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PGY-3

EM (26 weeks) - R3 supervisor shifts: 8 hour shifts (R3s as a group can choose to make the weekends 12 hour shifts in order to get more weekends off.) The supervising R3:

  • Is responsible for maintaining the general "flow" of the department, is expected to know all of the patients in the department, and also sees patients in a primary role
  • Sees every West Side patient briefly upon arrival in the ED to ensure that patients are assigned to junior residents in an order based on their acuity
  • Advises junior residents in patient management decisions, supervises procedures, and instructs third-year medical students who are on their required EM rotation. (Junior residents include those from ob/gyn, internal medicine, psychiatry, anesthesia, and EM programs)
  • Together with R2s and attendings, provides on-line medical control for the region's paramedics

The R3 Supervisor shifts offer valuable experience in managing a busy ED, teaching, and seeing patients at a varying pace. Because of the supervisory role, the R3 is able to learn from the pathology of every patient in the ED, not just the ones they are seeing primarily. Sign out at the end of the shift is generally "clean" and straightforward; in most cases you go home within 30 minutes of the end of the shift.

PEDS-EM (6 weeks) - The Peds-EM experience is similar to previous years, but with expectations for increasing autonomy, answering the pediatric online medical control phone, instructing third-year medical students, and supervising junior residents who are handling procedures. These are 10 hour shifts.

Urgent Care (3 weeks) - Because our ED has such a large capacity, many of the minor/non-acute patients during the day and evening are triaged to the South Side, which sees urgent care-type patients. This rotation provides the graduating resident with an opportunity to get even more adept at seeing non-acute and minor illness and injury. These three weeks will be scheduled like a typical Adult ED rotation.

Elective (4 weeks) - A four-week rotation set up by the R3 and approved by the residency director. Very flexible.

Trauma (6 weeks) - During this rotation, the EM R3 is a member of the trauma team, which consists of a trauma surgery attending, general surgery chief R5, emergency medicine R3, and general surgery R2 or R3. The trauma team responds to all level 1 or level 2 trauma alerts (which are called at the ED's discretion) and handles all trauma and general surgery consults.

During trauma alerts, you'll gain experience "running" the trauma and have regular opportunities to perform procedures, including chest tubes, central lines, etc. The trauma team also rounds on all admitted patients, including ICU patients. However, the team is not responsible for day-to-day management of floor patients since there is a surgery intern assigned to this role (i.e., no "floor-scut").

This rotation also enables residents to handle general surgery consults. After evaluating the patient, you'll present the case either to the surgery chief or surgery attending. OR experience is available but not required.

The EM resident is considered an important member of the trauma team, and the surgery residents appreciate their presence. It's important to note that R3s generally are very comfortable managing traumas before they start the trauma rotation based on the R2/R3 "trauma/critical care bay" experience in the ED.

This rotation requires 24-hour shifts each Monday, Wednesday, and Friday (approximately 7 a.m. to 7 a.m.).

Vacation (4 weeks) - Four weeks of vacation split up into one- or two-week blocks.

Administration/Teaching (3 weeks) -This rotation is intended to simulate work as a department administrator. Throughout the rotation period, administrative meetings are mixed with a light load of clinical shifts in the ED. You'll also have more time for moonlighting.

You'll spend a total of 12 hours in one-on-one sessions with our department chair, Dr. Sandra Schneider, a national leader in our field, past-president of SAEM, and a highly respected chair within our hospital's administration. These meetings are very enlightening, provide invaluable insights, and are considered by all to be a key strength of our program. They span a broad range of topics, including:

  • Hospital and departmental management
  • JCAHO
  • Legal issues and COBRA
  • Employment contracts, interviews, and incentives
  • Documentation
  • Consent
  • Insurance reimbursement
  • Disability
  • Signs of an "ailing hospital"

You'll also spend a total of four hours in one-on-one meetings with Dr. Frank Zwemer, the ED Medical Director and department vice-chair for operations. These sessions, which focus on areas such as quality assurance review and patient complaint response, leverage Dr. Zwemer's extensive experience to give you a close-up look into into the daily operations of the ED from an administrative perspective.