As an EM-PA 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.
Advanced Life Saving/Introduction to Emergency Medicine
For every EM-PA 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, residents spend most mornings in incredibly informative and interactive didactics, both in the lecture hall and in the simulation lab. 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-residents. The best part: students and residents participate in a super-mega-awesome wilderness medicine race. At the end of the Advanced Life Saving month, 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 PA residents really want to be; your time to shine. In the months in the department, PA residents are assigned to a specific block of rooms along with a senior physician resident and a faculty member. While working in the Emergency Department, PA residents see patients independently and staff them directly with an attending physician. There are no restrictions on which patients are seen by the PA residents, including critically ill patients in need of resuscitation. Any procedures that need to be done on patients cared for by the PA resident are performed by the PA resident with supervision by an attending physician. As PA residents become more comfortable and competent in caring for patients in the ED, they expand their role by carrying more patients and participate in teaching other lesser experienced providers.
Pediatric Emergency Medicine
EM-PA residents spend two dedicated months 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.
During your two-weeks on Burn Surgery, EM-PA residents are in the role of an intern on any surgical team. The team consists of only a junior resident, EM-PA resident, 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. EM-PA residents 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!
EM-PA residents spend two weeks on an orthopedic surgery rotation. The bulk of time on this rotation is spent in orthopedic clinics working closely with Physician Assistants specializing in orthopedics as well as with faculty orthopedic surgeons. EM-PA residents are exposed to evaluation and management of acute injuries, hand complaints, as well as having the opportunity to practice splinting and casting techniques.
The trauma surgery rotation is an exciting opportunity for EM-PA residents to experience trauma from the point of view of the surgeons rather than the EM practitioners. EM-PA residents along with other interns 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 EM-PA residents to a broad range of patient morbidity. They are also paged to the ED whenever a trauma is set to arrive. The EM-PA residents participate in the trauma resuscitation along with surgery residents and 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 EM-PA residents 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. EM-PA residents 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.
While on the Family Medicine rotation, EM-PA residents work with a team of 3 Family Medicine residents which usually consist of one senior resident and two junior residents. Sign out typically occurs at 6:45 every morning and you discuss the events overnight with the night team. People are assigned their particular patients for whom they are responsible for and pre-round. The entire team regroups and rounds on every patient and discussed the plan for the day. The Em-PA resident is responsible for devising a plan, presenting it to the attending, and following through with the plan for the day, whether that be entering orders, placing consults, performing procedures, or discharging the patient. Daily progress notes or discharge summaries are required for every patient. After rounding and work has been completed, the Family Medicine service has a conference every afternoon for residents that focuses on teaching. If any admissions come in during the day, the EM-PA resident and junior residents typically rotate turns and are responsible for admitting the patient. This month is great for improving your knowledge of general medicine and to see what happens after a patient is admitted from the ED with different pathology.
Radiology & Ultrasound
This rotation takes place within several divisions of the UIHC Department of Radiology. EM-PA residents spend one week each on chest imaging and musculoskeletal imagining. The mornings are spent reviewing radiographs with resident and faculty radiologists. Afternoons are spent in sessions with the Emergency Medicine Ultrasound director and performing ultrasound examinations on patients in the Emergency Department.
This two-rotation allows EM-PA residents to spend concentrated time learning to interpret EKG’s. The class is taken by all medical students at the University of Iowa, as well as residents from a variety of disciplines. The course is taught by one of the staff cardiologists at the University of Iowa. When not reviewing EKG’s, PA residents spend time in the Emergency Department working on their ultrasound skills.
Surgical 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 diagnoses include poly-trauma, intracranial bleeding, stroke, septic shock, hypovolemic shock, cardiogenic shock, respiratory distress, and hypertensive emergency. The opportunities 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.