Curriculum

 

Educational Objectives

1. To Produce Graduates Who:

  • Are well informed, well rounded and clinically competent, who can respond to the wide range of patient problems encountered in the emergency department setting.
  • Are sensitive to the behavioral, social, ethical and organizational aspects of emergency health care.
  • Are responsible, careful and respectful of the rights and dignity of patients, and who can conduct themselves with personal and professional integrity.
  • Have the requisite knowledge and skills to serve as leaders in the development, practice, and teaching of Emergency Medicine.
  • Are eligible for and who successfully complete specialty certification by the American Board of Emergency Medicine.

2. 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, interns spend 4 months in the Emergency Department beginning with a month-long orientation. 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 PGY-2 year, the residents spend 9 months in the ED with an equivalent of 1 month of research and 1 month ofof pediatric Emergency Medicine incorporated into the year as longitudinal experiences. In the PGY-3 year, residents are in the ED for 7 months. 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 completed in blocks (eg Global Health, Critical Care, Pediatrics) whereas others are longitudinal; (eg Toxicology, Research, EMS, Wilderness Medicine, Ultrasound, Education and Administration). PGY2-4 residents complete between 140-150, 9-10 hour shifts per year.

What are the rotations?
Rotations during the first year are completed in 4-week blocks.

There are 13, 4-week blocks in 12 months. Residents have 4 weeks of vacation and educational leave each year.

 

PGY-1
Emergency
Medicine
Anesthesia Ultrasound/
Derm/Eye
Medical
Intensive
Care Unit
Cardiology Trauma
Surgery
4 1 1 1 1 1
Burn/Plastic
Surgery
OB/Gyn Pediatrics Medicine
Wards
   
1 1 1 1    

 

Rotations during the final three years are one month each.

PGY-2 PGY-3 PGY-4
9 months Community Regional Medical Center (CRMC) ED 7 months CRMC ED 7 months CRMC ED
1 month Trauma Surgery 1 month Trauma Surgery 3 months
Area of Concentration
1 month Longitudinal Research
(incorporated into CRMC ED months)
1 month MICU 1 month PICU
1 month Longitudinal Pediatric EM
(scheduled during CRMC ED months)
2 weeks Toxicology consult service 1 month Elective
1 month Orthopedics ED consult service/ENT clinic 1 month Selective in Community Emergency Medicine
 1 month EMS 1 month elective  

 

Tell me about the rotations outside the ED.

Trauma Surgery: Each resident spends one month during the first, second and third years 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 that is on a nightfloat system. There are many opportunities to lead resuscitations and for procedures such as central and arterial line insertions, chest tube insertions, endotracheal intubation, and needle thoracostomy.

Pediatrics: We see a large number of children in our ED at CRMC that is growing day by day. Interns rotate in our outpatient pediatric clinic. During the PGY-2, residents work 16-18 shifts in the ED at Valley Children’s Hospital spread out over the year. In the fourth year our residents serve as the senior resident in the PICU at CRMC.

Orthopedics-ENT: Each resident spends 1 month during his or her second yearcovering Orthopedic Surgery consults for the ED during weekdays from 7am to 5pm. The resident also sees patients in ortho and ENT clinic. There are no call responsibilities.

MICU: During the PGY-3 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 venous access, and advanced ultrasound. There are no overnight call responsibilities.

Emergency Medical Services (EMS): During the PGY-2, residents spend 1 month participating directly with our 4 county EMS system. Each resident has already taken the base hospital course at the beginning of the PGY-2 and is very familiar with on-line medical control. CRMC 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 EMS and work one on one with faculty in quality improvement and assurance, incident review, parkmedic training, disaster medicine and teaching. This month also includes mandatory paramedic ambulance 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.

Research: During PGY-2, residents spend the equivalent of 1 month learning and practicing the fundamentals of evidence-based medicine through a series of readings, meetings, on-line modules, and dedicated time to design and / or work on a project. This is a longitudinal experience that extends over the academic year. Residents must complete a scholarly project during the program and this is a great time to get it started.

Community Emergency Medicine Selective: During PGY-3, our residents choose between 2 community EDs to complete a month-long rotation.  Residents can choose to work at either Kaiser or Clovis Community Medical Center (CCMC). The Kaiser ED provides a unique opportunity to practice in an integrated healthcare delivery system.  Kaiser faculty set aside time to speak one-on-one with the resident regarding the job search process, private ED administration and democratic group structure.  The ED at CCMC is a busy, private ED with a different patient population than cared for at CRMC.  Both are staffed by board certified, residency trained emergency physicians.

Elective Time: There is a 1 month elective during both PGY-3 and PGY-4. The elective time is utilized 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.