During your PGY-II year you not only spend more time in the Emergency Department, you also take on a much higher degree of responsibility. You will act as the senior resident on your “team”, be responsible for responding to traumas, and caring for multiple critically ill patients simultaneously. PGY-II residents spend several months working in a variety of Intensive Care Unit settings to hone their critical care skills. Additionally, residents have their first opportunity to rotate at our community hospital counterpart.
For the senior resident (PGY-II & III) in Emergency Medicine, there continues to be graduated responsibility. The PGY-II resident learns the role of the senior by beginning to supervise medical students and interns while still maintaining excellent patient care. He or she is expected to see more patients than as an intern, and learn to handle multiple complex patients simultaneously.
Community Emergency Medicine
Rotating at St. Luke's Hospital in Cedar Rapids is an excellent opportunity to experience emergency medicine in a community setting. Your role at St. Luke's is to see patients under the supervision of your staff physician, just as you would during other emergency medicine rotations. The educational highlights of this rotation include a high volume of pediatric and high acuity patients, large amount of orthopedic emergencies, mentorship relationships with community emergency medicine physicians,and independence practicing medicine without the presence of other sub-specialty residents.The rotation at St. Luke's is certainly a favorite among residents, and offers a great deal of educational and practical experience.
Medical Intensive Care Unit
The team usually consists of an Emergency Medicine Resident, Internal Medicine Residents, and a Critical Care/Pulmonary Fellow. Call is every 5th day, where you are on with an IM resident and the Fellow. Expect to work from 7am to 5-6pm on non-call days. Yousplit takingadmissions on non-call days with the other residents until 3pm, when the call team starts taking admissions. There are teaching sessions on three week day mornings. These teaching sessions cover most of the essentials of critical care and are invaluable. Residents learn about ventilator management, vasoactive drugs, and medical resuscitations. Procedures are plentiful on this rotation including intubations, arterial lines, central lines, thoracenteses, andparacenteses.
Surgical and Neuroscience Intensive Care Unit
While rotating in the SNICU, residents manage critically ill patients from the Trauma Service, General Surgery, Neurosurgery, Cardiothoracic Surgery, Transplant Surgery, and other surgical patients. Common diagnosis include poly-trauma, intracranial bleeding, stroke, septic shock, hypovolemic shock, cardiogenic shock, respiratory distress, and hypertensive emergency. The opportunity to perform an abundance of procedures/critical skills relevant to Emergency Medicine are performed on a regular basis including: intubation (direct, glidescope, fiberoptic), central lines, arterial lines, ventilator management, tube thoracostomy, vasopressor management, and volume resuscitation. The daily schedule generally involves arriving at 6am, rounding with staff at 7am, procedures and daily work after rounds until sign out at 2pm.
While on the Obstetrics rotation, EM residents work directly with an OB-GYN faculty managing patients in active labor and those past 20 weeks of gestation. This rotation is done at St. Luke’s Medical Center in Cedar Rapids. Procedures and critical skills for EM physicians include deliveries, fetal heart monitoring, rule-out active labor work-ups, ob-gyn ultrasounds and participating in neonatal resuscitations. The rotation utilizes a day float/night float system, so there are no call days. You also get weekends off.
This two week rotation is spent with a group of cardiologists at St. Luke’s Medical Center in Cedar Rapids. The day is spent with the cardiologist on call seeing Emergency Department consults, reading ECGs, ECHOs and perfusion studies, observing stress tests, performing cardioversions and going to the cardiac cath lab. The day generally starts around 9am and ends at 5:30pm. There are no overnights or weekends. This is a great rotation for fine tuning your ECG reading skills, gaining familiarity with a variety of cardiac stress testing modalities, participating in the cath lab, performing cardioversions, and cardiac pacing!