Institutional Policy on Discrimination and Sexual Harassment
Family Medical Leave Act
The Impaired Physician
Emergency Preparedness 222
Student Education 226
Computers/Web Page/Internet Resources 230
Requirements for EM Residency Training
PREFACE TO THE 11TH 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:
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,
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.
SUNY Downstate Medical Center & Kings County Hospital
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.
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
Work with health care professionals, including those from other disciplines, to provide patient-focused care
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
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