Rotations

Rotations

EM I - Emergency Medicine (University Hospital) - 14 Weeks

EM I Emergency Medicine residents are assigned to the adult emergency department at the University of Louisville Hospital for twelve weeks during the initial academic year. They are to see patients with a variety of complaints (i.e. chest pain, syncope, abdominal pain, suicidal ideation) and present them to attending staff who supervise residents, evaluate methods and provide instruction regarding differential diagnosis and the appropriate use of diagnostic tests. As they gain in knowledge and experience they may perform simple procedures such as lumbar puncture, incision and drainage of abscesses, or arthrocentesis. They assist with cardiopulmonary and trauma resuscitations during their shifts. An introduction to pre-hospital EMS is also provided.

EM I - Pediatric Emergency Medicine (Kosair Hospital) - 6 Weeks

EM I residents are assigned to Kosair Children’s Hospital. This rotation includes three weeks during the PED/ED month and two weeks during the JW of patient care in the ED under the supervision of Pediatric Emergency Medicine attending physicians and fellows. Scheduling by the Pediatric Chief Resident will include approximately six shifts per week for three weeks and one week of vacation.

EM I - Community Emergency Medicine (Jewish Hospital) - 6 Weeks

EM I residents are assigned a total of six weeks in the Jewish Hospital Emergency Department in the first year. These shifts consist of emergent patient care under the supervision of an independent group practice of ABEM certified attending emergency physicians.

EM I - Cardiology Critical Care - 4 Weeks

EM I residents are assigned to the Cardiology (CCU) Service which includes faculty, a supervising senior resident and an upper level Internal Medicine resident. The rotation is for one month at the University of Louisville Hospital. This rotation includes on-call emergency department coverage, inpatient clinical responsibilities and acute/chronic clinic educational opportunities.

EM I - Medical Intensive Care (University Hospital) - 4 Weeks

EM I - Obstetrics and Gynecology - 4 Weeks

The EM I resident is assigned to an obstetrical team that includes Obstetrical and Gynecological (OB/GYN) faculty, a senior OB/GYN resident, and a PG II and PG III OB/GYN resident. Intern coverage varies. The rotation is for one month at the University of Louisville Hospital. This rotation includes in-patient OB/GYN clinical responsibilities, labor and delivery, as well as supervised evaluation and treatment of female patients presenting to OB/GYN triage.

EM I - Orthopedic Surgery - 4 Weeks

EM I residents are assigned to an orthopedic team that includes Orthopedic faculty, a supervising senior Orthopedic resident and a PG II Orthopedic resident. The rotation is for one month at the University of Louisville Hospital and the Acute Ambulatory Care Clinics. This rotation includes on-call emergency department coverage, inpatient clinical responsibilities, operating room experience and acute/chronic clinic educational opportunities.

EM I - Trauma Surgery - 4 Weeks

EM I residents rotate on the Trauma Service for one month and are integral members of one of two teams. Their role is to perform an initial assessment of patients with minor, serious and critical surgical problems that may be of traumatic or non-traumatic etiology. They assist in the operative suite and perform daily pre-and post-operative assessments on patients admitted to the service. They follow the care of patients in the Surgical Intensive Care and Burn units and may assist with central line placement, ventilator management, arterial lines, and care or post-operative complication. They are on-call at University of Louisville Hospital every other day and are supervised by surgery attending staff, a senior surgery resident and/or fellow in trauma surgery. There is also a surgery out-patient clinic where patients from the ED are referred or where patients with less acute problems are seen and evaluated by PG I residents. Patients who have been discharged are often followed in this clinic as well.

EM II and EM III residents may elect additional trauma surgery experience.

EM I - Emergency Medical Services - 2 Weeks

EM II - Emergency Medicine (University Hospital) - 28 Weeks

EM II residents are assigned to the adult-only University Hospital Emergency Department for six one month blocks. Weekdays are covered by three 8-hour second-year shifts. Weekends are covered by two 12 hour shifts and augmented with an additional 9 hour afternoon EM II shift on Saturdays. An additional overlap hour between shifts allows for care transitions and attending teaching rounds. EM II supervision is provided by core and clinical ABEM certified attending emergency physicians. A similar complement of EM III residents scheduled in the department also provide patient care, administrative leadership, and clinical teaching under the direction of the attending physician to complete the clinical physician “team”. Additionally EM II will be assigned 25% of duty hours in the pediatric emergency department each month scheduled for EM II ULH Block.

