Emergency Medicine

Emergency Medicine Residency Program - Clinical Curriculum

HUP EM & PPMC EM

This is why you chose this specialty! HUP is your home base, where you will gain clinical experience in the evaluation and management of patients with undifferentiated complaints. Penn Presbyterian Medical Center (PPMC) is our sister hospital and our level 1 trauma center located less than 1 mile away from HUP. Combined ED volume is over 115,000 patients annually. PGY-1s focus on improving their clinical and communication skills as well as learn how to take care of critically ill patients. As the years progress, so do the responsibilities. The PGY-2s and PGY-3s are expected to manage multiple patients simultaneously and begin to function like an attending. The senior residents (part of PGY3 and all of PGY4) are given a new role - that of an administrator, educator, and patient care provider - all at the same time. Our senior residents are expected to run an entire side of the ED. This includes overseeing sign-out rounds, supervising all major procedures and resuscitations, assisting the charge nurse with patient flow through the rooms they are overseeing (typically 20 or so), answering paramedic medical command calls, and managing all trauma airways. It may seem overwhelming now, but the graded responsibility over the training makes this transition as smooth as possible.

 

Curriculum by PGY Year

PGY-1
  • Intern Survival Series (2 wks)
  • EM (13 wks)
  • Peds EM @ CHOP (4 wks)
  • MICU (4 wks)
  • SICU Jr. (4 wks)
  • CCU @ PPMC (4 wks)
  • Anesthesiology @ PPMC (4 wks)
  • Ward Medicine (4 wks)
  • Obstetrics (4 wks)
  • EM Ultrasound (2 wks)
  • EM Psych @ Hall Mercer (2 wks)
  • Holiday block (2 wks)
  • Vacation (3 wks)
PGY-2
  • EM (23 wks)
  • Peds EM @ CHOP (4 wks)
  • Trauma Jr. @ PPMC (4 wks)
  • Resuscitation (4 wks)
  • PICU @ CHOP (4 wks)
  • Peds Anesthesia @ CHOP (2 wks)
  • EM Ultrasound (2 wks)
  • Ortho (2 wks)
  • Toxicology (2 wks)
  • Holiday block (2 wks)
  • Vacation (3 wks)
PGY-3
  • EM / CHOP / PPMC (26 wks)
  • EM @ PAH (4 wks)
  • SICU Sr. (4 wks)
  • Elective (8 wks)
  • EMS (2 wks)
  • CHOP transport @CHOP (2 wks)
  • SAEM vs EM (1 wk)
  • Holiday block (2 wks)
  • Vacation (3 wks)
PGY-4
  • EM / CHOP / PPMC (30 wks)
  • Trauma Sr. @ PPMC (4 wks)
  • Elective (8 wks)
  • Admin (2 wks)
  • Teaching (2 wks)
  • ACEP vs EM (1 wk)
  • Holiday block (2 wks)
  • Vacation (3 wks)
 

DESCRIPTION OF ROTATIONS

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.

Intern & Nurses meet&greet
HUP ED

This is why you chose this specialty! HUP is your home base, where you will gain 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 and PGY-3s 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 an entire side of the ED. This includes overseeing sign-out rounds, supervising all major procedures and resuscitations, assisting the charge nurse with patient flow through the rooms they are overseeing (typically 20 or so), answering paramedic medical command calls, and managing all trauma airways. It may seem overwhelming now but the graded responsibility over the training makes this transition as smooth as possible. Shifts during the first three years are mix of 9, 10, and 11 hours, decreasing to 8 hour shifts as a senior resident.

HUP ED Rounds

Emergency Psychiatry

This is a wonderfully unique and useful rotation. During your PGY-1 year, 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. In your 2nd year, you will move to the Hall-Mercer Community Behavioral Health Center of Pennsylvania Hospital, where the police will bring known psychiatric patients who are having major emergencies. Seeing the most decompensated psychiatric patients is extremely valuable and rewarding as you learn how to manage agitation, psychotropic medications, and substance dependence acutely.

Anesthesiology

During this rotation you will become comfortable with our most valuable procedure – airway management. Located at Penn Presbyterian Medical Center, the focus is on getting you as much experience as possible managing adult airways. Residents average 50 intubations per rotation! You will learn to use various devices including the Glidescope, laryngeal mask airway, and the bougie. The attendings are very willing to teach and show off their intubation toys. The CRNAs will also give you great tips. Overall, you will definitely have a great time and feel very comfortable with this vital skill at the end of the month. An additional highlight of this month is a paid trip to Baltimore to attend a cadaver-based difficult airway course during which you’ll hear lectures from airway experts and practice dozens of airway procedures from laryngoscopy to cricothyroidotomy on fresh-frozen cadavers.

anesthiologist in action

Obstetrics

As an 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. Your primary function will be to deliver as many babies as possible, while learning about the intricacies of peri-partum care. You will also spend some time in the Perinatal Evaluation Center, where labor patients are evaluated and triaged.

