Emergency Medicine Residency Curriculum
We are happy to offer detailed information on the EVMS Department of Emergency Medicine curriculum and programs. Interested students are invited to learn more about qualifications and to apply for our residency.
For the first month (August), all PGY-I residents are in the Emergency Department. A special introductory lecture series is provided, as well as a suture lab, an introductory bedside Ultrasound course, and a base station course. The residents also complete a Pediatric Advanced Life Support (PALS) Provider course and an Advanced Trauma Life Support (ATLS) Provider course during the month. An Advanced Cardiac Life Support (ACLS) Provider course is required for those residents not already Provider-certified.
The PGY-I year includes five months of Emergency Medicine, one month each of Pediatric Emergency Medicine, Internal Medicine, Orthopedics, Trauma, Anesthesia, OB/GYN, and Cardiology.
The PGY-II year consists of six months of Emergency Medicine, and one month each of Trauma, Pediatric Emergency Medicine, Pediatric Intensive Care, Medical Intensive Care, Surgical Subspecialties and two weeks of Pediatric Anesthesia and two weeks of ED Ultrasound.
The PGY-III year consists of a more intense experience and additional responsibility in the Emergency Department for eight months. The remainder of the year consists of rotations of one month each in Pediatric Emergency Medicine, Emergency Medical Services/Emergency Department Administration, Elective, and Medical Intensive Care.
The Anesthesia rotation is completed at Sentara Norfolk General Hospital. Emergency Medicine residents work under the supervision of Anesthesia attending physicians. Emergency Medicine residents gain experience in the performance of nasotracheal and orotracheal intubation, LMA, bag-valve mask ventilation, and the proper use of medications for rapid sequence intubation and conscious sedation.
This rotation is completed at Maryview Medical Center. Residents work under the supervision of attending Cardiology faculty, becoming proficient in the interpretation of EKGs and rhythm strips. In addition, the resident will gain experience in the evaluation and management of many cardiovascular conditions and emergencies.
This is a two week rotation at SNGH during the PGY-2 year. During the rotation, the resident will complete all of the on-line teaching modules for ED Ultrasound. They will work several sessions in the ED with our Ultrasound faculty and will submit a minimum of 100 US exams performed during the rotation.
Virtually every type of elective is offered at our institution, including Sports Medicine, Hyperbaric Medicine, Occupational Medicine, Plastic Surgery, Dermatology, etc. The only elective not available at our institution is Toxicology. Emergency Medicine residents are permitted to complete a rotation at another institution for one month during the PGY-III year if they are in good academic standing.
Emergency Medical/ED Administration
The Department of Emergency Medicine has been intimately involved with Emergency Medical Services (EMS) in the Tidewater area for many years. Faculty members serve as Operational Medical Director for 17 different EMS agencies in the area. During the rotation, residents have the opportunity to ride in the ambulance with the Norfolk Paramedical Services and the Virginia Beach Volunteer Services. Norfolk is a paid system; Virginia Beach is an all volunteer system — in fact, it is the largest all-volunteer EMS system in the country. In addition, Emergency Medicine residents have the opportunity to fly on the area's only air ambulance helicopter, Sentara Nightingale, based at Sentara Norfolk General Hospital. This part of the rotation is strictly optional; residents are not required to fly on the helicopter. During the month, residents attend regional and state meetings of the various EMS agencies, participate in the review of EMS run sheets, and give lectures to the paramedics.
Incorporated into this rotation is valuable experience in the administrative function and responsibilities of the Medical Director of an Emergency Department. Residents meet with the Medical Directors of several hospital Emergency Departments, ranging from a Level l Trauma Center to a small, rural hospital Emergency Department. In addition, residents attend meetings with hospital administrators concerning the operation of the Emergency Department. Residents also learn about quality assurance and improvement, JCAHO requirements, and billing.
A total of nineteen months of training is on the Emergency Medicine service. All residents work 23 shifts per month in the ED on Emergency Medicine rotations. All shifts are eight hours in length. This allows the resident ample opportunity to read on his/her patients and have time to master the information necessary to become an outstanding Emergency Medicine attending physician.
Residents are supervised on a 24-hour basis by attending Emergency Medicine faculty.
All faculty are board-certified or board-prepared in Emergency Medicine; residents are never supervised by anyone other than a board-certified or board-prepared Emergency Medicine attending physician.
Attending faculty are always present in the Emergency Department; faculty do not sleep in the call-room during night shifts or complete paperwork in their offices during day shifts
We use a templated charting system supplemented with 24h unlimited access to dictation (for addendums, critical or difficult patients, etc.) at all of our EDs.
A major advantage of our program is the exposure to pediatric patients in the Emergency Department. In addition to our dedicated Pediatric Emergency Medicine rotations, you will see pediatric patients during all of your regular Emergency Medicine rotations. All of our Emergency Departments are undifferentiated; that is, they are not divided into a pediatric side or surgical side. You will see pediatric patients throughout your training, not just on pediatric rotations. Overall, you are exposed to pediatric patients during 23.5 months of your training.
