Core Curriculum

The core curriculum at SIU was developed to create a robust learning experience that prepares its residents to be successful practitioners and leaders in the field of emergency medicine. Clinical experiences, bedside teaching, didactic, small group, procedural, and simulation experiences are all intertwined to provide our residents with a strong foundation that will serve them well in their future careers. The curriculum is dynamic and always evolving to keep up to date with current practice guidelines and to respond to feedback from our residents

Clinical Rotations

Clinical Rotations at SIU are arranged in a matter to mirror the increasing clinical responsibilities of the matriculating resident. The first year is dedicated to familiarizing residents with the two clinical sites and to provide a good foundation in the basic procedural skills required of the emergency medicine physician. Year two provides clinical experiences that strengthen each resident's abilities in the critical care setting both in adult and pediatric populations, and the final year of residency is dedicated to understanding and mastering patient flow in the emergency department. All residents work 10 hour shifts.  As teaching and administrative responsibilities increase throughout training residents are afforded a shift reduction in the PGY 2 and PGY 3 years.

Rotations are built on a block schedule and last 4 weeks each; each year includes 13 blocks. Longitudinal experiences in pediatric emergency medicine, ultrasound, and rural medicine are integrated into EM blocks in the PGY 2 and PGY 3 years.

- R1s work 18 shifts per block

- R2s work 17 shifts per block

- R3s work 16 shifts per block

EM1

Rotation	Site	Time
Orientation / ED	MMC/SJH	1 Block
ED	MMC/SJH	5 Blocks
Peds EM	SJH	1 Block
Trauma Surgery	MMC	1 Block
Adult ICU	MMC	2 Blocks
Anesthesia/US	MMC	1 Block
Orthopedics/Ophthalmology/ENT	MMC	1 Block
OB/GYN	SJH	1 Block

 

EM2

Rotation	Site	Time
ED	MMC/SJH	6 Blocks
Trauma Surgery/SICU	MMC	1 Block
Adult ICU	MMC	2 Blocks
Pediatric Critical Care and Anesthesia	SJH	1 Block
Neurology (Stroke, Interventional, Critical Care)	MMC	1 Block
Elective	MMC/SJH	1 Block

 

EM3

Rotation	Site	Time
Education / ED	MMC/SJH	1 Block
ED	MMC/SJH	8 Blocks
Trauma Surgery / SICU	MMC	1 Block
Pediatric Critical Care	SJH	1 Block
EMS	MMC	1 Block
Elective	MMC/SJH	1 Block

 

Clinical Rotation Descriptions:

• EMOR (Emergency Medicine Orientation Block, PGY-1)
  • During the first block of the PGY-1 year, residents have a small number of clinical shifts in the emergency department at both Memorial Medical Center and St. John’s where they are paired with a senior resident. Senior residents help familiarize new residents with the EMR and each hospital’s workflow. The PGY-1 residents also participate in small group didactic sessions, procedure labs, and ultrasound sessions with core faculty to further prepare them for their clinical shifts. Finally, residents will complete ACLS, ATLS, PALS, and critical care certification during this block.

• MMC/SJH ED (Memorial Medical Center/St. John’s Hospital Emergency Department, all years)
  • Residents spend the majority of their training time in the emergency departments (ED), split evenly between the two sites. MMC uses a pod system for patient assignment, with the upper level resident being expected to eventually “run the pod”. At SJH, residents see patients throughout the department and staff with the appropriate attending. Additionally, during ED blocks at MMC, upper level residents will have a minimum of 1 shift per month at the ED at Taylorville Memorial hospital. This experience educates the residents on the unique opportunities and challenges that come with rural emergency care, and gives them practical experience in transferring patients, resource allocation, and ED throughput.

• Trauma (All years)
  • Emergency Medicine residents in each year will spend dedicated time with the trauma service through the Southern Illinois Trauma Center at MMC. They will work as part of the SITC trauma team during their rotation, actively assisting or managing trauma assessments and resuscitations in the trauma bays, as well as managing patients on the trauma service. Residents will be progressively provided more responsibility as they progress through their training, managing resuscitations in the trauma bays and in the surgical intensive care units, as well as managing patients on the trauma wards. Residents will graduate proficient in trauma resuscitation and related ED procedural skills, prepared to manage trauma patients in any setting they may eventually practice.

