Rotations

Rotations

INTERN YEAR

Orientation (University Hospital) – 4 weeks

During the month of July all 10 EM I residents rotate through the department.  Off service rotators and senior medical students are kept to a minimum to give the new interns a chance to acquaint themselves with department procedures and practices.  In addition to working 10 shifts, activities include ATLS, ACLS, and PALS certification, a tour of community health clinics, EMS/Fire day, resident manual overview, EMR and dictation training, and professional and wellness education.

Emergency Medicine (University Hospital) - 12 Weeks

EM I Emergency Medicine residents are assigned to the adult emergency department at the University Hospital for twelve weeks during their initial academic year. Residents see patients with a wide variety of chief complaints and acuity level (i.e. chest pain, syncope, abdominal pain, suicidal ideation, vaginal bleeding) and present them to senior residents and attending staff who supervise, evaluate methods, and provide instruction regarding differential diagnosis and the appropriate use of diagnostic tests. As the EM I gains knowledge and experience they may perform simple procedures such as lumbar puncture, incision and drainage of abscesses, arthrocentesis, splinting, etc. They also assist with cardiopulmonary and trauma resuscitations during their shifts.  Each month the EM I is scheduled for approximately 16 ten-hour shifts (7a – 5p, 1p – 11p, 10p – 8a), with one built in week of vacation.

Pediatric Emergency Medicine (Kosair Hospital) - 6 Weeks

EM I residents are assigned shifts at Kosair Children’s Hospital. This rotation includes four weeks during the dedicated pediatric emergency medicine month and two weeks during the split Jewish/Kosair month. Residents see patients under the supervision of Pediatric Emergency Medicine attending physicians and fellows. Scheduling is completed by the Pediatric Chief Resident and includes approximately 13 twelve-hour shifts and a vacation week during the full month (7 shifts during the half month).

Community Emergency Medicine (Jewish Hospital, Downtown) - 6 Weeks

EM I residents are assigned a total of six weeks in the Jewish Hospital Downtown Emergency Department and will work an average of 12 ten-hour shifts per month.  There is one dedicated Jewish month and one split Jewish/Kosair month.  These shifts consist of emergent patient care under the supervision of an independent practice group of ABEM-certified attending emergency physicians, all of whom are gratis faculty members, and many of whom are graduates of our residency program.  In conjunction with the scheduled clinical shifts, the resident will complete a focused EKG study with UL DEM faculty moderator, Dr. Martin Huecker.

Cardiology Critical Care - 4 Weeks

EM I residents are assigned to the inpatient Cardiology service based out of the Cardiac Care Unit (CCU).  The team includes attending faculty, fellows, a supervising senior resident, and an upper level Internal Medicine resident.  This rotation includes on-call emergency department coverage, consult evaluations, inpatient clinical responsibilities, and acute/chronic clinic educational opportunities. As a member of the CCU team, the EMI resident takes call every fourth day, and takes a week’s worth of night float coverage over the course of the month.

Medical Intensive Care (University Hospital) - 4 Weeks

EM I residents will have one month of Medical Intensive Care Unit (MICU) experience at the University Hospital where they will evaluate and assist in the managementof acutely ill and critical patients, including those requiring ventilator support and hemodynamic monitoring.  Residents are supervised by senior Internal Medicine residents, or Pulmonary/Critical Care fellows, and attending staff.  As a member of the MICU team the EMI takes call every fourth day, completing history and physical exams on patients admitted from the Emergency Department or transferred from outside hospitals.  The participate in daily work/teaching rounds and complete a week’s worth of night float coverage during the course of the month.

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 PGY-II and PGY- III OB/GYN resident. Intern coverage varies. This one month rotation includes in-patient OB/GYN clinical responsibilities for both post-partum and antenatal patients, labor and delivery, as well as supervised evaluation and treatment of female patients presenting to the specialized OB/GYN triage area.  EM I residents will have opportunities to perform vaginal deliveries, assist with Cesarean sections, and gain experience in pelvic and transvaginal ultrasounds.

Orthopedic Surgery - 4 Weeks

EM I residents are assigned to an orthopedic team that includes Orthopedic faculty, a supervising senior Orthopedic resident, and a PGY-II resident. This one month rotation includes on-call emergency department coverage, inpatient clinical responsibilities, operating room experience, and acute/chronic clinic educational opportunities.

