Clinical Rotations and Rotation Descriptions

The curriculum of the Emergency Medicine Residency Program is designed to provide hands-on patient care activities in the two component Emergency Departments of the University of Alabama Medical Center. The program conforms to all requirements specified by the Accreditation Council on Graduate Medical Education (ACGME) and has passed approval by the Residency Review Committee in Emergency Medicine (RRC-EM). Due to the number of visits in the participating Emergency Departments, the resident will have a broad and deep exposure to an variety of critical and non-critical adult and pediatric illnesses and injuries. Through a carefully graduated learning experience, the resident is provided appropriate direction and teaching to many disease states first at a basic level, progressing to increased patient care responsibilities.

PGY-1
University ED	6 blocks
Pediatric ED - Children's Hospital	1 block
Junior Trauma	1 block
Cardiology / CCU	1 block
Obstetrics & Gynecology	1 block
Internal Medicine	1 block
Orthopaedics	1 block
Anesthesia	1 block

CEFH = Callahan Eye Foundation Hospital

University ED

During the first year of EM residency training, all EM-1 residents will be fully supervised by the on duty EM faculty or EM-3 Emergency Medicine residents. First year EM-1 residents will be responsible for performing any basic non-nursing procedures on any patients that they are responsible for. In the later half of this year, they will initiate life-saving care and perform more invasive procedures under senior EM resident or faculty supervision.

During the second year of EM residency training, the care given by the EM-2 residents in the ED will continue to be supervised by more senior EM residents or faculty. EM-2 residents will be responsible for the performance of any significant procedures on their patients, as well as being responsible for procedures during the treatment of medical and trauma resuscitations, which will be led by a senior EM resident. They will serve as on-line medical control for the EMS system.

During the third year of EM residency training, the EM-3 resident will see patients more autonomously and consistent with increased responsibility and clinical expectations. The EM-3 resident will also act as the on-site administrative resident physician during his/her time in the ED. The EM-3 resident will be the team leader for any medical resuscitation during their shift and will be the Trauma Team leader for all 'Trauma Alert' patients in the University of Alabama ED during the days Emergency Medicine is assigned to this role (alternates with senior Surgical resident assigned to the Trauma team). Procedures will be delegated to the junior EM or other junior residents on duty in the ED at the time. Senior residents will also be assigned junior house-staff to supervise. In the latter half of the year, the EM-3 resident will be expected to "run" the ED, under the guidance of on-site EM faculty.

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Pediatric ED

At the Children’s Hospital of Alabama, EM resident responsibilities will be similar, but supervision will be provided by both Pediatric EM fellows and attending physicians. EM Residents will evaluate and treat all patients presenting to the Children's Hospital for emergency care, including both the Emergency Department and Acute Care Clinic. To ensure that EM residents experience the seasonal variations in pediatric illness, residents will work several shifts per block in the Children's Hospital ED when assigned to the University ED.

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Junior Trauma

The resident will participate broadly in the care of critically ill, traumatized patients, along with PGY-2 to PGY-5 Surgical residents, and be on in-house call every third night. They will assist in the initial evaluation and management of Trauma Alert and trauma consult patients in the University ED.

Cardiology/CCU

Residents will take primary care of patients on the Cardiology service assigned to them (usually 6-8, 2-3 of whom are in the coronary care unit). They will assess patients when called to the ED for consideration of admission to the Cardiology service. They will join Internal Medicine residents and the Cardiology fellow in taking night call every fourth night. They will interpret 12-lead EKGs, monitor strips and administer cardioactive medications, including thrombolytic therapy. The EM resident will be supervised by a Cardiology fellow or attending.

Obstetrics & Gynecology

The resident will take primary responsibility for all Labor and Delivery patients (8-12/day) presenting during regular business hours to L&D "triage," taking overnight call every fourth night. The resident will accompany the senior Ob/Gyn resident for any ED consultations when not busy in L&D triage. The resident will assist in performing C-Sections, forceps deliveries, perform obstetrical ultrasounds and manage fetal distress. The resident will be supervised by a previously experienced L&D PGY-2 or greater, chief resident, fellow or Obstetrics attending.