• Ortho (Orthopedics Block, PGY-1)
  • PGY-1 residents work closely with orthopedic surgery residents to learn the fundamentals of orthopedic evaluation, diagnosis, and treatment of common orthopedic emergencies. Residents become facile with x-ray interpretation by attending fracture rounds in the morning, and participating in consultations with the orthopedic surgery residents to assist in performing reductions and splinting.
  • Other educational experiences scheduled during this block include two days working directly with an ophthalmologist to learn about eye emergencies, their treatment, and to become familiar with ophthalmologic evaluation in the ED. One additional day is typically spent in the otolaryngology clinic performing fiberoptic nasopharyngoscopy.

• OB/GYN (Obstetrics and Gynecology Block, PGY-1)
  • PGY-1 residents spend one block in the Labor and Delivery unit at SJH, working with various attendings and SIU OB/GYN residents, focusing on learning the essentials of emergency obstetrical care and performing at minimum 10 vaginal deliveries. One day per week during this block is spent in the ED follow up clinic with an SIU OB/GYN faculty member to provide a longitudinal perspective to their training.

• PEM (Pediatric Emergency Medicine Block, PGY-1 and longitudinally)
  • PGY-1 residents rotate for one block in the Pediatric Emergency Department at SJH, working directly in an apprenticeship model with a fellowship trained Pediatric Emergency Medicine attending physician. They learn the basics of pediatric emergency department diagnosis and management during this block, and develop basic skills in pediatric resuscitation. This foundation is then expanded upon during the PGY-2 and PGY-3 years in a longitudinal fashion during ED blocks at SJH, when they will continue to have scheduled shifts in the Pediatric ED throughout these years.

• Anes/US (Anesthesia/Ultrasound combined Block, PGY-1)
  • PGY-1 residents split their time on this block between the operating room (OR) and the emergency department (ED), performing anesthesia and other critical care procedures in the ORs throughout the hospital in the mornings then performing ultrasounds on patients in the ED in the afternoon. An asynchronous ultrasound curriculum will be provided, as well as proctored ultrasound and quality assurance (QA) sessions with the ultrasound director. As time and interest allows, residents also can become proficient with regional anesthesia and more advanced anesthesia/critical care techniques including various nerve blocks and fiberoptic intubation techniques.

• SC ICU (Springfield Clinic Intensive Care Unit, PGY-1)
  • PGY-1 residents work with a local private practice ICU service to establish a foundation in adult critical care medicine. Residents work in an apprenticeship model directly with an attending to learn foundational critical care procedures as well as the medical care and resuscitation techniques needed to care for critically ill patients.

• SIU ICU (Southern Illinois University Intensive Care Unit, PGY-2)
  • PGY-2 residents work with the SIU ICU teaching service to advance their knowledge and training in resuscitation and care of critically ill patients, with particular emphasis on working as part of a team and teaching medical students and PGY-1 residents rotating on the service with greater, but appropriate, autonomy.

• PCC/Anes (Pediatric Critical Care/Pediatric Anesthesia, PGY-2)
  • PGY-2 residents gain foundational training in pediatric critical care and expand on their previous training in resuscitation during this block. They spend two thirds of the rotation in the Pediatric Intensive Care Unit at SJH, and one third of the rotation in the pediatric ORs at SJH. Residents will additionally become more familiar with indications and performance of procedural sedation and other procedures in the pediatric patient.

• Neuro (Neurologic Emergencies Block, PGY-2)
  • PGY-2 residents will spend this block receiving advanced training in neurologic emergencies. One third of this rotation will be spent with the SIU Stroke service, seeing Stroke alert patients in the MMC ED, assisting in making decisions on thrombolysis, and following these patients during their inpatient course. Another third of the rotation will be spent with the Neurointerventional radiology service, with a particular emphasis on learning the indications for thrombectomy and appropriate patient selection, as well as neuroradiology interpretation. The final third of the rotation will be spent with the Neurocritical care service at MMC, managing patients with critical neurologic emergencies during their time in the Neurocritical care unit. They will perform procedures as indicated with appropriate supervision, and will coordinate care with the many services these patients require, including neurosurgery, neurointerventional radiology, neurology, stroke, physical/occupational therapy, dietary, and critical care. On completion of this rotation, residents will have a broad and deep knowledge base to draw from for any patient presenting with a neurologic complaint to the ED.

