Welcome to the Adult Emergency Medicine R3+ Rotation

Description

The Adult Emergency Medicine R3+ rotation, based at TCH Emergency Department, is the second and final ED rotation in residency, fulfilling the ACGME requirement for Family Medicine residents of 200 total hours in the E.R. Residents work day-shifts for week one and night shifts for week two (schedule below). In both weeks, residents should work 1:1 with an A-pod attending. In both weeks, residents should let C-pod (fast track/urgent care) PAs/NPs know when you’re there, so they can call you for any procedures, such as suturing, I&D, splinting, or eye trauma. (The curricular emphasis for this rotation is the topic of “urgent care” since we do not have residency space for a true urgent care rotation due to ACGME requirements.)

Because you are “extra” in the E.R., you are encouraged to use your time to direct your learning toward areas of greatest need for you. Dive deeper into cases. Bring readings/laptop for module work if you have downtime. If you would like to practice POCUS, tell your attending at the beginning of the shift and ask them to page you if they have a POCUS opportunity and schedule a 2-hour 1:1 session with Dr Henkel. Please scroll further down for Tips.

Prior to the rotation, please review the curriculum including the list of topics to focus on during the rotation. Please note, there is a required quiz to complete during the month (see below) along with required reading. Dr. Steve Lewis is the specialty lead for the rotation. If you have any questions, please do not hesitate to contact your faculty oversight..

Urgent Care Curriculum                            Urgent Care Quiz

Tips for TCH Emergency Department

  • At the beginning of your shift, check in with attendings at A-Pod and work 1:1 with one of them. Let them know of your interest in POCUS scans. If an IM resident is on, be collegial and flexible—introduce yourself and plan to share mutually good cases/findings. Also check-in with C-pod to ask them to page you with procedures.

  • Own the work flow! You can place orders, order meds, start procedures, do the I&D, etc. If you have any questions during workup, ask the attending but they are generally fine with you doing the workup and staffing just before you discharge to ensure everything is correct.

  • Bring your procedure notepad. Not all attendings respond to Med Hub so logging your procedures with this is helpful

  • Consider signing up for M-Modal Dictation. Most of the providers in urgent care and ED use this and it is very helpful. To do so, call IT help desk and they will help you submit a SARF (just an inhouse form for electronic access to things). You can select Jennifer Reemtsma in the GME office as your TCH contact to grant you permission. After this is processed (can take about 1-2 days), you will get an email with directions how to set up M-Modal!

  • On your first day (as well as on every shift), get to the ED a few minutes before the start of your shift and introduce yourself to the attending who you will be working with that day. It is also important to introduce yourself to the provider who is covering the Fast Track (see above tip). Tell the provider each shift what your goals are and what type of patients and procedures you are looking for and they will steer things towards you!

  • If you want to practice POCUS, many of the attendings are trained in this—let them know you’d like to be paged if they are doing a scan (or would like your help getting one done)—here’s a suggested checklist of scans to try to do during your rotation. Dr David Henkel, who completed an ER-POCUS Fellowship, is also willing to volunteer 2 hours to teach any resident during their rotation if he is available—this is highly encouraged(!) but you have to arrange it with Dr Henkel: Please contact him directly to arrange (email/cell). (You are allowed and encouraged to do this during one of your already-scheduled shifts.)

Schedule

One month prior to the rotation, the resident will be sent a schedule from Judy. Each resident must complete shifts based on the number of hours needed to complete their ACGME Adult Emergency Medicine 200-hour requirement for residency.

The general schedule is as follows:*

WEEK ONE: (DAYS)*

  • 10-HOUR SHIFTS: 12:00pm-10:00pm: Tu, W, F, Sa, M (5 SHIFTS = 50 HOURS)*

  • 7-HOUR THURSDAY SHIFT: 5:00pm-12:00am: Th (1 SHIFT = 7 HOURS)

  • 2-HOUR POCUS 1:1: 10:00am-12:00pm: Tu (2 HOURS)

  • 4.5-HOUR THURSDAY DIDACTICS: 12:30pm-5:00pm: Th (4.5 HOURS)

WEEK TWO: (NIGHTS)*

  • 9-HOUR NIGHT SHIFTS: 10:00pm-7:00am: Tu, W, Th, F, Sa (5 SHIFTS = 45 HOURS)*

  • 4.5-HOUR THURSDAY DIDACTICS: 12:30pm-5:00pm: Th (4.5 HOURS)

*NOTE: 2021-22 R3s-R5s who completed a 1-month rotation in UCMC ER do not require as many hours in this rotation to meet the ACGME 200-hour requirement. Judy will let you know your required scheduled, typically 4 shifts per week (Wk 1 Days: Tue-Fri; Wk 2 Nights: Mon-Thu).