Today is Saturday, Jul. 4, 2020

Department of

Emergency Medicine

Curriculum/Schedule

The Emergency Medicine Residency Program at the University of Cincinnati Medical Center was both the first program in Emergency Medicine and the first program to recognize the advantages unique to a four-year training program. 

In July 1982 the residency expanded from a three-year format to the current four-year format, which we believe offers superior training and clinical excellence. Our curriculum is designed to develop clinical competence through hands-on training in a broad range of specialties pertinent to Emergency Medicine. Responsibility in the Emergency Department is graduated to allow continuous development as a clinician and teacher throughout the four years.  Our graduated responsibility model is routinely lauded by our alumni as the pinnacle of our training program and critical to its continued success.  

Despite being the first residency in Emergency Medicine, the University of Cincinnati takes pride in changing with the times to reflect the current atmosphere in Emergency Medicine. We continue to reevaluate our curriculum to make sure that we are providing our residents with a cutting-edge education, most recently adding rotation time with Critical Care Anesthesia to increase exposure to technology such as ECMO.  In addition, as previously mentioned, residents have unmatched elective time to explore research or subspecialty interests including operations, administration, education, toxicology, stroke, cardiovascular, wilderness, global health, public health, critical care or any other interest they choose to explore. 

Our curriculum supports a strong core of training in the Emergency Department with ICU training as well as subspecialty training in areas important to Emergency Medicine such as orthopedics, obstetrics & gynecology and plastic surgery. There are no “scut rotations”. All of our rotations are carefully chosen and regularly reviewed to assure that they are appropriate to training strong Emergency Medicine clinicians. The residents play a critical role in the continuing evolution of our curriculum.

Residency Rotations by Year

 First Year    Third Year
 Orientation  1 month    Emergency Medicine*  7 months
 Emergency Medicine  4.5 months    Community ED*  1 month
 CommunityEM  2 weeks    SICU  1 month
 Pediatric EM  2 weeks    Plastic Surgery  2 weeks
 PICU
 1 month    Elective  1.5 months
 MICU  1 month    Vacation  1 month
 Ultrasound  2 weeks      
 Pediatric Anesthesia  1 week      
 EMS  1 week      
 Plastic Surgery  2 weeks      
 Orthopedic Surgery  1 month      
 Vacation  1 month      
         
 Second Year    Fourth Year
 Emergency Medicine*  5 months    Emergency Medicine*  6 months
 Community ED*  1 month    Community ED*  1 month
 CVICU**  1 month    Elective  4 months
 Neurocritical Care (NSICU)  1 month    Vacation  1 month
 Trauma  1 month      
 OB-GYN  1 month      
 Elective  1 month      
 Vacation  1 month      

*After first 6 months of the first year, pediatric EM shifts are integrated in adult EM months. EMS ground shifts and Air Care aeromedical shifts are also integrated into months in the ED. After first year, Community EM shifts are integrated into every EM month, such that the total shifts for Community ED are at least one-month equivalent per year.

**As of academic year 2019-2020, the CVICU rotation involves two weeks with Cardiology and two weeks with Critical Care Anesthesia, learning to care for critically ill cardiovascular and cardiac surgery patients, including those with LVADs and on ECMO

Additional Education Opportunities:

Grand Rounds

Grand Rounds on Wednesday mornings from 8am-1pm serves as the center of our didactic training. This is protected time for the residents and the ED is staffed by attendings during this time. We frequently have visiting Emergency Medicine faculty as guest lecturers in addition to our own faculty expertise. In addition, residents hone their speaking skills by providing lectures to their colleagues. Our format is a mixture of evidence-based lectures, clinical pathologic cases (CPCs), Morbidity and Mortality, Journal Club, oral boards review, small group discussions/workshops, simulation and case reports.

Morning Report

In addition to Grand Rounds, our residents participate in daily Morning Report. Morning Report is an oral-boards format case presented each morning from 7:30 to 8:00 am.

