University of Rochester
Pediatric Emergency Medicine
Fellowship Manual
2009-2010
Director:
Anne Brayer, MD
1
Table of Contents
Introduction...............................................................................................
Tracks ......................................................................................................................
Resident and Fellows Benefits................................................................................................
INTRODUCTION
The Pediatric Emergency Medicine (PEM) Fellowship Program at the University of Rochester is an accredited
tra...
PROGRAM GOALS
The goal of the University of Rochester Pediatric Emergency Medicine Fellowship Program is to train pediatri...
P. Develop skills as an effective teacher of other health professionals at all levels.
Q. Successfully complete the pediat...
EXPECTATIONS FOR THE PEM FELLOW, CONT’D
Research
1. Completion of at least one research project is required. Ideally, this...
EXPECTATIONS FOR THE PEM FELLOW, CONTD
Personal Conduct
1. We expect professional behavior at all times.
2. Negative comme...
IMPORTANT PHONE NUMBERS
Program Director for Pediatric Emergency Medicine:
Anne F. Brayer, MD Office
463-2934
Home
473-082...
FACULTY
PEDIATRIC EM CORE FACULTY
All are Pediatric ED attending physicians, and all participate actively in teaching PEM ...
EMERGENCY MEDICINE CORE FACULTY
All take part in EM teaching conferences by lecturing and/or actively participating.
Name
...
FELLOWS
Fellow Fellowship
Dates
Medical School Residency/Postdoctoral Education
Elizabeth Murray, DO 2007-2010 University ...
Name Position Location of Practice
Mark A. Hostetler, MD, MPH
1997-1999
Associate Professor & Director
Pediatric Emergency...
CURRICULUM OVERVIEW
The curriculum consists of a wide variety of rotations to ensure a complete range of training that is ...
For Graduates of an EM Residency (2 Year Program):
Year 1
¼ block Orientation
¼ block Reading Elective
8 blocks ED
1 block...
Clinical Knowledge and Procedures
Year 1 Has mastered the large majority of the subject material of Pediatric Emergency Me...
SAMPLE OF YEARLY BLOCK SCHEDULES
PEM FELLOWS SAMPLE PEM FELLOWSHIP PROGRAM SCHEDULE
2009-2010
Blocks
ROTATION
PERIOD
ROTAT...
PEDIATRIC ED SCHEDULE
Daily schedule of attending physicians and fellows in the pediatric emergency medicine department.
19
JUL.09 PEDS PEDS PEDS PEDS-FACULTY PEDS-FELLOWS TRAUMA O/N
Date 0700-1500 1500-2300 2300-0700 1730-2330 1500-2300 2330-073...
EM Grads Curriculum
# of
Blocks
# of
Weeks PED Shifts/Block Conference Attendence
Year 1
Orientation 0.25 1 2 Peds EM Conf...
EMERGENCY DEPARTMENT POLICY FOR SCHEDULING VACATION/CME AND TIME-AWAY
Graduates of an emergency medicine residency program...
SAMPLE PEM FELLOWS SCHEDULE REQUEST
Physician Name ______________________
Rotation name Dates # ED shifts
1.______________...
THE EDUCATIONAL PROGRAM
I PEM CLINICAL EXPERIENCE
PEM fellows will be expected to work significant clinical time in the Pe...
• SOCS (Scholarly Oversight Committee) Meeting*  Changed to FELLOWS’ RESEARCH
UPDATE * NOTE CHANGES
Scheduling/Conflicts:...
v. Take home points  Each case should have a “Pearl” associated with it, or
why you were drawn to the case in the first p...
iii. Please make sure to be familiar with ALL the answer choices on the multiple
choice questions, as this is a board revi...
4. Say, “I have no idea what that statistical test is, let alone how to
interpret it” If you picked the article, figure it...
KEEP. SOCS Committee should be the same people as you have on your MPH
committee.
2) Department of Emergency Medicine Conf...
assimilate new knowledge, concepts, and techniques related to the field of one’s practice; to
formulate clear and testable...
