Wilderness Medicine Fellowship

 

To Apply:

Please contact:

Christanne Coffey, MD
Fellowship Director
UCSD Medical Center
200 W. Arbor Dr. #8676
San Diego, CA 92103
(619) 543-6463
chcoffey@ucsd.edu

Rosa Longacre, MLIS
Fellowship Program Coordinator
(619) 543-6213
rlongacre@ucsd.edu

“The tendency nowadays to wander in the wilderness is delightful to see. Thousands of tired, nerve-shaken, over-civilized people are beginning to find out that going to the mountains is going home; that wilderness is a necessity. Awakening from the stupefying effects of the vice of over-industry and deadly apathy of luxury, they are trying as best they can to mix and enrich their own little ongoings with those of Nature, and to get rid of rust and disease."

 

- John Muir

Overview

Practicing effective emergency medicine outside the convenience of the modern hospital can prove challenging. Wilderness Medicine is a growing field that is increasingly recognized within emergency medicine, as well as by professionals and enthusiasts in outdoor recreation, humanitarian and disaster relief, military medicine, scientific research and exploration. In the United States emergency departments are well-equipped with the core resources (facilities, equipment, staffing, consultants) needed to diagnose, treat and, if needed, stabilize patients until a higher level of care is available. It is incumbent to have physicians trained to meet the unique challenges and emergencies that arise in diverse environmental conditions far from definitive medical care. There are currently only 11 Wilderness Medicine Fellowships in the United States.
The UCSD Wilderness Medicine Fellowship is a unique and comprehensive fellowship program which aims to provide clinicians with the critical thinking, applied hands-on training experience and improvisation skills necessary to deliver high-quality care in the world's most austere environments with varying resources and limited access to health care.

Why UCSD EM is a Leader in Wilderness Medicine

wildernessThe UCSD Wilderness Medicine Fellowship is the premier fellowship program for emergency physicians to train in this dynamic multidisciplinary specialty. San Diego offers a complete array of environmental exposures - desert, ocean, rivers, mountains, international, while having ties to disaster relief, aerospace and military medicine, and travel and tropical medicine. Fellows at UCSD will gain experience to become educators and leaders in Wilderness Medicine. Within the UCSD Department of Emergency Medicine existing fellowship programs can provide unique opportunities for exposure to and participation in areas of wilderness and austere medicine:

  • UCSD DEM Ultrasound Fellowship - investigate the use of small portable ultrasound devices in wilderness medicine to diagnose high altitude pulmonary and cerebral edema, acute fractures, backcountry trauma, etc.
  • UCSD DEM Undersea and Diving Medicine Fellowship - offer unique experiences to train in diving and hyperbaric medicine with the Clinical Hyperbaric Medicine Service, San Diego Center of Excellence in Diving and Diving Medicine Clinic.
  • UCSD DEM Toxicology Fellowship - Clinical Toxicology Service, association with California Poison Control System, Collaboration with Zoological Society of San Diego to manage venomous animals and ativenims.
  • UCSD EMS Fellowship - DMAT CA-4 disaster relief teams, aeromedicine program. 

Other unique experiences specific to UCSD:

  • Yanamono Clinic, Amazon basin, Peru
  • Flying Samaritans international work in Baja, Mexico
  • Telemedicine
  • UCSD Simulation Center
  • SOM 275 Wilderness Medicine Student Elective
  • Jackson Hole Avalanche Mitigation and Ski Patrol
  • Divers Alert Network
  • FAA Flight Physiological Training and FAA Post-Crash Survival Training
  • San Diego Center of Excellence in Diving
  • University of California White Mountain Research Center - high altitude research Mt Whitney
  • UC San Diego Global Health Initiative
  • San Diego Mountain rescue Team (SDMRT)
  • Collaboration with Naval Medical Center Balboa DEM wilderness medicine lecture series
  • Mozambique Ultrasound Education
  • Outstanding UCSD DEM faculty already considered experts in all aspects of wilderness medicine

The Institution

UC San Diego Medical Center is located in the Hillcrest area of San Diego, twelve miles from the UCSD School of Medicine. The clinical complex includes a 466-bed acute hospital, an Ambulatory Care Center offering 148 specialty and subspecialty clinics and ambulatory facilities, the Family Medicine Center, the Primary Care Center, the Internal Medicine Group Practice, and the Moores Cancer Center. UCSD Medical Center serves as a diversified population of inner city and suburban patients, while offering accredited training programs in virtually all of the major medical and surgical specialties.

The Medical Center offers a full range of primary, secondary, and tertiary care services. It serves as the Level I Trauma Center for both San Diego and imperial Counties, and offers numerous highly specialized services including the Regional Burn Center, the Infant Special Care Center, the Regional Transplant Center, the Comprehensive Central Nervous System Injury Center, and the General Clinical Research Center. UC San Diego has a 4-year fully ACGME-accredited emergency medicine residency program that began in 1990 and graduates 9 residents per year.

