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PGY-I

As a PGY-I emergency medicine resident, you spend time both in the Emergency Department learning the basics of emergency medicine, and additionally spend time on a variety of other services to learn skills essential to the practice of emergency medicine.

Introduction to Emergency Medicine / Advanced Life Support

For every new resident, the first month of residency at University of Iowa Hospitals & Clinics is spent together on an introduction to emergency medicine rotation called Advanced Life Support. During this month, interns spend most mornings in informative and interactive didactics, both in the lecture hall and in the simulation lab. They are also assigned to eight shifts in the Emergency Department to allow them to get to know the department, the faculty and nurses, and the way around the hospital.

This rotation is a great balance between getting accustomed to the hospital and life as a resident at UI Hospitals & Clinics, while still allowing for some free time to get settled into a new town and to get to know your co-interns. The best part: students and interns participate in a wilderness medicine race. At the end of the Advanced Life Saving month, first-year residents participate as medical support in the Register’s Annual Great Bike Ride Across Iowa (RAGBRAI) by riding along with the four ambulance crews. RAGBRAI is an annual event with 15,000-20,000 riders traveling from the Missouri River to the Mississippi River across the state over one week. It is a great time for learning field medicine, making independent treatment decisions, and getting to know our EMS colleagues.

Emergency Medicine

In the months in the department, interns work with a senior resident and faculty member with close supervision, gaining independence in practice at their own pace. Senior residents are assigned to go to any incoming trauma, but otherwise interns are encouraged to see any cases they want. Patient load in the department can be daunting at times, but it is stressed that the job of the interns is to learn, not to move patients through the department. Typically, if the senior residents are comfortable performing procedures and have reached their goal, the interns are then sought out to perform the procedures.

Pediatric Emergency Medicine

Residents spend one dedicated month seeing only pediatric patients in the Emergency Department. Residents work most often one-on-one with an attending, making this a great learning experience. Residents are exposed to many typical pediatric patients, but also complex ones being a tertiary referral center.

Residents can perform a number of different pediatric procedures, including:

  • Procedural sedation
  • Foreign body removal
  • Laceration repair
  • Lumbar punctures

During these months residents participate in pediatric traumas. There are also dedicated pediatric didactic sessions throughout this month.

Trauma Surgery

This rotation gives interns the experience of trauma from the point of view of the surgeons rather than the emergency medicine practitioners.

There are four interns on the service, and we they alternate responsibility for long and short call, as well as trauma evalustions/resuscitations. Interns can go to the OR if they want, or they can handle floor calls for polytrauma patients on the service. These calls include medication checks to wound care to pulling chest tubes and.or other bedside procedures. 

The patient population is typically split about equally between the SNICU and the floor, exposing the interns to a broad range of patient morbidity. They are also paged to the ED whenever a trauma is set to arrive. The emergency medicine interns participate in the trauma resuscitation along with surgery residents working in the emergency department. The hours are typical of a surgical service, running from 5:30 a.m. to 6:00 p.m. on weekdays with shorter hours rounding on the weekends, but interns do get two full weekends off during the month-long rotation with no patient care responsibilities.

The weekly trauma conference is an excellent learning experience, and the topics presented frequently overlap with emergency medicine issues and practice. Interns also attend surgery grand rounds and M&Ms, which are also great for learning.

Orthopedic Surgery

Emergency medicine residents work as an integral part of the orthopedic trauma team. The block is split into two halves, giving the residents a well-rounded exposure to orthopedic emergencies.

During one half of the rotation, residents are members of the orthopedic trauma service. Residents are expected to attend daily morning conferences, which can be very educational. You carry the orthopedic pager and take calls on inpatients and Emergency Department consults during the day. When not busy with consults, you will work in the clinic. There are some operating room opportunities if you so desire.

During the other half of the rotation, residents work on the orthopedics night float team. This team is responsible for seeing all the orthopedics consultations, both in the Emergency Department, as well as inpatient units. Residents gain a broad exposure to not only traumatic orthopedic emergencies, but also infection, pediatric, joints, and spine cases. The most valuable experiences of the rotation include gaining experience casting, splinting, fracture and dislocation reductions, as well as fine tuning exam skills.

Anesthesiology

During the month on anesthesiology, interns are assigned to one operating room for the day. Usually they will be working with a certified registered nurse anesthetist, but at times they may be with an anesthesiology resident. Most often, emergency medicine interns can manage the airway while starting a case. First case starts at 7:15 a.m. or 8 a.m. and arriving 20-30 minutes before case start to get to know the patient is advised. There are no weekend duties on this rotation. This month is a great time to perform as many intubations as possible and to get to be an expert at bag-valve-masking patients.

Burn Surgery

During the two weeks on burn surgery, emergency medicine interns are in the role of an intern on any surgical team. The team consists of a junior resident, emergency medicine intern, and possibly another co-intern from another service. Rounding is dependent on staff and patient load and usually starts around 6:15 a.m. with first operating room cases starting at 7:15 a.m.

Interns are allowed and encouraged, if they choose, to split time with the other residents scrubbing in to surgery, and typically can do as much of the surgery as they desire. On the floors, time is spent managing patients and writing notes. No worries about not knowing all of burn management right off the bat: nursing staff is very knowledgeable and helpful and will direct you as needed. The exact day-to-day task performed is dependent on the junior surgery resident. This is a great month to help manage very sick patients and to get some time operating!

Cardiothoracic Surgery

Residents spend two weeks working with our cardiothoracic surgeons. The primary goal of this rotation is to give the emergency medicine residents an opportunity to place many chest tubes under the supervision of the cardiothoracic surgery staff. Residents also can learn a great deal about the management of thoracic disease including pneumothoraces, hemothoraces, aortic dissections, and others.

Quality Improvement and Patient Safety

During this two-week rotation, our residents train in a variety of quality areas, including

  • Patient safety
  • Administration
  • Research
  • Education

Residents will obtain the Institute for Health Improvement (IHI) Basic Certificate in Quality and Safety. A billing and coding teaching session will take place with our lead coder to improve charting. Residents complete their human subjects training as required by the IRB to be better researchers. Residents will take the lead on one of the recommendations from the resident improvement committees to improve the overall education in our department. Seventy-two-hour patient returns to the emergency department will be analyzed for quality improvement.