EM – 1
The EM-1 year serves as the intern year of the residency program. The purpose ofthe intern year is an introduction into emergency medicine and obtaining abroad-based knowledge in areas essential to the practice of Emergency Medicine.These areas include Medical and Surgical Critical Care, Cardiology, General Medicine, Neurology, Orthopedics, Obstetrics, and Anesthesia.
As an EM – 1 intern at Jacobi ED, patientsare assigned by the EM – 3 resident. Patient management and training includes peripheral IV lines, endotracheal intubation, suturing, chest tubes, and ultrasound.
At the Montefiore ED, EM -1 will work onthe North and South sides in an autonomous manner with direct one to oneinteraction with an Attending in patient management and clinical decisions.
EM-1 Interns rotate for 4 consecutive months on the Internal medicine and CCU/MICU wards. All medicine rotations arecompleted at Jacobi Hospital. During the rotations the EM – 1 is completely integrated into the medical and critical care teams with patient responsibility and care.
• EM-1 Orientation Program
July orientation consists of 4 weeks of lectures to cover core topics in emergency medicine and workshops to introduce interns to necessary ED skills, such as endotracheal intubation, suturing, chest tubes, and the various uses of the ultrasound machine. All lectures will take place in the mornings, Monday through Friday from 8am to 12pm. Interns will attend the regular Wednesday conferences with the rest of the residents. As an introduction to clinical emergency medicines, all interns will work in the emergency room every third day (including weekends), from noon to midnight. Two interns will be at each site (Jacobi Medical Side, Jacobi Surgical Side, and Montefiore ED)
Every year EM residents complete 4-6 weeks of dedicated Pediatric Emergency Medicine rotations. Residents alternate between the Jacobi Pediatric ED, an independent level I pediatric trauma center and the Montefiore Children’s Hospital, one of the nation’s top pediatric specialty center. With exposure to dedicated Pediatric residents, fellows and attendings, the Pediatric rotation allows specialized training and pathology throughout all years of residency.
• Internal Medicine
As an EM-1 two months are spent at Jacobi Hospital on an Internal Medicine team with primary patient responsibility. As part of the inpatient medical team residents have the same q3 call schedule and present to the Medical Attending. The experience of inpatient medicine allows the EM resident to broaden their general medicine knowledge and allows for a more complete medical experience as the resident is responsible for every aspect of his/her patient care. Responsibilities include admission, inpatient therapy, discharge and follow-up. Residents find themselves with stronger bonds between the Emergency and Inpatient service from the diversity of interaction and participation between services. EM residents are exempt from attending Medical Clinic during the rotation.
• Critical Care
To provide EM residents exposure to current cardiologic thinking regarding Acute Ischemic Syndromes. To provide EM residents exposure to a variety of arrhythmias and their management. To provide EM residents exposure to different cardiologic testing and treatment modalities to better understand their role in the diagnosis and management of heart disease. To provide residents with the opportunity to improve ECC reading skills through daily ECG reading sessions.
During the EM-1 year, two weeks are spent OB service exclusively on the Labor and Delivery floor. EM residents participate in triage, assessment and delivery of prenatal patients. With a thriving delivery service, residents typically participate and assist in more than the minimum of 20 live births.
EM – 2
As a second year junior resident, the EM- 2 residents continue to learn and develop skills within all core areas of Emergency Medicine. In addition, EM-2 residents are assigned patients of highest acuity level by the EM – 3 resident while at Jacobi ED. During all medical notifications EM – 2 is firstattempt at intubations. Added training during the EM-2 year include dedicated Ultrasound, EMS and Radiology blocks. EM-2 residents have increased autonomy with dedicated management of GYN area ofthe adult ED.
At the Montefiore ED, EM – 2 will workshifts with more autonomy in the higher acuity West side.
As an EM-2, residents have 4 weeks of working daily in the Jacobi ER dedicated GYN area. With more autonomy, residents are able to evaluate and treat patients with gynecological complaints and presents directly to an attending. Integral to the rotation is the utility of transvaginal ultrasonography, which residents will continue to sharpen throughout their residency.