About the Wilderness Medicine Fellowship

The UC San Diego Wilderness Medicine Fellowship is a one year clinical and educational experience. The goals of the fellowship are to provide physicians with knowledge, formal training, and clinical skills in Wilderness Medicine. Each fellow will be expected to further their knowledge by performing original research, educating other physicians and medical students, and serving as a medical resource for outdoor organizations. Fellows will attend and present at local, national and international conferences, gaining experience to become educators in Wilderness Medicine. There is a core curriculum; however in addition, the fellow’s specific areas of interest will dictate their research and clinical activities. Wilderness Medicine is a multidisciplinary specialty incorporating disaster medicine, toxicology, hyperbaric medicine, ultrasound, all of which are established fellowships in the Department of Emergency Medicine at University of California, San Diego. The Wilderness Medicine fellow will work closely with experts in each of these fields. The goals of our fellowship program include:

  1. Providing a one year clinical and wilderness experience, at the completion of which, fellowship graduates should be prepared to lead or provide expert wilderness medical care anywhere on the globe.
  2. Pursuing intellectually-rigorous research to advance the state knowledge in wilderness medicine and publish these results.
  3. Providing opportunity for extended field experience in the practice of wilderness medicine.
  4. Providing experience teaching wilderness medicine to students, residents, and staff - both in the classroom, simulation center, and in wilderness settings.
  5. Providing opportunity for the fellow to learn/ develop advanced outdoor technical skills (whether ice/rock/alpine climbing, whitewater, diving, etc.).
  6. Providing access to medical experiences in the developing world (remembering that wilderness medicine is defined by the practice of medicine in resource-limited environments - not exclusively by distance from human population centers).
  7. Encouraging exploration of environmental policy issues as they impact human health and well-being.
  8. Providing an ongoing, clinical emergency medicine experience in a Level I trauma center in a busy urban ED.

The Fellowship Objectives and Opportunities

  • Core didactics and regularly scheduled meetings with the Fellowship Director. 
  • Attend weekly lectures and discussions on selected seminar topics in fields such as emerging infectious disease, wilderness medicine, environmental health, aerospace medicine, diving medicine, and disaster medicine. 
  • Work with experts in the field of wilderness and environmental medicine at UC San Diego Health to intergrade didactic training with hands-on experience in the clinical setting in specialty areas such as hyperbaric medicine, toxicology, telemedicine, and sonography. 
  • Membership in the Wilderness Medical Society with concurrent advancement toward becoming a Fellow of the Academy of Wilderness Medicine. 
  • Active membership and participation in ACEP's Wilderness Medicine Section. 
  • Attendance at national wilderness medicine conferences. 
  • Research or other scholarly activity. 
  • Clinical opportunities in wilderness medicine (search and rescue, EMS management, DMAT CA-4, ski patrol, international medicine with Flying Samaritans, diving and hyperbaric medicine, tropical medicine, Mozambique Ultrasound Education, etc.) based on the specific area of interest of the fellow with agreement and supervision of the fellowship director.

Resident and Medical Student Education

Splint and litter improvisation in wilderness  medicine hike, Torrey Pines.UCSD School of Medicine Wilderness Medicine Electives - We offer both a first/second year medical student elective (EMED 275) and a fourth year elective (EMED 427: Medicine in the Wild: A Fourth-Year Student Clerkship in Emergency and Wilderness Medicine) that include covering diagnosis and treatment of injuries and illnesses encountered in the wilderness environment including cold, heat, high altitude, diving medicine, outdoor orthopedic trauma, plant and marine life poisonings, and survival in the wilderness. The electives include two optional weekend workshops and the fourth year elective includes field experience in remote areas of Southern California. The Wilderness Medicine fellow works directly with the elective directors to present lectures and assist in directing the elective. 

In addition, there are multiple wilderness medicine events sponsored by EMIG and the UCSD Department of Emergency Medicine throughout the year that are open to all medical students. 

The Wilderness Medicine fellow also participates in preparing and presenting on the fundamentals of wilderness medicine to residents, faculty and medical students as part of the Department of Emergency Medicine Tuesday Conferences, developing and executing cases for residents and medical students at Simulation Center and leading 1-2 emergency residency journal clubs dedicated to current research in wilderness medicine.

