Emergency Medicine Curriculum

Interns spend five and a half months in the Emergency Department beginning with a month-long orientation. The remainder of the first year is spent outside of the Emergency Department developing the broad knowledge base needed to become a successful emergency physician.

In the PGY-2 year, residents spend eight months in the Emergency Department along with one-month of Pediatric Emergency Medicine at Valley Children’s Hospital, one-month of Trauma ICU, one-month of EMS/Toxicology/Palliative Medicine and one-month of Orthopedics.

In the PGY-3 year, residents are in the Emergency Department for seven and a half months. The remainder of the third year is spent completing two-weeks of Toxicology consults, one-month of Trauma ICU, one-month of Medical ICU, one-month at a Community Selective site and one-month of Elective.

During their last year, residents spend approximately six-months in the Emergency Department. PGY-4 residents could spend up to 10 months in the Emergency Department depending on their Area of Concentration (AOC) and Elective. Some AOCs are completed in blocks, whereas others are longitudinal.

PGY2-4 residents complete between 140-145, 9-10 hour shifts per year.

Rotations during the first year are completed in two or four-week blocks. PGY2-PGY4 rotations are completed in month-long or 2-3-week rotations or longitudinally.

Residents have four weeks of vacation and educational leave each year.

Tell me about the rotations outside the ED.

Anesthesia: Interns will rotate for one four-week block in the operating room under the direct supervision of anesthesiology attendings and certified registered nurse anesthetists. This rotation will develop airway management skills, familiarity with pharmacological agents used in anesthesia and requisite knowledge of airway anatomy. It is also a great opportunity to practice IV placement.

Cardiology: Interns will assist in the management of patients admitted to the cardiology service and in providing cardiology consultations throughout the hospital on this two-week rotation. There are opportunities to observe and discuss echocardiography in the echo lab. 

Community Emergency Medicine Selective: During PGY-3, our residents choose between three community Emergency Depatments to complete a month-long rotation.  Residents can choose to work at either Kaiser, Clovis Community Medical Center (CCMC) or California Pacific Medical Center (CPMC) at Mission Bernal.

Emergency Medical Services (EMS): During the PGY-2, residents spend one month participating directly with our four county EMS system. This month is coupled with an outpatient toxicology experience at the Poison Control Center in Madera and inpatient palliative medicine consults at CRMC. Each resident has already taken the base hospital course at the beginning of the PGY-2 and is very familiar with on-line medical control. Community Regional Medical Center (CRMC) is a paramedic and parkmedic base station. Approximately 1,250 paramedic radio calls are handled monthly. The Department of Emergency Medicine is actively involved in the training and supervision of paramedics and parkmedics. Emergency Medicine residents play an active role in this process. Members of our faculty serve as Medical Directors for the Fresno County and Madera/King Counties EMS system, the Sequoia/Kings Canyon Parkmedic Program, and the local helicopter program. This rotation is designed to allow a flexible schedule with a wide diversity of activities. The resident will gain a broad experience in EMS and work one on one with faculty in quality improvement and assurance, incident review, parkmedic training, disaster medicine and teaching. This month also includes mandatory paramedic ambulance ride-along time that totals 24 hours.

Elective Time: There is a one-month elective during both PGY-3 and PGY-4. The elective time can  be deployed longitudinally. Common  electives for PGY-3 and PGY-4s are listed below and we welcome novel ideas for electives.

Medical ICU: During the PGY-3 year, the resident spends one month managing patients in the MICU under the supervision of fellows and Pulmonary / Critical Care and Emergency Medicine / Critical Care faculty. They often serve as supervisors / educators for critical care procedures.. There are no overnight call responsibilities.

Medicine Wards: Interns will spend two-weeks on the Medicine Ward Service and will be responsible for patients admitted to the team on that resident’s admitting day.Residents are supervised by Internal Medicine attending physicians and residents on the service.

Observation Medicine: Interns will spend two-weeks in the Emergency Medicine Observation unit.  The resident will help to identify patients in the Emergency Department who are appropriate candidates for ongoing care in the Observation Unit and manage their care on the unit.

Obstetrics & Gynecology: During the intern year, residents spend 1 week in gynecology clinic and 3 weeks in labor and delivery.  On L&D the resident will work with the night float team Friday-Monday nights and manage patients from observation through delivery. While in the GYN clinic, residents will evaluate patients with obstetric and gynecologic problems and frequently see patients following up from the Emergency Department.

Orthopedic Surgery: Each resident spends one month during their second year covering Orthopedic Surgery consults for the Emergency Department. The resident also sees patients in ortho clinic. There are no call responsibilities.

Pediatrics: We see a large number of children in our Emergency Department at CRMC that is growing day by day. Interns rotate in our outpatient pediatric clinic. During the PGY-2, residents work 16 shifts in the Emergency Department at Valley Children’s Hospital. In the fourth year our residents serve as the senior resident in the PICU and NICU at CRMC.

Trauma Surgery: Each resident spends one month during the first, second and third years on the trauma surgery service. The service, in general, consists of two interns, one rotating PGY-2 or PGY-3 Emergency Medicine resident, the trauma chief resident, and the surgical attending. The Emergency Medicine resident functions as an integral member of the trauma surgery team. This tends to be a very busy rotation that is on a nightfloat system. There are many opportunities to lead resuscitations and perform procedures such as central and arterial line insertions, and chest tube placement

Toxicology: PGY-2 and PGY-3 residents participate in toxicology rotations. The PGY-2 experience is coupled with our EMS rotation. Residents will have didactic sessions with California Poison Control as well as case discussions. The PGY-3 toxicology rotation is 2 weeks long and based at Community Regional Medical Center. It includes direct patient care of poisoned patients, bedside teaching rounds, regular didactic sessions.

Ultrasound: The intern rotation is designed to introduce the use of point of care ultrasound in the Emergency Department. Residents will receive hands-on training as well as a variety of didactics to learn the basics of emergency ultrasound. Residents will complete required readings and lectures to develop background knowledge in each of seven core areas of emergency ultrasound including EFAST, renal, aorta, biliary, cardiac, OB pelvic, and procedural. They will be given autonomy to practice and develop their ultrasound skills, scanning patients both with real time supervision and independently. Senior residents on the Advanced Emergency Ultrasound Rotation will be available for a portion of their shifts to provide expertise and mentorship.