Department of Emergency Medicine Residency Program
Transcription
Department of Emergency Medicine Residency Program
Department of Emergency Medicine Residency Program An Overview The Ohio State University Department of Emergency Medicine A Message from our Chairman It is my pleasure to welcome you to our Department of Emergency Medicine's Residency Program at The Ohio State University and Wexner Medical Center. I sincerely hope that you find these pages useful and informative. We at OSU are dedicated and proud to provide the best possible patient care, while respecting the individual's background and needs. We endeavor to provide evidence based education and clinical decision making. We believe that innovation is strongly linked to improvements in patient care and research findings. Our shared vision is based upon our leading principles of fairness, transparency and accountability. We believe that innovations in our mission areas of education, clinical care and research can unify and improve emergency care (EC), including through important interdisciplinary collaborations which desires to personalize emergency care delivery. We see ourselves as team members, importantly linked to our Nursing, technical and support staff, in all that we do clinically. Details on our academic missions of teaching and research include pages for the medical student interest group, EM and EM/IM residency training, fellowships, faculty, and programmatic efforts in our clinical and basic research foci. My thanks for viewing our pages and do please contact me if you have any questions. Thomas Terndrup M.D. Professor and Chairman Department of Emergency Medicine The Wexner Medical Center at The Ohio State University Residency Director’s Perspective We try to accomplish several goals during the training of Emergency Medicine residents at Ohio State. In achieving these goals, three elements must be present: (1) There must be a desire by the resident to become the best emergency physician possible, (2) there must be a means to achieve this goal which includes the highest quality, state-of-the-art patient care and a broad clinical experience, and (3) there must be limitless academic opportunity. Through our resident selection process, we look for highly motivated physicians who will become exceptional residents and emergency physicians. Because Ohio State has over 450 residents in training programs representing all specialties, our residents become part of an extensive teaching program dedicated to clinical excellence and academic strength. Our residents are supervised by faculty, whose primary career goals are education, research and making an academic contribution to Emergency Medicine. Our Department of Emergency Medicine has gained international acclaim for scientific research, especially in the area of cardiac resuscitation. In addition, we collaborate with specialist in other disciplines in the conduction of a variety of clinical studies. Our primary focus in the residency program, however, is the attainment of clinical skills in Emergency Medicine. Our conferences cover the entire Emergency Medicine Core Content and reference the most recent Emergency Medicine literature. The goal of many of our conferences and journal clubs is to evaluate critically the current literature in such a way that this knowledge can be applied to the practice of Emergency Medicine and taught to others. We place great emphasis on the methodology of evaluating, understanding and applying the knowledge gained from the recent literature as a means of ensuring continuous lifelong learning following residency training. Limitless academic opportunity is achieved in several ways. Residents are exposed to numerous clinical problems and populations. They are exposed to ongoing clinical and laboratory research involving several aspects of Emergency Medicine. The training at Ohio State also exposes residents to the subspecialties of Emergency Medicine. In fact, there are opportunities for fellowship training in nearly all subspecialties within our department. In summary, our overall goals as Residency Program Director, academicians, and clinicians are to impact in a significant way the emergency care of the maximum number of patients possible, to save as many lives as possible and to contribute significantly to the specialty of Emergency Medicine. By being instrumental in helping Emergency Medicine residents to fulfill their potential in becoming Emergency Medicine physicians, we feel that we are achieving these goals. Diane Gorgas, M.D. Associate Professor and Residency Program Director Department of Emergency Medicine The Ohio State University Wexner Medical Center . Sarah Greenberger, M.D. and Jillian McGrath, M.D. Associate Residency Program Directors . Daniel Bachmann, M.D. Assistant Residency Program Directors Daniel Martin, M.D. Professor and Vice Chair of Education Emergency Medicine Residency The Ohio State University affiliated Emergency Medicine Residency is a three-year program (PGY 1, 2, 3) designed to provide education and experience in the clinical, educational, administrative, and research aspects of emergency medicine and its allied fields. The clinical program is the cooperative endeavor of The OSU Medical Center, OSU East, Nationwide Children’s Hospital (NCH), and Ohio health sites, Riverside Methodist Hospital (RMH) and Grant Hospital. The Ohio State University Wexner Medical Center and the Department of Emergency Medicine are located on the largest unified university campus in the United States with outstanding academic and cultural environments. The Department of Emergency Medicine has full departmental status within The Ohio State University’s College of Medicine and many of our faculty serve in hospital administrative roles within the College of Medicine. The Wexner Medical Center at The Ohio State University Medical Center is one of the largest University Hospitals