Department of Emergency Medicine

Emergency Medicine | Education

Clinical Curriculum

The Hospital of the University of Pennsylvania Emergency Medicine Residency Program is a four (4) year postgraduate training program. Each class consists of 10 residents for a total of 40 residents in training.

The clinical curriculum is designed to take advantage of the rich clinical and academic environment at the University of Pennsylvania Health System. Emergency medicine rotations are not only at the Hospital of the University of Pennsylvania (HUP) but also at 3 different community hospitals with a wide variety of practice settings.

All our pediatric training is right next door at Children’s Hospital of Philadelphia (CHOP). As a national leader in pediatric care, CHOP is a fantastic place to learn and get comfortable caring for critically ill pediatric patients.

In addition, rotations in resuscitation, administration, toxicology, hyperbaric medicine, ultrasound, sports medicine, emergency psychiatry, and both adult and pediatric anesthesiology provide unique opportunities that truly broaden the educational experience.

Several months of elective time are available to residents in order to customize their training to more fully explore their interests. With faculty interests as diverse as EMS, toxicology, hyperbaric medicine, education, ultrasound, violence prevention, travel medicine, resuscitation, early goal directed therapy, sports medicine, global health, and ethics, the options are many.

Furthermore, because of our department's leading efforts in emergency medicine research, residents enjoy tremendous opportunities to be actively involved in new and ongoing clinical, administrative, public health, and NIH-granted basic science research.

For those who are interested in international medicine and global health, we have joined with the Department of Internal Medicine at Penn to create an EM global health tract.  This tract will allow a resident to focus their residency training on developing the skills and experiences essential for developing a career in global health.  Residents will have a required 4 week didactics course taught by faculty from all over campus at the University of Pennsylvania including social work, history, the Wharton business school, and the nursing and medical schools.  Then they will travel to Guatemala to Santiago Atitlan to a clinic in the highlands surrounding Lake Atitlan for a 4 week experience both in their 3rd and their 4th years.  This will allow a more longitudinal perspective and provide opportunities for significant research and service projects.

PGY-1

PGY-2

PGY-3

PGY-4

Intern Survival Series

The Intern Survival Series is a two-week introduction to life as a HUP Emergency Medicine Intern. It is a relaxed period consisting of a combination of presentations on the evaluation of symptoms, practical "on call" sessions on how to troubleshoot situations such as dyspnea and telemetry in the night hours, suturing, splinting and cadaveric procedure workshops.

In addition, there are short clinical shifts which allow the new interns to meet many of the ED staff and to get comfortable in their new "home". Finally, no "survival series" would be complete without a healthy dose of socializing with fellow residents.

Emergency Department
Hospital of the University of Pennsylvania (HUP)

This is what you chose this specialty for! Clinical experience in the evaluation and management of patients with undifferentiated complaints. PGY-1s focus on improving their clinical and communication skills. As the years progress, so do the responsibilities. The PGY-2s are expected to manage multiple patients simultaneously and typically are asked to care for the most critically ill patients.

The senior residents are given a new role - that of an administrator, educator and patient care provider - all at the same time. They are expected to run sign out rounds at shift changes, assist the charge nurse with patient flow through the rooms they are overseeing (typically 12 or so), answer paramedic medical command calls, and manage all the airways in the trauma bay.

It may seem overwhelming now but the graded responsibility over the training makes this transition as smooth as possible. Shifts in the 1st and 2nd year are 12 hours, decreasing to 8 hour shifts as a senior resident.

Peds EM at CHOP

Every year during residency you spend time over in the CHOP ED.  This hospital is world class and while the care is sometimes “only at CHOP” (slushee machine in the ED for the patients!) with almost 80,000 visits annually, there is a tremendous amount of bread and butter pediatrics that comes through those doors.  The opportunity to come back year after year and treat, and possibly even get, all the seasonal infections of pediatrics.  Our EM residency graduates always point to their CHOP training as one aspect of their education they knew was important and special but didn’t truly appreciate it until a few years later when “the really, really sick kid” arrived in their care on an overnight. 

MICU at HUP

This 4 week rotation is at HUP and focuses on the care of the most critically ill patients in the hospital.  Tremendous exposure to ventilators, pressors, antibiotics, managing multiple consultants and working on your data organization skills.

