Emergency Medicine Residency Manual

Transcription

1 Emergency Medicine Residency Manual 2017 Edition

2 Table of Contents VCU Equal Opportunity Policy 4 VCUHS Campus Map 5 Program Leadership Contact Information 6 Program Administrative Leadership Contact Information 7 Chief Residents 8 Department Leadership 9 Faculty 10 Fellows 15 Current Residents 16 EM/IM Program 19 Goals of Residency 20 Rules of Residency 20 Program Accreditation 21 Milestones 22 Clinical Learning Environment Review (CLER) 34 EM response to CLER 36 Expectations of Residents 37 Advancement 38 Year Specific Goals and Objectives 39 Grounds for Dismissal 40 Evaluation of Residents 41 Faculty Advisors 42 Vacation 43 Illness 44 Resident Tardiness 45 Didactic Conference 46 Conference Attendance 47 Professionalism 51 PEA Accounts 52 Travel 53 Travel Checklist 54 Moonlighting 56 Duty Hours 58 Procedure and Resuscitation Logs 59 Follow Up Logs 60 Scholarly Activity Requirements 61 Progressive Responsibilities 62 Chief Resident Position 62 2

3 Non VCUHS rotations 65 Wellness 68 Common websites 70 Education Curriculum 71 Switch Dates Longitudinal Tracks 73 SEPARATE DOCUMENTS EM1 Rotation Goals and Objectives EM2 Rotation Goals and Objectives EM3 Rotation Goals and Objectives Electives Policies 3

4 Affirmation of VCU s Equal Opportunity Virginia Commonwealth University is a comprehensive, public university whose mission is to provide a fertile, stimulating environment for teaching, learning, research, comprehensive medical care and service; to promote the pursuit of knowledge; and, to disseminate professional skills. Virginia Commonwealth University will maintain a strong commitment to outstanding achievement, educational excellence and high principle. Activities of the university are designed to promote the continuing policy of providing equal opportunity for employment and educational access to all programs and services without regard to race, color, religion, national origin, age, sex, political affiliation, veteran status, genetic information, sexual orientation, gender identity, gender expression, or disability. Noncompliance with this policy may result in disciplinary action up to and including termination. VCU supports an environment free from retaliation. Retaliation against any employee who brings forth a good faith concern, asks a clarifying question, or participates in an investigation is prohibited. Office of Equity and Inclusion Office of Multicultural Student Affairs 4

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6 Program Leadership Program Director Joel Moll, MD (804) Cell (804) Office Pager 6731 Associate Program Director Peter Moffett, MD (609) Cell (804) Office Pager 3173 Assistant Program Director Steve Miller, DO (804) Cell (804) Office Pager 1701 Assistant Program Director Clerkship Director Nate Lewis, MD (804) Cell (804) Office Pager

7 Program Coordinator Kevin Keller (804) Cell (804) Office Clerkship Coordinator Fellowships Coordinator Emily Deskin (804) Office Program Administrator Sharon Fleming (804) Office 7

8 Chief Residents Mike Billet, M.D. Medical school: University of Virginia Schedule Cell: (757) Pager: 7264 Drew Clare, M.D. Medical school: Trinity Academics Quality Improvement Cell: (757) Pager: 7290 Richard Zhang, DO Medical school: Lake Erie College of Osteopathic Medicine Recruitment Cell: (757) Pager: 7538 Chief on-call pager (urgent needs):

9 Department Leadership Academic Chair Chief of Service EM VCUHS Joseph P. Ornato, M.D., FACP, FACC, FACEP Department Chairman Professor, Division of Emergency Medical Services Medical Director, Richmond Ambulance Authority Harinder Dhindsa, M.D., M.P.H., M.B.A., FACEP, FAAEM Associate Professor and Associate Chair Chief of Emergency Services Operations Medical Director, LifeEvac Division Chiefs EMS Pediatric EM Toxicology Observation Medicine Harinder Dhindsa, M.D., M.P.H., M.B.A., FACEP, FAAEM Associate Professor and Associate Chair Chief of Emergency Services Operations Medical Director, LifeEvac Harinder Dhindsa, M.D., M.P.H., M.B.A., FACEP, FAAEM Associate Professor and Associate Chair Chief of Emergency Services Operations Medical Director, LifeEvac S. Rutherford Rose, Pharm.D., FAACT Professor Chair, Division of Clinical Toxicology Director, Virginia Poison Center Pawan Suri, M.D. Assistant Professor Director, Internal Medicine-Emergency Medicine Residency Chair, Division of Observation Medicine 9

10 Faculty Taruna Aurora, M.D. Assistant Professor, Division of Observation Medicine Co-Director, CDU Aline Baghdassarian, M.D., M.P.H Assistant Professor, Division of Pediatric Emergency Medicine R. Wayne Barbee, Ph.D. Professor Samuel Bartle, M.D. Assistant Professor, Division of Pediatric Emergency Medicine Judith Barto, M.D. Assistant Professor, Division of Pediatric EM Chris Bradshaw, MD Assistant Professor Adam Bullock, MD Division of Pediatric Emergency Medicine Francis Chuidian, M.D., M.B.A. Assistant Professor Bryan Clark, D.O. Clinical Instructor Angela Creditt, DO Assistant Professor Kirk Cumpston, D.O. Associate Professor, Division of Clinical Toxicology Medical Director, Virginia Poison Center Harinder Dhindsa, M.D., M.P.H., M.B.A. Associate Professor and Associate Chair Chief of Emergency Services Medical Director, LifeEvac 10

11 Lisa Dodd, D.O. Clinical Instructor David Evans, M.D., RDMS, RDCS Associate Professor Director of Ultrasound V. Ramana Feeser, M.D. Assistant Professor Quality Director Jeffery Ferguson, M.D. Associate Professor Director, EMS Fellowship Robin Foster, M.D., Associate Professor Division of Pediatric Emergency Medicine Carmen Foster, M.D. Assistant Professor Paulo Gazoni, M.D. Assistant Professor Danielle Gong, M.D. Assistant Professor Christopher Hogan, M.D. Associate Professor Michael Joyce, MD Assistant Professor Nathan Lewis, M.D. Assistant Professor Director, Student Clerkship Assistant PD Adam MacLasco,PharmD 11

12 David Martin, M.D. Assistant Professor Stephen Miller, D.O. Assistant Professor Assistant Program Director Peter Moffett, M.D. Assistant Professor Associate Program Director Joel Moll, M.D. Associate Professor Residency Director J. Rene Morrissey, M.D. Assistant Professor, Division of Observation Medicine Jessica Morton, M.D. Assistant Professor Tammy Nguyen, PharmD, BCPS Clinical Pharmacy Specialist, EM Clinical Asst Professor, School of Pharmacy Patrick Oliver, M.D. Clinical Instructor Joseph P. Ornato, M.D. Chairman, Professor, Medical Director, Richmond Ambulance Authority Beth Perdue, M.D. Clinical Instructor Christopher Pruitt, MD Assistant Professor Renee Reid, M.D. Assistant Professor 12

