23
SEP
2014
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Curriculum

Block Schedule:


Year 1
 ED Orientation
Emergency Medicine
Emergency Medicine
Emergency Medicine Trauma
Trauma ANES/US
MCC
MTS OB/GYN Pediatric Emergency Med
 Orthopedics
Year 2
Emergency Medicine   Emergency Medicine Emergency Medicine Emergency Medicine   Emergency Medicine Emergency Medicine    Critical Care / JAX
Elective EMS MCC PICU SCC
Year 3
Emergency Medicine   Emergency Medicine Emergency Medicine  Emergency Medicine  Emergency Medicine Emergency Medicine    Emergency Medicine Emergency Medicine   Elective
Elective Community ED
Teach

PGY-1

Interns focus on widening their breadth of exposure to Emergency Medicine: they see a wide variety of urgent, emergent and critical patients. Off-service rotations provide a wide variety of clinical experiences. The year includes:

  • 4 months - Emergency Medicine (integrated adult and pediatrics) which includes one month of orientation
  • 1 month - dedicated Pediatric Emergency Medicine
  • 2 months - Trauma & General Surgery
  • 1 month - Anesthesia (mornings) and Emergency Ultrasound (afternoons).
  • Fellowship-trained Ultrasound faculty and an Ultrasound Fellow provide direct teaching and opportunities for independent practice.
  • 1 month each - Medicine wards, OB/GYN, Orthopedics, Medical ICU.

PGY-2

Second-year residents' goals are to improve efficiency and task management in the ED, and to bolster their resuscitation skills and care of critically ill patients. The year includes:

  • 6 months - Emergency Medicine
  • 4 months - Critical Care (1 month each - Medical, Surgical, Pediatric, and community Medical/Cardiac Critical Care in Jacksonville, FL)
  • 1 month - Elective
  • 1 month - EMS

PGY-3

Senior residents are responsible for patient flow in the department. They are kept aware of critical patients and issues occurring on shift. They teach and supervise medical students throughout the year and improve their didactic skills. The senior resident staffs the trauma bay and sees all trauma patients, with the primary responsibility of managing the airway. The year includes:

  • 8 months - Emergency Medicine
  • 2 months - Elective
  • 1 month - Community Emergency Medicine
  • 1 month - Dedicated Teaching month

Hours Worked and Shift Configuration:

Shift configuration in the emergency department is a mix of different shift types and lengths, which varies with each year of training. Interns typically work approximately 20 shifts per regular ED month and 16 per ED Vacation month. These months consist mostly of 12 hour shifts and several 9.5 hour shifts. Second year residents work approximately 19 shifts per regular ED month and 16 shifts per ED vacation month, which is a mix of 8-, 9-, 10- and 12-hour shifts averaging roughly 180 hours per month. Third year residents work roughly 16 shifts per regular ED month, with fewer shifts in vacation months, also a mix of 8-, 9-, 10- and 12-hour shifts which also includes teaching shifts (8 hour shifts overseeing medical students). The typical PGY3 schedule totals 165 hours per month. Monthly totals vary based on the length of the rotation
.

EM Didactic Curriculum

  • There is a minimum of 5 hours of evidence-based conference time weekly, from 7-9:30 AM on Tuesdays and Thursdays.
  • Approximately 75% of presentations are by our EM attending physicians or guest faculty, and 25% by emergency medicine residents.
  • Conferences vary among interactive didactic case-based lectures, hand-on procedural labs, simulation-based learning, and joint-conferences with radiology, pediatrics, internal medicine as well as other specialties.
    • Simulation experience occurs in conference and in our fully-equipped simulation lab.
  • PGY-1 EM residents give two one-half hour lectures their first year, PGY-2's give four 1/2 hour lectures, and PGY-3's give four 1/2 hour and two hour-long lectures.

Curriculum Objectives


Facilities
Orlando Health is a 1,788 bed system consisting of 8 hospitals. See our facilities here.

