The story begins when I was a resident back in 2005. My program director wanted a way to document the ACGME core competencies. With the help of a fellow resident and a high school friend who was a developer, I built a tool to track residents’ activities. We called it ePortfolioMD. It was a web-based social network for residents, inspired by Facebook and MySpace circa 2006, designed to help residents document their progress and experiences.
The product had traction, but I had to step away to focus on surgical training. I learned the hard way that you can’t be a startup founder and a general surgery resident at the same time. You have to become one first. In 2006, I chose to become a surgeon.
Fast forward to 2021. Now I’m a surgeon—and I teach residents. And I realized they were dealing with the same issues I faced 15 years ago. So this time, I decided it was time to become a founder. I created UNIRA, a digital platform to help residents document their surgical cases and extract more value from their activities.
Development took a year. I worked closely with the residents to improve their case logging experience. I looked at every friction point in the ACGME case log platform—everything that made logging slow, tedious, or frustrating—and we solved them in UNIRA.
One key issue was coding. Residents often struggled to find the right CPT code for their procedures. So we integrated the AMA CPT code list with a Large Language Model, enabling natural language search. Sure, residents could already use Google or ChatGPT to find codes, but we made it faster, more accurate, and built into the case logging flow. It worked. The app started gaining traction nationwide.
Before long, residents at major programs—Harvard, Stanford, Yale, Duke, Mayo Clinic, Cleveland Clinic, NYU, Mount Sinai, and many more—were using UNIRA.
In fact, 60% of all General Surgery Residencies in the US had at least one resident who used UNIRA.
In fact, 60% of all General Surgery Residencies in the US had at least one resident who used UNIRA.
At the same time, the American Board of Surgery (ABS) was rolling out the Entrustable Professional Activities (EPA) initiative to help programs better assess resident performance. I saw an opportunity to integrate both systems—the ACGME Accreditation Data System (ADS) and the ABS Entrustability framework (EPA)—into a unified experience. And we did it.
UNIRA was riding high. But I knew that for it to truly succeed, it needed formal recognition by the ACGME and ABS. These institutions oversee the education and certification of every general surgery resident in the U.S. The ACGME ensures that hospitals and residents uphold high standards, and the ABS certifies that residents are competent to practice. Their role is vital: they protect the quality of medical care in this country.
I managed to get meetings with the CIO of the ACGME and the Vice President of the ABS. We had several sessions. But in the end, I couldn’t form a partnership with either of them.
It was a tough blow. At first, I was frustrated. I didn’t understand why they wouldn’t want to work with UNIRA. We were solving a real problem. The platform worked. Residents loved it. They were logging their cases—and their EPAs—faster and more accurately than ever.
I obsessed over it for weeks and then it clicked.
The ACGME and ABS aren’t tech companies. They are certifying bodies. Their job is to safeguard one of the most important parts of a nation’s healthcare system: its physicians. Every decision they make has weight. Every choice affects patient care.
UNIRA, by contrast, is a software startup. And in startups, the motto is: move fast and break things. We weren’t breaking things—but we were still a startup, founded by a random surgeon in South Florida.
Eventually, I understood them. And I made my peace with it.
