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EM Categorical Residency

Clinical

Our curriculum changed from the "traditional" 12 calendar month template to the 13 x 4 week block schedule in 2007. This assures a uniform experience in each rotation, eliminates confusion about change-over dates, and affords an additional training block each year. The "experiential" (non-didactic) curriculum is described below.

Year 1

  • Heavy emphasis on the sickest patients with 3 ICU rotations (2 medical, 1 trauma).
  • The emphasis on the "sick" patient allows for excellent training in procedures assuring that all R1's are proficient and skilled at nearly all procedures by the end of the 1st year (e.g. airway management central lines, chest tubes).
  • 18 weeks in the ED (including an orientation block that includes experience in both the Eskenazi and Methodist EDs.
  • R1s complete a dedicated block in the Riley Pediatric ED.
  • A 1 week focused immersion ultrasonography ED experience.
  • Focused experiences in imaging interpretation and EKG interpretation during 2 ED blocks.
  • R1 vacation is 21 days.
Year 1 Blocks
ED Orientation 1
Methodist Hospital ED 2.25
Eskenazi Hospital ED 2.25
Trauma ICU 1
Adult ICU 1
Pulmonary ICU 1
Cardiology inpatient 1
Anesthesiology 0.75
Riley Pediatrics ED 1
OB/GYN 0.25
ED Ultrasonography 0.25
Medical Toxicology 1

Year 2 and 3

  • Our upper level residents (R2 and R3) function as "scheduling equals" in our program. The same responsibilities are given to residents in these two years. Our faculty understandably have differing expectations and supervision for each year level.
  • R2's have several unique "Knowledge Translation" shifts each ED rotation. Primary patient care is not a priority during these shifts. Instead, the EMR2 spends time generating focused clinical questions about patients in the ED, database searching skills, and engages in "other" activities to include US scanning and procedures.
  • R3's do 2-3 "teaching shifts" each ED block. They serve as the initial staffer for med students and off service residents. During these shifts they have no primary patient care responsibilities.
  • R2 and R3 residents rotate through Riley Hospital for Children ED during each ED Block to ensure seasonal variety in taking care of pediatric populations
  • A "triple-threat" block permits an integrated and longitudinal experience to meet the RRC-EM mandated scholarly project, immersion EMS experiences and to learn the principles of a well operated ED.
  • The resident may develop a "de novo elective" experience as long as it meets 3 criteria
    • Involves the practice of administrative components of EMS
    • The work environment is not unduly hazardous
    • A supervisor can provide and attestation that the rotation objectives were met
  • International electives are permitted. IUSM maintains a teach hospital in Kenya, our residents have worked in over 10 different nations on 3 continents.
Year 2 Blocks
Methodist Hospital ED* 4
Eskenazi Hospital ED* 4
Orthopedics 1
Adult ICU 1
Riley Pediatrics ICU 1
Admin/EMS/Research 1
Elective 1
Year 3 Blocks
Methodist Hospital ED* 4.5
Eskenazi Hospital ED* 4.5
Riley Pediatrics ICU 1
Pediatric Anesthesia 1
Elective 2

*Riley Peds ED Shifts Integrated

Typical Electives  
Allergy/Immunology Missionary Medicine
Anesthesia Nephrology
Anesthesia/Ultrasound Ophthalmology
Dermatology Pediatric Surgery
Diaster medicine Palliate Care
ENT Radiology
Hand Surgery Rehabilitation
Hermatology/Oncology Research
Infectious Disease Rheumatology
International Medicine Sports Medicine
Mass Gathering Others (upon request)
Motor Sports  

Didactics

Core Lecture Series

The core curriculum is designed to repeat itself every 2 years, with critical topics being repeated every year. Topical themes are ongoing on a monthly (EM-Trauma, Toxicology, Pediatric Critical Care, M & M, Case Conference, IM-EM), bimonthly (EM-Pediatrics, ECG, Literature Review) and quarterly (EM Administration/CQI, EMS/Base Station, Community Practice perspective and  Mock Oral Boards) basis. EM Residents are released from clinical responsibilities in order to attend core conferences with the exception of Trauma Surgery and Adult ICU during the R1 year, and the Adult and Pediatric ICU rotations during the R2 year. EM residents present approximately 25% of the core lectures each year with the remainder being presented by faculty. Core lectures are held on Wednesday and Thursday mornings from 0700 to 0900. Nontraditional teaching formats with emphasis on interactive features are encouraged.  Perrenial favorites include our quarterly 2 hour mock pediatric resuscitation and unique M&M conference that focuses on system issues and cognitive bias.  Each year, our residents rate their didactic sessions as being as good, or better, than those they experience at national EM meetings.