Emergency Medicine Residents spend the majority of their time at ORMC and Arnold Palmer Hospital for Children. They also rotate through:
  • Winnie Palmer Hospital for Women & Babies during the obstetrics month
  • South Seminole Hospital for community medicine
Hospital facts:
Orlando Regional Medical Center (ORMC)
  • 808-bed tertiary medical center
  • Central Florida's only Level One Trauma Center serving 18 counties.
  • The Orlando Health Air Care Team transports critically ill patients within a 100-mile radius.
  • 70,000 annual visits.
  • 58-beds covering 50,000 square feet.
  • 36 acute care beds with 5 trauma / resuscitation bays, 13 Flex Care beds, and 4 Rapid Care beds
  • Electronic patient tracking, computerized ordering, and PACS radiology systems
  • Staffed by radiologists 24-hours a day
  • 2 CT scanners are located in the Emergency Department. MRI is available in the radiology department.
Arnold Palmer Hospital for Children (APH)
  • 158-bed dedicated pediatric hospital
  • The only Level One Pediatric Trauma Center in Central Florida
  • Bert Martin's Champions for Children Emergency Department & Trauma Center was dedicated in 2007
  • Electronic patient tracking, computerized ordering system, and PACS radiology system
  • 23,500 square-foot state-of-the-art facility
  • 3 treatment pods consisting of the following: 29 acute care beds, 4 resuscitation / trauma beds
  • 50,000 visits (700 pediatric trauma admissions)
Winnie Palmer Hospital for Women and Babies (WPH)
  • Opened in 2006
  • 285-bed, 11-story hospital, dedicated completely to the care of women and neonates
  • 30 Labor and Delivery rooms, host to over 10,000 births per year, among the most deliveries in the entire country.
MD Anderson-Orlando
  • State-of-the-art Charles Lewis Pavilion
  • 220,000- square-foot structure, completed in 2003
  • 60 private inpatient beds
  • 10-story comprehensive multidisciplinary cancer center, containing all ambulatory and ancillary services required for cancer care from diagnosis through all phases of treatment and follow up

Program Highlights


Orientation Month

http://orlandohealth.com/mediabank/images/photo_meded_ed_training1.jpgThe orientation month is a structured experience composed of daily morning lectures and 10 ED shifts. This serves as an introduction to emergency medicine curriculum, including didactic lectures, skills labs (e.g. wound care lab) and interactive sessions. New interns also participate in a 2-day Introduction to Ultrasound course. In addition, interns participate in required courses such as PALS, ACLS and ATLS. Interns spend the majority of their first shifts in the adult ED, though there are pediatric shifts as well, allowing for time to settle into the new environment with supervision and guidance. Having the extra time to get oriented to the ED, the computer systems, and the ED staff (ancillary as well as other physicians) is an excellent advantage for a new resident, and eases the transition from medical student to intern. The lectures and extra time spent with attending physicians and senior residents allows new interns to learn what is expected of them and how to provide superior patient care. It also serves as an opportunity to form close relationships amongst their classmates.

Ultrasound

Emergency Ultrasound is an extremely useful aid in both the diagnosis and treatment of various medical conditions. The residency training experience promotes advanced emergency ultrasonography through formal education, hands-on scanning, resident and faculty education, and original research projects. Residents become comfortable in the original six primary Emergency Ultrasound applications (FAST, cardiac, aorta, first trimester pregnancy, gallbladder, renal), as well as vascular/ DVT, pleura/pulmonary, testicular, ocular, musculoskeletal, and procedural studies. Emergency Ultrasound is used daily in our department in the form of diagnostic assessment, procedural assistance, and active research.



Clinical Care
Multiple ultrasound machines are available in the department for quick access. Direct supervision and feedback is available at the bedside by fellowship trained attending physicians. Ultrasound is used extensively for non-traumatic and traumatic resuscitation, abdominal pain in pregnancy, gallbladder and aortic evaluation, and for procedural assistance.

Director of Emergency Ultrasound
The Director of Emergency Ultrasound is Steve Leech, MD, RDMS. Dr. Leech is Ultrasound Fellowship trained and continues to improve the Ultrasound curriculum through clinical training, active research, and expansion of the Ultrasound program. He provides direct resident instruction, along with review and feedback on resident video recordings of patient bedside ultrasounds.

Residency Training
Training in Emergency Ultrasound is incorporated into the didactic lecture series and clinical rotations. Emergency Medicine residents utilize bedside ultrasound during their clinical evaluation of patients in the department. There is a dedicated PGY-1 ultrasound rotation and the opportunity for an additional elective rotation.

Ultrasound Fellowship
The program sponsors a one-year fellowship in Ultrasound.

Learn about the Ultrasound Fellowship

Research and Publication
Research has also been a focus of our ultrasound program, specifically directed toward education, diagnosis, and procedural applications.

Competency Feedback
Our ultrasound training focuses on competency-based training. The goal is to insure that our residents are skilled in the performance and interpretation of Emergency Ultrasound, as well as being able to teach the skills to others. To achieve this, resident-performed ultrasound exams are recorded in real-time to a DVD. The residents then sit in on Quality Improvement sessions during their ultrasound month and learn to identify common findings and technical errors. The Ultrasound Director and fellows review other resident performed exams and e-mail each resident a web link corresponding to each of their exams that have been reviewed. Each resident receives a detailed review and analysis of their ultrasound exams. These reviews are contained in web links and are stored on a dedicated website.