Core Curriculum

Mountaineering Medicine  

  • High altitude medicine & physiology 
  • Cold & Heat Illness 
  • Avalanche safety 
  • Lightning Injuries 
  • Burns, Fire, Radiation
Hyperbaric and Marine Medicine  
  • Hyperbaric & Dive Medicine 
  • Marine Injuries 
  • Marine Toxidromes & Envenomations 
  • Safety & Survival at sea 
  • Submersion & drowning 
Wilderness Trauma  
  • Injury Prevention Assessment & stabilization 
  • Orthopedics/bandaging/splinting 
  • Foot care & Wound care 
  • Wilderness improvisation 
Disaster and Tactical Medicine  
  • Incident command Disaster mitigation 
  • Firearm safety and usage 
  • Tactical medicine/urban scene safety 
  • Global Humanitarian/Disaster relief 
Rescue and Survival  
  • Search and rescue techniques 
  • Aerospace Medicine 
  • Meteorology & weather prediction 
  • Tracking and land navigation 
  • Survival care self/others 
Special Considerations 
  • Wilderness preparation & equipment 
  • Expedition medical kits 
  • Special populations 
  • Chronic disease and wilderness activities 
  • Expedition Medicine 
Animal and Plant Hazards  
  • Arthropod and zoonotic infections 
  • Envenomations & Antivenins 
  • Bites & Animal attacks 
  • Medicinal and poisonous plants 
Wilderness Ultrasound  
  • Trauma evaluation, FAST 
  • Tropical medicine ultrasound 
  • Obstetrical ultrasound 
  • Musculoskeletal ultrasound 
Travel Medicine, Food and Water  
  • Field water disinfection 
  • Travel & infectious disease 
  • Infectious diarrhea 
  • Sanitation, public health issues 
  • Travel methods/packing efficiently 
Research and Faculty Development  
  • Research design & implementation 
  • Lecture presentations 
  • Negotiation, diplomacy, conflict resolution 
  • Mentorship

Program Leadership

2016-2017 Fellows in Wilderness Medicine

Related Links

Frequently Asked Questions

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What is the Fellowship recruitment timeline?

Recruitment for the following academic year opens in May and applications will be accepted through the end of business day on September 15. Interviews will be scheduled with candidates in October. The Wilderness Medicine Fellowship Program has a Match Notification date of November 1st.

What is the Duration of the Fellowship?

The fellowship is one year, non-ACGME accredited program.

How many fellows will be accepted?

We expect to be able to offer slots for 1 candidate per year of the fellowship.

What are the requirements for eligibility?

Fellows must be board-eligible in emergency medicine. Although the primary training site is UC San Diego Health, rotations are also offered at Rady Children’s Hospital, Veterans Administration Medical Center, San Diego, and El Centro Regional Medical Center.

Does the fellowship program accept international applicants?

International medical graduates are eligible to apply to the Wilderness Medicine Fellowship if they are US Board eligible in emergency medicine and have graduated from an ACGME accredited Emergency Medicine Residency Program. For more information about the application process for international medical graduates, click here.

What are the current Wilderness Medicine Fellowship Programs available in the United States?

  • Baystate Medical Center
  • Denver Health Medical Center/University of Colorado Hospital
  • Loma Linda University
  • Massachusetts General Hospital
  • Medical College of Georgia
  • Stanford University
  • State University of New York Upstate Medical University
  • University of California San Francisco Fresno
  • University of California San Diego
  • University of New Mexico
  • University of Utah Health Sciences Center
  • Other: 
    • Fellowship in Extreme Environmental Medicine (FEEM) - George Washington University DEM

What are the fellowship requirements to successfully complete the training program?

Requirements: 

  • United States Emergency Medicine Board Eligible or Board Certificate 
  • Clinical Requirements: 7-9 shifts per month as an Attending Physician in the UCSD Department of Emergency Medicine 
  • 1-2 months will be devoted to field-work in which there is no clinical responsibility
  • Salary: Highly competitive 
  • Full UCSD benefits including medical and dental with the clinical position 
  • Spending Account: Discretionary Allowance
  • Attend at least one National/International Conference on Wilderness Medicine 
  • Administrative support 
    • Applications: A letter of intent, CV, and 3 letters of recommendation 
    • Application Deadline: September 15th, annually o Interviews: October 
    • Application Decision: November 1st, annually
  • Fellowship start date: July 1st or August 1st
Evaluation Procedures:

Fellowship director will meet informally as well as formally on a quarterly basis. Written evaluations will be completed on a semi annual basis. The fellow will be evaluated on the quality of research completed and on formal research presentations. Successful completion of the fellowship will be ultimately determined by the fellowship director and core faculty. The wilderness medicine fellow will evaluate all components of the fellowship as well as core faculty.

Scholarly Activities/Research:

It is expected that all Wilderness Medicine Fellows will actively pursue research as a focus of their fellowship. Fellows will conceive and perform original investigations leading to presentations and publication of results. There are numerous research opportunities within the DEM:

  • The use of ultrasound in the diagnosis of high altitude cerebral edema (HACE) - funded study through UCSD DEM Division of Ultrasound and the US Navy
  • Research on stingray envenomations presentation, treatment and sequela in conjunction with the division of Toxicology
  • Ongoing and novel research opportunities through the San Diego Center of Excellence in Diving
Clinical Activities:
Fellows with a background in Emergency Medicine are expected to maintain their primary board skills in the ED. Opportunities are available at both UC San Diego Health sites, Rady Children’s Hospital, and El Centro Regional Medical Center.