Educational Objectives

  1. To Produce Graduates Who:


  1. To provide a rich environment that will encourage promising emergency physicians, on completion of their residency training, to pursue careers in the clinical practice of Emergency Medicine, in academic Emergency Medicine, in Emergency Medical Services and other
    areas of subspecialty interest to Emergency Medicine.


How much time is spent in the Emergency Department?

During PGY-1, residents spend 3 months in the Emergency Department. The remainder of the first year is spent outside of the emergency department developing the broad knowledge base needed to become a successful emergency physician.


In the PGY2 year, the residents spend 8 months in the ED with their 1 month of research incorporated into the year as a longitudinal experience.  In the PGY3 year, residents 7 months in the ED.  During their last year, residents spend 7-10 months in the ED.  The variability is dependent on the senior residents Area of Concentration (AOC).  Some AOCs are done by block (eg critical care, pediatrics) whereas others are longitudinal; (eg toxicology, research, EMS, Wilderness Medicine, Ultrasound, Education and administration).  PGY2-4 residents do 150 nine hour shifts/year. 


What are the rotations?

Rotations during the first year are taken in "blocks".

There are 13 four-week blocks in 12 months. Residents may take four weeks of vacation and educational leave during each year.







Care Unit





















Rotations during the final three years are one month each. 





8 months Community Regional Medical Center (CRMC) Emergency Department

7 months Community Regional Medical Center (CRMC) Emergency Department

7 months Community Regional Medical Center (CRMC) Emergency Department

1 month Trauma Surgery

1 month Trauma Surgery

3 months
Elective Area of Concentration

1 month Longitudinal Research

1 month MICU

1 month St. Agnes ED

2 months Pediatric EM

2 weeks toxicology consult service

1 month Elective

1 month Orthopedics ED consult service/ENT clinic

1 month EMS


1 month elective


Tell me about the rotations outside the ED.


Trauma Surgery: Each resident spends one month each during the PGY-1, PGY-2 and PGY-3 on the trauma surgery service. The service, in general, consists of two interns, one rotating PGY-2 or PGY-3 Emergency Medicine Resident, the trauma chief resident, and the surgical attending. The Emergency Medicine Resident functions as an integral member of the Trauma Surgery Team. This tends to be a very busy rotation. In general, call is every third to fourth night, although we just recently converted to a night float system. There are many opportunities for procedures such as central and arterial line insertions, chest tube insertions, endotracheal intubation, and needle thoracostomy. There is little competition for procedures or leading resuscitations due to many factors including the large amount of pathology, the person taking first call is often an Emergency Medicine Resident and that the Emergency Department and Surgery Department enjoy friendly synergistic relations.


Pediatrics: During the PGY-2, the Emergency Medicine Resident spends a month in the ED at Children’s Hospital Central California (CHCC) working with Peds/EM faculty. CHCC ED census is approximately 90,000. It is the only Children’s hospital in the San Joaquin Valley.


Orthopedics-Urology-ENT: Each resident spends one month as the PGY-2 covering Orthopedic Surgery consults for the Emergency Department during weekdays from 7am to 5pm. The resident may also see patients in the respective clinics (ortho, urology, ENT): There are no call responsibilities. The interns of the respective services write the notes and follow the patients after the initial consult or admission. Residents become very comfortable with the many procedures in these areas, including, but not limited to, fx reduction, splinting, cauterization, and nasal packing.


MICU: During the PGY3 year, the resident spends one month managing patients in the MICU under the supervision of pulmonary/critical care fellows and faculty. They often serve as supervisors/educators for procedures including but not limited to:  intubation, central access, and advanced ultrasound.  There are no overnight call responsibilities.



Emergency Medical Services (EMS): During the PGY-3 year, the Emergency Medicine Resident spends one month participating directly with EMS. Each Emergency Medicine Resident has already taken the base hospital course at the beginning of the PGY-2 and is very familiar with on-line medical control. Community Regional Medical Center is a paramedic and parkmedic base station. Approximately 1,250 paramedic radio calls are handled monthly. The Department of Emergency Medicine is actively involved in the training and supervision of paramedics and parkmedics. Emergency Medicine residents play an active role in this process. Members of our faculty serve as Medical Directors for the Fresno County and Madera/King Counties EMS system, the Sequoia/Kings Canyon Parkmedic Program, and the local Helicopter Program. This rotation is designed to allow a flexible schedule with a wide diversity of activities. The resident will gain a broad experience in Emergency Medical Services and work one on one with faculty in quality improvement and assurance, incident review, parkmedic, disaster medicine (including disaster medical assistance team), and teaching. This month also includes mandatory paramedic ride-along time that totals 24 hours.


The main medical helicopter program (SkyLife) also encourages resident participation, and the SkyLife medical director is on our faculty. Residents may choose to ride-along, or to spend more substantial time on the helicopter during elective time or as an Area of Concentration; however, flying is not required as part of the residency program.


St. Agnes Emergency Department: During the PGY-4 year, the Emergency Medicine Resident spends one month in the St. Agnes Emergency Department. St. Agnes Emergency Department is a busy private emergency department staffed by board certified, residency trained emergency physicians. This provides Emergency Medicine Residents with exposure to a private practice experience and geriatric emergency medicine. The Director of the St. Agnes Emergency Department also sets aside time during this rotation to speak one-to-one with the resident regarding job searching in the private setting, private ED administration, and democratic group structure.


Research: During the PGY-2 year, residents spend one month of time learning about the fundamentals of research through a series of readings, meetings, videotapes, and dedicated time to design and/or work on a project. This is a longitudinal experience that extends over the academic year. We do not require a research project during the residency, but there is a requirement for “scholarly activity”. Even those who do not plan to participate in any research will find this rotation of great value in learning how to evaluate the medical literature—something all of us must do the rest of our careers.


Elective Time: There is a 1 month elective during the PGY3 and PGY4 years. The elective time is selected largely according to the desire and previous experience of the resident. Electives have included but are not limited to Aeromedical, Ophthalmology, Radiology, Ultrasound, Anesthesiology, Dermatology, Oral Maxillofacial Surgery, Toxicology, International Emergency Medicine, Sports Medicine, Research, etc.