Integrated Residency in Emergency Medicine

Edward Fieg, D.O., Director

Year-Directed Didactic Curricula

R1 Orientation

The R1 orientation program is conducted from mid-June through the end of July. In addition to administrative requirements necessary for inprocessing and payroll; R1s experience a wide variety of didactic and experiential sessions to enable them to prepare for clinical duties and get the most out of the remainder of their residency.

  • Orientation in June is largely conducted in groups with other residents in other programs affiliated with Wright State University. This half-month includes short courses in basic life support (BLS), advanced cardiac life support (ACLS), advanced trauma life support (ATLS), and pediatric advanced life support (PALS).
  • Orientation in July begins with an overview of the three-year curriculum by the Program and Education Directors, followed later in the month by an introduction to evidence-based medicine (EBM) and guidance on writing and presenting Critically Appraised Topic (CAT) discussions.
  • July also initiates the R1 year-directed curriculum (YDC) focusing on the approach to undifferentiated presentations grouped by chief complaint. Most of these are conducted before new residents begin clinical shifts, so they have a foundation to approach some of the most common and potentially most serious patient complaints. A session on the rational use of ancillary studies is also presented. ED directors discuss documentation, risk management, cultural barriers to care, and patient satisfaction.
  • R1s receive introductions to the subdisciplines of emergency medical services (EMS), pediatric emergency medicine, sports medicine, and toxicology. An additional discussion on how physicians interface with EMS providers is also conducted. Additionally, an introduction to disaster medicine is provided. R1s are fully introduced to their integral roles in disaster-response plans for the eight-county Ohio Emergency Management Agency Region II. R1s subsequently complete the short course in basic disaster life support (BDLS). This is complemented by a day of hands-on instruction in personal protective equipment (PPE) and decontamination techniques for healthcare providers managing patients exposed to chemical, biological, or radiological (CBR) materials.
  • Managing personal & professional stress is another session targeted at resident wellness. Additionally, a series on workplace violence, physical safety in the ED, and personal defensive tactics is presented during the orientation month. This prepares R1s for three hands-on defensive-tactics classes taught over the next few months by key faculty and other local combatives experts.

Topics and supporting experiential activities include the following:

 

Small-Group Discussions

Experiential Activities

Short Courses

Jun
   

BLS

ACLS

ATLS

PALS

Jul

Approach to Airway Management

Approach to Altered Mental Status

Approach to Abdominal Pain

Approach to Chest Pain

Approach to Dyspnea

Approach to Poisonings

Approach to the Red & Painful Eye

Approach to Syncope

Approach to Wound Management

Airway Interventions Laboratory

Lumbar Puncture Laboratory

Slit-Lamp Examination Laboratory

Tube Thoracostomy laboratory

Wound Management Laboratory

Vascular Access Laboratory

 

Ancillary Study Use Documentation

Managing Personal & Professional Stress

Multiculturalism and Care Delivery

Patient Satisfaction

Risk Management

Workplace Violence and Physical Safety

 

 

Intro to Disaster Medicine

Intro to Emergency Medical Services

Intro to Pediatric Emergency Medicine

Intro to Sports Medicine

Intro to Toxicology

Decontamination Laboratory

Resident Roles in Regional Disaster Response

BDLS

Intro to Medical Simulation

Medical Resuscitation Simulations

Trauma Resuscitation Simulations

Procedure Skills Practice

Unknown EM Simulation Cases

OSCEs

Intro to Bedside US

Intro to US Physics and Practical Scanning

Bedside Abdominal US

Bedside Obstetrical US

Bedside US for Procedures

Intro to the R2 US Rotation

Aortic US Laboratory

Hepatobiliary US Laboratory

Renal US Laboratory

FAST and Extended FAST Laboratory

First- & Second-Trimester US Laboratory

Procedural US Laboratory

 

ACLS = Advanced Cardiac Life Support; ATLS = Advanced Trauma Life Support; BDLS = Basic Disaster Life Support; BLS = Basic Life Support; ECG = Electrocardiography; DVT = Deep Venous Thrombosis; FAST = Focused Assessment using Sonography for Trauma; PALS = Pediatric Advanced Life Support; US = Ultrasonography

R1s work six 10-hour shifts in one of the emergency departments during the latter half of July, so all will experience clinical emergency medicine in their first month before starting the remainder of their onservice and offservice rotations.

