Emergency Medicine Residency Curriculum | Loyola Medicine

Emergency Medicine Residency Curriculum

PGY1 Rotations

PGY1 rotation

ED: Based in Loyola’s Emergency Department, the PGY1 rotation will focus on learning the skills needed to be an effective & efficient EM team-member. You will work 1-1 with an attending physician to allow for dedicated teaching time.

Orientation: Loyola EM offers a full 4-week rotation at the beginning of the PGY1 year. Activities will include team-based learning exercises (didactics, simulation, etc) to build a level of knowledge that will allow for an effective introduction into our ED, team-building & social time to create an environment of family & support both within your class & with our faculty. There will also be ED shifts to allow for an introduction to our training environment.

Peds ED: In the PGY1 there will be a 4-week rotation early in the academic year, caring for pediatric patients in dedicated rooms in Loyola’s ED. After this rotation has been completed, you will be scheduled for 1-2 pediatric EM shifts during every ED rotation, to allow for longitudinal exposure.

OB: This 4-week rotation, will take place with our Ob/Gyn faculty & residents, allowing for the care of pregnant patients, and for the required deliveries as per ACGME guidelines.

Trauma: The PGY1 will function as a junior resident on the trauma service, caring for patients in our Level-1 Trauma ED, and on the inpatient side. You will learn the initial approach, work-up and management of trauma patients in a team-based setting.

CCU: During this 4-week rotation, the PGY1 will learn to care for the critically ill cardiovascular patients. Loyola is fortunate to have 24-hour in-house Interventional Cardiology, and also houses a dedicated LVAD service, allowing for access to patients that few programs can deliver.

MICU: Similar in design to the CCU rotation, the MICU rotation is 4 weeks in length, and will facilitate the learning and management of critically ill medical patients. Working on one of the 2 MICU teams, the PGY1 will function as a junior resident, and have dedicated teaching time with the MICU fellows & attendings.

EMS: Loyola EM is very closely affiliated with our EMS teams, with our Chairman acting as EMS Director. This rotation exists to give our PGY1s exposure to both ground & air crews, and provide opportunities to engage with our EMS staff in educational activities.

Ultrasound: This rotation will take place early in the PGY1s academic year, to allow for an introduction to the skills needed to be an effective bedside ultrasonographer. Our APD, Dr. Amy Kule, who is fellowship trained in Emergency Ultrasound, leads this rotation.

Anesthesia: Emergency airway management is a cornerstone of EM training. During this 2 week rotation, the you will spend dedicated 1-1 time in the OR with our Anesthesia colleagues mastering the skills needed for effective airway management, while also learning additional procedural skills under their guidance.

PGY2 Rotations

PGY2 rotation

ED: Building on the experiences gained in your PGY1 year, you enter this year with increased exposure to acuity and volume. You are also responsible for the airway management of all of the trauma patients in our Level-1 ED.

Elective: During this 4-week rotation, you can choose from many available options to increase exposure and build additional skills. Examples include: Advanced Toxicology, Advanced Ultrasound, Aeromedical/EMS, Disaster Medicine, Global Health/International Medicine, Medical Education/Simulation, Quality, Sports Medicine, Administration. You are also able to craft your own unique elective experience, given the wide range of specialties & services at our quaternary care medical center.

PICU: You will have 4 weeks to care for critically-ill pediatric patients during this rotation, working alongside pediatric residents & attendings, without fellow coverage.

Toxicology: Our own Dr. Christina Hantsch, who is Fellowship Trained and Board Certified in Medical Toxicology, is responsible for the Toxicology service at LUMC. You will work directly with her during this 4-week rotation caring for adult and pediatric patients with a variety of medical toxicology issues, such as intentional and unintentional overdoses, exposure to chemicals, and envenomations.

Burn ICU: Loyola is very fortunate to have one of the few Burn ICU’s in the Chicago area. This rotation will give the PGY2 exposure to this patient population and the unique procedures, resuscitations, and management that accompanies them.

Pediatric Sedation: This service, comprising a PICU attending and a PGY2 resident, will provide Pediatric Sedation services 5 days a week to both the outpatient and inpatient setting, including Bone-Marrow, LPs, and many other procedures. The resident will be responsible for creating a sedation plan, readying the room, and delivering the medications under the close supervision of the PICU attending, creating a unique and highly educational experience. Please read more in our growing ‘Curriculum Spotlight’ section: Peds Sedation Spotlight

Radiology: This 2-week rotation will allow the resident to further their knowledge & reading of common radiology modalities, working 1-1 with specialized Radiology faculty.

Orthopedics: With LUMC being a Level-1 Trauma Center, our Orthopedic service see’s a great number of acute fractures, dislocations and hand injuries. During this rotation the PGY2 resident will help care for all of these patients, learn the skills required for effective bedside reduction and splinting, and advanced hand injury management skills.