EM II - Medical Intensive Care (VA Hospital) - 4 Weeks

EM II Emergency Medicine residents will have two months of Intensive Care Unit experience at the Veteran’s Administration Medical Center where they will be responsible for the evaluation and management of acutely ill and critical patients, including those requiring ventilator support and hemodynamic monitoring. They will have night call usually every fourth night and be supervised by the Medical Intensive Care Unit (MICU) senior residents or Pulmonary fellow and attending staff. They will make daily work and teaching rounds, perform history and physical exams, and manage the care of patients admitted from the Emergency Department or transferred from other hospitals who require intensive care.

EM II - Pediatric Emergency Medicine (Kosair Hospital) - 4 Weeks

The EM II resident is assigned 4 shifts at Kosair Children’s Hospital Emergency Department during each ULH EM month rotation. These shifts consist of patient care responsibilities in the ED under the supervision of the Pediatric Emergency Medicine attendings.

EM II - Surgical Intensive Care (University Hospital) - 4 Weeks

EM II - Emergency Medical Services - 2 Weeks

The Emergency Medicine resident is assigned to assist and participate in EMS operations during the second and third years of training. The assignments will vary based on level of training with progressive responsibility in both clinical and administrative functions. The integrated responsibilities year of training will be at the University of Louisville Hospital and Oldham County Emergency Medical Services Headquarters. The responsibilities include administrative and management duties, providing follow up to EMS providers, direct patient care in the pre-hospital setting, planning for and/or participating in multi-casualty incidents and training, providing and participating in quality assurance measures, and participate in field medical direction activities.

EM II - Community Emergency Medicine (Jewish Hospital) - 2 Weeks

The EM II resident is assigned fourteen 12-hour shifts in the Jewish Hospital Emergency Department for a one month period. These shifts consist of emergent patient care under the supervision of an independent group practice of ABEM certified attending physicians.

EM II - Pediatric Anesthesia - 2 Weeks

EM II resident is assigned to the anesthesia team at Kosair Children’s Hospital for a two week period. The team consists of the attending anesthesiologist, resident anesthesiologists, and certified registered nurse anesthetists. During this rotation, residents learn the critical skill of airway management thoroughly, including proper technique in intubation, laryngeal mask airway, and how to choose among the different pharmacologic agents in sedation and paralysis. Intravenous access issues in pediatrics will be explored. The rotation primarily includes experience in the operating room and outpatient areas with additional exposure in other units contingent on emergent patient needs.

EM II - Ultrasound - 2 Weeks

EM III - Emergency Medicine (University Hospital) - 28 Weeks

EM III residents are assigned to the adult-only University Hospital Emergency Department for seven one month blocks. Weekdays are covered by three 8-hour EM III shifts. Weekends are covered by two 12 hour EM II shifts. An additional overlap hour between shifts allows for care transitions and attending teaching rounds. EM III supervision is provided by core and clinical ABMS certified attending emergency physician presence. A similar complement of EM II residents are scheduled in the department under the direction of the attending physician to complete the clinical physician “team”. Scheduling is accomplished via Tangiers by Chief Resident, Dr. Jill Stearman. Additionally EM III residents will be assigned 25% of duty hours in the pediatric emergency department each month scheduled for EM III ULH Block.

EM III - Community Emergency Medicine (Jewish Hospital) - 4 Weeks

The EM III resident is assigned fourteen 12-hour shifts in the Jewish Hospital Emergency Department for a one month period. These shifts consist of emergent patient care under the supervision of an independent group practice of ABEM certified attending physicians.

EM III - Pediatric Emergency Medicine (Kosair Hospital) - 4 Weeks

The EM III resident is assigned 4 shifts at Kosair Children’s Hospital ED during each ULH EM month rotation. These shifts consist of patient care responsibilities in the ED under the supervision of the Pediatric Emergency Medicine attending physicians and fellows.

EM III - Administrative Emergency Medicine - 2 Weeks

EM III are assigned to one month of administrative departmental duties under the supervision of Dr Royce Coleman, the University of Louisville Emergency Department Director. EM III will be provided coordinated opportunities to explore administrative tasks necessary for the responsive participation in and direction of an independent group practice of emergency medicine, as well as operational leadership issues within a hospital’s ED.

