Resident Responsibilities

The Emergency Medicine residency program is designed to develop dedicated leaders in Emergency Medicine who are 1) excellent clinicians, 2) dedicated, skilled teachers, and 3) effective, participatory administrators.  The graduate will be expert at recognizing and treating life-threatening emergencies.  They will be skilled at diagnosing, stabilizing and managing a wide variety of patients in the acute care setting.  They will be accomplished team leaders and proficient at coordinating patient care across specialty boarders.  The graduating resident will be able to proficiently manage patient flow in a busy Emergency Department.  The resident will have mastered effective teaching techniques.  They will be a skilled Emergency Medicine educator both in the clinical setting and the classroom.  The graduate will learn effective leadership skills necessary to be effective in Emergency Department administration.  The program is specifically designed to give each resident graded, progressive clinical, supervisory, teaching and administrative responsibility.

PGY-1
Emphasis is placed on 1) perfecting a problem-oriented history and physical exam, 2) efficiently developing a practical list of differential diagnoses for each patient, and 3) developing a logical, ordered approach to the evaluation and management of the Emergency Department patient.  The PGY-1 resident will receive a strong background in various specialties needed to care for acutely ill or injured patients, and taught how to apply this knowledge to the Emergency Department patient.  Clinical faculty will continually help residents develop their problem-solving and logical thinking skills.  First year residents will receive instruction in effective teaching methods and will be expected to complete six (6) case conference presentations.

Supervision

• No supervision of other residents or students.

Clinical Responsibilities

• Perform comprehensive history and physical examinations.
• All patients seen by the PGY-1 residents are managed under direct faculty supervision.
• The PGY-1 resident must discuss all diagnostic and therapeutic orders with a supervising PGY-3 or faculty attending prior to their implementation.
• The PGY-1 resident must review the results of all diagnostic testing and any interventions with the supervising PGY-3 or faculty attending.
• The resident must discuss all consultations, disposition decisions, discharge instructions, prescriptions and follow up care instructions with the supervising PGY-3 or faculty attending.
• The PGY-1 resident must confirm that the patient has been presented to an Emergency Medicine attending prior to discharge.

Teaching

• The PGY-1 resident is expected to present three (3) journal club articles.
• The PGY-1 resident is expected to present six (6) patients at case conferences.
• The PGY-1 resident will present at least one case at Morbidity and Mortality Conference.
• The PGY-1 resident has no direct teaching responsibilities during their clinical time in the Emergency Department.
• Effective teaching techniques will be covered in Emergency Medicine conferences.

Administration

• Leadership and administrative skills are part of the Emergency Medicine conference schedule.
• PGY-1 residents will participate in the quality improvement process during case conferences.

PGY-2
The Emergency Medicine PGY-2 resident will be allowed more clinical responsibility under less direct faculty supervision.  They will improve time management skills and learn to efficiently manage multiple emergency department patients simultaneously.  They will learn to maximize Emergency Department patient flow.  Clinical faculty will continually help residents develop their prioritization and time management skills.  They will learn to effectively trigger and coordinate specific care teams and processes for critical patients including those with ST elevation myocardial infarction, multiple trauma, and acute stroke.  The PGY-2 resident will supervise medical students and participate in Emergency Medicine conferences.

Supervision

• The PGY-2 resident will supervise third and fourth year medical students on Emergency Medicine rotations with an Emergency Medicine faculty member. 
• Clinical faculty will observe the supervision of medical students by the PGY-2 resident and continually help residents develop their teaching skills.

Clinical Responsibilities

• Manage multiple Emergency Department patients simultaneously.  Increase multi-tasking skills and demonstrate an increased case load as the PGY-2 year progresses.
• Care for critically ill and injured patients under direct faculty supervision.
• Perform invasive procedures on Emergency Department patients under faculty supervision. 
• Develop team leadership skills for medical and pediatric resuscitations under faculty supervision.  By the end of the PGY-2 year, demonstrate effective team leadership.
• May initiate diagnostic tests prior to presenting to PGY-3 or faculty.
• The resident must discuss all consultations and patient disposition decisions with the supervising PGY-3 or faculty attending.
• The PGY-2 resident must confirm that the patient has been presented to an Emergency Medicine attending prior to discharge.

Teaching

• The PGY-2 resident is expected to present three (3) journal club articles.
• The PGY-2 resident is expected to present sixteen (16) patients at case conference.
• The PGY-2 resident will present at least one case at Morbidity and Mortality Conference.
• The PGY-2 resident will be responsible for two (2) resident conferences.
• The PGY-2 resident will supervise third and fourth-year medical students on Emergency Medicine rotations with an Emergency Medicine faculty member. 
• Clinical faculty will observe the supervision of medical students by the PGY-2 resident and continually help residents develop their teaching skills.
• Effective teaching techniques will be covered in Emergency Medicine conferences.

Administration

• Leadership and administrative skills are part of the Emergency Medicine conference schedule.
• PGY-2 residents will participate in the quality improvement process during case conferences.
• PGY-2 residents will participate in formal resident interviews when requested.

PGY-3
The third year resident will perfect clinical, team leadership, clinical resource management, supervisory, teaching and administrative skills.  The PGY-3 resident will supervise and teach medical students, Emergency Medicine PGY-1 and 2 residents, and residents rotating from other specialties.  By the end of the PGY-3 year, the resident will demonstrate capability in taking charge of a busy Emergency Department including the directing of resuscitations, managing multiple patients simultaneously, coordinating patient flow through the Emergency Department and coordinating clinical resources.  They will be active participants in Emergency Department administrative activities including the quality improvement process, policy development and clinical program development.  They will provide medical direction to pre-hospital services.

Supervision

• The PGY-3 resident will supervise third and fourth year medical students, PGY-1 and PGY-2 Emergency Medicine residents, and residents rotating from other specialties on Emergency Medicine rotations.

Clinical Responsibilities

• Manage multiple Emergency Department patients simultaneously. 
• Demonstrate the ability to manage a busy Emergency Department by the end of the third year.
• Direct Emergency Department resuscitations as team leader.
• Coordinate patient flow through the Emergency Department.
• Demonstrate effective team leadership skills for medical, pediatric and trauma resuscitations under faculty supervision.
• Confirm that the patient has been presented to an Emergency Medicine attending prior to discharge.

Teaching

• The PGY-3 resident is expected to plan and moderate two (2) journal clubs with a faculty advisor.
• The PGY-3 resident is expected to moderate two (2) case conferences.
• The PGY-3 resident will present at least one case at Morbidity and Mortality Conference.
• The PGY-3 will be responsible for two (2) resident conferences.
• The PGY-3 resident will supervise third and fourth year medical students, PGY-1 and 2 Emergency Medicine residents and residents from other specialties rotating in Emergency Medicine.
• Clinical faculty will observe the supervision of medical students and residents and confirm the PGY-3 teaching proficiency.
• Effective teaching techniques will be covered in Emergency Medicine conferences.
• Every effort will be made to pair PGY-3 residents with junior Emergency Medicine residents to maximize the opportunity for the PGY-3 residents to serve as role models and to hone their teaching and supervisory skills.

Administration

• Leadership and administrative skills are part of the Emergency Medicine conference schedule.
• PGY-3 residents will participate in the quality improvement process in planning case conferences and during case conferences.
• PGY-3 residents will participate in formal resident interviews when requested.
• PGY-3 residents will participate in one quality improvement initiative during the PGY-3 year.
• All residents will rotate through an administrative month.  They will serve an additional month (two months total) as the administrative resident.  During that time they will make resident schedules, attend resident meetings, represent residents, select monthly case conferences and plan the monthly journal club.