Didactic Presentations Requirements
R1 Year  R2 Year R3 Year
No Requirements Grand Rounds 1 Grand Rounds 1
EMS Optional Student Sim Labs 2 M&M Conferences 1
        or Lecture 1 Student Sim Labs 2
  EMS Lectures 1      or Lecture 1
      EMS Lectures 1

Year Directed Conferences

These are held 10-11 months of each academic year, and usually last 2 hours. Each Year level meets separately from other year groups. This allows an entire peer group to assemble for a topic of interest to their level of training, as well as afford an opportunity to socialize with one's peers. The Year Directed conferences may take place at off-campus locations.

R1 Year

The R1 Year-Directed Conferences focus on an in-depth discussion of the presentation, differential diagnosis, evaluation, and treatment of a variety of medical complaints including asthma, chest pain, and abdominal pain. Future trends are also discuss. A full day immersion EMS Base Station skills course capstones the year.

R2 Year

The R2 Year-Directed Conferences are centered around X-ray interpretation, use of diagnostic testing, and emergency procedures. This includes procedure labs for head and neck pathology, intraosseous infusions, and advanced slit lamp use. A session focusing on didactic teaching skills is held in the summer, and a two day clinical teaching skills course is held in the spring.

R3 Year

The R3 Year-Directed Conferences explore personal (how to prepare a CV, interview for and evaluate a job, prepare for life=long learning, dos and dont's of arriving at the new job, etc.), administrative and reimbursement topics. These conferences are designed to prepare the EM resident for transition to his or her post-residency career. Personal finances, contract negotiations, career longevity and wellness, ethical dilemmas, and malpractice issues are covered.

Residents have online access to major EM texts free through the IUSM medical library.  Additional education funds are provided to each resident to purchase additional resources and attend a national meeting.

Pediatrics

Pediatric training is emphasized through our clinical and didactic training. Due to the seasonal variation of pediatric illnesses and injuries, we strongly believe that a constant exposure to pediatric patients is critical to resident development. Our EDs are fully integrated, thereby assuring the resident will have pediatric exposure on every shift in our ED. On many of our off service rotations (e.g. Orthopedics, Neurosurgery & Toxicology) the resident will continue to care for pediatric patients (on some up to 40% of the patients will be children).

Our R2 and R3 residents rotate in the Riley Pediatric ICU, caring for ill children across the spectrum of disease, to include trauma and acute complication of chronic disease.  The addition of the Riley ED in 2009 simply added the "icing" to an already incredibly strong focus on providing emergency care for children. Two blocks are dedicated to this third partner in our resident education, in the R2 and R3 year.

Our didactic series places a strong emphasis on pediatric topics, including the quarterly 2 hour mock pediatric resuscitation series and the recently revamped PEM Core Content lecture series bimonthly. Thirteen of our faculty are double boarded or fellowship trained in EM and Pediatrics. In addition, our combined 5-year EM-Pediatric residency has opened even more collaborative efforts. Our graduates, and their employers, rate their comfort and capabilities in the care of emergency pediatrics as outstanding.

Riley.jpg

Emergency Ultrasound

Emergency ultrasound is used in the resuscitation and evaluation of hypotensive patients, the evaluation of patients who present following acute trauma, the evaluation for the presence of abdominal aortic aneurysms (AAA), recognition and detection of first trimester pregnancy complications, detection of pericardial effusion and evaluation of cardiac function, renal and biliary applications, evaluation for deep venous thrombosis, as well as assistance in a number of procedural applications such as line placement, peripheral nerve blocks, and assessment and drainage of localized fluid collections.

Eskenazi and Methodist see nearly 200,000 patient visits per year.  Almost 4000 ultrasounds are performed annually within the two emergency departments.  All scans are recorded on a combination of video and still imagery and are evaluated for quality assurance and educational purposes by the respective ultrasound directors at each hospital.

Each emergency department has two ultrasound machines that have curved abdominal, linear, endocavitary, and phased-array probes for wide variety of applications.  Wishard also has a dedicated machine for vascular access.