Leadership Curriculum

During the 2011-2012 academic year, multiple residents came forward with the following question: If we have a reputation for developing future leaders in Emergency Medicine, then why do we not have a formal curriculum in leadership development? The question was a good one and prompted many meetings and much discussion over the next year in order to try to define how we developed residents into leaders. Ultimately, it was determined that this occurred in a passive fashion, primarily through the graduated responsibility model of our clinical training program. Led by Dr. Brian Stettler, the Program Director at the time, we then embarked on a plan to turn this passive leadership education into active leadership education. The result was the evolution of the Leadership Curriculum over the next few years. This started with the launch of a Grand Rounds curriculum in 2013-2014, which was followed the next year by the creation of specialized interest groups such as the Education and Operations Leadership Academies. These Academies not only created their own curricula through extracurricular meetings and workshops but they also provided the opportunity for residents to take on mentored projects in their area of interest under the guidance of leadership mentors. In 2017, we graduated the first class of the Leadership Curriculum, consisting of those fourth-year residents who had completed the pre-specified graduation criteria within their chosen Academy. While all residents are exposed to the Grand Rounds curriculum, more extensive involvement in the Leadership Curriculum is voluntary. Currently approximately 25% of the residents are actively involved in the Leadership Curriculum, supported by approximately 20 faculty.

Leadership Curriculum Faculty Leaders:

Founder:  Brian Stettler, MD
Current Chair:  Erin McDonough, MD
Chair, Education Leadership Academy:  Jeff Hill, MD
Chair, Operations Leadership Academy:  Jack Palmer, MD

Grand Rounds Leadership Curriculum:

The Grand Rounds curriculum is based loosely on a two-year revolving curriculum so as the maximize the exposure of all residents to the core content over their four years of residency. Leadership Curriculum Grand Rounds presentations occur quarterly and typically consist of a small didactic component on the given topic with significant emphasis placed on case-based learning and discussion in small groups with faculty preceptors. Recurring topics include: attitudes of a leader, how to pitch an idea, the finances of leadership, gender and age differences in communication, mentorship, etc. Novel content is occasionally introduced as well with some recent topics including: failure, styles of leadership, how to receive feedback, etc.  The overall goal of the Grand Rounds curriculum is to provide residents with hands-on experience in the thought process of leadership as well as to build skills in collaborative problem-solving. 

Leadership Academies:

Those residents who wish to have deeper involvement in the Leadership Curriculum may join a special interest Academy. The current available Academies include the Education Leadership Academy (ELA) and the Operations Leadership Academy (OLA). There is also much opportunity in the area of Research as well (and to earn a graduation distinction in this, although this occurs through the previously developed Leadership Track offered by the Division of Research). 

Residents who wish to join an Academy must identify a leadership mentor within that Academy as well as a mentored project. Residents in the ELA will select an education-based project and residents in the OLA will select an operations/administration-based project. Faculty within each Academy can help residents identify a project of interest. Residents should then meet with their leadership mentor at least 2 to 4 times per year to discuss the resident's progress in leadership development, reflecting on the resident's strengths and areas of focus as a leader.

Each Academy also produces quarterly workshops, also on a loosely revolving curriculum. These are scheduled outside of Grand Rounds, typically at a restaurant or faculty house. Residents within the particular Academy are strongly encouraged to attend, although these workshops are open to any resident or faculty member, even those not formally affiliated with the Leadership Curriculum. Residents can join more than one Academy as long as they complete the requirements of each Academy, including a separate mentored project. 

 

ELA Recurring Curriculum:

Year 1 - Getting Academic Credit for your Work in Education/Education Research, Providing Feedback, How to Run a Meeting/Lead a Discussion Group

Year 2 - Networking in the Digital Age, Finances of Education, Curriculum Development

OLA Recurring Curriculum:

Year 1 - Leadership 101, Project Management, Patient Progression

Year 2 - Data & Analytics, Culture & Experience, Errors

Year 3 - Quality Improvement, Innovation & Design, Balancing Act (work-life balance/professional satisfaction)

We have found the Leadership Curriculum to be a unique, rich experience that achieves the goal of turning leadership development from a passive process into an active one. The Leadership Curriculum was presented at the SAEM Annual Meeting in May 2015.

Procedures and Resuscitations

The Shock and Resuscitation Unit (SRU) in our Emergency Department is rarely quiet. Managed by the third-year resident, this busy area operates as both medical and traumatic resuscitation bays. Managing hundreds of resuscitations under attending guidance provides our residents substantial critical care skills.

Procedural skills are developed throughout residency training; however the second-year resident has a special role as the primary proceduralist in the SRU. Educational evidence demonstrates that completing multiple repetitions with a specific procedure in a short period of time results in more durable muscle memory in performing that procedure. In addition to managing chest tubes and central lines, all emergency airways are managed by an EM R2, with the EM R4 providing back-up.

Teaching Opportunities

UC Emergency Medicine is committed to training our residents as teachers. Both clinical bedside and didactic teaching is emphasized here. All residents develop their presentation and speaking skills by delivering didactic lectures in Grand Rounds.