• EMS (Emergency Medical Services Block, PGY-3)
  • The EMS Block rotation will occur during PGY-3 and is comprised of didactic, operational, and asynchronous learning opportunities. There are additional components of EMS-centered education that will occur in residency outside the confines of the dedicated EMS Block, such EMS Day, Fire Day, SIU EM Wars, etc. Clinical field time with local EMS providers is a core part of this rotation, as well as education of EMS providers. Residents will teach EMS providers during a dedicated lecture and/or hands-on learning session during their EMS block.

• Elective (PGY-2 and PGY-3)
  • Residents are given the opportunity to design an elective block to pursue an area of interest within Emergency Medicine. Recent elective rotations include: Emergency Ultrasonography, EM Education, Rural EM, EMS, and Critical Care Resuscitation.

• EDU MMC (Education Block at Memorial Medical Center ED, PGY-3)
  • PGY-3 residents will spend this block working directly with medical students and junior residents to hone their previously developed teaching skills. They will have a mix of shifts in the ED, some where they will learn to balance quality bedside teaching with ED patient throughput, others where they will focus primarily on quality teaching and less on ED throughput. The resident will work closely with the Clerkship Director throughout their block, primarily teaching didactic sessions for medical students and guiding students through simulation cases. At the end of the rotation, residents will be prepared to teach learners of all stages in training in a variety of settings.

• PICU (Pediatric Intensive Care Unit, PGY-3)
  • PGY-3 residents expand upon their pediatric critical care training, reinforcing and deepening their knowledge of pediatric critical care and resuscitation while rotating in the PICU at SJH. They will assist the attending physician in educating junior residents and medical students in the fundamentals of pediatric critical care as needed.

Core Education Activities

The core curriculum at SIU Emergency Medicine includes a wide variety of didactic sessions that are held every Thursday morning. These conference days involve a mix of lecture based topics and small group interactives. Residents receive the core of their medical knowledge through the Foundations of Emergency Medicine curriculum which is done in a small group learning format. Topical grand rounds, case conference and reviews, and specific sessions in EMS, US, and patient safety/quality are included to cover the more nuanced aspects of our specialty in a larger didactic format. During two weeks of each block residents are divided into smaller “resident families” for three hour small group sessions. During this time residents receive more personalized and directed training through our procedures, simulation, and professional development curriculum. More specifics on some of the components to the core curriculum have been included below.

Foundations of Emergency Medicine

To ensure our residents cover the EM Model of Clinical Practice, our program utilizes the Foundations of Emergency Medicine curriculum. This is a year directed curriculum that involves “flipped classroom” type methodology. Residents are given guidance on preparation material for each small group session. Our junior residents then run oral board style cases with their senior residents or core faculty. This format allows for nuanced discussion on each subject matter and better prepares our learners for the rigors of oral boards. (link to foundations page here)

Grand Rounds & Large Group Didactics

At the heart of our larger group didactics are the grand round sessions that are presented by core faculty, invited experts, and our more senior residents. These sessions involve deeper dives into specific topics with adjunct discussion. These grand rounds topics have in the past been core content related (i.e. evidence based presentation of resuscitation techniques, ECMO, etc) and have expanded into patient centered and systems-based topics (i.e. caring for vulnerable populations, working with advanced practice providers, etc). EMS and US also have longitudinal large group didactic sessions. These sessions help to solidify skill sets in two fundamental and dynamic areas of our speciality. Special attention is made for prehospital protocols and direction during EMS didactics and quality assurance and review of images during US didactics.

Clinical Case Review and Patient Safety & Practice Improvement

These resident-run sessions are some of the most highly rated on our didactic calendar. During these sessions our residents present to their colleagues and faculty interesting cases. With over 120,000 patient care visits in our system, the pathology our residents are exposed to continue to feed these conferences with great teachable moments. Patient Safety & Practice Improvement conferences allow for a safe and supportive learning environment for our residents and staff to go over tough cases and learn from common diagnostic, cognitive, and system errors. We are firm believers at SIU that unexpected outcomes do happen and they are some of the best learning experiences.