in the country. It serves as a tertiary referral center for the State of Ohio as well as neighboring states and delivers primary care to a large segment of central Ohio. The Medical Center is completing a $1.1 billion hospital which will include a new ED on the ground floor that is scheduled to open in 2014. The new ED will provide an exceptional setting for delivering outstanding care and for promoting cutting edge education for residents and students alike. Nationwide Children’s Hospital is also one of the largest children’s hospitals in the country. It is the pediatric tertiary referral center of Central Ohio. Both hospitals offer multiple subspecialty training programs and expertise in a variety of disciplines. Riverside Methodist and Grant Hospitals are large private hospitals with numerous residency training programs, subspecialty support, and a strong interest in clinical education. More than 200,000 patients are collectively treated at The Ohio State University Wexner Medical Center and Nationwide Children’s Hospital Emergency Departments. Each of the sites provide care to a vast Accreditation The three-year residency program has been approved by the Residency Review Committee of the Accreditation Council for Graduate Medical Education. Residents completing the program will be eligible for board certification in emergency medicine. We offer 14 categorical emergency medicine positions and we now offer a five-year Emergency Medicine/ Internal Medicine Residency program and offer one position. The Emergency Medicine/Internal Medicine Residency Program is a Non-ACGME accredited program but residents will be eligible to sit for both the ABEM and ABIM board exams after completion of training. Emergency Medicine Residency Curriculum First Graduate Year Orientation (OSU/NCH) 1 Block Adult Emergency Medicine (OSU) 4 Blocks Adult Emergency Medicine (OSU)/ Selective 1 Block Cardiology (OSU) OB/GYN (OSU) Medical Intensive 1 Block Care (RMH MICU) 1 Block 1 Block Pediatric Emergency Anesthesia/Ultrasound Neurosurgical ICU/ (OSU) Critical Care Consults Medicine (NCH) 1 Block (RMH) 2 Blocks 1 Block The orientation curriculum in the first block is designed to orient new residents to the emergency departments, offer an intensive didactic experience highlighting management of emergent patient conditions, and provide experience and certification in Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS). During the first year of the program, the resident will gain experience in a variety of disciplines relevant to Emergency Medicine. The experience in the management of pediatric emergencies is particularly strong, as are the core experiences in cardiology, anesthesia, obstetrics, and medical and neurosurgical critical care. The resident also gains formal training in emergency ultrasound and will choose from several selective subspecialties opportunities to personalize their residency experience. Second Graduate Year Adult Emergency Trauma Surgery Intensive Care Medicine (OSU (OSU SICU) East) 1 Block 1 Block Pediatric Emergency Adult Orthopedics/ Ultrasound/ Hand Surgery Selective (OSU) Medicine (NCH) (OSU) 1 Block 2 Blocks 1 Block Adult Emergency Medicine (OSU) 5 Blocks Trauma Surgery (Grant) 1 Block Toxicology/ Selective (NCH) 1 Block During the second year, emphasis is placed on Emergency Medicine, with rotations at three clinical sites. This time focuses on development of progressive autonomy in patient management. In addition, the resident obtains experience in a variety of subspecialties including trauma and surgical critical care. As a member of the trauma team, the resident plays an integral role in all major trauma resuscitations. In the surgical intensive care unit, the resident provides management for the most critically ill surgical and trauma patients. The resident gains further experience and expertise in performing procedures such as placement of central lines, airway management and emergency ultrasound. The resident will also gain experience in orthopedic and hand emergencies with the consultation service and hand center. Toxicology is taught by our faculty in conjunction with clinical experience at the Central Ohio Regional Poison Control Center. The resident will also choose from several subspecialties selective opportunities to personalize their residency experience. Third Graduate Year Adult Emergency Medicine (OSU) 7 Blocks Pediatric Emergency Medicine (NCH) 2 Blocks Adult Emergency Medicine (OSU East) 1 Block Electives (Hawaii/Other) 2 blocks Medical Intensive Care (RMH) 1 Block The third year of the program provides the senior resident with the opportunity to accept responsibility for managing many patients simultaneously, while supervising and teaching junior level house officers and students in the Emergency Departments of The Ohio State University Wexner Medical Center, Ohio State University East, and the Nationwide Children’s Hospital. This graded responsibility helps the senior resident to gain independence and expertise in managing the department. The senior resident will receive experience in emergency department administration and management of emergency medical service systems. The third year resident has an active role in the planning of teaching conferences, presiding over morbidity and mortality conferences, and conducting follow-up conferences on particularly educational patient presentations. Numerous electives are available as part of the third year curriculum. Although unlimited possibilities exist, popular electives include: community medicine in Hawaii, Sports Medicine, Hyperbaric Medicine, Aeromedical Transport, Plastic Surgery, Radiology, Otolaryngology, Ophthalmology, Critical Care, Oral Surgery, Dermatology, Trauma Surgery, Disaster Medicine or EMS. The third year resident can also participate in the extensive research that is ongoing in our department. Pediatric Emergency Medicine Nationwide