Residency Training

The training of residents and emergency ultrasound incorporates a combination of didactic sessions, year directed hands-on workshops, self-study, literature review, video review, and

primary bedside teaching in the emergency department to learn to properly evaluate patients with this bedside tool to speed diagnosis, guide resuscitation, and improve patient safety.  Ultrasound training both uses simulation and is being incorporated into the simulation training that is part of the residency program.  Residents receive training in all common applications of ultrasound within the emergency department as well as training in ultrasound documentation, program development, and billing issues.

PGY-1

Interns have a primary orientation day to ultrasound during their first month when they have lectures on all the primary ultrasound applications and hands-on sessions to become familiar with the machines and scanning. Each intern then spends a week of the anesthesia/ultrasound rotation with the ultrasound directors performing scans at the bedside and receiving additional didactic teaching

PGY-2 & PGY-3

An ultrasound elective is available for upper-level residents providing additional training in both the primary applications and some secondary applications of ultrasound within the emergency department. Additional time can be scheduled at other points within the curriculum such as during the "Triple Threat" block, during knowledge translation shifts, and at other times with the prior notice to the ultrasound directors.

Additional Learners

Teaching is also provided to rotating off service residents, medical students, emergency department faculty, and emergency department nursing staff for a variety of applications that aid in patient care.

Credentialing

Credentialing is both provided for residents and required over the course of the three-year residency.  Residents graduate with superior ultrasound knowledge and expertise--skills that are increasingly sought in both community practice and academia.  This includes a minimum total of 150 approved scans, with additional requirements in a variety of specific scanning applications, and meets the current ACEP guidelines.

Ultrasound Directors

Frances Russell, MD currently directs ultrasound education within the IUSM EM Residency Program.

Work Hours

In 2011, the ACGME implemented new work hour restrictions. The IUSM anticipated and has actively working on these changes. The IUEM Residency program required minimal changes to meet these new standards.

We pride ourselves in creating a non-abusive work environment that fosters, as opposed to threatens, intellectual curiosity. Since 1985 our residents have worked a unique circadian schedule that assists physiologic wellness and avoids long blocks of night shifts. Resident's participating in the Emergency Medicine Residency program will abide by requirements for resident work hours as outlined by the program requirements for Emergency Medicine published by the Residency Review Committee. This entails the following stipulations:

  • Residents in Emergency Medicine training programs will not work more than 80 hours per week when averaged over a two-week time period.
  • Residents will not be on call in the hospital more frequently than every third night (averaged over one month). For the majority of on-call rotations this averages every fourth or fifth night. Residents on call for more than 24 hours must have an adequate opportunity to rest and sleep.
  • Residents should have at least one 24-hour period off duty each week. On rotations such as Intensive Care Units where continuity of care is critical, the resident may be expected to participate in brief work rounds on a daily basis.
  • While on duty in the Emergency Department, the resident's shift will not exceed 12 continuous hours. Emergency Medicine residents will have no more than 6 consecutive shifts scheduled in the Emergency Department and will have a period of time off between each shift commensurate with the scheduled shift duration.

EM Resident Requirements / Responsibilities (on EM Rotations)

6 Day Shift Flow
7:00 AM - 4:00 PM
8:00 AM - 5:00 PM
2:00 PM - 11:00 PM
3:00 PM - 12:00 AM
5:00 PM - 2:00 AM
11:00 PM - 8:00 AM

R1: 45-55 hours per week
R2/R3:  41-44 hours per week

Our residency adopted a unique circadian schedule in 1985, one year after the faculty had done so. Shifts flow in a progressive fashion over 6 days (7am-4pm, 8am-5pm, 2pm-11pm, 3pm-midnight, 5pm-2am, and end with a single 11pm-8am shift. This allows the resident to never have to shift their circadian rhythm, and has been found to be the best physiologic schedule to deal with night shifts. Off service R2 and R3 residents assist in coverage of the 3 p.m. to midnight shifts unless rotating on services with on-call responsibilities. R3¹s are scheduled for a 2-11 pm teaching shift in which they serve as the first line staffers for medical students and off-service R1¹s.

Chief Residents work 2 less shifts per month

Specialty Tracks

1701 N. Senate Blvd, B401 | Indianapolis, IN 46202 | (317) 962-5975