SICU at HUP

The Trauma/SICU rotation can be summarized in one sentence: take care of the sickest people you will ever meet in your life. Great teaching by the Anesthesia/Surgical Critical Care faculty will make you comfortable with all forms of resuscitation and vent management. An incredible number of procedures round out the experience.

In addition, during your PGY-3 year, you will be responsible for more supervising and education of the junior residents. This graduated responsibility is one more step in developing leadership and teaching skills.

CCU at PPMC

A community-based CCU, Penn Presbyterian Medical Center is part of the University of Pennsylvania Health System. Patients are flown in from Atlantic City and transported from smaller area hospitals for emergent cardiac catheterization.

This block-long rotation will provide you with a good knowledge of how to interpret EKG's, cardiac pharmacology, how to manage the critical cardiac patient and learn what is hot in the field of cardiology.

Anesthesiology

During this rotation you will become comfortable with what is perhaps our most valuable procedure, the orotracheal intubation. Located at Penn Presbyterian Medical Center, the focus is on getting you as much experience as possible. Residents average 50 intubations per rotation! You will learn to use the LMA and maybe use a Bougie.

The attendings are very willing to teach and show off their intubation toys. The CRNAs will also give you great tips. It's also a great time to practice putting in some lines. This will earn you bonus points with the ED nurses when they are really busy. Overall, you will definitely have a great time and feel very comfortable with this vital skill at the end of the month.

Ward Medicine

This intern rotation is a block long rotation of floor medicine. Education consists of daily lectures by the Department of Medicine and a weekly Intern report. Learn the ins and outs of what happens to your patient once they are admitted and what you can do in the ED to help facilitate patient care once they get to the floor.

In addition, it is a great opportunity to meet and work with HUP medicine residents. Most teams plan an evening out during the rotation to help decompress and have some fun.

Obstetrics

As in integral part of the labor floor team, we participate in the management of term labor, delivery and complications such as pre-eclampsia, eclampsia and postpartum hemorrhage. The L&D is mainly managed by residents, which offers excellent hands-on experience and deliveries.

Emergency Psychiatry/Dermatology

Psychiatric disease is often the most challenging problem to deal with in the emergency department not because of the diagnostic dilemmas but because of the behavioral management and interpersonal dynamics that often manifest. This 4 week PGY-1 rotation will help prepare you for these situations.  Most of your time is spent evaluating patients both in the Psychiatry Emergency Evaluation Center (PEEC), and those who are inpatients with the psychiatry consultation service. These cases range from altered mental status to acute psychosis and from depression to suicide, with a good dose of substance abuse as well. There are daily work rounds, conferences and one on one teaching regarding cases in the PEEC.  The fourth week of this experience is at the Hall Mercer Center. This is an emergency evaluation center for the City of Philadelphia where police bring patients they feel require emergency psychiatric evaluation.  Patients tend to be poorly differentiated and very ill.  This is a new addition to the rotation and one very well received.

One afternoon a week is spent in the Dermatology Teaching Clinic where you will see a wide variety of dermatologic conditions. In addition there are two different dermatology conferences that provide you with a fundamental way to approach rashes.

Community EM

We have three separate rotations at emergency departments throughout the city: Penn Presbyterian Medical Center, Holy Redeemer Medical Center, and Pennsylvania Hospital. All three are affiliated with our department and yet they provide distinctly different experiences.

This exposure to three different clinical environments, patient populations and hospitals teaches residents to rely on their transportable EM skills and adapt to new environments.

Resuscitation

This 4 week rotation focuses on all things resuscitation.  Our department is fortunate enough to have several leaders in the field of resuscitation and we’ve tapped into that by creating this rotation.  You’re on call 24/7 and whenever a patient requires early goal directed therapy for their sepsis, post arrest hypothermia, or prolonged ICU care in the ED, you’re called to come in and care for the patient.   This is really popular not only because of the significant one on one teaching with the faculty and the numerous procedures, but because it’s a chance to really immerse yourself into the care of one and only one critically ill patient.  Then you get to read and follow up on that patient.  This is a one of a kind rotation and a fantastic experience.

Trauma

Over the course of the Penn residency, you will rotate for 10 weeks with the trauma/critical care team. Over that time you are given more and more responsibilities so that the 4th year residents are the acting chief on that service and managing not only the trauma bay resuscitations, but also the floor service. This provides great experience both clinically, procedurally, and leadership opportunities.