Children's Hospital Features brand new facilities, including a new 130 bed Emergency Department. It is part of a tertiary care Pediatric Center and a Level I Trauma Center. This ED has an annual census of over 75,000 patients. The resident is the primary caregiver, under the supervision and guidance of Pediatric Emergency Medicine boarded faculty physicians. The Pediatric EM rotation offers an outstanding clinical experience, extensive bedside teaching, and allotted time for pediatric and adult emergency medicine resident conferences. Ultrasound Ultrasound is an integral tool for emergency physicians and a strong focus of the Emergency Medicine residency at The Ohio State University. Residents have a longitudinal ultrasound experience, with both a dedicated longitudinal curriculum and integration into clinical shifts. Our program is at the cutting edge, with up-todate ultrasound machines, wireless connectivity and a state-of-the-art skills training area. Leading faculty have championed training and use of ultrasound in emergency medicine and critical care at this facility and worldwide. Upon graduation, our residents become credentialed in emergency indications for ultrasound and many have taken positions as ultrasound directors at their new facilities. Trauma Services The Ohio State University Medical Center has an active trauma service with a Level 1 trauma center designation. Our Emergency Department receives patients from the community as well as trauma referrals from throughout Central and Southeastern Ohio. Emergency Medicine residents are an integral part of the trauma team in all trauma resuscitations. Third year residents in the Emergency Department participate in management of trauma resuscitations both as trauma team leaders and airway managers. Second year residents also spend time in the OSU Surgical ICU and on the trauma surgery team at Grant Hospital, the only other Level 1 Trauma Center in the City that manages a high proportion of penetrating trauma patients. Emergency Medical Service (EMS) Experience Pre-hospital care is emphasized throughout the residency program. First year residents are assigned to paramedic units operating through the Columbus Fire Department and other local emergency medical services. Curriculum is longitudinal under the direction of EMS faculty and fellows In addition to accompanying paramedic teams on emergency calls, residents will be directly involved in the planning and operation of the EMS systems. A cooperative effort between the Department of Emergency Medicine and the OSU Wexner Medical Center, and the Center for EMS (CEMS) seeks to provide an educational and research resource to the central Ohio EMS community. Since 2004, the Center for EMS at The Ohio State University Wexner Medical Center is dedicated to improving outcomes for cardiac arrest, trauma and other patients in our community. By uniting the efforts of the pre-hospital provider with the hospital-based team, the Center for EMS is dedicated to providing everyone in the community the best opportunity for survival and improved quality of life. MedFlight is the critical care transport service serving Central Ohio and operated by The Ohio State University Wexner Medical Center, Grant Medical Center and Akron General Hospital. Online medical control for the helicopter and mobile ICU is provided by the Emergency Department at The Ohio State University Wexner Medical Center. Residents may also elect to participate in patient transports with the crew of MedFlight and participate in physician medical direction of the program. The general principles of aeromedical and critical care transport. Resident Conferences Emergency Medicine conferences take place weekly, every Wednesday morning and include 4-5 hours of lectures, discussions and case conferences. The format of this educational setting is specifically designed to be innovative and interactive. Emergency Medicine conferences are attended by faculty and are considered protected time for residents working in the emergency department and nearly all off-service rotations. Conferences encompass a variety of activities including: lecture, small group discussions, skills lab sessions, case-based scenarios, morbidity and mortality conferences, panel discussions and debate sessions, in-situ simulations, as well as online, asynchronous learning modules with substantial topic-based review and testing materials. Lectures are given predominantly by the Ohio State University faculty, both internal and external to our department. Visiting professors of national prominence are invited to share their expertise in specific areas of Emergency Medicine. Residents at all levels prepare at least one conference per year. Concise, 30 minute lecture format is incorporated whenever possible. Monthly 2-hour small group discussions are led by designated EM faculty with particular interest and expertise in education. During the first year of residency, additional lecture sessions are scheduled during the month of July to provide an overview of Emergency Medicine and an orientation to the curriculum. At OSU, emphasis is placed on active learning and engaging, thought provoking educational formats. Hyperbaric Medicine The Emergency Department at The Ohio State University offers 24-hour hyperbaric coverage. Many of the Emergency Medicine faculty are hyperbaric medicine certified and supervise scheduled dives as well as emergently performed dives. Two critical care-capable chambers are contained within the OSU Main Emergency Department. Throughout their training, residents have the option of participating in a formal hyperbaric medicine course and participating in dives conducted by attending physicians. Clinical Skills Education and Assessment Center The Clinical Skills Education and Assessment Center at The Ohio State University Wexner Medical Center is a state-of-the-art training center simulating actual