Equally important to the clinical experience in a resident’s education is the formal education experience. This experience is composed of medical simulation, weekly conference, online learning activities, medical simulation, ultrasound, formal teaching blocks, and a scholarly activity work. The wide variety of experiences allow residents of all learning types to acquire the knowledge that they need to practice emergency medicine.
The Dorrance Hamilton Medical Education Building
Home of the Thomas Jefferson University Hospital
Emergency Medicine Simulation Program.
Our conference curriculum is designed to cover the Core Curriculum of Emergency Medicine (as developed by the American College of Emergency Physicians and the American Board of Emergency Medicine). Each month covers a specific topic and an 18-month curriculum has been developed to assure coverage of the core curriculum topics. Four hours (8am to noon every Thursday) are devoted to covering the monthly topic and is done so with a variety of formats, including lectures, case discussion, critical review of the literature, combined specialty conferences, interactive question-and-answer sessions, small group sessions, and grand rounds. While the majority of conference is conducted by faculty, EM residents, under the supervision of a faculty member, are expected to give lectures during each year of their residency. Click here to view conference schedules and related information.
To augment the weekly conferences, residents are assigned to complete one topic-based module per month. Each module consists of up to 4 hours of online lectures and questions that are related to the assigned topic of the month. Residents complete these assignments at their convenience. All of the online resources are available at any computer with internet access and many of the lectures can be downloaded to personal devices such as iPods. The modules are constructed to augment the weekly conferences.
Simulation is an important aspect of medical
education today. It allows a program to assure that
a resident will gain experience in a variety of
emergencies (both common and rare).
We are one of the few Emergency Medicine residencies in the United States with direct access to a simulation center located on campus. Thomas Jefferson University Hospital and Jefferson Medical College is home to the Dorrance H. Hamilton Medical Education Building (top of this page). Opened in October 2007, the Hamilton Building is home to a state-of-the-art simulation center that uses high and low fidelity simulators and standardized patients. Additionally, faculty both within the Department of Emergency Medicine as well as faculty in Jefferson’s Clinical Skills Center participate in our resident’s education. Our institution is also 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. These two resources together provide the resident with access to multiple adult, pediatric and obstetrical simulator mannequins 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 enough experiences to prepare them for a variety of 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.
Every Thursday afternoon, four residents participate in a simulation session. Each resident serves as the team leader for a case while the other residents play a variety of roles. This allows a resident to be exposed to a total of four different critical care cases in a session. All sessions are videotaped and are reviewed with the resident by one of three faculty members to assure an in-depth learning experience. Residents participate in four simulation sessions per year.
Essential to the practice of emergency medicine is the acquisition of procedural skills. Procedural skills laboratories are held twice a year in the Jefferson Medical College’s Department of Anatomy cadaver lab. In the fall of the academic year, residents teach surface anatomy to the first year Jefferson medical students and demonstrate invasive procedures. In the spring, a dedicated procedural skills laboratory is done to teach and assess procedural skills. Procedures include lateral canthotomy, needle and open cricothyroidotomy, pericardiocentesis, needle and open chest tube thoracostomy, and venous cutdown. These sessions afford our EM residents the opportunity to practice and perform needed skills.
Three ultrasound fellowship-trained faculty members (J. Matthew Fields, MD, Bon S. Ku, MD, MPP and Arthur Au, MD) provide a dedicated ultrasound training experience to the EM residents. An ultrasound fellow in the Ultrasound Fellowship in the Department of EM will serve as an additional dedicated ultrasound instructor for the resident.
Currently, our EM residents have 4 weeks of formal ultrasound training during their first year of residency where they have at least 8 eight-hour scanning shifts and are paired with an RDMS ultrasonographer. During the rotation, a number of ultrasound textbooks are made available for assigned readings. Each resident performs ultrasound scans on ED patients who require an ultrasound based upon their clinical presentation. The ultrasonographer teaches the practical aspects of ultrasound performance. All scans are recorded and saved for later review by our ultrasound-trained faculty. Each Monday of the rotation the resident participates in a formal three-hour didactic session along with review of ultrasounds done by the ultrasound faculty and fellow.
