Emergency Medicine Resident Rotations

PGY-1 Rotation Descriptions

Emergency Medicine and Pediatric Emergency Medicine

PGY-1 residents are scheduled for 8.5 blocks of emergency medicine (of which four weeks are spent on vacation). Each block, residents are assigned 17 clinical shifts and longitudinal experiences (EMS, ultrasound, QI/PS, wellness, EM administration). The EM clinical shifts occur at Bethesda Hospital East, Delray Medical Center, and St. Mary’s Medical Center and are comprised of 8 to 12 hour shifts in adult and pediatric emergency medicine.

Residents primarily see patients and then present the case to an attending physician or a senior resident. The case is discussed as to history and physical findings. The residents are asked to formulate a differential diagnosis, and a diagnostic and treatment plan. The supervising physician examines the patient, and compare his/her findings with the resident. Any needed modifications to the care of the patient is discussed. The case is again discussed at the time the decision is made to either admit or discharge the patient. Follow up plans are discussed with the supervising physician. The individual resident's responsibility is commensurate with experience, and clinical maturity based on evaluation by supervisory emergency medicine faculty.

Trauma

PGY-1 residents function as integral members of the trauma team at St. Mary’s Level-1 Trauma Center and respond to the emergency department when the trauma team is activated. The resident’s role in the initial management of the trauma patient is determined by the trauma team leader. On the trauma service, the residents take part in all aspects of the comprehensive care of the injured patient. The residents participate in all services offered by the trauma team (initial evaluation and resuscitation, operative intervention, post-operative care, in-hospital observation, monitoring and care, discharge planning, and out-patient follow-up). The residents will participate in all trauma service conferences and activities.

Medical ICU

The PGY-1 ICU experience is held at Bethesda Hospital East. On the ICU/CCU rotation the PGY-1 emergency medicine residents will perform the initial history and physical examination, determine a plan of diagnosis and treatment, write all necessary orders, and will be the primary physicians under the supervision of more senior residents and in consultation with the patients’ attending physicians. Residents are also responsible for all procedures performed on their patients (including central venous lines, endotracheal intubation, thoracentesis, paracentesis, temporary transvenous pacemaker insertion, and arterial line placement) under the supervision of certified senior housestaff or attending physicians.

Surgical ICU

The PGY-1 ICU experience is held at St. Mary’s Medical Center. The residents will perform the initial history and physical examination, determine a plan of diagnosis and treatment, write all necessary orders, and will be the primary physicians under the supervision of more senior surgical residents, and the surgical intensivists. Residents may be called to trauma activations and are responsible for all procedures performed on their patients (including central venous lines, endotracheal intubation, thoracentesis, thoracostomy, and arterial line placement) under the supervision of certified senior housestaff and the surgical intensivists.

Obstetrics/Anesthesia

Obstetrics
PGY-1 residents direct inpatient and outpatient care of OB patients at Bethesda Hospital East. Residents manage patients on the L&D floor and in the emergency department. Patients are sent to the labor & delivery (L&D) triage where they are evaluated for admission by the emergency medicine residents. Patients are then presented to attending physicians and the determinations for admission are made. Patients in the second and third trimester with abdominal pain, vaginal bleeding, or any type of trauma that is deemed non-life threatening are sent from the emergency department to L&D for evaluation. If a patient is admitted, the resident who initially evaluated her will write the H&P and admitting orders, and if time permits, will deliver the patient. The minimum requirement is ten vaginal deliveries.

Anesthesia
PGY-1 residents work on the anesthesia service under the supervision of anesthesiology attendings at Bethesda Hospital East. They develop skills in emergency airway management, the use of paralytic agents, and general anesthetic agents. Residents receive instruction on rapid sequence induction, oral awake intubation, nasotracheal intubation, fiberoptic intubation, use of the intubating laryngeal mask airway, central line placement, and arterial line placement. They also assist in the performance of complex procedures such as transesophageal echocardiography and regional nerve blocks when available.

PGY-2 Rotation Descriptions

Emergency Medicine and Pediatric Emergency Medicine

PGY-2 residents are scheduled for 9.5 blocks of emergency medicine (of which four weeks are spent on vacation). Each block, residents are assigned 16 clinical shifts and longitudinal experiences (EMS, ultrasound, QI/PS, wellness, EM administration). The EM clinical shifts occur at Bethesda Hospital East, Delray Medical Center, and St. Mary’s Medical Center and are comprised of 8 to 12 hour shifts in adult and pediatric emergency medicine.