patient care experiences. The changing nature of medical practice and the national demand for accountability in medical education highlight the need for a leading-edge clinical skills center like the one at Ohio State. National accrediting bodies are challenging medical education institutions to demonstrate that medical students and residents possess the requisite knowledge, skills, and attitudes essential to the practice of medicine. Emergency Medicine residents participate in protected monthly 2-hour skills labs to review indications and contraindications and practice skills pertinent to emergency medicine processes and procedures. Formal simulation curriculum has been implemented. The Clinical Skills Center recently completed an extensive expansion with the construction of an additional dedicated floor in the Prior Health Sciences Library. The facility features patient encounter rooms, patient models, actors, high-tech patient simulators and electronic monitoring stations. This offers simulated ICU, ED and OR rooms, as well as dedicated space for ultrasound training and hands-on procedural training. The Center provides exciting opportunities for comprehensive interdisciplinary education. We anticipate continued acquisition of high fidelity simulators to meet a broad range of educational needs. National Conferences The residency provides funds and time off annually for each class to attend one conference. This conference time has been proven to be both educational and fun. Many residents value the bonding experience with co-residents, the dedicated educational experience, and the opportunity to become involved in emergency medicine at a regional and national level. Currently, the PGY-1 class attends the Ohio ACEP Board Review Course, the PGY-2 class attends the AAEM or SAEM National Meeting, and the PGY-3 class attends the ACEP National Meeting. Observation Medicine The Clinical Decision Unit (CDU) in the Emergency Department at The Ohio State University Wexner Medical Center is a 20-bed unit that specializes in the efficient treatment of certain patient populations whose care dictates an extended stay for either diagnosis or therapeutic management. There are over 30 active patient observation protocols, and the unit is staffed by mid-level providers and attending physicians who specialize in ED-based observation care. This offers experience in observation medicine and a wealth of research opportunities for our residents. Research and Scholarly Activity Residents are required to participate in at least one scholarly activity during the course of their training. This may be a basic science project, a clinical or epidemiological study, a case report or a collective clinical review of publishable quality. One or two blocks of elective time may also be used to supplement this experience. The purpose of the requirement is to introduce the resident to the critical evaluation of the biomedical literature and research methodology. The Emergency Medicine faculty are active in all facets of research and scholarly activity and serve to guide residents through this requirement. For basic science research projects, the faculty use animal research facilities and are actively involved in interdisciplinary research within the University. In addition, several ongoing pre-hospital and emergency department clinical research projects provide an opportunity for residents interested in educational research robust nationally recognized clinical studies. Residents are encouraged to publish and present at regional or national meetings during their training. All emergency medicine residents have protected time to attend or present monthly journal clubs under supervision by our research faculty. This provides excellent training in critical review of current literature in emergency medicine. Hawaii This rotation is a one-block exposure to community emergency medicine at the Kaiser Foundation Hospital Emergency Department in Honolulu, HI. Third year residents choosing this elective will manage patients in the ED presenting with a wide variety of acute complaints under the supervision of attending physicians. The population has a unique culture and a higher percentage of elderly patients. This elective also provides an opportunity for residents to practice in a Health Maintenance Organization care setting. Additionally, the residents will have eight hours of didactic training in hyperbaric medicine at the Kuakini Medical Center. Diversity The College of Medicine and the Department of Emergency Medicine recognizes and value a varied background among its physicians and cultivates a culture that is inclusive and diverse. Resident Wellness At The Ohio State University Emergency Medicine Residency we understand that work-life balance is essential to physician wellness. The residency features a formal wellness education and wellness committee that organizes frequent social events and activities. The residents have participated in intramural kickball, basketball, volleyball and flag football. The residency emphasizes a collegial and professional environment. Many social events bring residents, faculty and staff together throughout the year. To welcome the new interns, the department hosts an annual Welcome Picnic for residents and faculty. There is also an annual graduation activity such as golf or attend a baseball game. In addition, a holiday party for the department and the residency program brings festivities and laughter. Residents and attendings frequently get together outside of the department, especially for breakfast after night shifts. Residents have teamed up together to participate in the annual "Med Wars" race, formed cycling teams for Pelotonia, traveled abroad for an international medicine experience, provide care at the Columbus Free Clinics, as well as many other social and community activities. The Ohio State University The Ohio State University