13 Joe Romano, MD Assistant Professor, Division of Observation Medicine S. Rutherford Rose, Pharm.D. Professor, Chair Division of Toxicology Director, Virginia Poison Center Jeremy Sauer, M.D. Assistant Professor Director, VCUHS Transfer Center Mahendra Shah, M.D. Assistant Professor, Division of Pediatric Emergency Medicine Pawan Suri, M.D. Assistant Professor IM/EM Residency Dir Chair, Observation Medicine Lindsay Taylor, M.D. Assistant Professor Jordan Tozer, M.D. Assistant Professor Michelle Troendle, M.D. Assistant Professor Matt Tymowski, M.D. Assistant Professor Michael Vitto, DO Director of Simulation Assistant Professor Brandon Wills, D.O. Associate Professor, Division of Toxicology Director, Toxicology Fellowship Virginia Poison Center Julie Winkle, M.D. Associate Professor 13

14 Christopher Woleben, M.D. Associate Professor, Division of Pediatric Emergency Medicine Associate Dean of Student Affairs, School of Medicine Allen Yee, M.D. Assistant Professor, Division of Emergency Medical Services Operational Medical Director, Chesterfield County Fire EMS Indicates Core Faculty Frank Zwemer Jr., M.D., M.B.A. Associate Professor and Hunter Holmes McGuire VA Medical Center 14

15 Fellows Amir Louka EMS Stephanie Louka EMS Ashley Litchfield Pediatric EM Dee Willis Pediatric EM Jessica Gertz Ultrasound Jason Jennings Ultrasound/Resuc Cindy Oliva Ultrasound/Resuc 15

16 Current Residents Class of 2020 Chris Carpenter Univ of Mississippi Mike Chiappone Midwestern Univ Shane Davis Univ of South Carolina Kevin Gould United Services Grace Hickam VCU Emily Kershner VCU Brendan Mahon Rowan Jacob Moyer VCOM Landon Mueller UAB Aaron Surrey George Washington Jake Wayman VCU JC Wiggins UVA 16

17 Class of 2019 Aaron Borgmeyer Univ Missouri Sean Brooks VCU Sarah Foster VCU Jenny Harris VCOM Tim Layng VCOM Cyrus Massouleh UAB Joey Mazzei PCOM Sean Mlodzinski UVA Chas Schall Lake Erie Greg Wilhoite Nova Lauren Wingfield Univ South Carolina 17

18 Class of 2018 Michael Billet UVA Lance Beier UC Davis Michael Brown VCOM Drew Clare Trinity Brian Dye St George s Stephen Ferraresi Florida International Steve Grodman UNC Syed Hasan VCOM Kacie Sweat Mercer Richard Zhang Lake Erie 18

19 EM/IM Program Pawan Suri, MD EM/IM Program Director PGY1 PGY2 PGY3 PGY4 PGY5 Burke Best EVMS James Humble Univ Tennessee Kyle Taylor Univ South Alabama Lety Flores Univ Michigan Michael Carter MCG Bex Goodwin Univ of Washington Zach Zemore VCU Alan You Univ Alabama Nina Vitto VCU Vinny Gopaul Univ Maryland 19

20 Goals of the Residency Program The Program Requirements for Residency Education in Emergency Medicine includes the following paragraph regarding the general characteristics of accredited residency programs and the goals of EM residency training: Residencies in emergency medicine prepare physicians for the practice of emergency medicine. These programs must teach the fundamental skills, knowledge, and humanistic qualities that constitute the foundations of emergency medicine practice. These programs provide progressive responsibility for and experience in these areas to enable effective management of clinical problems. Residents must have the opportunity, under the guidance and supervision of a qualified faculty member, to develop a satisfactory level of clinical maturity, judgment, and technical skill. On completion of the program, residents should be capable of independent practice of emergency medicine, able to incorporate new skills and knowledge during their careers, and able to monitor their own physical and mental well-being. The Virginia Commonwealth University Department of Emergency Medicine believes that residency training must prepare graduates to: 1. Provide the recognition, resuscitation, stabilization, evaluation, and care of the full range of patients who present to the Emergency Department (ED). 2. Arrange appropriate admission, follow-up or referral as required. 3. Manage the pre-hospital care of the acutely ill or injured patient. 4. Participate in the administration of the emergency medical service (EMS) system providing pre-hospital care. 5. Provide appropriate patient education directed toward the treatment and prevention of illness or injury. 6. Engage in the administration and teaching of EM. 7. Understand and evaluate research methodologies and their application. In evidence based practice improvement Rules of Residency Program In addition, because we recognize the environment and circumstances in which residency training takes place we have the following residency rules: 1. Be good to your patients 2. Be good to yourself 3. Be good to those who love you and who you love 4. Be good to each other 5. Be good to your muse 20

21 Program Accreditation Your residency program is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). The ACGME defines the following core competencies: Patient Care (PC) --residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Medical knowledge (MK)--residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient. Practice-Based Learning and Improvement (PBL)--residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Interpersonal and Communication Skills (ICS)--residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Professionalism (P)--Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Systems-based practice (SBP) -- Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. In 2012, the ACGME started the Next Accreditation system which contain residency milestones. The concept is that they milestones are sub competencies of the above core competencies and thus can quantify your progression throughout your education. There are 23 milestones, as described below. These will serve as your semi-annual report card to the ACGME on your progress in the residency program, and will be reviewed with you at your semi-annual evaluation. The overriding goal of this residency program is to allow you to become the best EP that you can be. While the faculty is committed to helping you achieve this goal, the ultimate responsibility for your education lies with you. What you accomplish will depend largely on your dedication and resilience in pursuing the opportunities that are presented to you, the number of patients you examine, the number of conferences you attend and the amount of reading you do. 21

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33 Milestones can be found at: 33

34 Clinical Learning Environment Review (CLER) CLER Program Overview As a component of its next accreditation system, the ACGME has established the CLER program to assess the graduate medical education (GME) learning environment of each sponsoring institution and its participating sites. CLER emphasizes the responsibility of the sponsoring institution for the quality and safety of the environment for learning and patient care, a key dimension of the 2011 ACGME Common Program Requirements. The intent of CLER is to generate national data on program and institutional attributes that have a salutary effect on quality and safety in settings where residents learn and on the quality of care rendered after graduation. 1 CLER provides frequent on-site sampling of the learning environment that will: increase the educational emphasis on patient safety demanded by the public; and, provide opportunity for sponsoring institutions to demonstrate leadership in patient safety, quality improvement, and reduction in health care disparities The CLER program s ultimate goal is to move from a major targeted focus on duty hours to that of broader focus on the GME learning environment and how it can deliver both high-quality physicians and higher quality, safer, patient care. In its initial phase, CLER data will not be used in accreditation decisions by the Institutional Review Committee (IRC). CLER consists of three related activities: 1. The CLER site visit program is used solely for providing feedback, learning, and helping to establish baselines for sponsoring institutions, the Evaluation Committee, and the IRC. The first cycle of visit findings will result in dissemination of salutary practices by the Evaluation Committee. 2. The CLER Evaluation Committee includes a broad cross-section of individuals with expertise related to the aim of the CLER program. The Committee provides input to the design and implementation of CLER site visit activities and conducts evaluation review of sponsoring institutions that are visited during each cycle. 3. The ACGME recognizes the great interest by sponsoring institutions to support faculty development in those areas on which the CLER program will focus (e.g., patient safety, health care quality, transitions of care, etc.). Therefore, as part of the CLER program, the ACGME will develop a program to support faculty development. 34