Residents spend 70 percent of their Emergency Medicine rotations at the primary training site, Sentara Norfolk General Hospital. Approximately 20 percent is spent at Sentara Virginia Beach General Hospital and 10 percent at Sentara Obici Hospital. This allows the resident experience in every type of Emergency Medicine practice setting, ranging from a university-type emergency department to a semi-rural community hospital emergency department.
This rotation is completed at Sentara Norfolk General Hospital. Residents complete one month of ward medicine under the supervision of residents and faculty of the Department of Internal Medicine. Residents gain valuable experience in the evaluation and management of a wide variety of medical conditions and illnesses. Residents are also provided ample opportunity to perform procedures, such as lumbar puncture, central line placement, etc.
The Medical Intensive Care rotation is completed at Sentara Norfolk General Hospital; one month in the second year and one month in the third year. Emergency Medicine residents work under the supervision of attending Intensivist physicians. They serve as the senior resident on the service. Emergency Medicine residents gain valuable experience in the evaluation and management of the critically ill adult patient. Residents have the opportunity to become proficient in the performance of central line, arterial line, and Swan-Ganz catheter placement.
This rotation is completed at Sentara Norfolk General Hospital. Residents work under the supervision of senior OB/GYN residents and attending physicians. Emphasis during the rotation is on the initial evaluation and management of common obstetrical and gynecologic conditions and emergencies, as well as experience in performing vaginal deliveries.
The Orthopedic rotation is completed at Sentara Virginia Beach General Hospital, twenty-five minutes driving distance from the primary training site. Residents work under the supervision of Orthopedic attending physicians in the outpatient setting. Emergency Medicine residents gain experience in the initial evaluation, diagnosis and management of orthopedic, musculoskeletal, and soft tissue injuries.
This two-week rotation is completed at the Children's Hospital of the Kings Daughters, the only pediatric hospital in the Commonwealth of Virginia, during the EM-2 year. Residents work under the direct supervision of Pediatric Anesthesia attending physicians. Resident gain valuable experience in the management of the pediatric airway, including performance of orotracheal intubation.
Pediatric Emergency Medicine
The Pediatric Emergency Medicine rotation is completed at the Children's Hospital of the King's Daughters (CHKD). This hospital is adjacent to, and connected on several floors with, Sentara Norfolk General Hospital.
The Emergency Department consists of 40 beds. Residents work approximately 20 shifts/month, each 10 hours in length. Residents are supervised by Pediatric Emergency Medicine attending physicians on a 24 hour basis. The Emergency Department has an annual census of approximately 40,000 patients, and is equipped to handle all types of pediatric illness and injury except major trauma; those patients are seen at Sentara Norfolk General Hospital. Residents rotate through the Pediatric ED for one month during each year of training.
Pediatric Intensive Care
The Pediatric Intensive Care rotation is completed at the Children's Hospital of The King's Daughters (CHKD), the only pediatric hospital in the Commonwealth of Virginia. Emergency Medicine residents work with Pediatric residents under the supervision of attending Pediatric Intensivist physicians. The call schedule is every fourth night. Emergency Medicine residents gain experience in the evaluation and management of critically ill pediatric patients.
Residents also have the opportunity to become proficient in performing invasive procedures, such as orotracheal intubation, central and arterial line placement, tube thoracostomy, and intraosseous line placement in the pediatric patient.
This rotation is completed at Sentara Norfolk General Hospital. This one month rotation is divided into two two-week blocks. All EM residents complete Ophthalmology during the first two weeks. Residents work under the supervision of Ophthalmology resident and attending physicians and learn the appropriate evaluation and management of a wide range of ophthalmologic conditions and injuries.
The EM resident has a choice of ENT or Plastic Surgery for the second two-week block. For both rotations, EM residents work with residents and attending physicians in these specialties and gain hands-on, practical experience.
The Trauma rotation is completed at Sentara Norfolk General Hospital, the only area Level I Trauma Center.
The trauma team is staffed by an attending physician with specialty training in Trauma.
Additional team members include a PGY-IV General Surgery resident, and a PGY-I or PGY-II Emergency Medicine resident. Residents from other services, such as Orthopedics and ENT, and fourth year medical students, usually rotate on the service as well, so the typical team consists of four or five members. Residents are on-call every third night.
The EM residents and faculty manage all trauma airways. As a PGY-I Emergency Medicine resident on the trauma team, you will learn the appropriate evaluation and management of blunt and penetrating trauma. Emergency Medicine residents become proficient in the performance of central and arterial line placement, tube thoracostomy, diagnostic peritoneal lavage, and all of the other procedures necessary for the resuscitation and stabilization of the traumatized patient.
As a PGY-II Emergency Medicine resident on the trauma team, you will have the opportunity to "Captain" the team, and gain valuable experience in directing and supervising the care of trauma patients.