Ward Medicine

This is a 4-week long rotation of floor medicine. Education consists of daily lectures by the Department of Medicine and a weekly Intern report. You will 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.

CHOP EM

Every year during residency you spend time over in the CHOP ED. This world-class children’s hospital with 90,000 ED visits annually provides our residents with the opportunity to see everything from bread-and-butter pediatrics to “only at CHOP” syndromes and genetic problems to transplants to trauma. We have the opportunity to come back year after year and treat (and possibly even personally experience) all of the seasonal infections of pediatrics. Junior EM residents see patients under the supervision of pediatric EM fellows and attendings. Senior residents have CHOP shifts integrated throughout their ED months and work only with attendings. They have significantly more autonomy, including responsibility for running major resuscitations and airways. Our EM residency graduates always point to their CHOP training as a major strength. Many have said that they knew CHOP was special but didn’t truly appreciate it until a few years later when “a really, really sick kid” arrived in their ED, and they felt completely prepared to handle anything.

doctor examining infant

MICU

This 4 week rotation is at HUP and focuses on the care of the most critically ill patients in the hospital. You will have tremendous exposure to ventilators, pressors, antibiotics, managing multiple consultants and working on your data organization skills in a high-acuity ICU environment. In addition to bread-and-butter ICU patients with sepsis, diabetic ketoacidosis, and GI bleeds, you will care for transplant and oncology patients with multi-system organ failure. In addition, you will gain experience with placing central lines, arterial lines, and variety of other procedures.

PPMC CCU

Penn Presbyterian Medical Center (PPMC) has a very busy cardiology service and cath lab. Through a program called HeartRescue, patients are flown to PPMC from throughout the region for emergent cardiac catheterization or cardiac surgery. This block-long rotation will provide you with a solid foundation in bread-and-butter cardiology, You will interpret tons of EKGs, and deepen your knowledge in cardiac pharmacology and critical care. You will also learn to manage balloon pumps and inotrope infusions, and place tons of central lines and arterial lines.

HUP SICU

The Trauma/SICU rotation can be summarized in one sentence: You will take care of the sickest people you will ever meet in your life. Great teaching by the Anesthesia and Trauma/Surgical Critical Care faculty will make you comfortable with all forms of resuscitation and vent management. An incredible number of procedures including central lines, arterial lines, chest tubes, and dialysis catheters round out this experience. In addition, during your PGY3 year, you will return to the SICU as a “Pseudo-Fellow” during which time you will run daily rounds, supervise procedures, and take overnight call in the fellow role. This graduated responsibility is one more step in developing leadership and teaching skills.

Trauma

Over the course of the residency here, you spend 10 weeks on the trauma service. We are a high volume penetrating trauma center with tons of opportunities for learning and procedures. Over that time you will have progressive responsibility and autonomy. Junior residents learn to perform the primary and secondary survey, FAST exam, and key procedures such as chest tubes, central lines, and arterial lines. Senior residents function as trauma chiefs, during which they not only run the trauma bay, but are also responsible for care of trauma patients in the ICU and on the floors. They also develop significant procedural experience and hone their skills on less common procedures such as the ED thoracotomy, cricothroidotomy, and lateral canthotomy. ED senior residents are also responsible for managing all trauma airways. Because we spend so much time working with them, we have an outstanding working relationship with the Division of Trauma and have been adopted as "their residents". They take this seriously and make certain that we all get the best training possible.

Ultrasound

EM residents in our program undergo 4 weeks of basic training in bedside ultrasonography. This is divided into 2 weeks each in the PGY-1 and PGY-2 years. Senior residents also have the option to use some of their elective time for an ultrasound refresher prior going into clinical practice. In addition to proctored scanning practice in the ED, rotators spend one day of dedicated video review per week in which all the scans with significant pathology or of particular educational value are reviewed with all members of the ultrasound division present. This weekly conference is also attended by trainees and faculty from other departments including the pediatric Critical Care Unit and the pediatric ED at CHOP, and fellows from the MICU program at HUP, as well as visiting and medical student rotators. Video review also includes review of relevant literature, and the rotator is expected to give a 10-15min presentation (Power Point or Keynote, maximum 10-slides) on a pre-agreed topic, usually stemming from a case that presented particular challenges or interest. The rotation includes formal lectures on critical care topics.


Residents with a special interest in EMBU are encouraged to become involved in research. Numerous papers published by the Division have included residents as authors, as noted in the "Research" section, below). Residents who wish to reinforce or extend their basic ultrasound skills, are welcome to use elective time gaining additional emergency ultrasound experience or in special projects.