35 CLER assesses sponsoring institutions in the following six focus areas: Patient Safety including opportunities for residents to report errors, unsafe conditions, and near misses, and to participate in inter-professional teams to promote and enhance safe care. Quality Improvement including how sponsoring institutions engage residents in the use of data to improve systems of care, reduce health care disparities and improve patient outcomes. Transitions in Care including how sponsoring institutions demonstrate effective standardization and oversight of transitions of care. Supervision including how sponsoring institutions maintain and oversee policies of supervision concordant with ACGME requirements in an environment at both the institutional and program level that assures the absence of retribution. Duty Hours Oversight, Fatigue Management and Mitigation including how sponsoring institutions: (i) demonstrate effective and meaningful oversight of duty hours across all residency programs institution-wide; (ii) design systems and provide settings that facilitate fatigue management and mitigation; and (iii) provide effective education of faculty members and residents in sleep, fatigue recognition, and fatigue mitigation. Professionalism with regard to how sponsoring institutions educate for professionalism, monitor behavior on the part of residents and faculty and respond to issues concerning: (i) accurate reporting of program information; (ii) integrity in fulfilling educational and professional responsibilities; and (iii) veracity in scholarly pursuits. Above from ACGME website: 35

36 VCU and CLER VCU underwent its first CLER visit in January of Much of this initial visit focused on collecting data and initial feedback. In general VCU received positive feedback, although we continue to strive for improvement. The EM residency has taken the following steps to be more integrated in patient safety and to improve the educational environment. Patient Safety 1. Appointment of a Chief Resident for Quality who will be involved with patient safety imitative and review 2. Each senior resident must present an M & M conference 3. Each senior resident must attend one department quality meeting 4. Each senior resident must be on a department or institutional committee and attend a minimum of 50% of their meetings (PGY2 or PGY3) Quality Improvement 1. Starting in 2015 a longitudinal evidence based quality improvement curriculum will involve residents at the intern level, through graduation. This is a class specific project that will include concept, evidence, proposal, change management, and metrics to assess improvement and adaption. 2. Residents must now submit charts periodically to maintain scribe privileges. Performance will be fed back, and resident charts will be audited for education and quality purposes. Transitions of Care 1. The residency maintains a transition of care policy since January VCU as an institution is transitioning to IPASS handoff system which will be adopted by emergency medicine in the upcoming year 3. Transitions in care will be audited and simulated as part of training program Supervision 1. In 2015 a resident supervision policy was adopted 2. All patients are seen by faculty prior to disposition, and early when unstable or potentially unstable 3. Faculty are continuously available for supervision in real time Duty Hours Oversight, Fatigue Management and Mitigation 1. Emergency medicine is deemed a high risk program for duty hour violations due to rotation on many services in the hospital that care for critical and/or high volumes of patients. The department reports its duty hour compliance to GME twice a year. 2. Duty hour violations are reviewed monthly at Clinical Competency Committee 3. All residents on non-em months must report hours in New Innovations, and all residents who moonlight must log all hours including moonlighting, regardless of rotation. To not do so will result in suspension of moonlighting privileges. Professionalism 1. All residents and all faculty are expected to behave professionally at all times. Unprofessional behavior that is demeaning, bullying, or belittling should be reported immediately for corrective action. VCU and the department of Emergency Medicine are committed to a positive work environment. 36

37 Expectations of Residents The Department of Emergency Medicine has the following expectations of the resident staff: 1. The resident will at all times maintain the highest level of professional conduct. This conduct must complement and parallel the moral and ethical obligations that the physician assumes at the bedside. The resident must assume responsibility for their actions and conduct, and must treat all members of the health care team and the patient and their family with dignity and respect. 2. The resident will be actively involved in their education, seek learning opportunities, participate fully in the activities of the residency program, offer constructive input into the residency program, and actively aid in the recruitment of additional quality residents. We expect our residents to be involved, enthusiastic, proactive, and constructive in their personal education and in their attitude toward the residency program. We will not tolerate negativism, indifference or lassitude. We also expect our residents to set and achieve short and long-term goals and to develop an active reading plan. 3. The resident will be an effective, involved and enthusiastic team member when assigned to services outside of the ED. Nearly one-third of the residency program is spent on services outside of the Department of Emergency Medicine. While on those services it is expected that residents will represent themselves and their home department in a manner that brings distinction to both. 4. The resident will support and contribute to departmental research activities. The Departmental mission includes expanding the horizon of medical knowledge. The resident is expected to participate in ongoing Departmental research and scholarly projects. 5. The resident is expected to show annual improvement on the American Board of Emergency Medicine in-training examination. Passing the American Board of Emergency Medicine s certifying examinations on the first attempt is a defined goal of the residency program. Because the completion of the certifying exam is a quantifiable measure of the success of the program, it is important for residents to demonstrate progress toward this goal by showing improvement in their performance on the ITE. The residency years can be among the most challenging years of your life. You will frequently feel stressed, overworked, underpaid, and sleep deprived. However, these years may also be among your most rewarding as they provide you with the opportunity for great personal and professional growth. The short term sacrifices of the residency years will allow you to gain the professional, personal, and financial rewards that being a board certified emergency physician offers. Our expectations are great because you are in training to become a professional. This requires that you assume responsibility for your actions and conduct. 37

38 Advancement Promotion from a resident s EM year to the next higher year of training in the residency program requires the following: Approval of the residency leadership, with the advice and input of the Clinical Competency Committee (consisting of the program director, associate/assistant program directors, the core faculty, faculty advisors, interested other faculty and the residency coordinator). This approval is based on the resident s satisfactory completion of all academic requirements and expectations specific to the resident s current EM year and milestones. The resident must demonstrate the readiness and ability to function at the next level as defined by the residency s progressive responsibility requirements. Satisfactory skills in all of the core competencies as evidenced by faculty evaluation forms and the program director s semi-annual evaluation. Satisfactory completions of all block rotations. A failure to satisfactorily complete a block rotation may require all or part of that rotation be repeated and may result in a failure to be promoted, additional training beyond thirty-six months, and/or a delay in graduation. A failure to complete the required scholarly activity requirements as determined by the residency leadership will result in a failure to graduate. Approval to sit for the ABEM certifying examination will be withheld by the residency director until completed. Criteria for promotion require that the resident (a) have adequate procedural experience (b) be in compliance with expectations for maintaining conference attendance record of 70% or greater (c) maintain complete and accurate procedure tracking (d) have satisfactory participation in the residency follow-up program including maintaining satisfactory documentation of that participation (e) complete evaluations of faculty, rotations and program and (f) satisfactory completion of all required departmental written and oral examinations. A mandatory program of structured, supervised study is required for: Any score below the 25 th percentile on the ABEM in-service examination for the resident s EM year A resident on formal academic probation will not be promoted to the next higher year unless the resident successfully completes the terms and conditions of academic probation. At the discretion of the Program Director with advisement from the Clinical Competency Committee, a resident participating in a program of structured, supervised study or a resident on academic warning or remediation may be promoted to the next higher year if that resident has met all other criteria for promotion as outlined above. 38

