Emergency Medicine Residency Handbook 2009 Edition table of contents chapter page
Yüklə 1,16 Mb.
|
123 Williams Street, New York, NY212-732-8700 Contact person: Wayne Roth Description of Rotation: The resident will spend a 2 or a 4 week block with at McAloon and Friedman, the law firm which represents HHC hospitals in most large malpractice cases. Work schedule is 5 days per week, Monday through Friday, excluding Wednesday morning. Daily activities generally begin by 9:00am every morning, with residents acting as medical experts for selected cases. Attendance at Wednesday Conference is mandatory. The resident will work under the supervision of staff at McAloon & Friedman.
The resident will demonstrate competence in:
Evaluation: At the end of the block, an evaluation form will be filled out by the supervising staff member at McAloon & Friedman. The resident will also fill out and submit a rotation evaluation form. MEDICAL EXAMINER Location: Office of the Medical Examiner Contact: Charles Catanese, M.D., Medical examiner 718-221-0600 (ext. 214) 917-537-8179 (pager) The resident will spend a 2-week block with the Office of the Medical Examiner. Work schedule is 5 days per week, Monday through Friday, excluding Wednesday morning. On Wednesday morning the resident will be expected to attend the ED weekly conference. The resident will work under the supervision of attending pathologist from the Office of the Medical Examiner. Goals and Objectives: The resident will demonstrate competence in:
Evaluation: At the end of the block, an evaluation form will be filled out by the supervising staff. The resident will also fill out and submit a rotation evaluation form. DERMATOLOGY Location: KCHC & SUNY – Downstate Medical Center Contact: Alan Shalita, M.D., Chairman , Dept. of Dermatology 718-270-1229 Description of Rotation: The resident will spend a 2-week block with the Department of Dermatology. Work schedule is 5 days per week, Monday through Friday, excluding Wednesday morning. On Wednesday morning the resident will be expected to attend the ED weekly conference. The resident will work under the supervision of attending or senior residents from the Department of Dermatology. Goals and Objectives: The resident will demonstrate competence in the evaluation and treatment of: 1. Cancers of the skin 2. Dermatitis, including but not limited to:
ORAL SURGERY Location: KCHC & SUNY – Downstate Medical Center Contact: Stewart K. Lazow, M.D. 718-245-2987 917-253-0002 (pager)
The resident will spend a 2-week block with the Department of Oral Surgery. Work schedule is 5 days per week, Monday through Friday, excluding Wednesday morning. On Wednesday morning the resident will be expected to attend the ED weekly conference. The resident will work under the supervision of attending or senior resident from the Department of Oral Surgery. Goals and Objectives: The resident will demonstrate competence in evaluation and treatment of:
Evaluation: At the end of the block, the supervising staff will fill out an evaluation form. The resident will also fill out and submit a rotation evaluation form. Administration Rotation Faculty Liaison: Dr. Rajesh Mittal rmittal5@yahoo.com Cell 917-309-8456 Dr. Michael Lanigan thelanis@aol.com The administrative block of your fourth year is a month designed to give you some of the tools and information you will need as you move ahead in your career from resident to attending. Administration essentially boils down to meetings and paperwork, but there are several aspects of this work that can be useful clinically- from documentation to ED mortality review. The layout of this rotation has recently changed and the following represents the current format.
