Emergency Medicine Curriculum

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 at Birmingham Medical Center, UAB Hospital and Children's Hospital of Alabama. Additionally, rotations at Baptist Medical Center South in Montgomery, Alabama, add exposure for residents to a community ED setting.

The program conforms to all requirements specified by the Accreditation Council on Graduate Medical Education (ACGME) and is fully accredited 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 5 blocks
Pediatric ED - Children's Hospital 1 block
Junior Trauma 1 block
Cardiology/CCU 1 block
Obstetrics 1 block
Internal Medicine 1 block
MICU 1 block
Anesthesia/Ultrasound 1 block

 

PGY-2

University/Peds ED 8.5 blocks
Community ED 1 block
Trauma and Resuscitation Integrated
Ophthalmology - Callahan Eye Foundation 0.5 block
EMS Integrated
Pediatric ICU 1 block
Elective 1 block

 

PGY-3

University/Peds ED 9 blocks
Community ED 1 block
Trauma and Resuscitation Integrated
ED Administration/Research 1 block
Elective 1 block


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 for whom they are responsible. In the latter half of this year, they will initiate life-saving care and perform more invasive procedures under senior EM resident or EM 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. The EM-2 resident will also provide definitive airway management for critically injured trauma patients in the ED, alternating with Anesthesiology. They will serve as online medical control for the local EMS system.

During the third year of EM residency training, the EM-3 resident will see patients more autonomously, consistent with increased responsibility and clinical expectations. The EM-3 resident also will 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 resuscitations during their shift. Procedures often will be delegated to the junior EM residents or other junior residents on duty in the ED. 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 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 Children's Hospital for emergency care, including both the Emergency Department and the 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 the PGY-3 EM resident on the Senior Trauma rotation, and be on in-house call every fourth night. They will assist in the initial evaluation and management of Trauma Alert and trauma consult patients in the University ED as well as manage patients on the inpatient trauma units.

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

The resident will take primary responsibility for all Labor and Delivery patients (8-12/day) presenting during regular business hours to the Labor and Delivery (L&D) triage area, 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.

Internal Medicine

The resident will work as a part of a team of junior and senior Internal Medicine residents. The resident will function as a PGY-1 resident on the internal medicine team, participating in the evaluation and management of general internal medicine patients from admission through discharge. The resident will be supervised by senior medicine residents and attending physicians from the Department of Medicine. The resident will be on call every fourth night.

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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 will take call every fifth 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 several EMS shifts during each University ED block participating in EMS activities under the direction of the Director of the Office of EMS. 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, Alabama (on-board flight participation is strictly optional). Throughout residency training, the EM resident will be encouraged to assist the Alabama Disaster Medical Assistance Team or the National Disaster Medical System, through interactions with the director of the Office of EMS.

Pediatric ICU (PICU)

The resident will rotate in the PICU at Children's Hospital of Alabama as part of a team comprising pediatric residents, pediatric emergency medicine fellows, pediatric critical care fellows, and pediatric critical care attending physicians. The resident will participate in the evaluation and management of critically ill and critically injured pediatric patients. Dedicated time also is allotted for training in pediatric airway management in the operating rooms at Children's Hospital, supervised by pediatric anesthesiology personnel.

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.

Ultrasound

Residents will perform emergency bedside ultrasound exams under the supervision of dedicated Emergency Ultrasound faculty and Ultrasound fellows as well as EM attending physicians in the University ED during the afternoon, Monday through Friday, after finishing Anesthesia rotation requirements in the morning. Residents will receive dedicated training in FAST exam, cardiac, AAA and biliary exams, pelvic ultrasonography (including endovaginal exams), ultrasound-guided vascular access, and soft tissue ultrasound exams. Residents will also participate in weekly Ultrasound Image Review, in which the ultrasound images from the preceding week are reviewed and discussed. Residents also will review current ED ultrasound-related medical literature and textbook chapters.

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Community ED

The resident will evaluate and manage a wide variety of adult and pediatric patients in a busy, urban community ED setting at Baptist Medical Center South in Montgomery, Alabama.  This ED receives approximately 50,000 visits per year.  The resident will work closely with board-certified emergency physicians in all aspects of adult and pediatric emergency care, including the initial primary and secondary evaluation of trauma patients presenting to the ED.  Housing is provided by the medical center and real-time teleconferencing facilities are available to allow rotating EM residents to participate in weekly didactic lectures at UAB.

Ophthalmology

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 Monday-Friday, 8:00 a.m.-12:30 p.m. 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.

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Trauma and Resuscitation

As part of the ED rotation during assigned Trauma/Resuscitation shifts, the PGY-2 and PGY-3 EM resident will be a member of the Trauma team responding with assigned Surgical residents in caring for acutely injured adult patients.  The resident will also be the initial physician assigned to the evaluation and management of all arriving ambulance patients needing immediate resuscitation.

ED Administration/Research

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.

Each resident is required to complete a scholarly project while enrolled in the residency program. Although the project may continue throughout residency, time during the ED Admin/Research block is scheduled during the EM-3 year. The project may encompass bench research, a community project, clinical research, administrative projects, etc.

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