EM-2 residents have a two week intensive dedicated radiology rotation. Residents report to the plain film radiology attending daily during the block. From 9am-3pm residents review all ER plain films, ICU plain films on a 1 on 1 basis with the attending with instantaneous critique and evaluation.
EM – 3
The EM-3 year focuses on developing leadership skills in managing the Emergency Department, while also solidifying core Emergency Medicine priniciples. As a senior resident, the EM – 3 is acting “chief” resident while rotating through Jacobi ED. Responsibilities include initial assessment of all new patients and delegating patients to the junior residents on the team. During all medical and surgical notifications, EM – 3 will delegate patient responsibility, junior resident resuscitation areas, and is first attempt at all Trauma/Surgical intubations.In addition the EM – 3 will see, manage, present and discharge their own loweracuity patients. EM-3residents also rotate through lower acuity Urgent Care and Fast Track area inthe Jacobi and Montefiore Emergency Departments.
• Urgent Care/Fast Track
From 8am through 9pm, patients who present at the Jacobi ED with relatively minor complaints will be seen in the Urgent Care / Fast Track area, which is adjacent to the main ED. EM-3 and EM-4 residents work there under the direct supervision of an attending, alongside other attendings and a nurse practitioner. This is a Monday-Friday rotation, with no weekend responsibilities. EM-3 residents will work from 1pm to 9pm on Mondays, Thursdays and Fridays, and from 8am-4pm on Wednesdays and Thursdays (although you do attend Wednesday conference as per usual). EM-4 residents will have the opposite schedule. Until 4pm, there are dedicated nurses and PCAs in the urgent care area. From 4pm to 9pm, the resident will work alone with one nurse, and will present cases to the teaching attending in the main ED.
Fast track shifts at Montefiore are from noon to 10pm, Monday through Thursday. There are no holidays. Similar to the Jacobi urgent care, the Montefiore fast track is adjacent to the ED, and low-acuity cases are triaged there. Fast track is open 24 hours at Montefiore, and you will work directly under the supervision of an attending, and alongside experienced physician’s assistants.
The rotation is at the New York Poison Control Center. Meet in the ED at Bellevue for Morning Rounds at 8am on the first day of the rotation, and ask for any of the Toxicology fellows. Each Resident will be expected to give one presentation at the Poison Center, the subject of which is at the discretion of the Toxicology Fellows. 8am morning lecture is conducted in the conference room adjacent to the main adult ED, the lectures tend to be very informative.
EM – 4
The EM-4 year in Emergency Medicine isdesigned to raise the knowledge and skills developed in the first three years of postgraduate training to a consultant or “Pre-attending” level inthe specialty. Residents spend all of their clinical time at Jacobi ED in aleadership role with an emphasis on the supervision and teaching of junior residents and medical students in the department.
EM-4 residents have very significant authority and the responsibility to make decisions that have far-reaching implications, both within the department and throughout the Medical Center. All junior residents and medical students present only to the EM-4, who has all decision making capability with consultation from the Attending as needed. EM-4 residents run all medical and surgical notifications, and assume primary responsibility for overseeing critical patient care.
This unique clinical experience produces some of the most prepared and capable Emergency Medicine residents.Typically graduates of the Jacobi/Montefiore program are ready to assume anyattending role and adapt deftly to the dynamic environment which is Emergency Medicine.
During the EM-4 year, residents spend two weeks at the Jacobi Dermatology Clinic working with dermatology residents and attendings in both common and uncommon dermatological presentations. In addition, dermatology residents hold bi-weekly hours in the Jacobi Urgent Care clinic for follow-up and evaluation of dermatologic cases.
All EM-4 residents will have four elective blocks, All away electives will require the approval of the Program Director on a case-by-case basis.
Formal electives are available at Montefiore in Neurology, Endocrine, Rheumatology, Pulmonary Medicine, Plastics, Ophthalmology, Forensics Medicine, and a Teaching Elective in the Adult ED.
As an EM-4, residents rotate through the North Central Bronx Hospital PICU service over a course of 2 block rotations. Residents work directly with PICU attendings, fellows and Pediatric residents.
© 2009 Albert Einstein College of Medicine of Yeshiva University