Yearly Curriculum and Rotations Schedule

Curriculum: Year One

First-year residents concentrate on developing skills in individual patient evaluation. First-year residents are encouraged to take advantage of all educational resources to broaden all elements of their knowledge base. They work on gathering an appropriate history and a focused physical examination. Each resident is assigned to an area of the main ED that allows for the most direct attending-to-resident interaction. The resident is expected to act as the primary care provider under the direct supervision of the ED attending. After interview and exam, all patients must be presented to either the supervising faculty or the supervising EM resident to organize treatment and evaluation.

The EM1 resident is expected to participate in the decision-making regarding care of their patients. Residents at this level are expected to become proficient in patient care relative to the expectations set for their peer group. The focus is on the efficiency and accuracy of each patient evaluation. The resident at this training level is expected to acquire a familiarity with delivering high-quality care and identifying life-threatening illness and injury. They are expected to see a reasonable number of patients, but the focus is on quality of care, not the volume of patients evaluated.

During the EM1 year, the resident will become credentialed in BLS, ACLS, ATLS and PALS, as well as complete the Airway Management Course and the Emergency Medicine Ultrasound Course. Basic procedural skills include suturing, bandaging, splinting, wound and burn care, incision and drainage, peripheral and central venous access, lumbar punctures, and orthopedic manipulation. Rotations on ultrasound, pediatrics, obstetrics and gynecology, trauma, and ICU will provide a broad-base knowledge and experience in patient care to assure the resident is ready to progress to the EM2 level. EM1 residents also are expected to start their scholarly project to develop medical writing and evidence-based medicine evaluation skills as well as consider an academic track to further their career development.

EM1 residents interact with senior-level EM residents but do not evaluate case presentations from students or other residents. Residents at this level participate in learning basic teaching skills through morning reports and teaching stations at sign-out. Residents also will be taught basic research methodology.

Curriculum: Year Two

The second-year EM resident concentrates on expanding and refining patient care skills. During the EM2 year, the resident is assigned to an area of the main ED that allows for direct attending-to-resident interaction. They are also provided an opportunity to interact with the senior residents. At this level, residents are expected to perform history and physicals and initiate most orders with the exception of more complex studies. They are expected to manage their own patient load, seeing a greater number of patients per hour to broaden their expertise.

The EM2 resident begins to focus on developing an efficient approach to patient care and learns the skills needed to manage several patients simultaneously. They are not expected to oversee departmental issues or accept cases from off-service residents. They will, on occasion, help direct care being provided by students. Advanced procedural skills include intubation, cricothyroidotomy, venous cutdown, thoracostomy and pericardiocentesis. It is starting with the EM2 year that residents begin to independently cover the ICU overnight.

During the EM2 year, the resident will complete the Base Station Command Course. EM2 residents also are expected to define a research project that will be completed by the end of the training program and begin to focus on their academic tracks.

Curriculum: Year Three

The third-year EM resident concentrates on broadening their exposure to various pathologies, more complicated procedures and developing efficiency. As they progress to an EM3, residents are more frequently assigned to the area considered to be the most central of the ED. Typically, this is the area overseen by the charge nursing personnel. This provides the resident a chance to be involved with the overall flow and throughput of patients being seen in the department. Oversight of junior residents and students is expected. Residents demonstrate their clinical ability to care for multiple patients and to increase their knowledge base in advanced procedures and critical care.

Residents at this level perform history and physicals and initiate orders as well as therapeutic interventions. They are expected to manage their own cases in the area assigned under the supervision of an attending. EM3 residents will assume more academic responsibilities, providing lectures to mid-level providers, physician assistant students and medical students, and give lectures in Grand Rounds. Additionally, they will begin to manage pre-hospital medical command as well as respond to trauma alerts while at Muhlenburg ED. EM3 residents are expected to complete an interim report on their research project and begin to collaborate with their classmates in defining a quality improvement project that will be accomplished as a group in their final year of training.

Curriculum: Year Four

The EM4 resident concentrates on developing managerial skills needed to run an emergency department and completes the academic track of their choice. As EM4’s, they are expected to continue to be able to manage the main area of the ED, have cases presented to them by junior residents and off-service residents, provide supervision/mentorship and teaching to the learners, manage the pre-hospital medical command, respond to trauma alerts while at Muhlenberg ED, field questions from mid-level providers and provide overall direction to the general management of the department in consultation with the attending physicians.

The residents develop skills in problem-solving, patient disposition, efficient delivery of emergency medical care and teaching.

Overseeing the operation of the emergency department and ensuring that all patients receive appropriate and timely care is of extreme importance, and it is expected that the resident be cognizant of waiting room and ambulance arrivals. The EM4 resident begins to facilitate ED throughput, admissions and discharges and assists in difficult dispositions. They will interface with the admission services when conflict arises. The resident supervises major medical resuscitations. As an EM4, the resident is expected to see patients individually and staff all cases presented to them. They confirm history, physicals and orders placed by junior residents and approve and initiate therapeutic interventions.

Although they still must present their cases to attendings, it is the expectation that preliminary disposition decisions already have been established. These disposition plans will be confirmed by the attending. The EM4 residents are afforded greater opportunity to provide lectures to the junior residents and students as part of their regular academic activities. Residents will also have an assigned administration rotation during which they will learn the basics of emergency department management and practice management. Additionally, EM4 residents complete their research project identified as an EM2 as well as participate actively in the class quality improvement project.

Curriculum: Rotations schedule

The number corresponds to the number of blocks dedicated to that rotation. There are 13 blocks per academic year.

PGY1

• 7 Emergency medicine
• 1 Ultrasound
• 1 Pediatric ED
• 1 Medical ICU
• 1 OBGYN
• 2 Night float medicine

PGY2

• 8 Emergency medicine
• 1 Anesthesia
• 1 Cardiology
• 1 Medical ICU
• 1 Trauma ICU
• 1 CHER (Children’s ER)

PGY3

• 6 Emergency medicine
• 1 Medical ICU
• 1 PICU
• 1 Neuro ICU
• 1 Trauma ICU
• 1 Toxicology
• 1 Administration/EMS
• 1 elective

PGY4

• 9 Emergency medicine
• 1 Pediatric ED
• 1 Medical ICU
• 2 Electives