Upper level residents and attending physicians help prepare junior residents for presentations to help them develop the strong presentation skills required for academic physicians. In addition, residents are responsible for precepting third- and fourth-year medical students on rotation in the Emergency Department.

Ample opportunity exists for those desiring additional teaching opportunities. Residents may volunteer to teach in the College of Medicine’s First Responder’s Course which serves as the first course for first-year medical students. Residents are also actively involved in the College of Medicine’s Emergency Medicine Interest Group for medical students. Residents are also encouraged to participate in the training of paramedics, as well as becoming ACLS and ATLS course instructors. In addition, the popular bedside teaching elective emphasizes self-evaluation and improvement of bedside and didactic teaching skills. The fourth year represents an entire year of daily bedside teaching of both EM R1s and off-service residents. Plenty of other teaching/mentoring opportunities exist for interested residents.

Leadership Opportunities

In Cincinnati, we strongly believe in developing leadership skills and helping residents reach their full potential. Below is a list of some of the potential opportunities:

  • Administrative electives and project development
  • Education electives and curriculum development
  • Development of asynchronous education modules on TamingtheSRU.com
  • Annals of B Pod author or resident editor
  • Service on national committees such as SAEM, EMRA and ACEP
  • Resident Assistant Medical Directors of Air Care, Mobile Care, UCMC ED, West Chester Hospital ED
  • EMS Assistant Medical Director
  • Resident Research Track
  • Research: Basic, Clinical and Translational
  • Urban Search and Rescue (USAR)
  • Disaster Medical Assistance Team (DMAT)
  • Special Weapons and Tactics- Medical (SWAT)
  • Mass Gathering Medicine

Research Opportunities

Residents have extensive opportunities to become involved in one of the most productive Emergency Medicine research programs in the nation. UC Emergency Medicine residents and faculty have presented at numerous meetings worldwide, including the Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians, American Heart Association, International Stroke Conference, Society of Critical Care Medicine, National Association of EMS Physicians, European Society of Cardiology, American College of Cardiology, Conference on Retroviruses and Opportunistic Infections, as well as other conferences.

There are about 60 publications involving department faculty annually, many of which involve or are authored by residents. The Department’s research division provides an extensive research infrastructure, involving multiple full-time personnel including a biostatistician on faculty, to support the needs of its many faculty and residents who are active in research.

Elective time is available for interested residents to pursue research in the 2nd, 3rd, and 4th years. Many residents also pursue research projects outside of elective time. Because of the volume of research activity in the Department, residents are often able to partner with a project that is already planned or underway. Others successfully develop their own projects with the mentorship from faculty with an immense range of expertise and interests.

Residents are invited and encouraged to attend the Emergency Medicine Research, Scholarly Activity, and Innovation meeting.  This weekly Departmental meeting serves as a forum to present new research and/or project ideas. Residents who are embarking on a new project, such as an operations, quality improvement, or medical education project, are encouraged to present their ideas at EM-RSI for guidance on turning the project into research.

The Department provides funding to support resident research and to allow residents to travel to present their original work at national meetings.

Resident Research Track

The UC Department of Emergency Medicine has a long and robust history of supporting resident research activity. Many residents conduct high quality investigations in collaboration with expert mentors. This baseline experience, available to all residents, is further augmented by the availability of the Resident Research Track.

The Residency Research Track is an individualized pathway by which highly interested residents can structure experiences and elective time in a focused and efficient way to achieve specific educational outcomes in research. This track is selected by a minority of residents and is a highly significant development for those residents interested in a research career. Those in the track will use a significant portion of their time during residency to prepare for a potential career in research.

Interested residents will most likely enter this track relatively early in their residency, but it is not necessary to select the track at the start of residency or before initial research experience is gained. Rather, residents naturally glide into the research track as a gradual and natural evolution of their initial involvement with the usual resident research process.

Every resident brings unique experiences and expertise which in turn requires individualized experiences to achieve the ultimate educational outcomes of the track. In general, residents complete an experience in both prospective and retrospective research methodologies, are closely mentored by multiple research faculty, spend additional time learning about basic research subjects (i.e. budgeting, human subjects protections, methodology, research career development, etc.), and attempt to select and coordinate their projects to create an area of concentrated academic/research focus. 

Residents in this track also have additional opportunities for didactic education in research either locally or by traveling to national courses.

Overall, this intensive experience provides more structure and direction than would otherwise occur and does so in a more longitudinal way. For those on the track, the primary goal is to shift from “completing a project” to using projects and other experiences as tools to achieve larger career-development goals that are specifically relevant to preparing for a research career.

Emergency Medicine Physicians