Due to our close working relationship with the Division of Trauma through the time of this service, the SICU, and the ED resident trauma airway management, , the EM residents have been adopted as "their residents". They take this ownership seriously and will make certain you get the best training possible.  Doesn’t mean you won’t work hard, but it does mean that you’ve got someone teaching you along the way.

During the rotation you are taught the ultrasound "fast" exam, and have the opportunity to become certified in the exam.

Sports Medicine

This is our newest rotation and one well received. You spend two weeks in the sports medicine clinic evaluating and learning about a wide variety of sports related injuries most notably shoulders and knees.  Focus is on improving and refining your physical examination skills as well as understanding some of the longer term treatment and rehabilitation options and requirements for sports injuries.

Pediatric Anesthesia at CHOP

Mini laryngoscopes. Itsy bitsy endotracheal tubes. Little tiny mouths. Eensy weensy vocal cords. And your giant hands. Most residents manage between 10-15 airways to improve their airway skills in one of the premier pediatric surgical arenas in the country.

This is an absolutely invaluable experience that is easily a favorite with the residents and one that is rarely found in EM training programs.

Ultrasound

This 4 week experience will change the way you think about technology and the way it can be integrated into patient care.  This is a rigorous and demanding rotation that has significant one on one dedicated time with our 2 ultrasound faculty as well as our 2 ultrasound fellows. Weekly image review ensures you’ll be learning from your mistakes as well as your successes.  Over the four weeks, residents average over 200 ultrasounds and develop a solid foundation to build upon throughout the next 2 years.

Elective

With 18 weeks of elective time spread out throughout the clinical curriculum, there are tremendous opportunities to tap into the intellectual resources within our department and our hospital.

Residents do a wide variety of things during this “flex” time, from working on their own research project or taking coursework toward another degree, to learning about other aspects of medicine at HUP such as rotating at the medical examiners office, the radiology reading rooms, or the oral surgery clinic.

International experiences are becoming more and more popular. We have not only residents, but also faculty members who have developed relationships and worked clinically in different countries throughout the world, most notably Botswana and Guatemala.

These elective experiences enrich the education of all the residents and allows them to tailor their training to their interests. This is one of the great benefits of a four year curriculum which cannot be underestimated.

PICU at CHOP

Learn pediatric critical care in one of the world's premier pediatric centers. Here you will see the sickest children, who are transferred in from all the hospitals in the surrounding area. This is an excellent opportunity to become comfortable with critically ill children, and learn the latest cutting-edge treatments.

EMS

Strap yourself in and ride along with the men and women of Philly EMS. Explore the "Wild, Wild West" and dine with the "Junkyard Dogs." Dr. Crawford Mechem, a member of our faculty, is also the Medical Director of Philadelphia EMS. This provides huge opportunities to learn the mysterious inner workings of the Fire Command Center, and visit the Airport Fire House.

During this excellent month-long experience, you will learn where your patients come from and what happens to them before you hear "Fire Rescue with a patient on a litter." Throughout the year, unique and exciting EMS opportunities are provided, including weapons training with the SWAT team, Basic Vehicle Rescue (using the"jaws of life," etc.), and fire grounds training (gearing up in full bunker gear, and learning how to climb the ladders and put out fires with a live burn in the fire tower).

And of course, for those who aren't afraid of flying, you will have the opportunity to fly with PENNSTAR helicopter team.

Toxicology/Hyperbaric Medicine

This is a glimpse into two of the premier subspecialties in emergency medicine: hyperbaric medicine and clinical toxicology.

The division of hyperbaric medicine is an active multispecialty group that manages a wide variety of both emergent and scheduled patients.

The clinical toxicology division is an active consult service at HUP and CHOP. The teaching is anchored at Philadelphia’s poison control center with daily lectures by toxicologists from several programs in the city. In addition, you’ll be able to consult on any toxicology patients admitted to CHOP or HUP. Ample time for reading is provided.

Administration

This 2 week rotation allows you to gain insight into the “behind the scenes” work involved in keeping an ED working. Spending time with our medical director, our quality assurance physician and the residency director and seeing what they do in their offices.  Attending meetings, working on projects to improve the overall day to day life in the ED, reviewing patient care practices, and contributing to the educational mission of are department are all aspects of this rotation.

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