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Residency Clinical Curriculum
The Hospital of the University of Pennsylvania Emergency Medicine Residency
Program is a 4 (four) year postgraduate training program. Each class
consists of 9 residents for a total of 36 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 toxicology, hyperbaric medicine, ultrasound, dermatology, emergency psychiatry, and both adult and pediatric anesthesiology provide unique opportunities rarely found in 3-year programs.
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, ultrasound, violence prevention, travel medicine, resuscitation, sports medicine, international medicine, and ethics, the options are limitless.
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.
PGY-1 |
PGY-2 |
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PGY-3 |
PGY-4 |
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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.
Hospital of the University of Pennsylvania (HUP) Emergency Department
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.
Trauma
Over the course of the Penn residency, you will do 10 weeks trauma.
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 and procedurally.
During the rotation you are taught the ultrasound "fast" exam, and have the opportunity to become certified in the exam.
Due to our close working relationship with the Division of Trauma through the time of this service, the SICU, trauma airway management, and our joint monthly conference, the EM residents have been adopted as "their residents". They take this ownership seriously and will make certain you get the best training possible.
Emergency Psychiatry/Dermatology
This PGY-1 rotation, while not time demanding, is a wonderfully unique and useful rotation. Most of your time is spent evaluating patients in the Psychiatry Emergency Evaluation Center (PEEC) both primarily and alongside the psychiatry residents. These cases range from altered mental status to acute psychosis and from depression to suicide, with a good dose of substance abuse as well. The attending and Medical Director of the PEEC conducts daily conferences and provides excellent teaching after every case.
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.
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.
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.
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.
Veteran's Administration ICU
A combination MICU/CCU, the Veterans Administration ICU is an excellent environment in which to learn. The Emergency Medicine team at the VA ICU consists of an EM Intern and an EM PGY-2. This is a great opportunity to manage critically-ill medical patients, and refine your procedure skills and ventilation management.
As a PGY-2 you are the senior resident on call, and are expected to run all codes and procedures independently. This supervisory responsibility is challenging and invigorating.
Penn Presbyterian CCU
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.
HUP SICU
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.
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.
CHOP PICU
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.
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.
Clinical 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.
Ultrasound
Emergency ultrasound is the new "important procedure" all
ED physicians will need to master. This is a full 4-week intensive emergency
imaging rotation that we can't wait to get started.
Electives
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.