The administrative rotation will be the resident’s education in all aspects of the emergency department (ED) and practice management. The rotation will provide exposure to the regulatory, legislative, administrative, political, and organizational aspects of department administration. Upon completion, the resident will have a basic understanding of the function and structure of ED management. The resident will be responsible for daily data collection, chart audits as well as correction of daily problems in the ED. The resident will be directly involved in the performance improvement and the peer review process. The resident will also attend monthly meetings with ED staff as well as become exposed to legislation governing the administration of the ED. At the completion of the rotation, the resident will have:
Core Competancies Addressed ledger: PC=Patient Care, MK=Medical Knowledge, PBL=Practice Based Learning and Improvement, C=Communication and Interpersonal Skills, P=Professionalism, SBP=System-Based Practice Structure: A four week block (EM) and a two week block (EM/IM) comprised of lectures, tutorials, chart review, and meetings. 1. Lectures- The EM’s are expected to prepare their senior lecture during this time. In addition, they will be expected to give a short (30min) lecture to the nurse practitioners and PA’s that work in the fast track (FT) area, to assist in improving the level of care in FT. Lecture topics will be typical FT level cases and management. This lecture will most likely be scheduled one time, on any Tuesday between 10:30a-11am during the course of the month. At this time it will be given for the members of the KCH FT only. 2. Chart review- a. KCH ED Mortality Review- A Joint Commission requirement is that all institutions analyze “in ED mortality” and complete a brief data sheet regarding the case. At the start of the block, you will be given a list of the ED mortalities for the previous month, request the charts from medical records, review the charts and fill out the survey. In the previous months this has been a relatively simple procedure after the charts have been pulled by medical records. Dr. Orlando Adamson will be the point person for this activity. b. UHB walk out/AMA call back- On the UHB side, you will be instructed how to use the T-system to compile the patients walked out or left before being seen or left AMA during the previous month. You are expected to call them back and check in about their condition and offer them return to the ED if there are any concerns. This review has been educational and relatively quick. Dr. Russell Flood will be the point person for this responsibility. 3. Meetings- There are many meetings that cover on several varied topics. The following calendar represents required meetings established by Dr. Doty and myself. You may be informed with little notice about any administrative meeting that may be pertinent and educational, but these should be very infrequent. 4. Morning report- You are expected to attend at least 2 morning report sessions per week. There will be a ledger/handbook kept in the CCT trauma bay to record the date, topic and presenter for each of the sessions you attend. 5. Resident Documentation Program (RDP)—This program was established for several reasons, including financial, medical-legal, and overall improvement of care. The structure is as follows: a. Receive a tutorial from Dr. Rajesh Mittal regarding ED documentation during the first week of the rotation. b. Give this same tutorial to each of the UHB rotating residents during the latter half of the second week of your rotation . c. On the first Monday of the 4th week we will pull the charts of the residents and evaluate for changes in numerical data points as well as make comments regarding areas of improvement. Each resident will receive his or her report by the end of his or her UHB rotation. 6. Meeting with chairman-- Dr. Lucchesi would like to meet with each of the graduating resident during their administrative block. Please schedule this with his secretary Edna 7. Expert Witness— You may be called upon by hospital counsel to act as an expert witness for a case involving physicians within the Health and Hospitals Corporation. If you are called to do so, please inform Dr. Mittal.
TEACHING RESIDENT ROTATION Meeting Place: KCH ED Schedule: Contact Dr. Doty (917-597-0466) 2 weeks prior to starting the rotation to get a brief orientation. The rotation will last 2 weeks and the resident will work 8 shifts (8 hour swings shifts) over the course of the rotation. The resident will have meetings and teaching responsibilities on Wednesday afternoons after conference with the Program Director and the directors of the skills labs.
Educational Objectives: PGY-4 categorical residents and the PGY-5 EM/IM residents will spend a two-week block serving as a teaching resident in the KCH ED. During this time, they will not be responsible for rapid assessment of general ED patients. Instead, they will be responsible for precepting general EM cases in the KCH Adult and Peds ED. The purpose of the rotation is to help the senior residents develop skills and experience teaching bedside Emergency Medicine. Summary of Responsibilities:
At the completion of this rotation, the resident will demonstrate competence in and be able to: · Evaluate learning styles and teaching techniques for teaching junior residents and students. (PC,C,P,MK) · Engage in medical literature searches derived from real-time medical questions and advise residents on methods to do the same (PC,MK,C,SBP,P,PBL) · Work with consultants and model solid interpersonal and system-based-practice behaviors. (C,P,SBP) · Compassionately interact with patients and their families during teaching encounters (C,P) Description of clinical experiences: Residents will function as EM residents but will focus on teaching juniors. They will NOT have primary patient care responsibilities. Description of didactic experiences: The residents will participate meet with the program director after conference to go over teaching and education issues each week of the rotation. Residents will attend meetings of the Medical Education mini-fellowship group during their rotation. EDUCATION READING “To see patients without reading is like a ship without a rudder, and to read and not see patients is like never having gone to sea” -Sir William Osler “What one knows, one sees.” -Goethe Each resident is ultimately responsible for his or her education. Kings County provides a rich environment to practice medicine, but it cannot be stressed enough the importance of reading. Residents must develop a method for acquiring the myriad of information required to competently practice Emergency Medicine. Some people find success with a structured reading list, while others find it more fruitful to do focused reading based on cases seen in the ED. The faculty at Kings County has allowed the residents great autonomy in their clinical education and will not dictate which method of study is best. Also, each of the major Emergency Medicine texts has strengths and weakness. The resident should choose one of the texts and develop a method to comprehensively go through it early in their residency. If you have questions about what to read or methods for review, ask one of the senior residents or faculty members for help. TOPIC REVIEW MODEL OF CLINICAL PRACTICE OF EM The “old” SAEM core content for EM was felt to be too unwieldy and was thus replaced by “The Model of Clinical Practice of Emergency Medicine”. In essence, it is a similar list as the Core Content but weighted in view of our daily emergency medicine practice as analyzed from over 1300 EM physicians. It contains three components:
This model was a collaborative effort by the following six organizations governing the practice of EM: ABEM (American Board of Emergency Medicine) ACEP (American College of Emergency Medicine) CORD (Council of Emergency Medicine Residency Directors) EMRA (Emergency Medicine Resident’s Association) RRC-EM (Residency Review Committee for Emergency Medicine) SAEM (Society of Academic Emergency Medicine) The actual document is too long to be printed here but may be easily accessioned at: http://saem.org/download/practice.pdf Reading this document gives you a good insight about what you should learn over the next four years or what you should know when graduating from your residency IN-SERVICE EXAMINATION The national emergency medicine in-service exam is held every year on the last Wednesday of February. The exam format is similar to the ABEM written examination. The exam is a 4.5 hour-long multiple-choice exam containing approximately 210 questions. While the exam is not perfect and does not necessarily predict who will become a competent clinician, the exam is written by the same question writers who contribute to the specialty board exam. Performance on the In-service Exam correlates well with success on the ABEM written exam (see attached graph). Proper preparation requires an ongoing effort of reading on core topics in Emergency Medicine and reviewing board-type questions. A strong fund of knowledge will be required to perform well on the in-service exam and the best preparation is to start early in your residency with regular reading and review. Residents who do not perform well on the examination when compared to the national average for their respective PGY year, are not eligible for exemption from the In-training and Board prep conference. Please see the section on that conference elsewhere in this book. Please Note: No vacation can be scheduled during In-service exam week. You MUST take this exam. Recommended Reading: Tintinalli – Emergency Medicine study guide Rivers, Carol – Preparing for the Written Board Exam, text and questions Peer VII questions Koenig – Emergency Medicine Pretest Self-Assessment and Review Pearls of Wisdom – Emergency Medicine Written Board Review Rosen-- Text of EM 
BOARD REVIEW GROUP EM Faculty Liaisons: Dr. Sigrid Wolfram (cell: 917-301-7222, email: sigridwolfram@yahoo.com) Dr. Joel Gernsheimer (cell: 917-750-1145, pager: 917-219-1976, email: gernsh@aol.com) Description and Goals: Participation in Board Review Group is an opportunity for residents to enhance their preparation for the yearly in-service examination and for the ABEM written examination. All residents should attend. You may opt out of attending this group if meet any one of the following criteria: You score above a 79% on the In-service exam. You score above the national mean for your PGY level. You are an EM/IM PGY1 and score above the 14th percentile of PGY1s nationally. You are an EM/IM PGY2 and score above the 14th percentile of PGY2s nationally. You are an EM/IM PGY3 and score above the 29th percentile of PGY3s nationally.
Meeting place/time: The Board Review Group meets every other week from June until the in-service exam in February for one hour immediately after Wednesday conference. You may bring your lunch. A detailed schedule will be handed out at the first meeting and may be revised throughout the year. If you are scheduled for a clinical shift immediately after conference, you must let the attending in the clinical area know prior to the beginning of your shift that you will be one hour “late”. Sometimes the clinical attending will insist that you go to the clinical area immediately if it will affect patient care otherwise. Any conflict should be discussed with Dr. Wolfram or Dr. Gernsheimer. If you cannot attend focus group for whatever reason you must notify Dr. Wolfram or Dr. Gernsheimer by email or phone or in person.
Residents will be assigned their topic for review at least 2 weeks in advance. The resident will prepare 20 multiple-choice questions (using Peer VII, Rivers, Tintinalli or other sources) and email them to the other focus group participants at least one week prior. This will allow for time to study and review of the topic. Everyone is expected to read up on the topic prior to Board Review Group. Remember, the more you put in, the more you will get out of this educational experience. Answers to the questions with explanations should be provided to everyone on the day of Board Review Group meeting. The resident will discuss the answers to the questions he/she prepared. The attending present will provide additional insight into the subject matter and attempt to resolve any "conflicts" regarding answers. This will require active participation by everyone and create an environment conducive to learning. Questions and answers must be given to Drs. Wolfram and Gernsheimer one week prior to focus group
You are required to have a score of 75% on each webtest. If a score of 75% or greater is not obtained, you will be required to retake that same webtest to achieve a score greater than 75%. Dr. Quinn will reset the exam so that you can take it again if needed. If you score receive a score of 80% or above on your in-service as a 3rd year EM resident or a 4th year EM/IM Resident, YOU DO NOT HAVE TO TAKE WEBTESTS DURING YOUR 4th or 5th YEAR, respectively. (Participation in Topic Review, however, is NOT optional) The Education division has modified the “Webtest” schedule listed on the CORD website. The current schedule is on the residency board located in the Emergency Medicine Office outside the conference room. Take the tests in the order that “we” have listed. You are allowed to miss 2 webtests per year. You are not allowed to miss the January Inservice review test. 2nd year residents on the orthopedic rotation may choose to skip the webtest of the month they are on the orthopedic rotation; this will count as one of the 2 webtests missed for the year. If you do not complete your webtests by the final deadline (June 15th,2009), you will not be promoted to the next PGY level. This means that you will be scheduled with the same number of shifts, including 12 hour shifts, as your current PGY level. If you have any questions regarding the monthly webtest topics please contact Dr. Gore – Robert.gore@downstate.edu or 312-399-3451 cell If you need a test reset because you did not score the required 75% contact Dr. Quinn- Antonia424@earthlink.net or 312-399-3451 cell For scores and explanations of the answers contact Sharissa Rivera-sharissa.rivera@downstate.edu EMERGENCY MEDICINE BOARD EXAMINATION The American Board of Emergency Medicine certification exam is the final exam hurdle to full board certification in EM. The exam is a two-part exam taken upon completion of an accredited residency training program in EM. The first part of the exam is a written test given in the fall (typically the first week in November) at a national computer testing center. The written exam is a six and a half (6.5) hour, 340 criteria referenced question exam. The candidate must answer 80% of the questions correctly to pass the exam. The scope and depth of the exam is similar to that of the annual in-service exam. The oral certification exam is offered to candidates who successfully complete the written exam. The exam is offered in the spring (late April) and the fall (early October). Assignment to the spring or fall exams is completely random. The exam is a three and a half (3.5) hour test consisting of seven patient encounters (single or multiple patients) lasting 15 to 40 minutes in duration. Residents will receive an information packet from ABEM in the spring of their final year that contains an application and fee schedule. The written exam is about $1,000 (this includes a $290 application fee), and the oral exam is approximately $960. The big question is how and what to study. The good news is that most people who graduate from an EM residency will pass the exam (last year’s pass rate was 93%). One may be able to roughly predict their degree of preparedness based on the yearly in-service exam. To restate from the previous sections of this handbook, the best method of obtaining the required information to pass the exams is to develop good reading habits early in residency. Most people spend a considerable amount of time in the fall after graduation preparing for the exam but the four years of residency is the time to obtain the Core knowledge required to be a competent EM physician. Details about the exam are probably best referred to the residency directors or recent graduates who are taking the exam. Contact: American Board of Emergency Medicine (ABEM) 3000 Coolidge Road East Lansing, Michigan 48823-6319 Tel: 517-332-4800 Fax: 517-332-2234
USMLE EXAMINATION REQUIREMENTS Residents must have passed USMLE step I & II before matriculation in residency and most will take and pass part III during the early years of residency. Applications may be acquired from NY State Board of Education by calling (518) 474-3817. Passing Step III will be required by the end of your 2nd year of residency and is part of your promotion criteria into the PGY3 year in the categorical and the combined programs. Passing Step III is required for obtaining a medical license in every state. SUNY has set up an institution-wide policy. If for some reason you have not PASSED Step 3 by the end of your PGY-3 year, then SUNY GME will terminate your contract. This means you are no longer a part of the residency. If you have not passed Step-3 by the beginning of your PGY-3 year, you will be given a notice of non-renewal in November of your PGY-3 year, which I can have rescinded if you pass Step 3 before the end of the academic year. You do not have to apply for a New York state medical license in order to be promoted, but you are strongly encouraged to. A NYS medical license is required to be a chief resident and is required to moonlight outside of our system. New York (NY) State no longer requires licensing fees and NY state application at the time of registration for the exam (about $600), i.e. you may sit for Step III without applying for NY state licensure. CIR will reimburse your costs of getting a license. DEPARTMENT CONFERENCES Yüklə 1,16 Mb. Dostları ilə paylaş:
|