R1 Year

The R1 year-directed curriculum (YDC) concentrates on the approach to the undifferentiated patient complaint [i.e., complaints for which the diagnosis is not already known]. The ability to conduct simultaneous resuscitation and treatment while evaluating life-threatening and other serious problems is an essential skill for all emergency physicians. The YDC begins in orientation and continues throughout the R1 year. Small-group sessions enable case-based discussions where R1s can ask questions and draw on the real-world experiences. The "approach to ___" topics are based on chapters in Mahadevan & Garmel [eds]: An Introduction to Clinical Emergency Medicine (Cambridge: Cambridge, UK; 2005). Supplemental information is drawn from section II of Marx et al. [eds]: Rosen's Emergency Medicine: Concepts and Clinical Practice [6th ed] (Mosby: Philadelphia; 2006).

The small-group discussions, experiential activities, and short courses specific to the R1 year include the following:

 

Small-Group Discussions

Experiential Activities

Short Courses

Jul

Approach to Airway Management

Approach to Altered Mental Status

Approach to Abdominal Pain

Approach to Chest Pain

Approach to Dyspnea

Approach to Poisonings

Approach to the Red & Painful Eye

Approach to Syncope

Approach to Wound Management

Airway Interventions Laboratory

Lumbar Puncture Laboratory

Slit-Lamp Examination Laboratory

Tube Thoracostomy Laboratory

Wound Management Laboratory

Vascular Access Laboratory

 
Aug

Approach to Dizziness and Vertigo

Approach to Headaches

Defensive Tactics Practical Class

BLS-Instructor

ACLS-Instructor

Sep

Approach to Rashes

Approach to Seizures

Clinical Teaching Simulations with R3s

 
Oct

Approach to Diarrhea

Approach to Vomiting

Defensive Tactics Practical Class

 
Nov

Approach to Joint Pain

Approach to Low-Back Pain

Oral-Board Practice Sessions

 
Dec

Approach to Abnormal Behavior

Approach to Fever in Adults

Defensive Tactics Practical Class

 
Jan

Approach to Crying and Irritability

Approach to Fever in Children

Clinical Teaching Simulations with R2s

 
Feb

Approach to Scrotal Pain

Approach to Urinary Problems

ABEM Inservice Examination

 
Mar

Approach to Constipation

Approach to GI Hemorrhage

 

 
Apr

Approach to Anaphylaxis

Approach to Bites and Stings

Oral-Board Practice Sessions

 
May

Approach to Pelvic Pain

Approach to Vaginal Bleeding

 

 
Jun

Approach to Diabetic Problems

Approach to Weakness

Adult Resuscitation Simulations

 

ABEM = American Board of Emergency Medicine; ACLS = Advanced Cardiac Life Support; BLS = Basic Life Support

In addition to scheduled simulation sessions, R1s are provided an extra day on unknown case simulations every month they are on an EM clinical rotation.

As part of the Emergency Medical Services (EMS) curriculum, R1s will schedule several ride-along shifts with the Dayton Fire Department and Kettering Fire Department.

R2 Year

The focus areas of the R2 year-directed curriculum (YDC) are critical care and procedural skills. Actual equipment and supplies are available for familiarization or demonstration when necessary. R2s may choose which of the two major procedure textbooks to read ahead of discussions: Reichman & Simon [eds]: Emergency Medicine Procedures (McGraw-Hill: New York; 2004); or Roberts & Hedges [eds]: Clinical Procedures in Emergency Medicine [4th ed] (Saunders: Philadelphia; 2004).

