Emergency Medicine Residency Handbook 2009 Edition table of contents chapter page

Emergency Medicine Residency Handbook

2009 Edition
TABLE OF CONTENTS
CHAPTER PAGE

1. 
   Table of Contents 1
   
2. 
   Preface 6
   
3. 
   Chairman’s Welcome 7
   
4. 
   Residency Director’s Welcome
   
5. 
   Vision Statement
   
6. 
   ACGME Core Competencies 9
   
7. 
   SUNY – KCH Emergency Departments
   
   1. 
      KCH Adult 12
      

KCH Important phone numbers

KCH Clinic Schedule

2. 
   KCH Peds 20
   
   1. 
      Peds Phone Numbers 28
      
   2. 
      KCH Peds Faculty 29
      
3. 
   UHB Emergency Services 32
   

8. 
   Affiliate ED Rotations – Contact Numbers 41
   
   1. 
      Brookdale Hospital ED
      
      1. 
         Brookdale Faculty 44
         
   2. 
      Staten Island Adult and Peds ED 49
      
      1. 
         Staten Island Faculty 56
         

c. VA Hospital 57

1. 
   Emergency Medicine 58
   

9. 
   Educational Objectives 69
   
   1. 
      Educational Objectives – PGY1 70
      
   2. 
      Educational Objectives – PGY2 73
      
   3. 
      Educational Objectives – PGY3 76
      
   4. 
      Educational Objectives – PGY4 79
      

10. 
    Off Service Rotations – PGY1 83
    
    1. 
       Emergency GYN/ED 84
       
    2. 
       ED-based trauma experience KCH 87
       
    3. 
       Obstetrics 90
       
    4. 
       MICU 92
       
    5. 
       Internal Medicine at the VA 94
       
11. 
    Off Service Rotations - PGY2 97
    
    1. 
       Airway Management 98
       
    2. 
       CCU at SIUH 100
       
    3. 
       NICU at UHB 104
       
    4. 
       ENT at KCHC 106
       
    5. 
       SICU at KCHC 108
       
    6. 
       Neurology at SIUH 112
       
    7. 
       Orthopedics/Fast Track at KCH 114
       
12. 
    Off Service Rotations – PGY3 118
    
    1. 
       EMS 119
       
    2. 
       Toxicology 131
       
    3. 
       Research 135
       
    4. 
       Research 140
       
13. 
    Off Service Rotations – PGY4 155
    
    1. 
       Elective 156
       
       1. 
          Medico-legal 158
          
       2. 
          Medical Examiner 159
          
       3. 
          Dermatology 160
          
       4. 
          Oral Surgery 161
          
    2. 
       Administration 162
       
    3. 
       Teaching Rotation
       

14. 
    Education 166
    
    1. 
       Reading 167
       
    2. 
       Topic Review 168
       
    3. 
       Model of Clinical Practice of EM 169
       
    4. 
       In-Service Examination 170
       
    5. 
       Board Review Group 171
       
    6. 
       Webtests
       
    7. 
       EM Board Examination 173
       
       1. 
          ABEM Written Exam Content 174
          
    8. 
       USMLE Step III and Licensure 175
       

15. 
    Department Conferences 176
    
    1. 
       Conference Contacts 177
       
    2. 
       Morning Report 178
       
    3. 
       Wednesday Conference 180
       
    4. 
       ED Conference Attendance Policy
       
    5. 
       Presentation Preparation Policy
       
    6. 
       Conference schedule 2009
       
    7. 
       Special Conferences
       
       1. 
          ICU Conference 181
          
       2. 
          Mortality and Morbidity Conference 182
          
       3. 
          Trauma Conference 183
          
       4. 
          Pediatric Conference 184
          
       5. 
          Adult Journal Club 185
          
       6. 
          Evidence Based Medicine Conference 186
          
       7. 
          Senior Resident Lectures 187
          
16. 
    Miscellaneous Policies and Procedures 188
    
    1. 
       Resident Responsibilities and Duties 189
       
    2. 
       Policy on Eligibility and Selection of Residents 190
       
    3. 
       Promotion/Graduation Criteria 191
       
    4. 
       Supervision of Residents 194
       
    5. 
       Policy on Resident Duty Hours and Work Environment 195
       
    6. 
       Clinical Procedures
       
    7. 
       Evaluations and Feedback 197
       
    8. 
       Patient Encounter Follow up 203
       
    9. 
       Resident Portfolio 204
       
    10. 
        CME 208
        
    11. 
        Travel Plans and Reimbursement Procedures 209
        