Pediatric Emergency Medicine Experience

Our program prepares residents to be highly skilled in the care of pediatric patients in the emergency setting. There are multiple pediatric emergency medicine board-certified faculty members in pediatrics or pediatric emergency medicine. Pediatric exposure is integrated through out the curriculum, and residents spend approximately 20% of each emergency medicine month in the pediatric emergency department. In addition, Orlando Health offers a Pediatric Emergency Medicine Fellowship.



Pediatric Emergency Medicine Fellowship


Learn about the Pediatric Emergency Medicine Fellowship

Academic Clinical Research

The resident experience at ORMC emphasizes evidence-based academic medicine in a community setting. Academic research at our program has grown significantly over the past several years. Please follow the link below for more information concerning our current research projects and fellowship programs.

EMS

http://orlandohealth.com/mediabank/images/photo_meded_ed_training7.jpgWe offer an outstanding EMS experience for our residents. In addition to a comprehensive didactic lecture series and interactive sessions, we offer a structured EMS rotation during the PGY-2 year. The curriculum is divided into didactic and experiential components. Our faculty serve as Medical Directors for the regional EMS system, giving our residents unique educational, scholarly and elective opportunities. Residents have required time on ground transport, as well as the option of flight time with the Aircare teams. Residents will also learn about Emergency Medicine disaster planning, have an opportunity to teach paramedics, and work closely with Central Florida's Medical Directors, the Orlando Health EMS Fellow, and the Disaster Center.

  • EMS Curriculum
  • Orange County/ORMC EMS Fellowship
    Orlando Health, in partnership with Orange County, sponsors a fellowship in Emergency Medical Services. This is a one-year fellowship that has given fellows detailed exposure into administration of a well-respected Evidence Based EMS System.
  • Disaster Preparedness Training
    Residents participate in 1-2 mass casualty incidents per year. Depicted here are a group of our residents from a disaster drill exercise at the Orlando International Airport.

Fellowships


Orlando Health sponsors the following fellowships:


Unique Opportunities


The Orlando Health Emergency Medicine Residency Program is proud to have many exciting opportunities available for residents.

Elective Opportunities
Our residents have multiple options to chose from during their 3 months of electives: ultrasound, radiology, simulation, ophthalmology, research, wilderness medicine, etc. There are also overseas electives available for interested residents:

  • Hawaii
    Residents may apply for a one-month rotation on Oahu, Hawai'i. Residents rotate in a brand new Emergency Department in the Kaiser Permanente-Hawai'i System. The elective allows residents to experience practicing medicine in an HMO setting. Residents receive a travel stipend, car, and housing. This is a wonderful month and it will give you a unique experience and interesting perspective on healthcare in a beautiful setting.

Community Outreach / Volunteerism

  • Coalition for the Homeless
    Coalition for the Homeless of Central Florida was created in 1987 by a group of concerned citizens who noted a growing problem of homelessness in the community. The Coalition is now the largest provider of homeless services in Central Florida. The Coalition is an emergency shelter that accepts intact families, men, women and children. Residents can volunteer to provide services to individuals at the shelter.
  • Shepherd's Hope
    Shepard's Hope provides medical care for the uninsured families of Orange County that fall below the federal poverty line. Emergency Medicine attending physicians and residents volunteer at this facility on a regular basis. Through the combined efforts of volunteer physicians and other health-care professionals, schools, hospitals, and churches, Shepherd's Hope Health Centers are able to provide quality, non-emergency medical care to those in need
Medical Missions
Our department supports efforts to deliver medical care to the underserved. Residents interested in medical missions may organize their own project or participate in collaboration with FSU and UCF medical missions.


Benefits

Orlando Health offers its residents a comprehensive benefits package. The following is a summary of the various house staff benefits offered at Orlando Health/ORMC.

Stipend
  • Competitive stipend provided with increases each PGY year. Bonus administration stipend is provided for chief residents

Educational Funding/Books
  • ACEP National Conference for PGY-3
  • Additional funding is provided for regional and national conferences when a resident presents original research.
  • Certification provided for: Advanced Trauma Life Support (ATLS), Pediatric Advanced Life Support (PALS), Fundamental Critical Care Support (FCCS) and Advanced Cardiac Life Support (ACLS). These are completed during the Emergency Medicine Orientation Month.
  • Rosen's Emergency Medicine text is provided to PGY-1.
  • Subscription to Annals of Emergency Medicine
Society Memberships
  • Membership provided in American College of Emergency Physicians
Additional Benefits including healthcare, boarding, and other core benefits are outlined here