Because our residents receive training in bedside ultrasonography in their internship and 2nd years, they also are frequently involved in teaching initiatives with the medical students and nursing. Activities include bedside teaching to medical students during their rotations as well as dedicated courses that have been put on at various times by our department.

Student working ultrasound machine on patient

CHOP Anesthesia

Mini laryngoscopes. Itsy bitsy endotracheal tubes. Little tiny mouths. Eensy weensy vocal cords. And your giant hands. We have the unique opportunity to gain significant experience in pediatric airway management. Most residents manage between 15-20 airways and hone their airway skills in one of the premier pediatric surgical arenas in the country. This is an absolute invaluable experience and one that is rarely found in EM training programs.

anesthesiologists treating child

Resuscitation

This 4 week rotation focuses on all things resuscitation. Our department is fortunate enough to have several leaders in the field of Critical Care and we’ve tapped into that by creating this rotation. This rotation has evolved from an on call rotation to one primarily based in our state of the art ED-ICU space. Whenever a patient requires early goal directed therapy for their sepsis, post-arrest hypothermia, or prolonged ICU care in the ED, you will be caring 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.

doctors in masks performing resuscitation

CHOP PICU

You will have the opportunity to spend a month in one of the nation’s busiest and sickest pediatric intensive care units. Here you will care for critically-ill children who are transferred from throughout the region (and even internationally!). This is an excellent opportunity to become comfortable with critically ill children, and learn the latest cutting edge treatments.

Adult and Pediatric EMS

Strap yourself in and ride along with the men and women of Philly Fire-Rescue. 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 Fire-Rescue .This provides huge opportunities to learn the mysterious inner workings of the Fire Command Center, and visit the Airport Fire House. You will spend two weeks on Adult EMS, during which you will learn where your patients come from and what happens to them before you hear “Medic 19 is en route with a Trauma Alert”. 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"), and fire training center (gearing up in full bunker gear, and learning how to climb the ladders and put out fires with a real live burn in the fire tower). Of course, for those who aren't afraid of flying, there’s always the opportunity to fly with Penn Star helicopter team. In addition, you will spend two weeks with the CHOP Emergency Transport Team as the integral transport physician. This one-of-a-kind rotation will teach you how to stabilize and transfer critically-ill pediatric patients to CHOP.

young resident in firefighter uniform

Community EM

Pennsylvania Hospital (PAH) is the nation’s first hospital, located in center city Philadelphia, caring for over 35,000 patients annually. Although part of PennMedicine patients at Pennsylvania hospital differ dramatically from those at HUP or PPMC and really allows residents to rely on their transportable EM skills as well as challenges residents to adapt to new environments.

Lancaster General Hospital (LGH) is our satellite hospital located in downtown Lancaster, PA. Each year, more than 100,000 patients visit this Emergency Department making it one of the busiest EDs in the area seeing both adult and pediatric patients. We currently offer an elective rotation at this hospital for those residents interested in more community ED experience. Housing and meals are provided on site and the train station from downtown Philadelphia is less than a 10 minute walk from Lancaster General.

Rural Emergency Medicine elective rotation at Mount Desert Island Hospital (MDI). This partnership was established in 2011 and has evolved into a model for future urban-rural partnerships. Residents have the opportunity to spend 4 weeks working in the emergency department at MDI Hospital during the busy summer and fall months. This unique opportunity challenges residents to translate their EM skills to resource limited environments and is a favorite among the residents. Housing is provided for this rotation as well.

Mount Desert Island Hospital

 

Toxicology

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 serve as a consultant for any toxicology patients admitted to CHOP or HUP. Ample time for independent learning is provided. See Rotation Schedule

Administration

This 2 week rotation allows you to gain insight into the “behind the scenes” work involved in keeping an ED working. You will spend time with our Vice Chair of Clinical Operations, medical director, our quality assurance physician, and the residency director to learn about their administrative duties. You will also serve as a resident representative on a variety of committees and attend meetings relevant to ED operations. All residents complete an administrative project during this rotation, with the goal of improving care in our ED.

Electives

Elective time allows one 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 some other aspects of clinical medicine. Residents have done a huge variety of clinical rotations in areas such as sports medicine, ophthalmology, neonatal ICU, Neuro ICU, medical examiners office, or oral surgery clinic. We offer popular “away” electives doing rural EM in Maine and Tuba City, Arizona. Finally, we offer a number of popular international experiences. Recently, faculty and residents have rotated in established clinical sites Botswana and Guatemala, as well as Everest Base Camp and Guyana. Residents have also used elective this time to obtain formal research training, write manuscripts, and complete coursework toward another advanced degree or complete various tracks (patient safety, global health, etc.) offered within the health system. This flexible time is a major benefit of our four year curriculum, and has enabled many of our residents to develop an area of expertise before they’ve even finished residency!

 

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