their community. We leave the definition of community pretty open and most proposals are accepted. As a department, we have wide involvement in the community, mostly through our extensive pre-hospital programs and faculty. Many of our resident projects are through these connections.

UNM Hospital is a division of the University of New Mexico, which is New Mexico’s flagship higher education institution. UNM Hospital is publicly funded with support from Bernalillo County and the State of New Mexico as well as revenue from clinical operations. Sandoval Regional Medical Center, our second location where residents rotate as part of their community experience in HO3, is similarly supported. All emergency medicine faculty hold an academic appointment in the School of Medicine and are also members of the UNM Medical Group. The medical group is a 501(c)(3) non-profit organization that represents 1100+ providers in the hospital system. Our residency is 100% funded through GME. Our institutions are strongly supported by our governor and legislature as UNM Hospital and the Health Sciences Center provide critical training and clinical services to the citizens of New Mexico. Although there are no guarantees with any health system in the country right now, we are pretty well situated when it comes to long-term viability.

From the PD: the big ones I see are an increase in fast track and obs service lines to address the tension between ED overcrowding and delivery of high quality care, potentially more incorporation of physician triage, and a move to more corporate community practice. There are probably many others if you pushed me on it, but these are big ones. In terms of how we are preparing residents, one of our current HO2’s is spearheading the incorporation of triage shifts for interns this year. We’ll see how this goes. A potential change is to incorporate these into HO3 year because this is when residents tend to be most receptive to system-based education. We used to have a fast track-type shift incorporated in HO3 when we had a lower acuity pod in our main ED. When this disappeared, it didn’t get replaced. I’m not sure of the clinical yield for residents, but we do incorporate fast track administration into didactics. Similarly with obs medicine. For the corporatization of community practice, we have internal and external experts and plan to continue to add more.

Our residency has always been very resident-driven, with an emphasis on two-way communication, and we have made most big changes throughout the decades based on resident input. The primary mechanism is through individual communication on rotation evaluations (anonymous) and semi-annual PD meetings (in-person), but we also have several other input mechanisms. We have monthly optional PD group meetings (right now they are called Bring-Your-Own-Breakfast with Baty) for residents to discuss issues, and that is centred around a Stoplight report created last year which is used to track all actionable issues on the PD’s radar from all sources. That report is shared with residents and accessible at all times from a resident dashboard, and they can provide comments or even attach relevant items to any ongoing issue. We also have semi-annual Program Evaluation Conferences where residency data is reviewed, other departmental leaders provide updates, we discuss issues, and residents provide anonymous program-level written feedback on faculty, rotations, and administrative issues. Lastly, we have an anonymous feedback link on our resident dashboard which can be used either identified or anonymously and sends feedback on anything to myself and our Program Manager.

Our intern orientation is a month of clinical, program orientation, cultural competency, and some administrative. Although we do provide clinical training (bread and butter topics, refreshers, ATLS, FCCS, splinting, suturing, etc), we’ve also found that interns retain a small percentage of this information. There is just so much information that comes in that month, so we are mostly focused on providing bonding opportunities for the intern class with each other and with the rest of the department. Due to COVID-19 restrictions, this year was a little different with fewer opportunities to gather as a group. We’ve found over the years that since our intern classes are usually quite geographically diverse, folks really need this time to create these relationships and trust to rely on for the remainder of training. Many residents form lifelong bonds with their colleagues.

There are two opportunities to engage with mass casualty incidents (MCIs): pre-hospital and hospital settings. Residents have roles in both. For MCIs in the department, we have protocols, and residents are definitely part of the necessary workforce, although not in the organization of the response. There is a response team of staff, administrators, and providers who train and run scenarios regularly. On the prehospital side, residents who are in the EMS track have been more involved in incident awareness and response. We have had residents in the past who have gone through disaster response training, and even joined our DMAT team.

The ED is divided into covid and non-covid sections. The entry point for covid (or suspected) patients is through our Critical Respiratory Care Center (CRCC). We have also just re-assumed administration of the Respiratory Care Center (RCC) which is a converted large conference room at the front entrance that has been the lower acuity and screening area since March 2020. Residents are not working in the RCC, but we have combined our ED Resuscitation Unit (EDRU) shifts and covering the CRCC. These shifts are shared with an Advanced Practice Provider who is in the CRCC. When the EDRU is busy, the APP is seeing most of the patients coming through the CRCC, when volumes allow, those patients are shared with residents covering the EDRU. Senior residents perform any necessary procedures on critically ill CRCC patients.