39 Year Specific Goals and Objectives PGY 1 Year Goals and Objectives: 1. To learn to recognize the acutely ill or injured patient. 2. To develop a systematic approach to the stabilization of acutely ill patient. 3. To refine patient evaluation and management skills, focus on the development of an appropriate differential diagnosis, and appropriate use and interpretation of laboratory and radiological studies. 4. To learn and recognize the indications for consultation and admission. 5. To recognize the indications, contraindications, and complications of ED procedures and to develop technical skills in the performance of these procedures. 6. To develop sound charting practices and become familiar with quality 7. To develop and maintain necessary interpersonal skills. 8. To become familiar with ED operations, the role of pre-hospital providers, nurses, and ancillary personnel. 10. To present at least one case conference, present at one Journal Club. 11. To complete their class specific scholarly activity goal PGY 2 Year Goals and Objectives: 1. To refine skills in individual patient evaluation and management with particular emphasis on life-threatening disorders in critically ill and injured patients. 2. To improve procedural skills. 3. To begin to understand the appropriate use of resources to optimize patient flow 4. To assist medical students and interns in-patient care issues. 5. To present at least one core lecture and at least one Journal Club. 6. To complete their class specific scholarly activity goal. 8. To participate in a departmental or institutional committee relating to practice improvement, GME, or VCUHS governance 9. To gain familiarity with the administration of the ED and hospital. 10. Fully participate in longitudinal evidence based performance improvement curriculum PGY3 Year Goals and Objectives: 1. To develop and refine skills in multiple patient management and function as the team leader in the management of patients with life threatening disorders. 2. To assume greater responsibility for the ED clinical areas with staff guidance 3. To refine leadership, management, interpersonal and teaching skills. 4. To assume greater responsibility to the education of residents and medical students 5. To develop increasing knowledge and involvement in EMS 6. To complete their class specific scholarly activity goal and to present to the residency. 7. To prepare and present two lectures including one Morbidity and Mortality conference. The month of the M & M Conference presentation, EM3 s are required to attend the EM quality review committee. 8. To participate in a departmental or institutional committee relating to practice improvement, GME, or SOM governance 9. To provide online medical command, and be competent to handle transfer requests from outside facilities under the guidance and supervision of faculty 10. Fully participate in longitudinal evidence based performance improvement curriculum 11. To graduate physicians prepared and eligible for certification by the American Board of Emergency Medicine. 39

40 Grounds for Dismissal from the Residency Program An atmosphere of trust must exist within a residency program in order for it to successfully function. Conduct in all areas of the residency must parallel the obligations the physician assumes at the bedside. Therefore, the Program will seek the dismissal of a resident from the residency program for: 1. Lying - including outright inaccuracies told to the staff, falsifying medical records, or inaccurate reporting of required residency activities such as procedure, resuscitation or follow up logs. 2. Cheating - tests will be run under the Honor System. 3. Stealing 4. Gross negligence jeopardizing a patient including abandonment of a patient. 5. Violation of privacy of patients, including willful HIPPA violations Should program leadership seek the dismissal of a resident for these or other reasons, due process procedures applicable to residents will apply as outlined in the VCU GME grievance procedure for resident s policy. Inquiries by future employers will include discussions regarding breaches by the resident in any of the above areas. 40

41 Evaluations of Residents Evaluations of the resident s performance on each rotation will be completed by the supervising faculty. These evaluations will be available at all times in the Residency Office and via New Innovations for your review. The Clinical Competency Committee, composed of residency leadership, core faculty, and faculty from selected areas of resident education will at periodically review and assist residency leadership in matters such as milestone attainment, progression, remediation, and other areas of academic development. Per ACGME guidelines, the ultimate decision on residency evaluation, progression (or lack thereof) and graduation rests with the Program Director. All residents are assigned a faculty advisor. This advisor will be required to monitor the resident s progress and meet with the resident at least quarterly. The advisor will be the faculty contact person for issues of resident development, advice or remediation. The advisor will be responsible for observing the resident at the ED bedside yearly and providing feedback regarding their clinical, interpersonal, and procedural skills. Written evaluations of these sessions will be included in the resident s evaluation file. The program director or designee will meet with the resident semi-annually to discuss the resident s performance and goals. At this time the resident s evaluations, conference attendance, performance on examinations, procedure and patient follow-up logs will be reviewed with the resident. Areas of concern will be addressed and remediation plans instituted as necessary. The program director will summarize the content of these evaluation sessions for inclusion in the resident s evaluation file, available on New Innovations. Residents will be monitored by a representative of program leadership based on their level in training, who will also conduct the semi-annual reviews. Currently the following structure exists for this purpose: EM1 Peter Moffett, APD EM2 Steve Miller, APD EM3 Nate Lewis, APD Note the program director is ultimately responsible for the progression and development of residents in the residency program. APD s in the reviews are acting as his surrogate. 41

42 Faculty Advisors RESIDENT FACULTY ADVISOR RESIDENT FACULTY ADVISOR Chris Carpenter Kito Pruitt Burke Best Rene Morrissey Mike Chiappone Brandon Wills Bex Goodwin Taruna Aurora Shane Davis Angela Creditt James Humble Rene Morrissey Kevin Gould Dave Evans Zach Zemore Rene Morrissey Grace Hickam Ramana Feeser Kyle Taylor Joe Romano Emily Kershner Lindsay Taylor Alan You Joe Romano Brendan Mahon Michelle Troendle Lety Flores Taruna Aurora Jacob Moyer Jonathan Silverman Nina Vitto Taruna Aurora Landon Mueller Jeff Ferguson Michael Carter Rene Morrissey Aaron Surrey Michael Joyce Vinny Gopaul Frank Zwemer Jake Wayman David Martin JC Wiggins Kirk Cumpston Aaron Borgmeyer Sean Brooks Sarah Foster Jenny Harris Tim Layng Cyrus Massouleh Joey Mazzei Sean Mlodzinski Chas Schall Greg Wilhoite Lauren Wingfield Mike Billet Lance Beier Mike Brown Drew Claire Brian Dye Stephen Ferraresi Sam Grodman Syed Hasan Kacie Sweat Richard Zhang Jordan Tozer Jeremy Sauer Angie Creditt Mike Vitto Brandon Wills Nate Lewis Jordan Tozer Michael Joyce Chris Bradshaw Kirk Cumpston Michelle Troendle Harinder Dhindsa Kirk Cumpston Chris Woleben Steve Miller Brandon Wills Francis Chuidian Dave Evans Brandon Wills Julie Winkle Nate Lewis 42