The EM III meets with Dr Coleman prior to the month to obtain specific assignments, meeting dates, and discuss expectations. An administrative project is negotiated with Dr Coleman based on current needs assessment and personal interests.

EM III EMS administrative duties are additionally completed during this month, coordinated through Dr Price, Dr O’Brien and Dr Orthober.

The EM III also serves as clinical shift back-up coordinator and may be called upon to cover an ED shift in case of emergency; therefore, for planned leaves during this month a cross-cover EM III shall be identified to the Program Director and Chief Residents by their notation on the “official” calendar on Walleen’s desk.

EM III - Emergency Medical Services - 2 Weeks

The Emergency Medicine resident is assigned to assist and participate in EMS operations during the second and third years of their training. The assignments will vary based on level of training with progressive responsibility in both clinical responsibility and administrative functions. Integrated responsibilities year of training at the University of Louisville Hospital and at the Oldham County Emergency Medical Services Headquarters. The responsibilities include administrative and management duties, providing follow up to EMS providers, direct patient care in the pre-hospital setting, planning for and/or participating in multi-casualty incidents and training, providing and participating in quality assurance measures, and participate in field medical direction activities.

EM III - ELECTIVE - 8 Weeks

Elective - Clinical Forensic Medicine

A one month elective is offered to Emergency Medicine residents in the EM III year. The resident will be under the supervision of the Chief Medical Examiner for the State of Kentucky and staff/or Dr. Smock. The clinical setting will be the morgue, Medical Examiner Office and accident/crime scene.

Elective - Medical Toxicology

A two week or one month elective is offered to Emergency Medicine residents. The resident will be under the supervision of the Medical Director of the Kentucky Regional Poison Center and will be stationed there from 8 am – 4 pm Monday through Friday.

Elective - Metro Search and Rescue (MSAR) Team

EM III Emergency Medicine residents elect this rotation under the supervision of Dr. Dan O’Brien in the Department of Emergency Medicine. This elective experience is integrated over the course of the residency, and involves self-study, quarterly training, and the experiential assignment to a local search and rescue platoon (MSAR) within the framework of FEMA’s Incident Command System (ICS). On-call time is required and is shared among the participants. On-call response shall not interfere with other clinical or academic assignments of the residency.

Elective - Radiology

EM III Emergency Medicine residents elect this rotation under the supervision of faculty in the Department of Radiology. This rotation is for one month at the University of Louisville Hospital, with primary education occurring in the Radiology Department. Schedule is Monday through Friday, 8:30 am until released by faculty.

Elective - Stroke-Neurology

EM III resident will have a unique one month experience in the specialized Neuro-Intensive Care Unit at University of Louisville Hospital where they will be responsible for the both the initial evaluation and subsequent ICU management of patients with acute, critical care neurologic and non-traumatic neurosurgical problems, including those requiring ventilator and intra-cranial hemodynamic monitoring as part of a multi-disciplinary team of stroke neurologists and specialized neuro-anesthesiologists at the region’s only Comprehensive Stroke Center.

The EM resident will take stroke team call daily 8am-5pm with the team’s Director, Dr Remmel, and be responsible for the rapid assessment, stabilization, diagnosis, and management of hospital consulted, inter-facility transferred, and emergency department patients with signs or symptoms of impending, acute or sub-acute stroke from their initial presentation through discharge. In addition to performing complete history/physicals and goal-directed neurologic examinations, the EM resident will apply advanced neuro-diagnostics, arrange/assist with providing medical and/or interventional treatments, admit, and provide continuity critical care into the neuroscience ICU. They will make daily work rounds on their patients and participate in teaching rounds and conferences with the attending stroke neurologist and neuroscience critical care anesthesiologists. Exposure to current stroke research trials as well as an inside view of a very successful comprehensive multi-disciplinary center of excellence will be provided.

Elective - Tactical Emergency Medicine Support (TEMS)

This will be a one-month rotation of tactical Emergency Medicine, offered as an elective in the EM III year. Rotation responsibilities will be spread out over the course of a full month. The rotation has a time commitment of 150 hours.

Elective - Ultrasound

EM III Emergency Medicine residents elect this rotation under the supervision of Dr Mary Nan Mallory in the Department of Emergency Medicine. This self-paced rotation is for one month at the University of Louisville Hospital, with primary education occurring in the Emergency Department. Other educational sites include the hospital’s ultrasound suite and the ambulatory care OB/GYN ultrasound suite in an attached office building.

Elective - Mastering the EKG