NICU: During the PGY2 year, the resident will be responsible for completing ~5 NICU call shifts, allowing for exposure to critically-ill NICU patients and their resuscitations – a much required skill for any EM practitioner. The majority of these will be completed during the Pediatric Sedation rotation, will time allowed for completion during other PGY2 rotations.

 

PGY3 Rotations

PGY3 rotation

ED: During the PGY3 year, the EM resident will spend the greater part of their year in the ED, completing their training to allow them to practice in any environment, in any conditions. This year will focus on room awareness & management, having an eye towards both those patients in the waiting room, and under the care of other teams. The PGY3 will be the back-up for any emergent procedure in the ED. They will also be responsible for teaching and mentoring the rotating medical students in the ED, and be seen as true senior residents in the emergency department.

Trauma/SICU: This unique 6-week rotation is completed in conjunction with a rotating senior General Surgery resident. This allows for shared responsibility of the trauma resuscitations, allowing for the PGY3 to run these resuscitations in the ED, and care for the critically-ill trauma patients in our SICU.

Elective: During this 4-week rotation, you can choose from many available options to increase exposure and build additional skills. Examples include: Advanced Toxicology, Advanced Ultrasound, Aeromedical/EMS, Disaster Medicine, Global Health/International Medicine, Medical Education/Simulation, Quality, Sports Medicine, Administration. You are also able to craft your own unique elective experience, given the wide range of specialties & services at our quaternary care medical center.

Administrative: During this 2-week block, which follows the Trauma/SICU rotation, the resident will be given time to further pursue scholarly activity, a required component of residency.

Didactics

Our weekly didactic & teaching sessions occur from 8am-1pm, every Tuesday .

A great deal of study and planning has gone into the design of this section of our residency program. Over the last several years, there has been a movement away from traditional 1-hour presentations, with adult-learner centered methodologies being incorporated with great success. As a new residency, we are able to build from scratch a curriculum that will use the latest methodologies and technology to deliver your education.

We have developed many different modalities to deliver the content that is required for success in EM, including a heavy focus on smaller-group instruction. A sampling of a PGY1 modality breakdown is shown below:

PGY1 modality sample

As can be seen, we have built-in a wealth of Simulation time, which will utilize our Stritch School of Medicine Simulation Lab. We are very fortunate to have access to this area, and the high-quality teaching rooms that are located nearby for the didactic part of the weekly conferences. Dr. Trent Reed, one of our EM Core Faculty, has been the Director of Simulation for the Stritch School of Medicine for several years, and is a key part of this educational area for our residency.

The conferences are built around 18-month blocks, that will be rotated twice during your residency. Core content is assigned using the EM Model of Clinical Practice and sessions are built around these topics. Our EM Faculty have delivered lectures, designed and delivered Simulation sessions, both locally to our medical students and at the national level.

Multiple additional breakout sessions are planned including:

  • Combined Conferences utilizing our large number of consultant and specialty services
  • Dedicated longitudinal sessions for key areas like Resuscitation, Airway Management, Documentation, EKG Review, CV & Career-Building, and many others
  • Key procedures will be taught utilizing technology already available to Loyola residents

All of our classrooms are equipped with the ability to record lectures and group sessions, but key to our residency is your presence at our weekly conferences, so with rare exception you will be able to attend your conferences during both EM rotations and off-service rotations alike. This is a crucial piece for building a new EM program.

The teaching, however, will not stop at the weekly conferences. Multiple modalities are being developed to ensure on-shift teaching is a large part of your training, including dedicated times for group on-shift teaching sessions, and coordinated shift finish times to allow for teaching and mentoring outside of the ED.

Put simply, our educational environment will provide everything needed to deliver a world-class Emergency Medicine education to you and your colleagues. Your contribution to your education is also crucial. As a resident, you will have a teaching curriculum that you will develop and deliver during each year of your training with us. We will provide guidance, mentorship, and constructive evaluations to allow you to hone the skills needed to be an effective and efficient teaching physician.

Specialty Tracks

Specialty Tracks in Emergency Medicine Education (STEME) are pre-designed pathways to utilize those faculty with additional/fellowship training, or substantial experience in an area of Emergency Medicine. Such tracks include:

  1. Toxicology (Dr. Christina Hantsch, Faculty Track Director)
  2. EMS (Dr. Mark Cichon, Faculty Track Director)
  3. Sports Medicine (Dr. Jolie Holschen, Faculty Track Director)
  4. Medical Education (Dr. Trent Reed, Faculty Track Director)
  5. Ultrasound (Dr. Amy Kule, Faculty Track Director)
  6. Pediatrics (Dr. Simon Ros, Faculty Track Director)
  7. Administration (Dr. Robert Riggs, Faculty Track Director)
  8. Global Medicine (Dr. Theresa Nguyen, Faculty Track Director)

Through discussion and mentoring, we work to find those residents with an interest in one of these areas, and look to assign them to a STEME Track Director after January of their intern year. The Track Director will supervise and monitor both didactic and clinical resident education within their area of expertise.