In addition to the 4 formal weeks of ultrasound training, residents have access to three Zonare and SonoSite MicroMaxx ultrasound machines (two are located at TJUH and the third is located at Methodist Hospital). The machines include curved array, linear array, phased array and endovaginal transducers. Residents are encouraged to use ultrasounds when clinically applicable. All scans done in the EDs of Thomas Jefferson University Hospital and Methodist Hospital are reviewed by the EM ultrasound faculty.
Third year residents spend one month on the EM Administration and Teaching (EMAT) block. During this time, the resident has a number of formal teaching responsibilities. The EMAT resident will prepare and present two lectures for the weekly conferences, prepare and present a critical review of the literature session, conduct a daily teaching session for the residents working in the ED, and will teach fourth year medical students in their required EM rotation. Jefferson Medical College fourth year students participate in a required four-week clerkship in Emergency Medicine. At the end of each of the first three weeks, medical students spend 3 hours in the class and 4 hours in the simulation lab learning EM. The EMAT resident teaches one lecture and one skill session per week in this course. EM procedural skills such as lumbar puncture, central line placement, and suturing are covered by the resident during the skill sessions. Additional EMAT duties during the rotation include participation in an ongoing continuous quality improvement (CQI) project, bedside teaching and procedures supervision of junior residents and medical students, and laboratory/radiology patient follow-up.
Second year residents spend two weeks on an Education block. During this time, the resident completes a module in Evidence Based Medicine (EBM). This module involves the completion of assigned readings on the process of EBM, the development of a question relevant to the practice of emergency medicine, a literature review, and a presentation, during our weekly conference, of an interactive session where the resident leads a discussion on the topic. Other duties during this block include teaching in the ED and teaching in the fourth year medical student course.
Resident Scholarly Project
A formal scholarly project is a residency requirement. Residents may accomplish in a number of different ways such as collaboration with a faculty member 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 and provides a unique opportunity to the resident interested in a laboratory experience. Residents have a one-week block in their second year dedicated to either starting or completing their scholarly project and can use up to four weeks of elective time in their third year as well.
With regards to elective time, there are four weeks in the third year that can be used for a variety of activities. A resident may use that time to complete their scholarly project, receive clinical experiences to enhance their education, or travel for a medical experience. For those interested in travel to a foreign country, their education will be augmented by the Global Health faculty as well as fellow from our newly-established Global Health Fellowship.
Examples of scholarly activity by TJUH EM residents:
1.Teng, H. et al. Telomere length in circulating serum DNA as a novel non-invasive biomarker for cirrhosis: a nested case-control analysis. Liver Int. 2012
2. Piela, N. et al. Impact of ED management on hospital quality measures: the negative case of atrial fibrillation. Am J Emerg Med 2013
3. Morley, D. et al. Rewarming for accidental hypothermia in an urban medical center using extracorporeal membrane oxygentation. Am J Case Reports 2013
4. Chien, J. et al. Demographics of carotid atherosclerotic plaque features imaged by computed tomography. J Neuroradiol. 2013
5. Catallo, K. et al. Resuscitation of the pregnant patient: What is the effect of patient positioning on inferior vena cava diameter? Resuscitation. 2013
Resident Scholarly Tracks
Scholarly tracks allow residents to develop a deeper understanding of a specific area of interest during their residency. It is designed to provide formal education along with experiences tailored to the resident’s interests and give them a level of expertise for use in their future careers. Residents meet with one of the program directors to discuss specific areas of interest. Once decided, the resident is assigned to the track’s faculty mentor for specific assignments. All tracks teach the resident skills in public speaking, scientific writing and presentation, education, and administration.
||Priya E. Mammen, MD, MPH
|Health Care Advocacy
|Medical Student Education
||; Dimitrious Papanagnou, MD
|CNS Injury Research
|Cardiac Ischemia Research
||Bernie Lopez, MD
||, , Arthur Au, MD