43 Vacations Hospital policy allows for three weeks of vacation during each year of the program. Vacations must be taken one week (7 days) at a time. For residents rotating in the ED, time off at either Christmas or the New Year will be arranged, but vacation may not be formally taken during these periods (see below). The three weeks of vacation during the first year will be taken during the anesthesiology and Adult EM. For anesthesia you should notify the service of when you plan to take vacation no later than first day of rotation. If more than one resident in on anesthesia, we strongly encourage you to not taker vacation at the same time. Vacation requests during AEM require the approval of scheduling chief resident (AEM). It is to your advantage to make these requests as soon as possible by entering vacations into SpinFusion for approval (granted on first come basis). Vacation during anesthesia must also be in SpinFusion so you are not scheduled on Pull Call. Three weeks of vacation during the second year will generally be taken during the CDU rotation, designated AEM block, and Toxicology. The exact time of the vacation during the rotations should be worked out with the rotation directors, or in case of Adult EM entered into SpinFusion as above. Since CDU and Toxicology residents are scheduled for Pull Call, those vacations must also be entered into SpinFusion. Three weeks of vacation during the third year will be taken during the elective rotation, the EMS rotation, and one of the adult EM rotations at VCUHS. The exact time of these vacations may be worked out with the rotation directors (Elective, EMS). All must be entered into SpinFusion as above. For vacations taken in the ED rotations, the resident will typically work four fewer shifts than they would have ordinarily been required to work. If the resident is on a track (see below), they will only get 4 shift reduction that month not 5 Vacation will not be allowed at the time of the American Board of Emergency Medicine In- Service Examination (the last Wednesday in February), the Thanksgiving or Christmas/New Year s holidays, the last week of June or during block 1 for interns. Other areas may be limited based on needs of department to maintain an adequate learning environment for residency. 43

44 Illness Residents with an acute illness or injury, who anticipate missing a scheduled ED shift should attempt when possible to swap with a peer to cover the shift. If this is not possible due to severity of illness, or timing of request, the resident must contact the Chief Resident in order to arrange a schedule change or swap of shifts. Residents missing more than two consecutive ED shifts due to illness must supply the residency office with a note from their PCP documenting this illness or injury. If the resident is unable to see his PCP, then the resident must present to the ED for an evaluation. The use of pull call to cover shifts will be monitored by the Clinical Competency Committee and program leadership The timing of elective procedures should be cleared with the program director prior to scheduling. Coverage for Unanticipated Absences from ED Shifts Illnesses and family matters may occasionally require unanticipated absences from previously scheduled ED shifts. All attempts should be made to trade with a peer resident to cover the shift. When not possible, because it is usually necessary to cover these shifts, the following system is in effect: 1. The first option for covering shifts will be to have residents of an equal level of training currently rotating in the ED cover the shift. The absent resident will be expected to pay back the covering resident unless the number of consecutive shifts missed is greater than 2, or at the discretion of the program director. The absent resident will be expected to fill their shift with the assistance of the Chief Resident, 2. If a resident currently rotating in the ED is not available, then a pull system is in place. The chief residents will be responsible for creating and disseminating the pull system. 44

45 Residency Tardiness The Emergency Department is staffed by residents 24 hours daily with shift changes throughout the day. These provider changes are critical to the continuity of patient care and impact the well-being of the residents involved. It is important that the sign out process is timely and efficient. A critical element in this is the prompt arrival of the residents relieving the prior shift. Punctuality is a component of the general competency of professionalism. Residents will be held to a standard as outlined below. 1. A resident must be present and ready to start their shift at least 5 minutes before the hour that the shift is scheduled to begin (i.e. 6:55 for a shift that begins at 7:00). 2. In the event that a resident anticipates being late for a shift, a phone call must be made by that resident to the emergency department to inform the resident being relieved of the potential for a late arrival (Yellow ED: or Green ED: ) 3. If a resident scheduled for a shift does not arrive in a timely fashion, that resident must be paged and a simultaneous page should be sent to the chief residents. 4. The chief residents will maintain a data base of late arrivals. 5. After three (3) late arrivals, the offending resident will be assigned an additional Emergency Department shift. The resident must meet with the program director or his delegate to discuss the lapse in professionalism unless waived by the PD due to legitimate and unavoidable circumstances. 6. Any late arrival greater than 15 minutes will result in an additional shift as well as counting towards the above three late arrivals. 7. For every late arrival after the above three, an additional shift will be assigned in the Emergency Department. 8. Violations of this policy will result in a notation being added to your academic file by the Program Director and will be included in the summary evaluation provided to future employers. 9. Any further actions that may be necessary will be at the discretion of the Program Director 10. On occasion, a resident may know in advance that a conflict will make them late for a clinical shift. On those occasions, the resident should notify the affected resident and the chief residents of this possibility so that proper accommodations can be arranged. 45

46 Didactic Conference The ACGME requires that emergency medicine residencies present 5 hours of educational instruction each week. You are required to attend a minimum of 70% of conferences, with only vacations and leaves of absence excused. However you should attend all conference whenever possible to optimize your education. Up to 20% of required conference attendance can be replaced with Individual Interactive Instruction (III) (commonly referred to as Asynchronous learning). In order to quality for asynchronous learning, the following criteria must be met: 1. The program director must monitor resident participation 2. There must be an evaluation component 3. There must be faculty oversight 4. The activity must be monitored for effectiveness Starting July 1, 2015 VCU will begin to offer III credit. A specific list of approved credit is posted on the internal word press website ( and includes the popular ALiEM Air series ( used by many EM residency programs. Residents may propose in writing to the program director additional activities, but should be advised until approved they should not expect credit if not on the approved list. The majority of education content is delivered during Wednesday morning conference 8a 1p. Conferences utilize adult learning theory by employing a mix of short lectures, small groups, and simulation education. Core content is divided into modules based on the Model of Clinical Practice in EM. Lectures are delivered by faculty (VCU and visiting) and residents. Residents are required to deliver the following talks by post-graduate year. EM1 EM2 EM3 Case Presentation 1 Core content didactic 1 In the News segment 1 Core content didactic 1 M&M Conference Graduation Scholarly Presentation 46

47 Conference Attendance The RRC for EM mandates that EM residents attend more than 70% of the Departmental educational conferences. The RRC calculates this per year of training, not cumulative. Residents are responsible for signing in to each conference. Arriving at a required educational activity greater than half way through the start of that activity will result in the resident being recorded as absent. Excused absences are applied for vacation or approved leaves of absence only per ACGME rules. It is the responsibility of each resident to notify the residency coordinator if such an excused absence is occurring when they will be absent from conferences. Residents have until the end of the rotation block to make this notification. Notify the Program Coordinator. Up to 20% of conference attendance may come from Individualized Individual Instruction (Asynchronous Learning). The list of approved III activities is posted on internal website: Failure to achieve 70% conference attendance will result in delay of promotion or graduation. The New Innovations residency management website will forward evaluation forms to residents in attendance on the conference attendance sheets. Please provide constructive feedback. Conference attendance can be calculated by going to New Innovations, Go to New Innovations, Conferences, and then Attendance Report. Select the current academic year from the dropdown, click the box for only displaying conferences covered by attendance requirements, and then click the button to show details, and then click view report 47