provides a wide range of athletic, entertainment and advanced educational opportunities. Numerous athletic events including the excitement of “Big Ten” football and basketball are available throughout the year. Residents have unlimited use of the superb Ohio State University athletic facilities. Participation in intramural sports is also available. Other regular events at The Ohio State University include numerous concerts, local and Broadway theatrical performances, and a wide variety of cultural events from the Wexner Visual Arts Center to the Nationwide Arena. Excellent opportunities exist for continuing education courses in all academic disciplines for physicians, spouses and dependents along with other benefits. Opportunities for Advanced Study The Emergency Medicine Residency Program at The Ohio State University Wexner Medical Center is an integral part of the Department of Emergency Medicine. Our faculty have wide ranging interests and thus provide opportunity for advanced study or fellowship training in several areas: 1. Emergency Medicine Research Fellowship This two-year fellowship is designed for emergency medicine residents interested in a career in academic emergency medicine. This is a well-established fellowship, which has graduated a number of fellows. The fellowship can include a Masters of Medical Science degree which includes a total of 45 hours of graduate work including courses in biostatistics, research design, research methodology, as well as electives appropriate to the fellow’s research interests. A thesis is developed from the fellow’s research efforts. Ph.D. options are also available. Fellows will have the opportunity to work with a funded, multidisciplinary, research oriented team. Principle areas of research include cardiac ischemia, reperfusion and left ventricular function. 2. Ultrasound Fellowship The Department of Emergency Medicine offers a one year ultrasound fellowship. This non-ACGME fellowship is a faculty position requiring 72 hours of clinical emergency medicine and 72 hours of clinical ultrasound scanning per month in addition to academic requirements to complete the fellowship. Fellows will be expected to accumulate over 800 ultrasound exams over the entire year. Requisite requirements to sit for the RDMS certification exam will be fulfilled during the fellowship. 3. Administrative Fellowship The Department of Emergency Medicine offers an administrative fellowship of 2 years duration with one position available. The fellowship combines executive leadership training with significant operational and project management experience. Applicants must complete a masters level formal degree granting program in addition to working with the fellowship directors on projects of strategic importance to the Department. The fellowship may include a Masters Degree from several OSU program including a MHA or MBA. 4. Pediatric Emergency Medicine The Department of Emergency Medicine is a co-sponsor of the Fellowship in Pediatric Emergency Medicine based primarily in the Department of Pediatrics at Nationwide Children’s Hospital. The fellowship is 2-3 years in length and prepares the fellowship graduate for a career in academics with clinical experiences in medical pediatrics. 5. EMS System Direction Fellowship During this one or two year fellowship, the Fellow may work as Assistant Medical Director in the City of Columbus Emergency Medical Service System to acquire experience in the operation of a sophisticated community EMS system. This includes training programs for BLS and ACLS personnel and the design of research in pre-hospital emergency care. The Fellow will also work with the Medical Director for the MedFlight critical care transport service as well. Periods of assignment for special experience and study may also be arranged in other institutions or EMS systems in the United States and abroad. 6. Medical Toxicology Fellowship Our residency program works closely with the Central Ohio Poison Control Center based at the Nationwide Children’s Hospital. The two year toxicology fellowship training program emphasizes expertise in toxicology, operation of poison-control programs, and research design. 7. Critical Care Fellowship A critical care fellowship is co-sponsored by the Departments of Anesthesia, Surgery and Emergency Medicine. The fellowship is available for one or two years and offers a broad based experience in critical care. The fellowship provides extensive exposure to the care of critically ill patients including trauma, burn and transplant patients. Opportunities for critical care research are provided. In addition, rotations can be assigned to accommodate areas of special interest. 8. Masters Program in Public Health Emergency Medicine residents have the opportunity of applying for the Masters in Public Health (MPH) degree program offered by the College of Public Health. The MPH program offers weekend instruction and intensive summer sessions that are attractive to our residents; especially those who wish to pursue a career in public health, EMS systems, or health administration. Course offerings in the MPH program include preventive medicine, public health, epidemiology, biostatistics, health economics and international health. When possible, thesis projects relating to topics in Emergency Medicine, including emergency medical services and injury prevention are encouraged. 9. Education Fellowship The Department of Emergency Medicine offers a two year fellowship in medical education. The department is home to an established and growing residency, a highly-rated medical student clerkship, and several innovative student and resident programs. The fellow will work directly with experienced, enthusiastic educators who are active in several national EM organizations and will have an opportunity to help develop their own individualized curriculum. 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