A well-rounded clinical experience is vital in the preparation of the emergency physician. Our curriculum was designed to provide an intense clinical experience both in and out of the emergency department to assure the acquisition of the skills needed to practice the specialty. The rotations outside of the ED include the intensive care unit (ICU), pediatric intensive care unit (PICU), coronary care unit (CCU), trauma and trauma intensive care, labor and delivery, and ophthalmology. These rotations, coupled with the emergency medicine rotations throughout the three year residency, provide the resident with the skills necessary to practice emergency medicine.
The basis of training for the resident is the emergency medicine experience and it includes both the ED as well as the prehospital care setting.
The emergency medicine experience is divided amongst seven hospitals - Thomas Jefferson University Hospital, Methodist Hospital, Our Lady of Lourdes Hospital, The A. I. DuPont Hospital for Children, The Children’s Hospital of Philadelphia, Wills Eye Hospital, and Paoli Hospital. These seven settings provide the resident with a wide variety of clinical experiences and practice settings. Given that variety is inherent in the field of emergency medicine, this prepares the graduate for practice in practically any environment.
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 spends eight months in emergency medicine with approximately 35 percent of this time at Jefferson, 30 percent at Methodist Hospital, 25 percent at Our Lady of Lourdes Hospital, and 10 percent at Paoli Memorial Hospital. In the PGY-III year, the resident spends eight months in emergency medicine with approximately 60 percent at Jefferson, 30 percent at Methodist Hospital, and 10 percent at Paoli Memorial Hospital. PGY-III residents spend one month at Children’s Hospital of Philadelphia.
Located in downtown Philadelphia, our state-of-the-science emergency department is a 28,000 square-foot facility which includes 60 acute emergency examination rooms, three trauma beds, a trauma operating room, a large resuscitation area, and an 10 bed observation/telemetry admit area. In addition, we have a dedicated radiology suite along with our own CT scanner. 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, TJUH is a regional spinal cord injury center and treats approximately 1000 acute spinal cord injuries per year.
The department treats more than 60,000 adult and pediatric patients annually. Approximately twenty percent of all ED patients are admitted. Twenty-five 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.
Located approximately 5 miles from Main Campus, the Methodist Campus of TJUH provides acute care services to the South Philadelphia community. It is the main community hospital experience for the residency. The ED is a modern, 12,000 square-foot facility which includes 19 acute emergency examination rooms and a four bed fast track area. The department treats 43,000 patients per year, of which twelve percent are pediatric patients.
Patients requiring a higher level of service (including acute neurosurgical intervention, acute stroke, major trauma, cardiac catheterization, obstetrical services) are transferred to Main Campus by JeffSTAT (Jefferson’s Prehospital and Emergency Medical Services provider).
Our Lady of Lourdes Hospital is located approximately 5 miles from TJUH in Camden, NJ and represents another community EM experience. The annual volume is 43,000 visits per year. One quarter of the patients seen in the ED are admitted to the hospital. What makes this site unique is the relatively high (20-25%) percentage of pediatric patients when compared to the typical ED. This experience allows the resident to see pediatric patients in a non-pediatric hospital setting.
The A.I. DuPont Hospital is TJUH's children's hospital and is located approximately 45 minutes south of Philadelphia in Wilmington, Delaware. The emergency department sees approximately 42, 000 pediatric patient visits per year. The EM resident will spend one month in the ED in their first year, one month in the intensive care unit in their second year, and one month in anesthesiology in their third year.
This world famous pediatric hospital is located approximately 2 miles from TJUH. The department sees over 80, 000 pediatric patient visits per year and is one of two pediatric hospitals in the cit of Philadelphia. The EM resident spends one month in the ED during their third year.
The use of the above five hospitals is specifically designed to expose the resident to a wide variety of patients and practice environments. The design includes university, pediatric, urban and community settings and provides our residents with the variety that prepares them for future independent practice in any setting that they may ultimately choose.
Paoli Hospital in Paoli, Pennsylvania, is a community hospital situated in the suburbs of Philadelphia. The hospital has a 28 bed ED and a total of 240 inpatient beds. It is the only trauma center (Level 2) for all of Chester County and serves a750 square mile area with a population of 491,000. Residents have the opportunity to participate first-hand, while working under the supervision of community emergency physicians, in a pure suburban community hospital experience (aside from Podiatry, there are no resident physicians at the hospital). In addition, residents have a unique trauma experience. TJUH Department of Surgery operated the trauma service with no other residents. Residents have the opportunity to work directly with our trauma surgeons under their supervision and run all trauma codes.
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 (the main prehospital care provider for the city of Philadelphia). It is also the home the the JeffSTAT Paramedic Training School. 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, ground and air transport experiences, provision of health care at mass gatherings, and teaching in JeffSTAT’s paramedic school.
The PGY 3 resident has a two-week rotation that is incorporated into the third year. During this time, the resident rides along with prehospital care transport (Philadelphia Fire Rescue, JeffSTAT, private ambulance companies) and has the opportunity, if so desired, to ride JeffSTAT’s helicopter. They spend time in the Philadelphia Fire Rescue Communications Center learning about the operational aspects of prehospital care. Lastly, the resident participates in the formal teaching of paramedic students in JeffSTAT’s Paramedic Training School.
In preparation for providing daily online medical command in the third year, residents complete a base station medical command course in their second year. PGY 3 residents function as medical commander for six advanced paramedic units and is responsible for answering the medical command phone.
One unique experience at Jefferson is the provision of on-site medical command at mass gatherings. Over their PGY 2 and 3 years, residents provide medical direction to paramedics and EMTs at mass gatherings at events at venues such as Citizens' Bank Park (Philadelphia Phillies, concerts), Lincoln Financial Field (Philadelphia Eagles, Army-Navy, concerts), and a variety of other events throughout the city (Philadelphia Distance Run).