As a PGY-I Emergency Medicine resident, you spend time both in the Emergency Department learning the basics of Emergency Medicine, and additionally spend time on a variety of other services to learn skills essential to the practice of Emergency Medicine.
Introduction to Emergency Medicine / Advanced Life Support
For every new resident, the first month of residency at the University of Iowa is spent together on an introduction to emergency medicine rotation called Advanced Life Support. During this month, interns spend most mornings in incredibly informative and interactive didactics, both in the lecture hall and in the simulation lab. They are also assigned to 8 shifts in the Emergency Department to allow them to get to know the department, the faculty and nurses, and the way around the hospital. This rotation is a great balance between getting accustomed to the hospital and life as a resident at UIHC, while still allowing for some free time to get settled into a new town and to get to know your co-interns. The best part: students and interns participate in a super-mega-awesome wilderness medicine race. At the end of the Advanced Life Saving month, first year residents participate as medical support in the Register's Annual Great Bike Ride Across Iowa (RAGBRAI) by riding along with the 4 ambulance crews.RAGBRAI is an annual event with 15,000-20,000 riders traveling from the Missouri to the Mississippi Rivers across the state over one week. It is a great time for learning field medicine, making independent treatment decisions, and getting to know our EMS colleagues. It is definitely one of the highlights of residency and really makes Iowa's program unique.
This is where interns really want to be; your time to shine. In the months in the department,interns are assigned to a specific block of rooms along with a senior resident and a faculty member. Senior residents are assigned to go to any incoming trauma, but otherwise interns are encouraged to see any cases that they want. Patient load in the department can be daunting at times, but it is stressed that the job of the interns is to learn, not to move patients through the department. Typically, if the senior residents are comfortable performing procedures and have reached their goal, the interns are then sought out to perform the procedures. This is a great learning experience all around!
Pediatric Emergency Medicine
Residents spend one dedicated month seeing only pediatric patients in the Emergency Department. Residents work most often one on one with an attending, making this a great learning experience. Residents are exposed to many “bread and butter” pediatric patients, but also complex ones being a tertiary referral center. Residents have the opportunity to perform a number of different pediatric procedures including procedural sedation, foreign body removal, laceration repair, and lumbar punctures. During these months residents participate in pediatric traumas. There are also dedicated Pediatric didactic sessions throughout this month.
This rotation is located at the VA Hospital adjacent to the main UIHC complex. Residents work on one of the general, internal medicine teams providing care to medicine ward and intensive care unit patients.Teams are composed of a staff physician, a senior resident, two interns, and students. “Long Call” is currently Q3 with the interns alternating between day call and night call, making overnight call Q6 for interns. This rotation provides the opportunity to learn to care for many common ED medical pathologies and gain perspective on how to better help internal medicine services from the ED. The fact that residents get to manage not only general floor patients, but also ICU patients makes this a very valuable month. This busy service also helps residents to further develop time-management, task-prioritization, teamwork, and educational skills that apply directly to EM.
The trauma surgery rotation is an exciting opportunity for EM interns to experience trauma from the point of view of the surgeons rather than the EM practitioners. There are two interns on the service, and they are responsible for handling floor calls for the trauma patients, ranging from medication checks to wound care to acute decompensation of patients on the team. The patient population is typically split about equally between the SNICU and the floor, exposing the interns to a broad range of patient morbidity. They are also paged to the ED whenever a trauma is set to arrive. The EM interns participate in the trauma resuscitation along with surgery residents the EM residents working in the emergency department. There is a small component of clinic work seeing follow-up patients, but this is typically quite straight-forward and there is a dedicated trauma nurse-practitioner who sees many of the patients in clinic. The hours are typical of a surgical service, running from 5:30am–6:30pm on weekdays with shorter hours rounding on the weekends, but interns do get 2 full weekends off during the month-long rotation with no patient care responsibilities. The weekly trauma conference is an excellent learning experience, and the topics presented frequently overlap with EM issues and practice. Interns also attend surgery grand rounds and M&Ms, which are also great for learning. All in all, the month is filled with remarkable educational experiences which help to hone skills necessary for working with traumas in the Emergency Department.
Emergency Medicine Residents work as an integral part of the Orthopedic Trauma Team. The block is split into tow halves, giving the residents a well-rounded exposure to orthopedic emergencies. During one half of the rotation, residents are members of the orthopedic trauma service. Residents are expected to attend daily morning conferences, which can be very educational. You carry the Orthopedic pager and take calls on inpatients and Emergency Department consults during the day. When not busy with consults, you will work in the Clinic. There are some OR opportunities if you so desire. During the other half of the rotation, residents work on the orthopedics night float team. This team is responsible for seeing all of the orthopedics consultations, both in the Emergency Department, as well as other inpatient units. Residents gain a broad exposure to not only traumatic orthopedic emergencies, but also infection, pediatric, joints, and spine cases. The most valuable experiences of the rotation include gaining experience casting, splinting, fracture and dislocation reductions, as well as fine tuning exam skills.
This rotation takes place within several divisions of the UIHC Department of Radiology. Residents spend one week each on neuro-radiology, body imaging, chest imaging, and musculoskeletal imagining.This is one of the more relaxed months of the year with weekends free and time for self-directed learning.Residents often take one of their vacation weeks during this rotation.The condensed repetition of exposures to both normal and abnormal imaging alongside of resident and staff radiologists helps to develop essential reading skills for application in the ED.Another important benefit of this rotation is that EM residents gain additional insight into how to more effectively and efficiently communicate with our radiology partners.
During the month on anesthesiology, interns are assigned to one OR for the day. Usually they will be working with a CRNA, but at times they may be with an anesthesiology resident. Most often, EM interns are allowed to manage the airway while starting a case. First case start is at 7:15am or 8am, and arriving 20-30 minutes before case start to get to know the patient is advised. There are no weekend duties on this rotation. This month is a great time to perform as many intubations as possible and to get to be an expert at bag-valve-masking patients.
During your month on Burn Surgery, EM interns are in the role of an intern on any surgical team. The team consists of only a junior resident, EM intern, and possibly another co-intern from another service. Rounding is dependent on staff and patient load, but rounding usually starts around 6:15am with first OR cases starting at 7:15am. Interns are allowed and encouraged, if they choose, to split time with the other residents scrubbing in to surgery, and typically are allowed to do as much of the surgery as they desire. On the floors, time is spent managing patients and writing notes. No worries about not knowing all of burn management right off the bat: nursing staff is very knowledgeable and helpful and will direct you as needed.The exact day-to-day task performed is dependent on the junior surgery resident. This is a great month to help manage very sick patients and to get some time operating!
Residents spend two weeks working with our Cardiothoracic Surgeons. The primary goal of this rotation is to give the Emergency Medicine Residents an opportunity to place a large number of chest tubes under the supervision of the Cardiothoracic Surgery Staff. Residents also have the opportunity to learn a great deal about the management of thoracic disease including pneumothoraces, hemothoraces, aortic dissections and others.