48 On the report blue dots show when you were in attendance, and when you are excused. Scroll to the bottom of the report and you will see the credit hours on the far right. The first number (in this case 130.5) is how much conference you have attended. The second number is the number of conference hours we have offered with your excused conferences already subtracted (in this case 193). To get an accurate final conference attendance, add the number of asynchronous hours you have to the first number and then divide by the second number. In this example if the resident had 20 hours of asynchronous credit then the result would be ( )/193 = 78% Resident should be excused from clinical service for conference, but on some rotations this can be difficult due to patient safety concerns. Although it is the residencies hope that arrangements are made to protect this education time, you may find it difficult getting release on ICU months, and internal medicine wards. Some rotations that are primarily night rotations have less of an expectation for conference attendance for wellness. When not scheduled for clinical duty, you should treat conference with the same responsibility you do toward a shift. The following guideline should allow every resident to maintain conference attendance at 70% minimum each year employing also III. 48

49 EM 1 ROTATION AEM/VA Teach/PEM IM MRICU US Trauma Ortho/Procedures OBGYN Anesthesia *Not after 5p-3a shift EXPECTATION All*^ After 11am When Possible All^ No All^ No All^ ^Vacation weeks excused EM2 ROTATION AEM/PEM/Community EM AEM-N VA EM CICU/CSICU/STICU Toxicology CDU Ultrasound *Not after 5p-3a shift EXPECTATION All*^ 1 st 2 hours All When Possible All^ All^ All ^Vacation weeks excused 49

50 EM3 ROTATION AEM/PEM AEM-N ED VA Teaching PICU-N STICU-N EMS Elective Ultrasound *Not after 5p-3a shift EXPECTATION All*^ 1 st 2 hours All No No All^ All^ All ^Vacation weeks excused 50

51 Emergency Medicine Residency Professionalism Violations of professionalism include, but are not limited to, confirmed and documented instances of not completing required Emergency Medicine or Graduate Medical Education annual training, surveys or competencies. In addition, an unexcused absence at any required conference lectures given by you will be considered a violation. 1. Not completing the annual on-line VCUHS and GME training and ACGME surveys by the deadline, will result in one additional Emergency Department shift for each instance. 2. If any resident is unable to give their scheduled lecture, they must inform the Program Director or Associate/Assistant Program Director and the Education Chief Resident of their inability to give their lecture. If the proper authorities are not notified and the absence is determined to be unexcused, the resident will reschedule the missed lecture and be assigned an additional shift in the emergency department. 3. Every violation of this policy will result in a notation being added to the resident s academic file by the Program Director and will be included in the summary evaluation provided to future employers. 4. Any further actions that may be necessary will be at the discretion of the Program Director 51

52 Professional Educational Accounts (PEA) Each year of the curriculum, residents will be assigned monies to be used for educational products or activities. These monies may be used for educational products and travel only (books, subscriptions, educational meetings, podcasts, etc.). This money may not be used for equipment (stethoscopes, laptops, etc.). The money if not used is forfeited at the end of the academic year. The amount varies by year. EM1 $1000 Virginia ACEP Conference EM2 $1500 SAEM EM3+ $2000 ACEP Please see policy on Professional Education Accounts for details. 52

53 Travel The Department of Emergency Medicine, and specifically residency leadership is committed to supporting resident scholarly activity. This often results in the opportunity to travel and present work, and/or attend educational conferences during your residency. However VCUHS has very specific policies in order to have this travel reimbursed. It is your responsibility to be aware of these requirements before you spend your own money on travel. 1. ALL travel must have a travel authorization form submitted BEFORE you travel (Under Accounts Payable on the intranet)). VCU will NOT reimburse you without having done this. Forms should be submitted to the Program Coordinator. 2. Rental cars are generally not reimbursed, as VCUHS prefers taxi/uber. If you plan to get one and you want VCU to pay for it, you must assure that it is in your pre-travel authorization and EM Administrator (Heller) has signed off. 3. Travel outside of U.S. or to Alaska or Hawaii is generally not reimbursed 4. All receipts must be ORIGINALS. Photocopies not accepted. 5. All Airplane travel you must have your ORIGINAL PAPER boarding passes for reimbursement. 6. Keep copies of all approvals, reimbursements and receipts. 7. You must submit Reimbursement request form within 60 days of travel. Any submission greater than 60 days after your return will not be paid. This comes directly from the CFO of VCUHS Additional information and guidelines are on the internal (word press) EM website under resources, and see travel policy for complete details 53

54 Travel Checklist All travelers must be familiar with both the VCU EM Residency Travel Policy and the VCU Health Travel Policy. Failure to follow both may result in failure to be reimbursed, or disciplinary actions. Planning/Travel: Do not purchase anything without an authorization form signed by the approval authority (Jonathan Heller). Download the Travel Authorization from the accounts payable website and fill it out using the electronic EXCEL version. Save this (it will make it easier for us to adjust if errors are made). Fill out the Travel Authorization form keeping the following in mind: o Hotel- You must pick the conference hotel or one in walking distance. Print a copy of your proposed reservation (with total costs) to submit with your travel authorization. o Airfare- You must travel coach/economy. Find a reasonably priced flight and print the proposed reservation (with total costs) to submit with your travel authorization. o Per diem- You get paid a daily rate for all food and incidentals (like taxi s you want to take somewhere to sightsee). Go to the GSA Per Diem Calculator Website ( to find out how much per diem is for where you are traveling. The first and last day of travel are only 75% of the full rate. o Conference Registration- Print a copy of the itinerary with circled or highlighted events you must attend. Print a copy of how much registration will cost. o Taxi/Uber- Estimate how much a taxi/uber will cost from the airport to your hotel (and back). o Parking- Estimate airport parking costs or estimate travel to/from airport with Taxi/Uber o Poster expenses- If you are going to print a poster, estimate cost. o Total Expenses: We will not pay more than $1500 per trip unless you have PEA left. Print and sign. Submit with copies of all supporting documents. KEEP COPIES. Once you have signed authorizations back (From Jon Heller) you may book travel. During Travel: Keep ORIGINAL PAPER BOARDING PASSESS. (Paper, not electronic). Hotel- Keep receipt. It must have a zero balance (shows nothing owed) at the bottom. o If you split the room with someone you MUST have the hotel split the bill and EACH of you has to have a zero balance receipt. Please do not have one person pay for the hotel and another pay for some other expense etc. This is impossible to reimburse. o Room service, internet, etc, are fine on the receipt but will not be reimbursed. Parking- Keep all original parking receipts Taxi/Uber- Keep all original receipts or print online receipts when home (Uber). You may only claim reimbursement for travel to/from home and airport, and to/from airport and conference. All other rides around your destination are on your tab. If it was not on your authorization it will not be paid. 54