Trauma Surgery - 4 Weeks

EM I residents rotate on the trauma service for one month and are integral members of one of two inpatient trauma teams. They assist in the operative suite as needed and perform daily pre-and post-operative assessments on patients admitted to the service. The trauma teams take call every other day and are supervised by surgery attendings, a senior surgery chief resident, and a PGY-III surgery wedge.  Trauma interns take one week of night call during which they provide cross coverage for multiple surgical services, including assessing direct admissions and ED consults.  EM I residents also assist in trauma clinic every other week.

SECOND YEAR

Emergency Medicine (University Hospital, Jewish South, Kosair Children’s Hospital) – 36 weeks

EM II residents complete nine, one month blocks of emergency medicine.  Each month the EM II is scheduled for approximately 18-20 shifts total.  The majority of the shifts are completed at University Hospital, but integrated into each month are pediatric and community emergency medicine shifts.  Pediatrics comprises 25% of the total, typically 3-4 shifts per month.  Additionally, EM II’s take approximately 2 shifts per month at Jewish South, a stand alone ED.  EM IIs have increased responsibilities in the assessment and care of undifferentiated ED patients of all acuity levels.  While at University they take turns with their EM III shift partner to direct “Room 9” trauma and medical resuscitations.  Supervision is provided by board 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”.  Four weeks of vacation time is included within these nine months.

Medical Intensive Care (VA Hospital) - 4 Weeks

EM II residents will have one month of medical ICU 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 Critical Care 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.

Surgical Intensive Care (University Hospital) - 4 Weeks

EM II residents will have one month of surgical ICU experience at University Hospital where they will be responsible for the ongoing evaluation and management of acutely injured trauma patients and general surgical critical care patients, including those requiring ventilator support and hemodynamic monitoring.   They participate in daily work/teaching rounds, perform necessary procedures, and manage the care of patients admitted from the ED or those transferred from the floor or an outside hospital that require critical care by a surgical specialist.  As with the EM I trauma surgery rotation, the EM II is again assigned to one of two inpatient trauma teams.  They work directly with a surgery PGY-2 “intensivist,” a PGY-3 wedge, and a PGY-5 chief.  The teams are supervised by Surgical Critical Care fellows and attending staff.

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 in the pediatric population, 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.

Ultrasound - 2 Weeks

EM II residents rotate under the supervision of Dr. Dan O’Brien.  Dr. Keith Cross is the pediatric emergency medicine liaison at Kosair Children’s Hospital.  This is a self-paced rotation.

 

THIRD YEAR

Emergency Medicine (University Hospital, Jewish Downtown, Kosair Children’s Hospital) - 36 Weeks

EM III residents complete nine, one month blocks of emergency medicine.  Each month the EM III is scheduled for approximately 16-18 shifts total.  The majority of the shifts are completed at University Hospital, but integrated into each month are pediatric and community emergency medicine shifts.  Pediatrics comprises 25% of the total, typically 2-3 shifts per month.  Additionally, EM III’s take approximately 1-2 shifts per month at Jewish Hospital’s downtown location.  EM IIIs have increased responsibilities, learning to manage the department as whole while balancing their patient load and teaching responsibilities. While at University they take turns with their EM II shift partner to direct “Room 9” trauma and medical resuscitations.  The EM III provides support and guidance to the EM II, interns, senior medical students, and off service rotators. Four weeks of vacation time is included within these nine months.

Administrative Emergency Medicine - 2 Weeks

EM IIIs are assigned to one month of administrative departmental duties under the supervision of Dr. Royce Coleman, the University of Louisville Emergency Department Director. The EM III will be provided coordinated opportunities to explore administrative tasks necessary for the responsive participation in, and direction of an independent group practice in 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 developed based on current needs assessment and personal interests.  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.

Elective - 8 Weeks

The EM III is allotted 8 weeks of elective experience.  A wide array of opportunities are currently available, and the department staff is more than happy to work with the EM III to coordinate and plan an elective in an area of interest if there is not one currently available.  Examples of past electives include:

  • Clinical Forensic Medicine
  • Medical Toxicology
  • Metro Search and Rescue Team (MSAR)
  • Underwater Search and Rescue
  • Radiology
  • Stroke
  • Trauma Surgery
  • Tactical Emergency Medicine Support (TEMS)
  • Ultrasound
  • Hyperbaric Medicine
  • Advanced EKG
  • Sports Medicine