PGY-2 emergency medicine residents assume increased responsibility in the initial evaluation, stabilization and disposition of the individual acutely ill or injured patient. The emergency medicine attending physicians and senior emergency medicine residents discuss patient care with the residents but individual role and degree of responsibility is commensurate with the level of training and experience based upon evaluation by supervisory staff. The residents are involved in the teaching of junior medical personnel and participate actively in emergency medical services.

Medical ICU

The PGY-2 ICU/CCU experience is held at Bethesda Hospital East. On the ICU/CCU rotation the PGY-2 emergency medicine residents will perform the initial history and physical examination, determine a plan of diagnosis and treatment, write all necessary orders, and will be the primary physicians under the supervision of more senior residents and in consultation with the patients’ attending physicians. In addition, PGY-2 emergency medicine residents may supervise a junior resident on the ICU rotation.

Pediatric ICU

PGY-2 residents assume graded responsibility for direct patient care in the pediatric special care unit at St. Mary’s Medical Center. PGY-2 residents are responsible for performing a history, physical examination, formulating a management plan, and writing appropriate orders. They will additionally perform the indicated invasive procedures with the intensivists, monitor the patients daily, and interface with the patients’ family and private pediatricians.

PGY-3 Rotation Descriptions

Emergency Medicine and Pediatric Emergency Medicine

PGY-3 residents are scheduled for 11 blocks of emergency medicine (of which four weeks are spent on vacation). Each block, residents are assigned 16 clinical shifts and longitudinal experiences (EMS, ultrasound, QI/PS, wellness, EM administration). The EM clinical shifts occur at Bethesda Hospital East, Delray Medical Center, and St. Mary’s Medical Center and are comprised of 8 to 12 hour shifts in adult and pediatric emergency medicine.

Emphasis is placed on the care of multiple patients and the management of emergent conditions. There are advanced clinical responsibilities along with major supervisory, administrative, and educational functions in the emergency department. Residents simultaneously manage critically ill patients while interacting with patients, families, consultants, and emergency department staff without relying on the attending physicians to "decompress" or "defuse" difficult situations. PGY-3 emergency medicine residents independently manage patient care in the role of emergency medicine attending physicians while the EM attending physicians are immediately available to assist.

Longitudinal Descriptions

Trauma

PGY-2 and PGY-3 residents are assigned ED-based shifts occurring during their emergency medicine rotations. They will serve as trauma team leaders and as integral members of the trauma team at St. Mary’s Medical Center. During these shifts, the residents will master the ability to stabilize and care for trauma patients at a Level 1 Trauma facility.

Ultrasound

Residents are expected to perform a minimum of 150 bedside ED ultrasounds during their residency with special attention made for the ultrasound exams including eFAST, aorta, first-trimester obstetric, echocardiography, and procedural use to include ultrasound guided central line placement. Residents participate in an ultrasound didactic curriculum comprised of textbook readings, on-line training modules, and bedside training. Specific bedside training experiences occur with a dedicated EM ultrasound faculty member as part of a longitudinal curriculum during their emergency medicine rotations throughout their residency training.

Emergency Medical Services (EMS)

Residents ride along on ambulances with local EMS crews to engage in pre-hospital emergency care of the acutely sick and injured patients. Residents participate in EMS experiences as part of a longitudinal curriculum during their emergency medicine rotations throughout their residency training. Residents also have the opportunity to ride in an air ambulance as a voluntary experience. Residents participate in mass casualty incident drills and prepare lectures on EMS topics to present during conference.

Administration

The EM administration curriculum is taught as part of their longitudinal curriculum throughout the 3 years of residency training. Residents select and serve as an active voting member on a hospital or university committee based off of their individual interest. Residents also have the opportunity to serve in leadership roles for regional and national organizations.

Quality Improvement and Patient Safety

The curriculum for Quality Improvement and Patient Safety (QI/PS) has the goal of providing a didactic curriculum and mentored practice in the principles of quality improvement and patient safety.

The didactics curriculum will involve a series of Institute of Healthcare Open School modules. These modules will teach you the necessary foundational information involved in the current physician practice of QI/PS.

In addition to the didactic training, residents will have the opportunity to obtain real-world experience serving on a hospital-wide QI/PS committee. This will afford the EM resident the ability to participate in projects with the aim of improving quality care and patient safety.

Time to participate in these experiences will be assigned as part of a longitudinal curriculum during their emergency medicine rotations throughout their residency training.