Professional Development Curriculum

As an adjunct to the procedures and simulation curriculum, small group sessions are integrated throughout the year to cover career development topics. Previous sessions have included residents as teachers, finances, administration, and wellness. These small groups serve as an opportunity for our faculty and residents to catch up and discuss things in a more intimate setting and aid to further prepare our residents for a career as an emergency medicine physician.

Written/Oral Board Review Curriculum

The written board review sessions at SIU are held during the months leading up to the annual In-Training Exam.  SIUEM provides Rosh Review and PEER review for all residents.  Supplemental board review sessions with core faculty are integrated into weekly didactics sessions. Much of the oral boards training our residents receive is from their participation in Foundations of Emergency Medicine. A mock oral boards is planned each year for our graduating residents. These cases not only prepare residents for board certification, but also helps to provide a systematic framework towards approaching any patient whether simulated in oral boards or seen in the real world.

Journal Club & Evidence Based Medicine Curriculum

Residents lead monthly Journal Club sessions which review recent articles pertinent to the practice of Emergency Medicine as well as seminal or landmark articles from the past that have affected our practice today.  Statistics and evidenced based medicine topics are also discussed. These sessions are integrated into Thursday Conference, however are often held off site and hosted by a faculty member. This allows for an inviting and informal learning environment that helps to strengthen the bonds within our program, while also learning some of the most up-to-date literature regarding patient care today.

Research & Quality Curriculum

Research is an important aspect of residency training. The ability to develop a focused research question, review past literature on the subject, structure a protocol for data collection, and evaluate the results of a study, are skills that help advance one's understanding of their field. Quality improvement is a practical application of the research method used to improve patient care and outcomes. Involvement in quality improvement projects is not only required for continued board certification, but is also an important aspect of emergency department operations and administration. Here at SIU we believe strong experiences in both research and quality are important in training future leaders and educators in the field of emergency medicine. Below are some of the highlights of how research and quality improvement are integrated into our residency program.

There are many opportunities for research involvement during residency training. With faculty interests including medical education, simulation, ultrasound, rural medicine, emergency department utilization, quality improvement, trauma, critical care, and pediatrics to name a few, mentorship in research is more than available. Our core curriculum includes journal clubs, didactics, and small group sessions overviewing hot to write case reports, clinical statistics, and manuscript appraisals. Resources and mentorship from members of the university's Center for Clinical Research are also available to aid in study design, IRB proposals, design implementation, and data analysis. Goals for our residents are for involvement in the production of a manuscript during their tenure with the program as well as abstract presentations at regional and national academic conferences. See below a list of our division's most recent scholarly activities.

Extracurricular Experiences

The role of the Emergency Physician extends beyond the ED.  Residents partake in several special activities each year to heighten their exposure to EMS, fire, law enforcement and wilderness medicine. These experiences are being adapted in the era of social distancing to continue to supplement our clinical education.

During the orientation month all residents participate in EMS Day at the Riverton Fire Department where they are educated on the composition and function of an EMS system and then learn the basics of prehospital care such as immobilization and extrication in addition to logistics of our air and ground transport vehicles.

SIUEM Wars occurs every August.  This annual event is organized and run by senior EM residents.  Fellow residents face-off competing in teams as they navigate different wilderness medicine challenges. Law Enforcement Day is hosted by the Springfield Police Department Academy.  Residents  are educated on firearms safety, ballistics, hemorrhage control and active shooter/mass casualty events.

Every Spring the Springfield Fire Department creates several scenarios during our annual Fire Day that allow our residents to better understand the role firefighters play in emergency response and patient care.  Residents learn breaching techniques to enter structures, undergo confined space maneuvers while wearing full turnout gear, run hose through elevated structures and learn ropes techniques for patient extrication.

In addition to these formalized activities residents interested in pre-hospital care or other community involvement may seek out other experiences.  In recent years residents have served as assistant medical directors for EMS agencies, instructed military personnel during combat lifesaver cadaver labs and taught critical care transport courses to local medics.