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One of the great strengths of the Emergency Medicine Residency program at UH/Case Medical Center is our nationally-renown faculty both within the department of emergency medicine and throughout UH/CMC. Our residents have the opportunity to rotate with our colleagues in the departments of orthopedic surgery, critical care medicine, women's heath, pediatrics, toxicology, radiology, anesthesiology, and trauma to name only a few. The quality of these rotations is outstanding and customized to the needs of the rotating emergency medicine resident. We rotate through MetroHealth Medical Center for our Level-one Trauma experience. We invite you to click on the links below for a further description of the curriculum for our residents.
This includes 4 weeks of Peds ED/Rapid Care. This is the heart and soul of your residency and the days are intense. You will be working 10-hour shifts under the direct mentorship of attendings that will provide you with gradual progressive responsibility as your training and experience progresses. You will become proficient in medical and trauma resuscitations, and all required ACGME procedures, and will be expected to keep logs of all those performed. Your PGY-1 year will have 18 ED shifts per month, and move towards 16/month as you advance in your training. You will have one shift with an option to fly with MedEvac, UH's AeroMedical Transport service. The purpose of this is to allow sufficient time for your academic growth with time for relevant reading, research, presentations, scholarly activities and to maintain general resident wellness. You will be expected to keep diligent logs of all procedures, resuscitations and ultrasounds performed as well as formal direct observation of your clinical evaluation of cases and formal inpatient and outpatient follow-up cases. Each month you will be expected to submit two of your 'best dictations' for formal review with your mentor. Your goal for each successive emergency medicine rotation is to grow clinically and academically - to incorporate your experiences and knowledge obtained from other rotations into your patient care style, and to become a well -rounded, professional emergency physician, versed in the knowledge, language, diplomacy and compassion that will be expected of a graduate of CWRU/University Hospitals Emergency Medicine Program.
This is a one-month period of time where faculty and senior residents help you 'hit the ground running' in the Emergency Department. It is the month you will feel yourself change from a medical student to an emergency medicine resident. Your main focus this month will be to assimilate the unique philosophy and the basics of the practice of emergency medicine. Much time will be spent with the Program Director and Associate Program Director developing your thinking processes on symptom based problems, plus acid-base, electrolytes, and manual dexterity skills in airway, ultrasound, and suturing skills. You will become certified and proficient in Advanced Trauma Life Support (ATLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) to prepare you for your years ahead. You will supplement these didactic sessions with two weeks of Clinical Emergency Room shifts to solidify what you've learned. You will also spend time in the Emergency Room as an acting Charge nurse, ED nurse and ED tech (under their mentorship) in order to learn basic IV skills, triage skills, performing and interpreting EKGs and to learn how the ED functions as a team. Required hospital on-line teaching and IRB certification modules will be done during this time as well. The goal of the Orientation month is to prepare you to begin that transition from medical student to a career emergency physician.
University Hospitals Case Medical Center Emergency Medicine Residents rotate through MetroHealth Medical Center for trauma. MetroHealth is a Level 1 Trauma center for Adult and Pediatric Trauma and Burn victims. Your intern year, you will be on the trauma team, responding to traumas and taking call twice weekly. You will also manage floor patients and hone trauma resuscitation skills. Your second year you will be an integral part of the Trauma team at MetroHealth with the goal of becoming proficient at running and participating in Trauma Resuscitations and will manage patients in the Trauma ICU. Standing elective opportunities exist to return during second and third year for more trauma exposure if desired. You will have exposure here to both adult and pediatric trauma patients.
Peds (Pediatric) Trauma :
University Hospitals/Case Medical Center is a Level 1 Pediatric Trauma Center. You will spend two weeks during your PGY-1 year on the Pediatric Trauma Team. You will also respond to Pediatric Trauma while rotating on the Pediatric Emergency Medicine Service through Rainbow Babies and Children's Hospital. There will be a graded level of responsibility with each successive year. The goal of this rotation is to further supplement your pediatric trauma experience to become comfortable and proficient in Pediatric Trauma Resuscitation.
Peds (Pediatric) ICU:
Ranked one of the top in the nation, the Pediatric ICU at Rainbow Babies and Children's Hospital provides an outstanding opportunity to learn from nationally renowned attendings in the field of Pediatric Intensive Care. The emergency resident functions as an integral member of the PICU team and learns the critical concepts of pediatric ventilator management, fluid management, medication dosing, central lines, and intubation among others. Your inpatient pediatric month in your PGY-1 year as well as your Pediatric Emergency Medicine rotations during your first years serve to prepare you for these challenging months in your PGY-2 and 3 years.
