Training Components
Our curriculum changed from the "traditional" 12 calendar month template to the 13 x 4 week block schedule in July 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, one 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 Wishard and Methodist ED's). You care for children during all of these.
- 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 2-3
- 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 medical students and off service residents. During these shifts they have no primary patient care responsibilities.
- Starting in 2010, R2 and R3 residents have Riley Hospital for Children ED dedicated block rotations.
- 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 an attestation that the rotation objectives were met.
- International electives are permitted. IUSM maintains a teaching hospital in Kenya, but our residents have worked in over 10 different nations on 3 continents.
THE 3 Year (39 BLOCK) CURRICULUM
| YEAR 1 | Blocks | YEAR 2 | Blocks | YEAR 3 | Blocks |
| ED Orientation Methodist Hospital ED Wishard Hospital ED Trauma ICU Adult ICU Pulmonary ICU Cardiology inpatient Anesthesiology Peds Urgent Visit Center OB/GYN ED Ultrasonography Medical Toxicology |
1 2.25 2.25 1 1 1 1 0.75 1 0.5 0.25 1 |
Methodist Hospital ED Wishard Hospital ED Riley ED Orthopedics Adult ICU Pediatric ICU - Riley Neurosurgery Admin/EMS/Research Elective |
3.0 3.0 1 1 1 1 1 1 1 |
Methodist Hospital ED Wishard Hospital ED Pediatric ICU - Riley Riley ED Pediatric Anesthesia/Ultrasound Elective |
4 4 1 1 1 2
|
Typical Electives
|
Allergy/Immunology |
International Medicine |
Radiology |
||
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 R1 Pediatric Urgent Visit Center rotation is designed to provide skills in the assessment of "bread and butter" acute pediatric illnesses and injuries. 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.
*Please see the Division of Ultrasound for further information
Emergency Ultrasound has become increasingly prevalent in the management of acute conditions that commonly present in the emergency department.
Clinical care
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.
Wishard 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 and 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
Hal Minnigan, MD and Gregory Snead, MD currently direct ultrasound education within the IUEM Residency Program. Both directors have significant experience within the area of ultrasound education and are active at the national level within ACEP, SAEM, and other organizations focusing on ultrasound. Similarly both directors have published peer-reviewed articles in the area of emergency ultrasound and ultrasound education.
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:
1. Residents in Emergency Medicine training programs will not work more than 80 hours per week when averaged over a two-week time period.
2. 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.
3. 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.
4. 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)
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, 2-11 pm, 3-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.
The patient population seen and treated in the Emergency Departments at IUEM provide a full-spectrum of disease and pathology in order for a resident to be clinically competent in Emergency Medicine. The simulation curriculum at IUEM is not intended to replace the exceptional education gained from direct patient care that will continue to exist at Indiana University; however, it is intended to AUGMENT our educational experience.
The simulation program at IUEM is a core-competency based curriculum designed in a tiered-fashion to provide the maximal educational benefit to each post-graduate training year. We believe that simulation is a powerful and necessary educational tool that cognitively reinforces core medical knowledge, interpersonal communication skills, systems-based practices, patient care/ clinical skills, procedural education , and professionalism for the practice of Emergency Medicine.
Our residents have the opportunity to participate in simulation sessions throughout their residency with over 57 unique simulation cases created by our faculty specific to each level of training.
Click here for more on the IUEM simulation experience
