Thomas Jefferson University Hospital
Emergency Medicine Residency
The emergency medicine residency program at Thomas Jefferson University Hospital is affiliated with Jefferson Medical College, one of the oldest and largest medical schools in the country and an institution rich with medical history. Initiated in 1983, our program is fully accredited by the Residency Review Committee of the Accreditation Council for Graduate Medical Education, and is one of the older and more established emergency medicine programs in the United States. We subscribe to the National Resident Matching Program and offer twelve PGY-I emergency medicine positions.
We are a highly academic residency program and our goal is to develop skilled and compassionate practitioners of emergency medicine. We are committed to academic excellence and combine superior patient care, strong teaching and quality research. We are also interested in your well being, and want to provide you with an environment that will encourage intellectual curiosity and stimulate your development of diverse interests.
Our program provides residents with the opportunity to pursue career paths as emergency medicine practitioners, teachers or researchers. Residents are also prepared to assume leadership and administrative positions or to continue their education with subspecialization.
As a result of the specialty’s rapid growth and expansion, this is an exciting time for emergency medicine. Our history at Jefferson parallels this change as we too continue to grow in size and strength.
The Emergency Department
The Emergency Department (ED) is an academic department of Jefferson Medical College of Thomas Jefferson University and a clinical department of Thomas Jefferson University Hospital. The ED is staffed 24 hours a day by Emergency Medicine board- certified faculty.
Our state-of-the-science emergency department is a 20,000 square-foot facility which includes a large resuscitation area, three trauma beds, an operating room, 23 acute emergency examination rooms, four bed fast track, 8 bed chest pain observation/telemetry admit area, triage areas, nursing stations, a radiology suite, a mini-lab, and a family room.
The department treats more than 63,000 adult and pediatric patients annually. Forty percent of all TJUH admissions come from the ED and of those admitted to the hospital’s critical care units, 25 percent have been seen by the ED.
The approximate distribution of patients is as follows:
• 50 percent medical
• 13 percent surgical
• 10 percent obstetrical/gynecological
• 7 percent pediatric
• 10 percent other
TJUH is a Level I Trauma Center as designated by the American College of Surgeons, and treats approximately 1400 major trauma cases each year.
In addition to the Scott Memorial Library, which maintains over 170,000 volumes and 2,300 journal subscriptions, the emergency department maintains its own active library. Academic offices and research laboratory space are located on the second floor of the department above patient care areas.
The Emergency Medicine Residency Training Program
The primary objectives of the emergency medicine residency training program are to train clinicians in the specialty of emergency medicine, to prepare academicians and to develop emergency medicine leaders for the future. The program is academically based and is designed to provide a well-balanced educational training experience that fulfills the special requirements established by the residency review committee for emergency medicine.
Our educational philosophy is to produce highly qualified physicians who have a superior base of medical knowledge, excellent procedural skills and the ability to apply these skills in the practice of emergency medicine. The curriculum therefore combines diverse emergency medicine and specialty block rotations with strong conference didactics. Block rotations have been structured to integrate specialty clinical experiences into the emergency medicine curriculum.
We are interested in training competent and caring clinicians while providing an environment that will nurture intellectual curiosity, support personal growth and prepare residents for the successful completion of the emergency medicine board examination.
Emergency Medicine Experience
The emergency medicine experience draw on clincal rotations at five different hospitals: Thomas Jefferson University Hospital (a university hospital), Methodist Hospital in South Philadelphia (an urban community hospital), Our Lady of Lourdes Hospital in Camden, New Jersey (a community hospital), and two pediatric hospitals – A.I. DuPont Hospital for Children in Wilmington Delaware and The Children’s Hospital of Philadelphia. The combined census for these five hospitals is over 200,000 patient visits, thus offering many learning opportunities for residents. During the residency training, residents have a structured emergency medicine experience that allows them to develop into an independent emergency physician.
During the PGY-I year, the resident spends four months in emergency medicine at Thomas Jefferson University Hospital and one month at A.I. DuPont Hospital for Children. In the PGY-II year, the resident rotates in emergency medicine for eight months with approximately 60 percent of this time at Jefferson and the remainder at Methodist Hospital and at Our Lady of Lourdes Hospital. In the PGY-III year, the resident spends eight months in emergency medicine at Jefferson and Methodist Hospital and one month at The Children’s Hospital of Philadelphia.
Our residents are exposed to a wide variety of clinical conditions and have the opportunity to develop expertise in resuscitations and procedures. Based upon the current documentation by residents of resuscitations and procedures, the following table is an estimate of the number of resuscitations and procedures that an EM resident at our program can expect to experience in the course of their residency. Procedures are done largely in the clinical setting and are supplemented by twice-yearly procedures labs and in bimonthly simulation sessions.
| |
Average # per Resident |
Adult Medical Resuscitation |
83 |
Adult Trauma Resuscitation |
76 |
Pediatric Medical Resuscitation |
17 |
| Pediatric Trauma Resuscitation |
13 |
Arthrocientesis |
10 |
Cardioversion/Defibrillation |
10 |
Central Venous Lines |
89 |
Conscious Sedation |
26 |
Cricothyroidotomy |
8 |
Dislocation Reduction |
17 |
Endotracheal Intubation |
106 |
Lumbar Puncture |
33 |
Pericardiocentesis |
3 |
Rapid Sequence Intubation |
29 |
Ultrasound |
106 |
Vaginal Delivery |
23 |
Emergency Medical Services
Thomas Jefferson University Hospital is a medical command base hospital for the City of Philadelphia and provides medical direction for the Philadelphia Fire Rescue System. Jefferson and Methodist are also major receiving hospitals for Philadelphia’s emergency medical service squads. The Emergency Medical Services experience includes direct contact with prehospital personnel, on line telephone medical command, participation in clinical didactics, a base station command course and quality assurance reviews. The PGY-II resident has a one-week rotation with the Philadelphia Fire Rescue Services. During this week, the resident tours the fire communication center, learns about the operational aspects of prehospital care and is assigned to ride with an advanced paramedic unit. In addition to the time with the Philadelphia Fire Rescue, the resident will spend time in the Center for Bioterrorism and Disaster Medicine at Thomas Jefferson University Hospital. The center is directed by an EM faculty member, Dr. Edward Jasper. The resident will learn principles of disaster management and will participate in the planning and conduction of a disaster drill. At the end of the second year, residents complete a base station medical command course. By the beginning of the third year, the PGY-III resident functions as medical commander for six advanced paramedic units and is responsible for answering approximately 15 telephone calls per day.
Formal Education
Five hours per week of conference time is devoted to the core curriculum of Emergency Medicine as developed by the American College of Emergency Physicians and the American Board of Emergency Medicine. Topics are covered in a variety of formats, including lectures, case discussion, critical review of the literature, combined specialty conferences, interactive question-and-answer sessions, and grand rounds. EM residents are expected to give a number of lectures during each year of their residency.
Formal Medical Student Teaching
Jefferson Medical College fourth year students participate in a required four week clerkship in Emergency Medicine. Third year EM residents, during their one month Emergency Medicine Administration and Teaching module teach weekly lectures to the students. In addition, the EM resident will teach EM procedural skills such as lumbar puncture, central line placement, and suturing in the Jefferson Medical College Clinical Skills Center.
Simulations
Our institution is home to the Center for Bioterrorism and Disaster Preparedness, a federally funded entity with a mission to provide continuing education to the nation’s healthcare workforce and to teach the public about emergency procedures. Multiple adult, pediatric and obstetrical simulator mannequins are used in twice-monthly sessions to teach and evaluate EM residents on a variety of emergency conditions. In addition, there are simulators for central line placement, lumbar puncture, umbilical vein and artery cannulation, pericardiocentesis, vaginal delivery, and endotracheal intubation. The simulation curriculum helps to assure that our residents have enough experiences to prepare them for emergent conditions and procedures that they may encounter during and beyond their residency training. It also allows the faculty to assess the skills of the resident so that deficiencies can be addressed in a timely fashion.
The Dorrance Hamilton Medical Education Building is currently under construction with an anticipated completion date of November 2008. The building will serve as the main education building for all of Thomas Jefferson University and will be used for the education of students from Jefferson Medical College, the School of Nursing, the School of Pharmacy, and the College of Health Professions. Aside from the classrooms, there are a number of state-of-the-art simulation centers that will include a fully functional emergency department room. Simulations sessions will take place in this setting.
Resident Scholarly Project
A formal scholarly project is a residency requirement. Residents may accomplish this through collaboration with a member of the faculty in clinical or laboratory research, epidemiologic surveys, written case reports, or book chapters. The Department of Emergency Medicine is home to two laboratories devoted to basic science research in neurologic and cardiac injury research. |