55 On Return: You have 60 days to turn in your reimbursement Download the Travel Reimbursement form from the accounts payable website and fill it out using the electronic EXCEL version. Save this file (it will make it easier for us to adjust if errors are made). Fill out the Reimbursement form keeping the following in mind: o Each expense gets one line. You do not have to split airfare or parking receipts over multiple days. You do have to split out each day of hotel and per diem. o Tape all small receipts to a piece of paper (they are scanned) o All receipts need to be originals. Print and sign. Copy the entire packet and keep a copy for yourself. 55

56 Moonlighting IMPORTANT: Our GME defines moonlighting as ANY clinical activity outside of residency requirements. This can be for pay or not for pay. It does not just include activity as a physician, thus activities such as serving as an EMT fall under moonlighting policy and definition. Moonlighting is a privilege and not a right. This privilege will only be extended to those residents who fulfill their duties conscientiously. These include clinical responsibilities, attendance at educational activities of the residency, completion of medical records and satisfactory completion of departmental and national examinations. The RRC for EM is concerned about the number of clinical hours worked by residents. Moonlighting activities are viewed as clinical work hours and such activities should not conflict with RRC guidelines for consecutive days worked, total hours worked per week or time off between shifts. Resident who moonlight MUST record duty hours during all months. Failure to do so will result in suspension of moonlighting privileges. EM1 s are not permitted to moonlight by ACGME and VCUHS policy EM2 s can apply to moonlight inside the VCUHS EM3 s and above can apply to moonlight outside the VCUHS system The Emergency Medicine Residency Program adheres to the VCU Health System Graduate Medical Education policy for resident moonlighting You must obtain permission to moonlight using the GME application (below, and located on above GME website with policy) Every case of moonlighting, external or internal, requires a separate application All initial external moonlighting applications require you to also submit: 1. An independent license to practice medicine 2. Copy of outside liability insurance Moonlighting is approved for 6 months at a time, at which time you must resubmit another application. In cases of external moonlighting you do not need to resubmit license (unless it has been renewed) or liability coverage (unless it has changed) See EM moonlighting policy for complete details. 56

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58 Duty Hours The ACGME mandates restrictions on resident work hours both as a patient safety and wellness concern. Emergency medicine at VCUHS is considered a high risk program for duty hour violations due mainly to rotation in other high intensity clinical settings. Therefore duty hours are required to be logged in New Innovations for all off service rotations. Emergency Medicine block schedules are published without duty hour violations thus it is only mandatory to log duty hours if you are moonlighting during these blocks. You cannot trade into an EM shift that produces a duty hour violation. ACGME Duty Hour Rules for EM are as follows: 1. Resident Duty Hours. Maximum Hours of Work per Week: Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting. 2. Mandatory Time Free of Duty: Residents must be scheduled for a minimum of 1 day free of duty on average every week. At-home call cannot be assigned on free days. 3. Duty periods: Residents must not exceed 24 hours of scheduled duty. In certain circumstances they can stay up to an additional 4 hours for transfer of care, critical ill patient, and etc but cannot assume new duties. 4. In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. Under those circumstances, the resident must appropriately hand over the care of all other patients to the team responsible for their continuing care; and, document the reasons for remaining to care for the patient in question and submit that documentation via New Innovations in every circumstance to the program director. 5. Residents should have 10 hours, and must have eight hours, free of duty between scheduled EM duty periods that are 10 hours in length. 6. Residents must have at least 14 hours free of duty after 24 hours of in-house duty. Although hours in conference and other academic requirements count toward duty hour totals, they are not subject to an equivalent period off before return. For example, if a resident attends 5 hours of conference, they may immediately work a ten hour shift following without any duty hour violation. 58

59 Procedure and Resuscitation Logs The RRC requires residencies to document procedures performed by residents. ABEM may in the future require residents to offer evidence of procedural competency, as defined by number of procedures performed, prior to certification. Employers are also interested in this information. Therefore, residents are required to maintain procedure logs. All procedures (including minor procedures such as laceration repairs and ultrasounds), and participation in and leadership of resuscitations must be documented. The process for documentation of procedures and resuscitations is as follows: 1. The residents will document the performance of a procedure or resuscitation in the New Innovations Residency Management website. This documentation must occur within one week of performing the procedure. For procedures performed in the ED, the supervising physician should be the ED faculty member of record. Procedures performed on off-services may be listed under Program Director (please see the section on dismissal from the residency program for the consequences of falsifying this information). The assigned faculty member will sign off on the procedure in New Innovations. Please be advised that faculty will not be required to sign off on the procedure if it is not recorded in New Innovations within one week of the performance of it. Failure of the faculty to sign off on the procedure means that the procedure was not done. 2. The exception for documenting procedures in New Innovations if for ultrasounds. The process for documenting ultrasounds is via qpath, and will occur at the time the images are recorded. Access to QPath is available on the VCUHS intranet website. Ultrasound faculty will review and approve satisfactory ultrasounds to count toward graduation requirements. 59

60 Follow up Logs (Problem Based Learning) Residents will be required to provide information on three patients each EM rotation block (including adult, pediatric, adult nights, VA, VA Teach, and community months.)in the form of follow-up visits, clinical course and a researched clinical question. These logs will be reviewed at the semiannual evaluation sessions. Follow up logs should be recorded using form in New Innovations. Go to Portfolio, Scholarly Activities, and click New. Then fill in the form and save. The format for these problem based learning exercises is as follows: 60

61 Scholarly Activity Requirement Policy Scholarly activity is required of each resident prior to graduation for the successful completion of the residency. Projects must be approved by the residency director and requires a faculty mentor. The EM residency program uses a point system to track scholarly requirements. Residents must accumulate a minimum of four points to fulfill the scholarly activity requirement. Points Description 1 Complete initial CITI course 1 year of participation in a regional/national committee Podium/poster presentation for hospital research day 1 year of active effort on a scholarly project that is planned for presentation or publication 2 Brief textbook chapter Published Clinical Image Published formal Abstract Formal poster/abstract presentation (regional/national) Development of evidence based protocol for the department Well written letter to the editor of a peer-reviewed journal 1 year of active editorial review services 3 Accepted/published textbook chapter Accepted/published review article Accepted/published case report or case series Development of an evidence based protocol for the institution CPC case Lecture at a regional/national conference (at least 1 hour) 4 Investigator for a completed clinical/bench research study Failure to complete scholarly requirements will constitute failure to complete the residency program. Residents are expected to contribute to the success of other Departmental and resident research projects by enrolling patients and actively assisting their colleagues in the completion of their projects. Every publication and presentation from our department elevates it in the eyes of the Emergency Medicine universe and ultimately reflects well on the residency program. Research projects are expected to be presented at the annual VCUHS annual resident and fellow research day. Each resident must have points from at least one of the following sources: National Presentation, Research Project/PubMed ID, Published Chapter/Textbook. Please see scholarly activity policy for details. 61