Here is an example of the goals for one of these tracks, the Education STEME:

The goals of the Medical Education Specialty Track:

  • To develop skills in curriculum development and innovative educational delivery and produce at least 1 form of instructional material.
  • To develop skills in teaching, mentoring, and career advising medical students.
  • To gain skills in evaluation and assessment of students and participate in mid-clerkship feedback for rotating medical students at least once per year.
  • To gain knowledge in research and dissemination through at least 1 scholarly work.
  • Share best practices in medical education with others by delivering at least 1 journal club related to medical education
  • To prepare and provide interested residents with the prerequisites necessary to match in an ACGME approved fellowship in medical education

Loyola Medicine EMS logo

The EMS program at Loyola University Medical Center was one of the original three resource hospitals recognized in Illinois in 1977. Since that time it has grown to the largest single resource hospital EMS system in the State. Our EMS providers range from volunteer first responders to critical care flight medics and everything in between. Our system is comprised of municipal, private, contract, and non-transport programs whose members number over 3000, and provide services to over 110,000 patients per year. Educators within the EMS system provide over 400 hours of CME to its members monthly.

What does this mean to you as a resident? This background provides a rich opportunity to gain insight and experience in all aspects of EMS; management, policy development, protocol refinement, SOP development, education delivery and diverse patient care modeling.

Whether core content, a self-developed elective, or the STEME track – the availability to learn and experience EMS within our Emergency medicine Residency awaits you at Loyola.

ED Staffing Information

The residents time in the ED is defined by the idea of 'team-based' coverage. 

The attendings moved to a 'Pod' assignment system in order to accomodate this approach. Now our residents and students are able to work in defined teams in the ED. There are 3 pods - A/B/C, each with their own set of rooms, and each with their own set of additional responsibilities.

In each pod there is 1 EM attending, and 1 EM resident. As the residency grows, there will be shifts designed to add teaching & supervisory responsibilities for the senior residents, so in these instances there may be more than 1 EM resident in a pod. Outside of this, we will always strive for the 1-1 system.

This is in place for a few reasons:

  • The resident knows who their attending is, who to go to for questions, and vice-versa. Sitting in close proximity to one another furthers this relationship on shift.
  • This allows for a more thorough evaluation of the residents performance, as the attending works with the resident for their entire shift
  • There is no crossover - both resident and attending finish their shifts at the same time, allowing a team approach to leave the shift in a timely fashion
  • Knowing the residents workflow allows the attending to both help the resident with this work, and to also increase their volume if needed during the course of a shift.

Put simply, this system allows for a more complete teaching and education experience for the resident. Also, as the program grows, these systems will adapt for senior residents who need more room to work without supervision that is as close.

ED Metrics

Loyola is fortunate to have a very diverse Emergency Department population to serve.

Firstly, it has a complement of patients expected of a quaternary care center, for example:

  • Oncology
  • Transplant (e.g. Heart, Lung, Liver, Kidney)
  • Sickle Cell
  • LVAD

Coupled with this is an even larger volume of patients from our surrounding communities. Many of these patients require the Emergency Department for both their primary and more urgent care needs.

We serve a very diverse populations with many ethnicities, religions, and care practices. Exposure to all of these is crucial for the experiences of an Emergency Medicine resident.

As for raw metrics, per year:

  • ED Volume: ~48,000
  • Percentage of patients not primarily seen by attendings (e.g. APNs): 0%
  • Pediatric ED Volume: ~10,000
  • Admission Rate: 33%

Teaching Opportunities

Given our close affiliation with Stritch School of Medicine, and the core values of our residency program, teaching is central to our residency:

Didactics

There is a defined teaching curriculum for each year of training. The goal is for the resident to be an expert in the preparation and delivery of both  lecture and small group teaching by the time of their graduation.

Medical Students

We have several opportunities for our residents to teach and mentor our medical students:

  • We deliver a 'Resident as Teacher' curriculum to give them the tools to succeed in this role
  • Ultrasound Teaching Sessions are given by our residents to medical student, starting in their first year of training
  • Formal Mentoring and Teaching programs exist in the School of Medicine, and the residents can volunteer to be a part of this. One of our current PGY1 is currently part of this program, which no PGY1 in the institution has ever been a part of
  • As they progress through residency they will be assigned medical students on shift with them. This will allow them to gain further exposure to teaching and mentoring, and also allow them to explore a supervisory role as a future career choice.