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Medical Intensive Care Unit

The resident will work as a part of a team of junior and senior Internal Medicine residents. All residents take primary care of MICU patients and call is every third night. The team will manage patients in an 18-bed Medical Intensive Care unit, typically carrying 3-5 patients each. The resident will be supervised by the critical care fellows and attending physician on the MICU service.

Emergency Medical Services

The resident will spend one block participating in EMS activities under the direction of the EMS/Disaster fellow and Office of EMS Medical Director. Following a brief orientation and completion of the Alabama EMS Medical Directors course, he/she will perform an observership with the Birmingham Fire & Rescue (BF&R) service assisting in the clinical care of patients at 911 call locations along with existing EMS staff. Supervision will be provided by BF&R senior personnel. Residents will observe at the BF&R Communication Center and may participate in provision of field care with the Air Medical service, Huntsville, AL (on-board, flight participation is strictly OPTIONAL). During the block, the resident will perform four 12-hour shifts at the University ED. Throughout residency training, the EM resident will be encouraged to assist the Alabama Disaster Medical Assistance Team or National Disaster Medical System, through interactions with the Office of EMS Medical Director.

Anesthesia

Residents will assist or perform the induction of general anesthesia, endotracheal intubation, and monitoring in patients assigned (usually 3 to 5 cases per day) to them. They will perform assessments of their patients in the post-anesthesia recovery unit. During the one block rotation, the resident is supervised in airway management by Anesthesia attending or senior residents Monday through Friday. There is no overnight call.

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Residents, along with a PGY-2 or -4 Ophthalmology resident, will primarily evaluate all assigned patients, present them to the senior resident or attending, and decide on appropriate evaluative and treatment steps. The EM resident will be present Mon-Fri 8 AM to 12:30 PM. Patients will be seen in the Lyons Eye Clinic and Eye Foundation ED. The resident will take call every fourth night, along with a fully oriented PGY-2 or -4 Ophthalmology resident.

Toxicology

The EM resident will be a member of the Toxicology consultation service responding to service requests for information and guidance with patients presenting for acute toxicologic emergencies. As a member of the Toxicology consultation service, the EM resident will be on in-house consultation call every day and respond to in-hospital consultation requests. The EM resident will be primarily responsible for all patients evaluated by the service during their rotation.

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Neonatal ICU

The resident will join 4 pediatric interns in providing direct patient care. The EM resident will respond to all delivery room calls and initial resuscitative measures. The EM resident will take call every fourth night. During the rotation the resident will be supervised by an attending during the hours of 7A-7P or by an in-house fellow.

The resident will join the Orthopaedic PGY-4 or -5 resident and attending in evaluating patients. The resident will be on call for Orthopaedic consultations in the University ED Monday - Friday 7:30 am-5 pm and will share night call approximately every fourth night for Orthopaedic consultation. When no Orthopaedic consultations are active in the University ED, a focused clinic rotation will provide educational opportunities for the resident in extremity orthopaedics, hand surgery and spine surgery.

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Research

Each resident is required to complete a scholarly project while enrolled in the residency program. Although the project may continue throughout residency, a research block is scheduled during the PGY 3 (EM2) year. The project may encompass bench research, a community project, clinical research, administrative projects, etc.

Trauma Surgery

The PGY-3 EM resident will be a member of the Trauma team responding with assigned Surgical residents in caring for acutely injured adult patients. In addition to acting as Trauma Team leader (alternating days with the Senior Surgical Resident in this role), the EM resident will be on in-house call every third night, respond to all trauma alerts, and provide trauma consultation. The average daily census of the trauma service is 45-50 patients, and the EM resident will be primarily responsible for 12-18 patients.

ED Administration

The resident will be exposed to the daily management decision-making processes of the Chair of the Department of EM and the Medical Director of the University Emergency Department. They will attend the weekly UED administrative committee meeting and attend appropriate local, regional, and state EM related activities with an EM faculty member. They will assist with departmental decision-making in the areas of scheduling, capital budget planning, complaint resolution, interdisciplinary relationships, staffing patterns, and other management activities. They will participate in the regular EM faculty meetings as well as standing EM departmental committee meetings during this block. The resident will participate in all Quality Improvement activities for the department throughout this block.

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