62 Progressive Responsibilities The entire curriculum is based on the concept of progressive increases in responsibilities of the resident staff. The clinical, teaching, administrative, and supervisory responsibilities of the EM residents are as follows: PGY-1 Clinical Orders, treatment plans should be discussed with the attending prior to initiation. Consultations and dispositions must be approved by the attending prior to initiation. Each resident will participate in resuscitations Each resident will work approximately 200 scheduled clinical hours in each ED block Teaching Each resident will present at least one case conference. While in the ED, the resident may participate in the education of junior personnel. While rotating on inpatient services, the resident will have responsibility for teaching students. Present articles during Journal Club Administrative Participate in CQI activities including chart review. PGY-2 Clinical Each resident will be expected to evaluate an average of 1.5 new patients per hour. The resident will be expected to participate in the care of the most critically ill and injured patients. This includes handling the airway in trauma resuscitations. The resident may initiate treatment and orders prior to discussion with an attending but must discuss the patient with senior personnel prior to disposition or consultation. The resident will work approximately 180 scheduled clinical hours during each ED block. Teaching Prepare and present one core lecture. Present articles during Journal Club. The resident will be involved in the education of medical students and junior residents when rotating in the ED or on inpatient services. Administration Participate in Evidence Based Quality Improvement Curriculum Clinical supervision of medical students and junior residents. On-line medical command under the direct supervision of the attending physician. 62

63 PGY-3 Clinical Each resident will be responsible for evaluating an average of 2 new patients per hour. Each resident will work approximately 180 scheduled clinical hours during each ED block. The resident will be allowed to evaluate, treat and make disposition decisions with consultation of the attending physician. The resident must consult the faculty for all patients prior to discharge and earlier for patients that are considered to be emergent, unstable or potentially unstable, potentially complicated, patients leaving against medical advice, or those in whom a conflict has arisen. The resident will serve as the team leader for all types of resuscitations. The resident will be involved in monitoring patient flow and supervising junior personnel. Teaching Prepare and present two lectures, one of which will be M & M. Bedside teaching of medical students and junior residents. Teaching of procedural laboratories. Teach pre-hospital providers during EMS rotation. Journal Club presentations Administration Participate in evidence based quality improvement curriculum Be a member of one institutional or department committee that focuses on quality, education, of governance Develop topics and choose articles for Journal Club Supervision Oversight of patients seen by medical students and junior residents. Provide on-line pre-hospital supervision, and take transfer calls from outside facilities under the guidance and supervision of faculty 63

64 Chief Residents Three residents in the program will be selected to serve as chief residents during their final year of training. In order to be considered for chief, the resident must not have ongoing concerns with academic development or professionalism. Should the ITE score be below 25 th percentile, the CCC must approve an exemption for the resident to be considered for chief. This selection will be based on a vote by faculty and resident peers, with equal weight between each group in the decision. The program director ultimately has final decision on eligibility and appropriateness of chief selection. Please see chief resident policy for more details 64

65 Community and VA Emergency Medicine Rotations Experiencing alternative practice environments is a valuable and important part of your EM training. Currently EM residents do 5 rotations based at Hunter-Holmes McGuire VA Hospital, and one block of community EM at Memorial Regional Community Hospital. While rotating at the community facility and at the VA the resident s clinical responsibilities will be identical to those outlined above. They will not have any teaching, administrative or supervisory responsibilities at the community rotation, MRMC. Hunter Holmes McGuire VA Medical Center 1201 Broad Rock Blvd, Richmond, VA (804) Acting Chief- Chuck Stuckey Charles.Stuckey@va.gov Education- Frank Zwemer Frank.Zwemer@va.gov Admin-Kathy Busch Kathleen.Busch@va.gov. Memorial Regional Medical Center 8260 Atlee Road Mechanicsville, VA Chief- Carlton Stadler, MD carltonstadler@gmail.com Admin-Tiffany Kirkham TKirk10@comcast.net

66 1250 East Marshall Street, Richmond, VA 1201 Broad Rock Blvd, Richmond, VA 8260 Atlee Road, Mechanicsville, VA 66

67 Staff Parking Weekday ED Shifts Best Options Staff Parking-Weekday Shifts

68 Wellness Residency is a stressful time with demands and stressors on you and your family, both personally and professionally. We seek to minimize these as much as possible, build support, and have events to build resiliency. We have established a wellness interest group. However sometimes we all need more. VCUHS has confidential free help should you need assistance. Any concerns expressed to program leadership also remain confidential. Project Carlos During 2015, a resident at the University of Kentucky committed suicide during his EM training. Several residents wanted to provide additional resource for those who may feel they cannot talk to anyone or feel hopeless. Project Carlos was born, named after the resident at UK, in order to provide a confidential peer contact. Each class elects a trustworthy representative. Current reps include: EM3 - Brian Dye (336) EM2 - Jenny Harris (804) EM1 - TBD It should be emphasized that program director and program leadership is also always a confidential resource at any time and should be contacted immediately if needed. We take this incredibly seriously. 68

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70 Common Websites VCU GME VCU EM website VCU EM internal VCU Library New Innovations (VCUHS) Spin Fusion 74A41A2F1DBD5DB ALIEM Air ECG Weekly Rosh Review ACGME BasedSpecialties/EmergencyMedicine.aspx AAEM ACEP CORD SAEM Peer IX

71 Educational Curriculum Goals and objectives for all clinical rotation are included in Appendix C: Rotation Goals and Objectives. For academic year the following rotations are part of the residency: PGY-1 Introduction to Emergency Medicine - 1 block Emergency Medicine 4.5 blocks*** VA EM Apprenticeship- 2 weeks Internal Medicine 1 block Trauma - 1 block Pediatric EM - 1 block Ortho/Procedures - 1 block Medical/Respiratory Intensive Care Unit - 1 block Obstetrics/Gynecology- 2 weeks Anesthesiology 1 block (VA) *** Ultrasonography 2 weeks PGY-2 Emergency Medicine (MCVH) 5 blocks*** Pediatric Emergency Medicine 1 block Community Emergency Medicine Memorial Regional 1 block VAMC Emergency Medicine 1 block Cardiac Intensive Care Unit 1 block Surgical/Trauma Intensive Care Unit - 1 block Cardiac Surgery Intensive Care Unit 1 block Medical Toxicology - 1 block*** Clinical Decision Unit/Advanced US 1 block*** PGY-3 Emergency Medicine (MCVH) 9 blocks*** Pediatric Emergency Medicine 1 block Emergency Medical Services--VAMC 1 block*** Pediatric Intensive Care Unit 0.5 block Surgical Trauma Intensive Care Unit (Senior) -0.5 block Elective 1 block*** Ultrasound- VAMC- 1 week ***Vacation 71

72 VCUHS Resident Switch Dates 72