Peds ED (Pediatric Emergency Department):
Rainbow Babies and Children's Hospital is a world leader in the treatment of children with heart disease, cystic fibrosis, sickle cell disease, endocrine and metabolic disorders. The Hospital is ranked 5th in the nation in Pediatrics and second in the Nation in PICU care. Their dedicated Pediatric Emergency Room is the only Pediatric Level-One Trauma Center in Northeast Ohio, sees a very high level of acuity and the attending staff are some of the best in the nation. Rainbow Babies and Children's Hospital offers its own Pediatric Emergency Medicine Fellowship as well. You will spend a total of 12 weeks with our colleagues in the Pediatric Emergency Department seeing a wide range of illness from the simple to the complex. Clearly though the level of acuity in the Pediatric Emergency room is not as high as the Pediatric Intensive Care Unit. Emergency physicians need training with these critically ill children, so pediatric training in emergencies is supplemented with 8 weeks in the Pediatric Intensive Care Unit (one month in the 2nd year and one month in the 3rd year).
This rotation also sets the stage, along with your Peds Emergency Medicine training for your Pediatric Intensive Care Unit (PICU) rotation during the PGY-2 and PGY-3 years. In addition, this month allows the ED resident to gain a better understanding of the management of pediatric patients following their initial stabilization in the ED. This experience will strengthen the resident's comfort in starting a treatment plan on pediatric patients they encounter in their future practice. The knowledge gained on this rotation will help to shape future decisions concerning which patients need to be managed as inpatients and which patients can be followed as outpatients. We understand that many emergency physicians will not practice in an environment where a dedicated pediatric emergency department exists and, therefore, we understand that this training is crucial to produce emergency physicians that will be proficient in diagnosing and stabilizing very ill children.
Admin/tox is a conjoint rotation. Administration. an essential part of any successful medical practice (whether private or academic) is the behind-the-scenes work in quality assurance, cost-containment, risk management, billing, coding, preparing nursing in-services, and addressing medical errors. This two-week block is a supplement to the program's quarterly Quality Assurance lectures and further introduces the emergency resident to these topics in greater depth. Emphasis on employee contracts will be stressed and each resident will have a mandatory project in quality, patient safety or patient satisfaction with which they will be involved. The goal of this rotation is to introduce the essential and seldom seen non-medical side of the emergency medicine practice - the oft-unrecognized backbone of any successful emergency department. Toxicology. University Hospitals is home to the Greater Cleveland Poison Control Center. Your experience in toxicology will include active participation on the toxicology consult service, participation in dedicated lectures on toxicology and poisonous envenomation as well as answering the poison control hotline. The goal of this rotation is to introduce you to common toxic ingestions; when to suspect them, how to diagnose them, their management and to know your resources when faced with a patient with possible toxin ingestion or envenomation. Interested residents will have the option for more toxicology training during PGY-3 year.
Basic knowledge of radiology nomenclature and proper identification of radiologic findings are essential for the emergency physician. During your four week rotation with our colleagues in radiology, you will be expected to spend time reviewing ED films with attending radiologists as well as spend time in CT, MRI, ultrasound and pediatric radiology. Additional superb tutorials are available to the resident for study if time allows. The goal of this rotation is for the resident to develop and solidify a systematic approach to reading films and to learn the skills to properly communicate with your consultants and colleagues concerning what you are seeing radiologically in the emergency department.
You will rotate one month during your EM1 year with our colleagues in the OB-Gyn department. This will provide you with an excellent basis to handle basic obstetric emergencies (precipitous deliveries, complicated fetal presentations) and further tune your skills in obstetric ultrasonography. Ten supervised deliveries are required for the month, but residents report many, many more. You will also cover the L&D room where patients presenting to the Adult ED over 20 weeks pregnant are sent with acute emergencies from severe pre-eclampsia, abruption, previa, or asthma. The goals of this rotation are to develop a working knowledge of the indications for fetal monitoring, labor induction and to become proficient in the basic of the obstetrics exam for a patient in labor as well as to handle some obstetric emergencies. University Hospitals MacDonalds Women's Hospital's Labor and Delivery department at University Hospitals/Case Medical Center is one of the busiest in the Midwest.
Proficiency in airway management in the controlled environment of the operating room is an essential precursor to proficiency in maintaining the airway in the uncontrolled environment of the emergency department. During these four weeks, you will rotate with our colleagues in the Anesthesiology learning basic airway management, intubation techniques, and the basics of laryngeal mask airways (LMAs) and receive one-on-one instruction. You will become comfortable with the basic pharmacology and proper dosing of paralytics and sedatives used in the emergency room every day. You will spend three weeks in the adult OR's and 1 week in the pediatric OR's becoming comfortable with choosing the correct size tube for your patients and becoming proficient in setting up your intubation procedure and anticipating a backup plan. You will be expected, upon completion of this rotation to be prepared for your first Rapid Sequence Intubation on your next supervised emergency room shift. You should have no trouble obtaining well over 30 independent, supervised intubations during this month from superb anesthesiologists.