The small-group discussions, experiential activities, and short courses specific to the R2 year include the following:

 

Small-Group Discussions

Experiential Activities

Short Courses

Jul

Advanced Airway Physiology and Management

Advanced Adult & Pediatric Airway Cases

Advanced Adult & Pediatric ECG Cases

Advanced Adult & Pediatric Imaging Cases

   

Dealing with Consultants

Resident Fatigue

Aug

Approach to Clinical Teaching

US-Directed Catheterization Procedures

 
Sep

Pediatric Resuscitation Algorithms

Pediatric Resuscitation Simulations

 

Oct

Adult Resuscitation Algorithms

 

ADLS NDLS-Instructor

Nov

Advanced Respiratory Physiology and Management

Oral-Board Practice Sessions

 
Dec

Nasal and Dental Procedures

Splinting Laboratory

 
Jan

TeamSTEPPS Concepts

Clinical Teaching Simulations with R1s

 
Feb

Orthopedic Immobilization Procedures

ABEM Inservice Examination

 

Mar

Regional Anesthetic Procedures

Multidisciplinary Simulations with KCMA

 
Apr

Job Seeking and Negotiating Skills

Oral-Board Practice Sessions

 
May

Advanced Cardiovascular Physiology and Management

EMS Extrication Course

PALS [recert]

Jun

Intro to Quality Management

 

 

ABEM = American Board of Emergency Medicine; ADLS = Advanced Disaster Life Support; ECG = Electrocardiography; KCMA = Kettering College of Medical Arts; NDLS = National Disaster Life Support; PALS = Pediatric Advanced Life Support; TeamSTEPPS = Team Strategies and Tools to Enhance Performance and Patient Safety

In addition to scheduled simulation sessions, R2s are provided an extra day on adult resuscitation simulations every month they are on an EM clinical rotation.

An introduction to quality management provides a framework for a required quality assurance (QA) or quality improvement (QI) project in the R3 year.

In addition to their continued experiences in Emergency Medical Services (EMS), R2s will participate in a hands-on laboratory learning how extrication is performed while providing medical care to trauma victims trapped inside vehicles.

PALS recertification is provided the month before its two-year expiration date. ACLS provider and instructor recertifications are usually not a problem, if residents have taught four classes in the preceding two-year period.

R3 Year

Success in personal and professional lives is one key characteristic for a fulfilling long-term career in emergency medicine. The R3 year-directed curriculum (YDC) focuses on some related knowledge, skills, and abilities necessary to achieve this. The small-group discussions are led by local experts in the respective topics.

The small-group discussions, experiential activities, and short courses specific to the R3 year include the following:

 

Small-Group Discussions

Experiential Activities

Short Courses

Jul

Advanced Airway Physiology and Management

Advanced Adult & Pediatric Airway Cases

Advanced Adult & Pediatric ECG Cases

Advanced Adult & Pediatric Imaging Cases

 

 

Personal Insurance Needs

Aug

Approach to Clinical Teaching

 

 

Sep

Personal Financial Management

Clinical Teaching Simulations with R1s

ABEM Review

Oct

Malpractice Medical-Legal Issues

Malpractice Insurance Needs

Unknown Case Simulations

ACEP Meeting

Nov

EM Best Practices

Oral-Board Practice Sessions

 

Dec

Regulatory Compliance, Billing, and Reimbursement

Multidisciplinary Simulations with KCMA

 

Jan

Documentation Feedback

 

 

Feb

Influences of AHRQ, TJC, and Other Quality Organizations

ABEM Inservice Examination

 

Mar

Hospital Administrative Structure

Hospital Credentialing Processes

 

 

Apr

Role of the ED Medical Director

Oral-Board Practice Sessions

 

May

Leadership versus Management

Individually Directed Simulations

SAEM Meeting

Jun

Q&A with Core Faculty

 

 

ABEM = American Board of Emergency Medicine; AHRQ = Agency for Healthcare Research and Quality; ECG = Electrocardiography; ED = Emergency Department; EM = Emergency Medicine; EMS = Emergency Medical Services; KCMA = Kettering College of Medical Arts; TJC = The Joint Commission

For those with an interest, some R3s become Assistant Medical Directors for local emergency medical services (EMS) systems. Others will continue the ride-a-long program with increased responsibility.