Educational Design of the Residency Program

Emergency Medical Services (EMS)

The Department of Emergency Medicine is extensively involved in the region’s EMS. Consequently, the residents' curriculum focuses heavily on EMS training, both through formal sessions (county meetings and committees), as well as through direct prehospital patient care as a certified flight physician with the county aeromedical provider, Mercy Air. Prior to flying on the helicopter, all residents are trained in an "advanced prehospital" life support course. All residents become certified as Base Hospital Physicians for San Diego County, and will be primarily responsible for the UCSD Base Hospital prehospital care. During the EMS rotation, residents will represent UCSD in City and County EMS meetings including: (1) San Diego County Base Station Physicians; (2) the Emergency Medical Care Committee; (3) San Diego Base Hospital Physicians Committee; and (4) the Prehospital Audit Committee. Residents ride along with paramedics on ambulances and spend time with the local EMS authorities, including the Medical Director of the County EMS Office. In addition, residents are actively exposed to the City of San Diego's Emergency Medical Dispatch system, of which Dr. Dunford is the Medical Director.

Emergency Department Administration

Throughout the residency, lectures pertaining to management skills and techniques, financial planning, quality care audits and computer applications are taught. Senior residents are given responsibility for coordinating lectures and arranging schedules. Chief residents participate in administrative meetings within the Department of Emergency Medicine, and represent the program on in-house committees. Residents play an active role in the recruitment of new housestaff and the teaching of Emergency Medicine to others.

Research

There are many opportunities for investigation within the UCSD Medical Center system and a research project is a requisite of the program. The Emergency Medicine faculty are currently involved in a variety of research projects. Some specialized areas of research include emergency airway management, imaging in emergency medicine, EMS, toxicology, diving medicine, hyperbaric medicine, and disaster medicine. Residents are encouraged to submit articles for presentation at national meetings and funding is provided for residents who present at those meetings.

Residents also attend a lecture series on research design, statistics, critical appraisal of literature, and effective teaching techniques, which is incorporated into the core curriculum. Seminars are held on a regular basis to discuss current or potential research ideas and methodology. The EM faculty and residents present their current research at an annual research meeting.

Internal Medicine

The Department of Emergency Medicine (DEM) works closely with the Department of Medicine in the training of both Medicine and Emergency Medicine residents. Our interns rotate on both the Medical ICU (MICU) as well as Cardiac ICU (CCU) services. Admitting responsibilities, primary patient care and consultation are inherent to the rotation. Interns are closely supervised, with daily rounds by senior residents and medicine attending physicians. Daily conferences are available. Attendance is expected at weekly Medical Grand Rounds and M & M Conferences while on this rotation. In addition, Internal Medicine Residents rotate in the ED, and work under the supervision of our senior residents.

Intensive Care Units

In addition to the two-month experience in the MICU and CCU (see above), the PGY-3 and 4 residents assume primary patient care responsibility in the Surgical ICU during their two-month trauma rotation at UCSD.

Trauma/General Surgery

The DEM works equally closely with the Department of Surgery in the training of surgery and EM housestaff. EM residents are assigned a one-month rotation during the PGY-I year and a two-month rotation during the PGY-3/4 year where they are an active member of the trauma resuscitation team. Ward teaching rounds are conducted daily by surgical chief residents and faculty. Expeditious surgical consultation to the ED is provided by the chief resident or attending physician on request. While on surgical rotations, attendance is expected at weekly Grand Rounds and M & M Conferences. Tuesday afternoon Trauma Resuscitation Conferences are attended by all EM residents and faculty.

Orthopedics

Extensive exposure to orthopedic problems will be available during the Emergency Department rotations at UCSD, Tri-City Medical Center, Children's Hospital, Pioneers Memorial Hospital, and Palomar Medical Center. UCSD is the reimplantation center for San Diego and Imperial Counties. Therefore, microvascular and reimplantation exposure is certain. In addition, each EM intern participates in a one-month rotation at UCSD's "Cast Room" and Outpatient Orthopedic Clinic, providing a high-volume outpatient environment, as well as responds to all emergency department orthopedic consultations. Basic Emergency Medicine skills such as splinting, casting and dislocation reduction are taught. Supervision is by the DEM faculty and the orthopedic residents and faculty of the UCSD Medical Center.

Obstetrics/Gynecology

Interns spend four weeks on the Scripps Mercy labor deck under the supervision of senior OB residents and faculty. Excellent facilities are available for the training of the acute management of minor and major Ob/Gyn emergencies. Delivery room experience is emphasized. UCSD provides the Regional Neonatal ICU Center and an elective is available.

Pediatrics

Children's Hospital is the Level I Pediatric Trauma Center for San Diego and Imperial Counties and has a three million-person catchment area. Throughout the year, residents work shifts at Children’s Hospital. UCSD faculty, fellows and senior residents, and the full-time pediatric and critical care faculty of Children’s Hospital provide supervision.

Neurology

EM residents primarily evaluate all neurologic emergencies in the ED under the supervision of DEM faculty. Residents have the option of an elective rotation in neurology at UCSD, providing experience with the Medical Center's state-of-the-art magnetic resonance imaging equipment. Detailed neurologic examination and management of neurologic emergencies is emphasized. UCSDMC serves as a regional Stroke Center. Senior neurology residents and faculty provide supervision.

Psychiatry

Residents perform all initial psychiatric evaluations in the emergency department. Those patients that require further evaluation by a psychiatric specialist are referred to our inpatient psychiatry team for further treatment.

Dermatology

Dermatology electives are available in the clinics at UCSD. Under the supervision of residents and faculty, EM residents have an opportunity to develop skill in the identification of both diseases of the skin and dermatologic manifestations of systemic illness.

Urology

Urologic emergencies are evaluated primarily by the EM residents. A urology elective rotation is available at UCSDMC, providing exposure to both the inpatient and outpatient settings. Lectures by DEM faculty will cover all of the commonly presenting acute urologic problems.

Ophthalmology

The EM residents primarily evaluate all eye complaints under the supervision of DEM faculty. DEM faculty and ophthalmology residents and faculty supervise EM residents. Residents are exposed to a large number of patients with common eye complaints such as the red eye, foreign body, pain, and visual deficits. Residents become adept in the use of the slit lamp. An optional elective experience is available for those residents who want more exposure to the subject.

Otolaryngology

EM residents may elect to do a four-week rotation in head and neck surgery at UCSD. The majority of the experience is in the outpatient clinic, seeing a large volume of patients with common head and neck surgery complaints. Additional experience can be obtained in the head and neck surgery clinic at Children's Hospital under the direction of pediatric otolaryngology residents and faculty. Common ED procedures are stressed.

Radiology

An elective in radiology offers formal didactic and practical instruction in the interpretation of radiographs and diagnostic techniques appropriate to ED evaluations. Emergency Department consultation is included in this rotation, wherein all ED x-rays are "wet-read" by the EM resident under the supervision of senior radiology residents and faculty. Radiology faculty members conduct a very popular radiology conference quarterly for the EM staff and residents.

Neurosurgery

A neurosurgical elective is available at UCSD Medical Center. Its emphasis is the initial diagnosis and treatment of head and spine trauma. UCSD's neurosurgical faculty has extensive research interest in these areas, and the Medical Center is a participating center in both national head and spinal cord injury studies. Consequently, many patients are referred to UCSD and the EM resident will have considerable experience in the management of these injuries. In addition, resident participation in the air medical transport program will allow significant exposure to the pre-hospital management of these patients.

Cardiothoracic Surgery

An elective in CT surgery is available at UCSDMC. Operating room experience is included and is appropriate to the needs of the EM resident. The management of a variety of chest problems, particularly trauma, is available. Supervision is by cardiothoracic senior residents and faculty.

Plastic Surgery

The Division of Plastic Surgery at UCSD offers an elective to the EM residents, which exposes the resident to basic surgical techniques and the essentials of wound care and management. Microvascular and reimplantation surgical exposure are also available. Residents are offered an opportunity to attend the division's nationally offered "Wound Management" workshop.

Burn Unit

UCSD is the Regional Burn Center for San Diego and Imperial Counties. The EM Intern rotates on the Burn Service. During this time, the resident fully participates in the acute resuscitation of burn victims. The Burn Unit's intake area for ambulatory burn victims offers, during these rotations, ample exposure to the management of minor burns. The Burn Clinic provides continuity of care to the EM resident's initial management. Supervision is under the direction of senior surgical residents, burn fellows, and the faculty of the Burn Service.

Anesthesiology

All airway issues are managed by emergency physicians in the ED. While on the trauma service, our residents perform all airways when they are on call. Our interns do a rotation in anesthesiology during which they experience all manners of anesthesia care with an emphasis on airway management. One week is spent in the Rady Children's Hospital Anesthesia as a PGY-4.

Electives and Other

The extensive resources of this residency's participating institutions offer Emergency Medicine related electives in essentially every subspecialty. However, with approval of the program director, residents may pursue outside electives and creativity to meet an identified educational need is encouraged.