MICU (Medical Intensive Care Unit):
When faced with a critically ill patient, the emergency physician's job is to quickly stabilize the patient, optimize his or her clinical condition and triage to the appropriate level of care - many times that level of care will be termed critical in which time is of the essence and the patient will be admitted to the MICU. During your rotation in the MICU, you will experience medicine from 'the other side', taking admissions from the emergency room and following your patient until discharge. This allows the emergency medicine resident to intimately see both sides of patient care and critique his or her approach to patient care as an emergency physician and observe how it impacts the care of the critically ill patient longitudinally. During your rotation in our nationally-recognized Medical Intensive Care Unit as a PGY-1, you will be an integral member of the team, taking overnight call every 4th night. You will gain experience in ventilator management, blood gas interpretations, central line placement, medical resuscitations, and overall management of the critically ill patient. You will again rotate through the MICU as a senior medical resident in your PGY-3 year, you will be in a more responsible role, overseen by the MICU fellow and attending physicians.
You will rotate on Cardiac Intensive Care Unit (CICU) as an EM2, where you will serve as an integral part of the CICU team, responding to in-house code blues and taking admissions from the emergency room. This will also be a time where the EM resident is expected to advance his or her skills in cardiac ultrasound use and interpretation. Experience in management of the acute MI and cardiogenic shock, and placement of central venous catheters will also be central to your experience in the CICU. Like the MICU, you will admit patients from the emergency room and follow them longitudinally to gain experience in how excellent management of the critically ill patient in the ED directly affects patient care and outcome long-term. University Hospitals CICU is an American Heart Association (AHA) award winning CICU with experience in IABPs, LVADs, aquapheresis, therapeutic hypothermia, and cardiac transplantation. There is a high volume 24/7 cath lab which serves entire UH system and the region. Dedicated CICU teaching staff with subspecialty expertise in interventional cardiology, electrophysiology, heart failure, and cardiac imaging are the backbone of this truly exceptional state of the art CICU.
EMS (Emergency Medical Services):
Certification to provide medical control for EMS and knowledge regarding professional safety and triage is paramount for the well-trained Emergency Medicine Physician. EMS days will be scheduled during your ED months in PGY 2 & 3 where you will spend one of your regular ED shifts on the air (MedEvac) and one as ground transport. Pediatric patients comprise 50% of these transports. In addition, residents will complete a specific 1 month rotation as 3rd years to become more proficient with the complexities of air and ground transport, pre-hospital care, and quality assurance.
Ortho Adult: Proper initial management of orthopaedic trauma, ability to intelligently discuss your physical exam findings with your orthopaedic consultant and proper knowledge of splinting are all imperative skills any emergency physician must possess. During your four-week rotation with our orthopaedic colleagues you will be expected to gain mastery of these skills. You will spend two days with the University Hospitals Case Medical Center renowned orthopedic technicians learning standard splinting and casting techniques. They have taught casting techniques for over 50 years and have trained the trainers. You will spend the rest of the time rotating with the orthopaedics consult team, managing consults in the Emergency Department, and attending outpatient clinics (hand, knee, spine, and ankle clinic) where you can learn pearls for your physical exam and the basics of useful anesthetic blocks (digital blocks, hand blocks, ankle blocks) that you will find useful in the Emergency Department. Children are not just small adults - particularly when it comes to Pediatric Orthopaedics. During Pediatric Orthopaedics service and sports medicine clinic you augment the skill-set you gained from your Adult Orthopedic experience. You master the recognition, nomenclature, stabilization and treatment of a subset of pediatric fractures and Salter types and evaluate the limping child and child athelete which are different from adult orthopedics. These are very worthy but unique goals for an orthopaedic rotation in emergency medicine.
Neurology/NSU (Neuroscience Unit):
One of the most outstanding aspects of Case Medical Center is the Neuroscience Unit (NSU). The NSU is a 14-bed unit designed for the care of critically ill neurological and neurosurgical patients who require specialized intensive nursing and medical care. Your time in the NSU is spent learning the management of very acute neurosurgical, stroke, and general neurology patients. Your goal is to become familiar with the initial care and stabilization of subarachnoid hemorrhages, hemorrhagic strokes, ischemic strokes, elevated intracranial pressure, and myasthenic crises among others. On this rotation, you will become more familiar with hypothermic therapy and many other specialized neurocritical care treatment modalities. Your other two weeks will be spent with neurology consult service on the Brain Attack Team (BAT team) and responding to strokes (brain attacks). The resident will continue to manage the brain attack patient in the NCU to learn the critical aspects of initial recognition, stabilization and long term treatment of these devastating events and to learn how excellent initial care in the emergency department affects long-term outcome.
One size does not fit all. We find that is true for training in emergency medicine as well. Residents in EM have different training needs depending on their backgrounds and goals. We allow for much customization involving selectives which are 2 weeks long which can include: ENT, ophthalmology, hand surgery, dental or oral surgery emergencies, clinical or basic research, trauma, pediatric emergency medicine, neuro ICU, and EMS to name a few. Additionally there is elective time where you design your own 1 month rotation either from the selectives or your own interests such as pediatric cardiology, ultrasound, or toxicology. These experiences are educational, intellectually stimulating, and allow the EM resident to explore the need for possible further training in an EM fellowship.