College of Medicine / Residencies / Emergency Medicine / Resident Rotations

Resident Rotations

The emergency medicine program is divided into 12 blocks per year. Residents have 4 weeks of vacation time per year, taken during emergency department blocks.

PGY-1

PGY-2

PGY-3

 

 

PGY-1

Emergency Medicine

PGY-1 residents are scheduled for 7 months in the ED (of which one month there is an organized clinical experience in anesthesia and four weeks are spent on vacation). Five months are at Bethesda Hospital East and 2 months are at St. Mary’s Medical Center. PGY-1 residents work 14 shifts per month in the adult emergency department plus 4 shifts per month in the pediatric emergency department comprised of 10 and 9 hour shifts.

Residents will primarily see patients and then present the case to an attending physician or a senior resident. The case will be discussed as to history and physical findings. The residents will be asked to formulate a differential diagnosis, and a diagnostic and treatment plan. The supervising physician will examine the patient, and compare his/her findings with the resident. Any needed modifications to the care of the patient will be discussed. The case will again be discussed at the time the decision is made to either admit or discharge the patient. Follow up plans will be 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.

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Trauma

PGY-1 residents function as integral members of the trauma team at Delray Medical 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.

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Medical ICU

PGY-1 residents in the ICU/CCU are responsible for an average of approximately 8-10 patients 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, Swan-Ganz catheterization, temporary transvenous pacemaker insertion, and arterial line placement) under the supervision of certified senior housestaff or attending physicians.

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Surgical ICU

PGY-1 residents in the surgical intensive care unit at Delray Medical Center are responsible for an average of 10 patients. 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 are also responsible for all procedures performed on their patients (including central venous lines, endotracheal intubation, thoracentesis, thoracostomy, Swan-Ganz catheterization, and arterial line placement) under the supervision of certified senior housestaff and the surgical intensivists.

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Pediatric ICU

PGY-1 residents assume graded responsibility for direct patient care in the pediatric special care unit at Bethesda Hospital East. The 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.

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Anesthesia

PGY-1 residents assist the attending anesthesiologists in the OR with pre-induction and management of anesthetized patients at Bethesda Hospital East. The residents are encouraged to spend some mornings exclusively in 1-2 cases and other mornings moving room to room performing multiple endotracheal intubations. The residents also participate with the anesthesiologists in informal discussion of basic topics in anesthesia during cases.

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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 and three cesarean sections for the month.

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Ultrasound

PGY-1 residents are expected to perform a minimum of 40 bedside ED ultrasounds during the rotation 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. These scans should additionally be logged by the resident in the tracking system. Residents are expected to prepare for ultrasound scanning sessions by reading sections of the ED ultrasound textbook: Ma & Mateer's Emergency Ultrasound 3rd Edition.

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PGY-2

Emergency Medicine

PGY-2 residents are scheduled for 7 months in the ED (of which four weeks are spent on vacation). Five months are at Bethesda Hospital East and 2 months are at St. Mary’s Medical Center. PGY-2 residents work 13 shifts per month in the adult emergency department plus 4 shifts per month in the pediatric emergency department comprised of 10 and 9 hour shifts.

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. The residents serve as medical control physician for incoming EMS patients after 15 satisfactory supervised calls.

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Trauma

PGY-2 residents function as integral members of the trauma team at St. Mary’s Medical Center and respond to the emergency department when the trauma team is activated. The residents’ role in the initial management of the trauma patient is determined by the trauma attending physicians and may also include a role as the resident 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, postoperative care, in-hospital observation, monitoring and care, discharge planning, and out-patient follow-up). In

addition, the PGY-2 emergency medicine residents may supervise a junior resident on the trauma rotation. The residents will participate in all trauma service conferences and activities.

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Medical ICU

PGY-2 residents in the ICU/CCU at Delray Medical Center are responsible for an average of approximately 8-10 patients. 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.

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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. The residents may 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 junior residents on the PICU rotation.

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Toxicology

PGY-2 residents rotate with the medical toxicology faculty at Bethesda Health. They present cases at conference and participate in medical toxicology research. The residents also prepare a lecture on a medical toxicology topic to present during conference. Residents are expected to prepare for toxicology sessions by reading sections of the Goldfrank’s Toxicologic Emergencies 10th edition.

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PGY-3

Emergency Medicine

PGY-3 residents are scheduled for 7 months in the ED (of which four weeks are spent on vacation). Five months are at Bethesda Hospital East and 2 months are at St. Mary’s Medical Center. Residents work 13 shifts per month in the adult emergency department and 3 shifts per month in the pediatric emergency department comprised of 10 and 9 hour shifts.

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. The residents serve as medical control physicians for incoming EMS patients.

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Trauma

PGY-3 residents function as integral members of the trauma team and respond to the emergency department when the trauma team is activated. One month is at Delray Medical Center and the other month is at St. Mary’s Medical Center. The residents’ roles in the initial management of the trauma patient are determined by the trauma attending and may include a role as the resident 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). In addition, PGY-3 emergency medicine residents may supervise junior residents on the trauma rotation. The residents will participate in all trauma service conferences and activities.

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Pediatric ICU

PGY-3 residents assume graded responsibility for direct patient care in the pediatric special care unit at Bethesda Hospital East. PGY-3 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. The residents may be the primary physicians in consultation with the patients’ attending physicians. In addition, the PGY-3 emergency medicine residents may supervise junior residents on the PICU rotation.

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EMS/Administration

PGY-3 residents will ride along on ambulances with local EMS crews to engage in pre-hospital emergency care of the acutely sick and injured patients. Residents will also have the opportunity to ride in an air ambulance as a voluntary experience. Residents will participate in mass casualty incident drills and prepare lectures on EMS topics to present during conference.

During this rotation, residents will also serve as the administrative resident. Responsibilities include completing an administrative audit project utilizing core competency goals and objectives, completing administrative readings, and performing 30 emergency department chart audits. The resident will also be responsible for coordinating morbidity and mortality (M&M) conference with the responsible faculty member. Residents will attend administrative departmental and residency meetings.

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Last Modified 11/8/16