Emergency medicine residency training began over lunch.

In 1969, at Cincinnati General Hospital, Bruce Janiak, MD, FACEP, sat down at a small cafeteria table where a group of physicians were debating the possibility of a new specialty: emergency medicine. At the time, the emergency department (ED) belonged to everyone and, in practice, to no one. Medical students were routinely sent across the Ohio River to Kentucky, where they served as the only “doctor” in a small ED. On Dr. Janiak’s first such shift, he was greeted by a nurse and a patient in cardiac arrest. The resuscitation failed. Stirred by what he had experienced, Dr. Janiak went home and read everything he could find about emergency care, which foreshadowed lunch.

Dr. Janiak

Dr. Janiak had planned on training in family medicine. At lunch, he asked if he could instead train in emergency medicine. Dr. Gordon Margolin, an internist, and Dr. Herbert Flessa, an intensivist, agreed, but on one condition:  Dr. Janiak would help create the curriculum during his rotating internship. What followed was the birth of emergency medicine, and in 1970, Dr. Janiak became the first emergency medicine resident in the United States.

Dr. Janiak did not set out to make history. He simply wanted to be, in his words, “where the action was,” and for him, the ED was it. He never regretted the decision. Emergency medicine demanded adaptability, decisiveness, and comfort with uncertainty. It required physicians who could care for anyone, at any hour, with whatever resources were available.  Dr. Janiak thrived in that environment.

Building Emergency Medicine

A small group of mentors helped guide the early formation of emergency medicine at Cincinnati General Hospital. Initially, the head of outpatient medicine, Dr. Jim Agna, was asked to oversee the ED because it was viewed as an extension of outpatient care. Together, they built rotations that allowed Dr. Janiak to function as an emergency physician in all but name. He completed a rotating internship through internal medicine, surgery, pediatrics, cardiology, and other specialties.

Dr. Janiak (seated, far left) at the 55th Anniversary of Department of Emergency Medicine Residency at University of Cincinnati, 2025.

A year later, Dr. Tom Blum, an internist, was formally named head of the emergency medicine residency program, giving the program its first official footing.

Dr. Janiak’s first co-resident, Dr. Bill Teufel, joined in 1971 after leaving California, where he had planned to pursue surgery. He chose instead to train alongside Dr. Janiak in this new and uncertain path. For the first time, emergency medicine felt like a shared effort.