    12. 
        Due Process and Grievance 210
        
    13. 
        Faculty Advisors 212
        
    14. 
        Sick Call Policies 214
        
    15. 
        ED Conference Attendance Policy
        
    16. 
        Work Attire Policy
        
    17. 
        Moonlighting
        
    18. 
        Policy on Chief Resident Selection
        
    19. 
        On Call Rooms 221
        
    20. 
        Employee Health Service 228
        
    21. 
        Needlestick/Body Fluid Exposure 229
        
    22. 
        Institutional Policy on Discrimination and Sexual Harassment
        
    23. 
        Family Medical Leave Act
        
    24. 
        The Impaired Physician
        
    25. 
        Emergency Preparedness 222
        
    26. 
        Student Education 226
        
    27. 
        Computers/Web Page/Internet Resources 230
        

17. 
    Schedules 248
    
    1. 
       Monthly Schedules
       
18. 
    Addendum
    
    1. 
       Requirements for EM Residency Training
       

PREFACE TO THE 11^TH EDITION

Welcome to the updated 2009 Edition of our Emergency Medicine Residency Handbook!

Please read this handbook carefully since it contains information about the residency, our Department, the affiliates, various rotations, protocols, guidelines, and policies.

This handbook was written not only for the residents, but also for faculty members, attendings, students and anybody involved in our department. It contains vital information for the smooth operation of the department and successful completion of your residency.

We would like to thank everyone who has contributed to this new edition. Please feel free to contact us about any discrepancies, questions, comments and suggestions.
It is important that you read through the handbook carefully. As always, several changes have been initiated. Please note changes in policies, rotations and affiliates. We have decided to publish the handbook in a loose-leaf format. As changes occur in the future, you will be able to pull old sections out and replace them with updated information. In addition, we have published this edition on the web under the following web address:
http://www.downstate.edu/emergency_medicine

We wish you the best of luck!

Christopher Doty, MD Mark Silverberg, MD

Residency Director Associate Residency Director

EM/IM Residency Co-Director
Antonia Quinn, DO Robert Gore, MD

Assistant Residency Director Assistant Residency Director

Claritza Rios, MD

Assistant Residency Director,

EM/IM Faculty

CHAIRMAN’S WELCOME

Welcome! We are all very pleased that you will be spending the next four or five years of your career in the Emergency Department of SUNY-Brooklyn at Kings County Hospital. You have chosen to train at one of the busiest Emergency Departments in the country. We are a full academic department (1 of 55 in the country). Our residents rotate through five of the twenty-one affiliated emergency departments in the SUNY-Brooklyn system. While rotating through these facilities, you will be working with the finest emergency medicine physicians in the New York City area. The combined census for these five emergency departments is nearly 500,000 patients/year, more than double of any other residency program in the nation. You will be exposed to an arena of pathology rivaled by no other program in the United States. From the critical care and infectious disease at Kings County and University Hospital of Brooklyn, to the cardiovascular disease at the Brooklyn VA Medical Center, as well as an unparalleled community hospital experience in Staten Island, you will “see…do…then teach”, as your peers merely read.

This does not come without a price. I expect you to work hard, be a caring physician, and to teach. As a resident in one of the finest university systems in the country, you have the responsibility to teach your colleagues, your students, your staff and your patients. Our goal is to turn you into academicians and lifetime teachers. We are looking to train the future leaders in the field of emergency medicine.
I look forward to our bedside presentations, lively discussions at Wednesday conference and searches for the diagnosis at 2am. We, together are about to grow… it’s the reason why I’m here.
Welcome, and good luck.

