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EM1 Rotation Schedule
EM-1 year starts with 2 weeks of orientation to allow interns to hit the ground running. The EM-1 curriculum is focused on learning the foundations of emergency medicine. Off-service rotations include pediatric EM, MICU, OB, Anesthesia, Ultrasound, and Red Zone, which is a procedural month with high yield 1:1 lectures with faculty. Interns will also rotate at two community emergency departments to allow for one-on-one teaching, experience with common procedures and ED presentations, and exposure to the full breadth of acuity that emergency medicine offers.
Orientation
Incoming interns spend their first two weeks in an intensive orientation program designed to prepare them to function effectively as Emergency Medicine residents. The orientation includes didactic sessions as well as multiple procedural labs. Procedural skills are taught in an animal lab, splinting and suturing workshops, and slit lamp lab. All interns receive Advanced Cardiac Life Support, Advanced Trauma Life Support, and Pediatric Advanced Life Support training and certification. A difficult airway management lab and a basic ultrasound course are also offered during the orientation.
Emergency Medicine
BIDMC: PGY1 interns manage all types of patients in the BIDMC emergency department under the supervision of senior Emergency Medicine residents and faculty. Interns perform all procedures for their patients. A significant proportion of special teaching shifts are designated for PGY1s, where residents work one-on-one with an attending with an emphasis on teaching.
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Beth Israel Deaconess Needham: During the PGY1 year, interns spend 4 weeks at Beth Israel Deaconess-Needham. This hospital sees a mixed of adult and pediatric patients. The same attendings that work at BIDMC work at BIDN. This allows one on one teaching and access to the high caliber BIDMC faculty in a community setting. Interns will learn how to evaluate patients without the constant availability of other services, when to appropriately transfer patients to tertiary care centers. Interns also have first access to any procedures and critically ill patients that arise in the ED.
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Cambridge Health Alliance: Interns also spend 4 weeks rotating at Cambridge Health Alliance. This is a busy emergency department that sees more than 6,600 pediatric patients each year. CHA also allows interns to experience practicing with a patient population that is indigent, primarily non-English speaking, and underserved. This contrasts with the patient population of BID Needham, which is a more suburban population with better access to care.
Pediatric Emergency Medicine
Boston Children’s Hospital: PGY1 interns spend 4 weeks in the emergency department at Children's Hospital Boston under the supervision of pediatric emergency attendings and fellows. They develop skills in pediatric resuscitation as well as diagnosis and treatment of common pediatric emergencies. The interns learn to manage pediatric airways, obtain intravenous access, perform lumbar punctures, perform conscious sedation, and how to administer appropriate doses of emergency medications. They assist in the evaluation and stabilization of pediatric trauma patients.
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Tufts Medical Center: PGY1 residents rotate for 2 weeks through the pediatric emergency department at this Level I trauma center. The pediatric emergency department is separate from the main emergency department. Residents have the responsibility in the resuscitation of pediatric patients and in performing indicated procedures under the supervision of fellowship-trained Pediatric Emergency Medicine attendings.
Medical Intensive Care Unit (MICU)
BIDMC: PGY1 interns spend 4 weeks caring for critically ill patients as part of the MICU team. They are also responsible for responding to cardiac arrests in the hospital. A significant amount of procedural skills are learned and reinforced in the MICU. Emergency Medicine interns are supervised and taught by medical attendings and fellows as well as senior medical residents.
Anesthesia/Ultrasound
BIDMC: PGY1 interns spend 3 weeks on the anesthesia service under the supervision of anesthesiology attendings. They develop skills in emergency airway management, the use of paralytic agents, and general anesthetic agents. The interns receive instruction on rapid sequence induction, oral awake intubation, nasotracheal intubation, fiberoptic intubation, use of the intubating laryngeal mask airway, central line placement, and arterial line placement. They also assist in the performance of complex procedures such as transesophageal echocardiography and regional nerve blocks. They spend an additional dedicated week for ultrasound.
Anesthesia/Ultrasound
BIDMC: PGY1 interns spend 3 weeks on the anesthesia service under the supervision of anesthesiology attendings. They develop skills in emergency airway management, the use of paralytic agents, and general anesthetic agents. The interns receive instruction on rapid sequence induction, oral awake intubation, nasotracheal intubation, fiberoptic intubation, use of the intubating laryngeal mask airway, central line placement, and arterial line placement. They also assist in the performance of complex procedures such as transesophageal echocardiography and regional nerve blocks. They spend an additional dedicated week for ultrasound.
Ultrasound
BIDMC: PGY1 residents spend three weeks on the ultrasound rotation. Designed to complement the residency ultrasound curriculum, the resident further refines his or her skills in ED bedside ultrasound. Abdominal, OB-GYN, trauma, echo, and procedural ultrasound are emphasized. Hands-on experience is supplemented by computer simulations and readings.
Obstetrics
BIDMC: PGY1 interns spend 2 weeks caring for obstetrical patients and performing vaginal deliveries under the supervision of obstetrics and gynecology residents and attendings. As the junior resident on the service, interns have ample access to normal vaginal deliveries and episiotomy repairs. Residents also first-assist on c-sections and participate in high-risk deliveries. In addition, they gain experience in performing first trimester ultrasounds.
Red Zone
BIDMC: This 2 weeks rotation is designed to give interns a dedicated exposure to critically ill medical and trauma patients in the emergency department. During this rotation, they have the opportunity to observe and perform various procedures, which could potentially include intubation, central line placement, lumbar puncture, arterial puncture and line placement, conscious sedation, fracture reduction, and others. Some dedicated time is also spent working with nursing and tech staff in the red zone, learning more about the role of these providers in caring for critically ill patients in the emergency department. There are also multiple informal one-on-one didactics held with BIDMC faculty. Residents will also spend a day in ENT clinic learning fiberoptic flexible nasopharyngoscopy and a day in ophthalmology clinic honing ocular exam skills.