Emergency Medicine Residency Handbook 2009 Edition table of contents chapter page



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EDUCATIONAL OBJECTIVES – PGY 4

In this last year of training the resident will receive progressive responsibility for the overall clinical and operational management of the Emergency Department. In essence, the PGY-4 should be ready to assume an attending-like position. With the guidance of Emergency Medicine faculty members, the Senior Resident will manage patient flow; train and assist in the evaluation of Junior Residents, Medical Students, Physician Assistant students and Pre-hospital personnel; assist with all admission, transfer and discharge decisions in their patient care area; and lead resuscitation situations. PGY-4 Residents will prepare and present curricula lectures; present cases at weekly discussions; run Morbidity and Mortality Rounds; and will assist Junior Residents in identifying cases for presentation and case reports. PGY-4 Residents will be able to independently admit, transfer or discharge patients after informing the faculty attending physician. All charts must still be co-signed by a faculty member.


At the completion of this training year, the resident will demonstrate competence in and will be able to:

  • perform rapid, accurate histories and physical diagnoses on all patients presenting to the Emergency Department

  • create comprehensive differential diagnoses for their patients

  • confidently and competently create and carry out treatment and disposition plans for all patients presenting to the Emergency Department

  • manage the activities of all more junior residents in their area, and be aware of all the patients in that area

  • be comfortable conducting teaching/management rounds in all patient care areas, including the direct supervision of care provided by PGY-1 and 2 residents

  • be an effective member of the Continuous Quality Improvement system

  • be able to perform the administrative responsibilities of an Attending Physician

  • be comfortable directing all patient resuscitation situations

  • be comfortable managing critically ill and injured patients

  • be an effective lecturer and teacher



Description of clinical experiences:

Fourth year residents should have had exposure and demonstrate competence in the following procedures:



  • All procedures previously delineated for PGY-1, 2 and 3

  • Emergency Department thoracotomy

  • Transvenous pacemaker placement

  • Fiberoptic laryngoscopy/intubation


Core Competencies
Patient care

  • Procedural practice and teaching of these procedures

  • Demonstration of physical exam skills

  • Supervision of care by junior practitioners

  • Independent formulation of treatment and disposition plans

  • Triage of patients and prioritization of patients

  • Direction of resuscitative efforts

  • Practice experience

  • Skills labs participation

  • Skills labs teaching

  • Simulator time

  • SDOT

Medical Knowledge



  • Conference attendance and participation

  • Supervision of educational conferences

  • Topic review groups mentoring

  • Webtests

  • Inservice exam

  • Bedside teaching rounds

  • Participation in skills labs

  • Simulator time

  • SDOT

Professionalism & Interpersonal



  • Modeling of behavior by faculty

  • Observation during clinical shifts

  • Web-eval system

  • SDOT

  • Simulator time

  • Responsibility for supervising case conferences

Communication



  • Modeling of behavior by faculty

  • Observation during clinical shifts

  • Web-eval system

  • SDOT

  • Simulator time

  • Responsibility for supervising clinical encounters

System based practice



  • Observation during clinical shifts

  • Web-eval system

  • SDOT

  • Simulator time

  • Participation in CQI committee

  • Supervision of M&M conference

Practice based learning



  • Simulator time

  • Participation in CQI committee

  • Participation in M&M committee

  • Participation in weekly conference

  • Resident portfolio and reflective statement


OFF SERVICE ROTATIONS

PGY-1 OFF SERVICE ROTATIONS

Emergency GYN at KCHC (part of ED month)


ED-based Trauma Experience at KCHC
Obstetrics at KCHC
MICU at KCHC
Medicine at VA

All residents completing an Off-service rotation are required to meet with that rotation’s EM faculty liaison/coordinator for an exit interview in oral exam type format.

This shall serve as an evaluation of the rotation and the fulfillment of the educational expectations.
JUNIOR ULTRASOUND ROTATION

LENGTH: 2 WEEKS
YEAR OF TRAINING: PGY 1
LOCATION: KINGS COUNTY HOSPITAL EMERGENCY DEPARTMENT
FACULTY LIAISON:

Dr. Stone Director, Emergency Ultrasound Division

Pager: (917) 218-5533

Cell: (646) 872-6285

Email: drmikestone@gmail.com


Dr. Chi Co-ordinator – Junior Ultrasound Rotation

Pager: (917) 219-6277

Cell: (716) 310-9407

Email: thomaschi@gmail.com



OBJECTIVES:

To obtain clinical experience in managing emergent and urgent medical problems using ultrasound as a diagnostic tool.


To learn the differential diagnosis, workup, and management of patients presenting with common gynecologic complaints.
To become proficient at performing and interpreting the transabdominal and transvaginal pelvic ultrasound exam.
To become proficient in performing the AAA and FAST ultrasound exams.
SCHEDULE:

Clinical shifts: generally 10am-10pm on Mondays/Tuesdays/Thursdays/Fridays.

Ultrasound didactic shifts: generally 9am-10am on Thursday (film review) and on the first weekend (time TBD in conjunction with ultrasound faculty).

You are expected to go to weekly conference on Wednesdays.



YOU MUST E-MAIL THE ULTRASOUND FACULTY COORDINATOR AT LEAST ONE WEEK PRIOR TO THE START OF YOUR ROTATION SO WE CAN ADJUST OUR SCHEDULES TO MEET WITH YOU,
ROTATION DESCRIPTION: Before starting each rotation please obtain the study materials from the Rotation Coordinator. Additionally there are still images and videos available at: http://www.sunysono.com

(username: suny password: s0n0)


At the beginning of the rotation the resident will meet with the faculty for specific instruction on the transvaginal and transabdominal pelvic ultrasound exam, the use and maintenance of the ultrasound machines, as well as receive didactic material such as books or image files.
During assigned clinical shifts in the KCH ER and under direct faculty supervision, the resident will evaluate patients who are triaged with gynecologic chief complaints. The resident will primarily pick up GYN-related charts. When there are no such patients to be seen, the resident will help out with the room and see other patients, with an eye to remaining available to pick up new GYN-related patients as they come in.
The resident will evaluate GYN patients during these clinical shifts as per usual clinical care (i.e., H&P, differential diagnosis, ordering diagnostic tests and therapeutics, obtaining and following consults, and disposition), with the addition of performing a pelvic ultrasound exam whenever appropriate. These patients should be presented to and followed by a faculty attending who is working clinically during the shift.
During one weekend, the resident will come to the KCH ED for non-clinical ultrasound time, with the goal of performing 25 FAST and 25 AAA exams on consenting patients. There will be a brief orientation and didactic session done with one of the Ultrasound faculty, and the exams will also be supervised. It is expected that with intensive repetition the resident will become proficient relatively quickly. The other weekend is normally off, unless there are necessary schedule changes.
All studies MUST be done under the DIRECT SUPERVISION of a provider credentialed in emergency ultrasound (faculty, fellow, or appropriate senior resident). When done for a clinical indication, the results MUST be documented in Quadramed by ED QuickNote or as otherwise directed. Additionally, ultrasound images should be saved with results documented on the Ultrasound Data Sheet. These will be critiqued by the ultrasound faculty during weekly film review sessions. The data sheets must be turned in at the end of the rotation. We require at least 25 documented and approved in each application of emergency ultrasound (AAA, FAST, and pelvic ultrasound – transabdominal and transvaginal combined), so every exam should be documented.
The rotating intern will be responsible for maintaining all appropriate supplies and keeping the Ultrasound machine clean and in its designated area. The machine should be turned on and checked at the beginning of each shift. Any problems with the machine should be immediately reported to the Emergency Ultrasound Attending on schedule that day. If the attending cannot be reached, the Director of the Division (Dr. Stone) must be contacted.
In case of an unexpected absence the resident must contact both the Chief Resident and the Director of the Emergency Ultrasound Division.

EVALUATION:

Upon completion of the rotation, the resident will be evaluated based on his/her attendance, motivation, didactic knowledge and procedural skills. There will be an exam consisting of written questions and videos covering the assigned knowledge base (basic ultrasound physics, general OB/GYN pathology, and AAA/FAST/pelvic ultrasound exams). The resident will also receive feedback during the rotation. The evaluation form will be submitted to the residency directors and placed in the resident’s file. The resident will have access to the evaluation. The resident will be also asked to evaluate the rotation and provide suggestions for improvement.





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