Michael Lucchesi, M.D

Chairman of Emergency Medicine

Chief Medical Officer, UHB

RESIDENCY DIRECTOR’S WELCOME

Welcome to the Combined EM-IM & Categorical Emergency Medicine Residency at SUNY Downstate Medical Center/Kings County Hospital and its affiliates.

The faculty and I believe that this residency will provide the best and strongest learning environments in the field of Emergency Medicine. My job as program director is to be the facilitator and guarantor on your way to becoming a superb Emergency Physician. Your role shall be that of a professional, with a desire to learn while providing excellent and compassionate care. Residency is not always an easy strait to travel and there are a myriad of obstacles to navigate before reaching the final destination. We will do this together. Let us be always mindful of the fact that we must keep high expectations of ourselves and others; this will lead us to be ever-working to achieve excellence of ourselves and for our patients.
This resident’s handbook shall serve as one of the roadmaps on your travel to success. It contains many useful tips as well as some very basic rules. Please read the manual carefully. It is implied that by signing a receipt for this book that you are familiar with its content.
I wish you success in your residency as a starting point of a wonderful and fulfilling career.

Christopher I. Doty, MD FAAEM FACEP

Assistant Professor

Program Director, Categorical EM Residency

Program Co-Director, Combined EM/IM Residency

Department of Emergency Medicine

SUNY Downstate Medical Center & Kings County Hospital
Vision Statement
The residents in the program will be leaders in the department, leaders in the university, leaders in the community, and eventually leaders in Emergency Medicine. We will be a culturally aware and ethnically diverse center of excellence in Emergency Medicine Education. The overall goal of this program is to provide outstanding and compassionate patient care while fostering critical thinking and curiosity as well as implementing advances in the care of the emergency patient. We will strive to transform our residents into role models in the provision of patient-centered healthcare beyond our own institution but with a global reach.

Work Environment

The department will create an environment for our residents that is conducive to learning; intellectually stimulating; personally satisfying; safe from physical and emotional harm; and free of discrimination based on the residents’ sexual orientation, spiritual beliefs, race, ethnicity, identified gender, or socioeconomic background.
ACGME CORE COMPETENCIES
Criteria by which residents’ performance will be judged is outlined below:
http://www.acgme.org/acWebsite/downloads/RRC_progReq/110emergencymed07012007.pdf
PATIENT CARE (PC)

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

• 
  Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
  
• 
  Gather essential and accurate information about their patients
  
• 
  Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
  
• 
  Develop and carry out patient management plans
  
• 
  Counsel and educate patients and their families
  
• 
  Use information technology to support patient care decisions and patient education
  
• 
  Perform competently all medical and invasive procedures considered essential for the area of practice
  
• 
  Provide health care services aimed at preventing health problems or maintaining health
  
• 
  Work with health care professionals, including those from other disciplines, to provide patient-focused care
  

MEDICAL KNOWLEDGE (MK)

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to clinical decision making. Residents are expected to:

• 
  Demonstrate analytic thinking and a systematic approach to clinical situations
  
• 
  Know and apply the basic and clinically supportive sciences that are appropriate to the Emergency Dept.
  
• 
  Develop an appropriate differential diagnosis.
  

PRACTICE-BASED LEARNING AND IMPROVEMENT (PBL)

Residents must be able to investigate and to evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:

• 
  Analyze practice experience and perform practice-based improvement activities using a systematic methodology
  
• 
  Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
  
• 
  Obtain and use information about their own population of patients and the larger population from which their patients are drawn
  
• 
  Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
  
• 
  Use information technology to manage information, access on-line medical information; and support their own education
  
• 
  Facilitate the learning of students and other health care professionals
  

INTERPERSONAL AND COMMUNICATION SKILLS (C)

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to:

• 
  Create and sustain a trusting and effective relationship with patients and family members
  
• 
  Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
  
• 
  Work effectively with others as a member or leader of the health care team
  

PROFESSIONALISM (P)

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

• 
  Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development
  
• 
  Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
  
• 
  Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
  

SYSTEMS-BASED PRACTICE (SBP)

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:

• 
  Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
  
• 
  Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
  
• 
  Practice cost-effective health care and resource allocation that does not compromise quality of care
  
• 
  Advocate for quality patient care and assist patients in dealing with system complexities
  
• 
  Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance