Frequently Asked Questions About the UCSD Emergency Medicine Residency Program

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What is the nature of the Emergency Department at UCSDMC?

The Department of Emergency Medicine (DEM) is a separate clinical department within the Medical Center. The Director of the DEM is responsible to both the hospital director and medical school dean.

What is the actual physical presence of faculty in the ED? What are their backgrounds?

Full-time DEM faculty are present in both the UCSD Hillcrest and Jacobs Medical Center Emergency Departments 24 hours a day.

All of the DEM faculty are board certified in Emergency Medicine. Other board certifications include Medical Toxicology (Drs. Clark, Schneir and Ly), General Surgery (Dr. Rosen), and Undersea and Hyperbaric Medicine (Drs. Hayden, Van Hoesen, Grover, Jacoby, Latham, Snyder and Witucki). Four of the DEM faculty are also board certified internists (Doctors Dunford, Guss, Jacoby and Neuman). Internal Medicine subspecialty degrees are held in Infectious Diseases (Dr. Jacoby) and Pulmonary Disease (Dr. Neuman). Longevity among the faculty is excellent with many of them working at UCSD for more than ten years.

Is the UCSD ED unselected, or are some patients triaged out?

The vast majority of all ED visits are unselected. The following patients are triaged:

  • Ambulatory pediatric conditions are referred, during the daytime hours, to the Primary Care Clinic.
  • Third trimester obstetric conditions are referred to the Labor and Delivery area. EM residents rotate through this service.
  • Major burn victims are triaged by emergency physicians to the Burn Unit.
  • "Major trauma victims," as identified by the UCSD Base Hospital (Emergency Department) physician, are triaged to either the Trauma Unit or Operating Room. EM residents are active members of the trauma resuscitation team, including two months as the resuscitation team captain.

What are the average number of hours per week of work for the residents?

Number of hours per week = 45-55, Length of shifts = 8-12 hours

Is resident responsibility graded?

Yes. PGY-I residents must present all cases to either staff physicians, and PGY-III or PGY-IV residents. PGY-II residents are given more responsibility: they follow their patients independent of PGY III or IV supervision and present directly to EM faculty. PGY-III and IV responsibilities include the supervision of junior housestaff and students, and the provision of more specialized consultation. PGY-IV residents are in charge of the Emergency Department, with responsibilities delegated by the on-duty DEM faculty physician.

When, how, and by whom are our residents supervised?

In the ED, all residents are supervised by DEM faculty and senior housestaff who are physically present 24 hours a day. Supervision on other services is provided by chief residents and faculty of those respective services.

Does our Emergency Department have hospital-to-ambulance or hospital-to-hospital communication systems?

UCSD Medical Center has both hospital-to-ambulance and hospital-to-hospital communication systems. Controlling over 1,000 calls per month, its Base Station is the busiest in San Diego County.

What is the proximity of the ED to X-ray? Who reads the films and when?

The Emergency Department has its own X-ray suite within the department which operates 24 hours/day. After hours, the main radiology suites (50 yards away) supply X-ray support, including computerized tomography and ultrasound. PGY-II and PGY-III radiology residents are in-house 24 hours/day and "wet-read" many Emergency Department films.

What is the availability of general lab and arterial blood gases (ABG)?

All ED laboratory tests receive first priority (with Trauma ICU) in the central laboratory services of the hospital.

What provision is made for follow-up of admitted, discharged and clinic patients?

Admitted patients will be reviewed by residents and interesting cases discussed with faculty at follow-up conferences.

All patients discharged from the Emergency Department receive written instructions, ranging from medical instructions to outpatient clinic appointments to return visits to the ED. Follow-up of air medical patients is provided through monthly case conferences.

What are our general objectives for EM training and how do we hope to achieve them?

The UCSD Emergency Medicine residency is committed to training physicians to a level of knowledge at which they are able to independently evaluate and manage the wide range of illness and injury inherent to the specialty.

This residency's philosophy will favor an interest in education, research, and critical thinking. Graded teaching and research responsibilities are provided. Workshops and journal clubs will teach methodology. Hands-on care in the prehospital environment will generate an understanding of "roadside medicine." The program will foster the leadership roles Emergency Medicine physicians must demonstrate both in the hospital and the community. A working understanding of EMS systems will derive from participation in city, county, state and national organizations. Finally, third and fourth year residents will have the opportunity to tailor the curriculum to meet their interests through elective experiences.

What is the salary and fringe benefits?

 

  • Click here for the MedEd Salary Scale
  • Chief Resident: PGY-IV salary plus $600/year
  • Fringe benefits include lab coats and lab coat laundry, meal funds, professional liability insurance for residency-related rotations, health insurance (including ophthalmology), and dental insurance. Funding for books, conferences, and other educational materials is available. The UCSD Housestaff Association provides various benefits for its members including disability insurance, financial planning referrals, legal services and referrals, and accounting service referrals.

Is the DEM involved in undergraduate, graduate, or postgraduate training?

Yes. The DEM faculty teach the "Introduction to Emergency Medicine" elective to first and second year UCSD medical students and the fourth year elective "Subinternship in Emergency Medicine."

In addition, all EM residents will become ACLS instructors and both PALS and ATLS providers by the completion of the residency. The DEM also conducts courses for nurses, other house officers, San Diego paramedics, lifeguards, the Coast Guard, Fire Department agencies, and the San Diego Police Department SWAT Team. Residents will be asked to participate in these training sessions as time permits.

Does the resident teach medical students and house officers?

All residents will actively participate in the didactic and clinical teaching of medical students and house officers.

How often do residents meet with the faculty to evaluate the residency program?

Residents as a group meet with the residency director during a dedicated one hour period on a monthly basis to evaluate the total residency program, its goals and any problems. Official minutes of each meeting are required. Formal written evaluation of each resident occurs twice a year, and residents regularly meet with their assigned faculty advisor.

How is the resident's performance evaluated?

The resident's performance is evaluated by those supervising his/her activities. A written and verbal assessment is given to the program director on a monthly basis. Formal evaluation of each resident will include both written and oral examinations. A summary of these evaluations will be communicated in writing to the resident. On at least a semi-annual basis, discussions of these results will be held between the resident and the program director. Should deficiencies be identified, plans to remedy them will be documented in writing and placed on file, and the resident's progress and improvement will be monitored at least every three months. In addition, documents of the resident's management of emergency conditions (major trauma, medical and pediatric resuscitations and emergency procedures) will be kept and reviewed periodically by the program director. Finally, should impaired residents be identified, the program director will intervene appropriately on behalf of the impaired resident, the patient, the institution, the public, and the faculty involved.

How are the faculty evaluated?

At the end of each rotation, the resident completes an evaluation of the faculty. At least annually, individual faculty members will be formally evaluated by the director of the DEM, the residency program director, and the EM residents. Review will include documentation of teaching ability, clinical knowledge, and scholarly contributions. Summaries of these evaluations will be communicated to each faculty member. The residency director is reviewed by the residents and the DEM Chairman.

How are the specific rotations evaluated?

Rotations are evaluated by the residents on paper and at meetings between the attending physicians and the program director. In addition, the curriculum is continuously evaluated by both residents and faculty. The results of these evaluations are kept on file.

What is the trauma experience like at UCSD?

The trauma experience obtained at UCSD is unique among emergency medicine residencies. It has truly become one of the strengths of the program for its diversity and variety of experience. The training is designed to provide the full spectrum of trauma care, not just initial ED stabilization. Residents will experience being the first advanced trauma provider in the field, trauma care in the ED, participation as an integral team member in a dedicated trauma unit, and providing trauma critical care in the SICU after initial stabilization. As a UCSD resident, you can become a flight physician with Mercy Air. 90% of Mercy Air’s flights are to the scene of a major trauma. You can fly Mercy Air shifts every month for the entirety of the program. Experience will be obtained in initial stabilization of trauma patients in the ED on multiple rotations through Mercy Hospital and Palomar Hospital, both regional level I trauma centers in San Diego County. Each facility sees a somewhat different patient population of trauma patients. As a PG-I resident you will rotate for a one month dedicated trauma rotation in the trauma unit. You will be an integral team member and learn a highly structured approach to the multiply injured trauma patient. As a PG-VI resident you will rotate for two months on the trauma service as a trauma senior resident. This is a unique experience for an emergency medicine resident and, as such, our residents have a continuous presence as senior resident on the trauma service and will be trauma team captain for an average of well over 100 major trauma resuscitations during this time! Additionally, you will be responsible for the ongoing care of trauma patients in the SICU after stabilization or operative intervention as the trauma team runs the intensive care unit.

What is the clinical workload like in the various EDs integrated into the residency program?

Over the past couple of years, the population of San Diego has been steadily increasing. This has reversed a slight downward trend in annual census in area EDs. At the primary training site (UCSDMC), we have been averaging from 100 – 130 patients per day, the majority of which are level 1 or 2 acute patients, and approximately 30 patients will be seen in our urgent care area which is staffed by one of our residents. We cover the acute care area of the ED with three senior ED residents over a 24-hour period, and two junior residents. The senior residents are expected to oversee, or primarily see all of these patients except for urgent care which calculates out to be approximately 25 – 30 patients per shift. The junior residents will see primarily half to two-thirds of the level 1 or 2 patients (20-25 patients per shift). At the other training sites there is typically one resident assigned per month and schedules are adjusted so little overlap occurs with residents from other services. Mercy Hospital sees approximately 45, 000 patients per year, Tri-City 48, 000 – 50,000 annually, Palomar between 42, 000 and 46, 000 per year, and Children’s Hospital approximately 30, 000 per year. The combined volume of all these ED’s integrated into the residency is over 200,000 patients per year drawing from the very diverse patient population of the entire County of San Diego. This provides a very rich clinical experience, a high degree of patient acuity, and a high per capita volume of patient pathology for each resident.

What elective rotations have residents recently completed?

UCSD Electives

  • Administration
  • Dermatology
  • EMS
  • Ophthalmology
  • Radiology
  • Research
  • Simulation Training

Non-UCSD Electives

  • Emergency Medicine, Santa Cruz La Laguna Clinic, Guatemala
  • Emergency Medicine, St. John's Hospital Bangalore, India
  • Emergency Medicine, Hopi Indian Health Care Center, Polacca, Arizona
  • Emergency Medicine, Universidade Eduardo Mondlane, Mozambique
  • Emergency Medicine, Texas Medical Center, Houston, Texas
  • General Medicine, Orota University Medical Ceneter, Eritrea, Africa
  • Obstetrics and Ultrasound, Phaplu Maternity Centre, Nepal
  • Primary Care, Yanamono Medical Clinic, Peru
  • Wilderness Medicine, Enchanted Rock State Park, Fredericksburg, Texas