• Meet with the fellow early in the training period and regularly thereafter
• Require the fellow to present/defend the pr...
services. PEM Fellows may complete this program without tuition fees. Attached is the current
curriculum. Additional infor...
should have a broad view of denominator-based medicine and be prepared for higher-level courses in
epidemiological methods...
enlighten and inform health policy determinations. In this course, students will be introduced to the
concepts underlying ...
RESEARCH
Mentored Research Experience to culminate in research paper suitable for publication.
ADMINISTRATION
The fellows ...
Coursework Guidelines
Year 1: Fall
Spring
Introduction to Epidemiology and Biostatistics
2 Courses
Year 2: Fall Ethics
Yea...
PEM TRAINING PROGRAM ROTATIONS
Rotation: Administration
Location: Department of Emergency Medicine, Strong Memorial Hospit...
emergency department to “run”. The trainee experiences administrative responsibilities including schedule
making, negotiat...
Rotation: Adult Emergency Medicine
Location: Department of Emergency Medicine; Strong Memorial Hospital
Rotation Length: 4...
Esophageal Spasm & Reflux, Varices & Mallory-Weiss Syndrome, Hepatitis, Cholecystitis &
Cholelithiasis, Acute Pancreatitis...
t. Urogenital and Gynecological Disorders including Ovarian Cyst and Torsion, Vaginitis,
Endometriosis and Dysfunctional U...
care for a wide range of patients of all ages, conditions and acuities while functioning at the level of an
upper level EM...
Rotation: Anesthesia
Location: Strong Memorial Hospital
Year Of Training: Year 1
Rotation Length: 4 weeks
Contact Person: ...
c. Scheduling should be arranged between trainees and supervising attending physician in advance,
so that expectations are...
Rotation: Child Abuse (REACH)
Location: Department of Emergency Medicine, Strong Memorial Hospital
Year Of Training: Year ...
Evaluation and Feedback Process:
Trainees are evaluated in writing at the end of each rotation, using a standardized evalu...
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
Download the manual for Fellowship in Pediatric Emergency ....doc
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  1. 1. University of Rochester Pediatric Emergency Medicine Fellowship Manual 2009-2010 Director: Anne Brayer, MD 1
  2. 2. Table of Contents Introduction...................................................................................................................................................................5 About this Manual.........................................................................................................................................................5 Program Goals..............................................................................................................................................................6 Program Objectives......................................................................................................................................................6 Expectations for the PEM Fellow................................................................................................................................7 Important Phone Numbers........................................................................................................................................10 Hospital Phones and Paging.....................................................................................................................................10 Faculty Core Pediatric Emergency Medicine Faculty (2009).................................................................................11 General Emergency Medicine Faculty........................................................................................................12 Fellows Current............................................................................................................................................................13 Alumni............................................................................................................................................................13 Curriculum Overview.................................................................................................................................................15 Training Goals by Year and Category......................................................................................................................16 Sample Yearly Block Schedule.................................................................................................................................18 Sample Clinical Schedule..........................................................................................................................................19 Peds Grad Curriculum...............................................................................................................................................20 EM Grad Curriculum...................................................................................................................................................21 Emergency Department Policy for Scheduling Vacation/CME and Time-Away..................................................22 Sample PEM Fellows Schedule Requests...............................................................................................................23 The Educational Program..........................................................................................................................................24 PEM Clinical Experience Other Clinical Experience Teaching/Conferences Research ....................................................................................................................................................................29 Master of Science.......................................................................................................................................................32 2
  3. 3. Tracks ....................................................................................................................................................................34 Continuing Medical Education..................................................................................................................................35 PEM Training Program Rotations.............................................................................................................................36 Administration...............................................................................................................................................36 Adult Emergency Medicine..........................................................................................................................38 Anesthesia.....................................................................................................................................................42 Child Abuse (REACH)...................................................................................................................................44 EM Orthopedics/Peds Orthopedics/Sports Med........................................................................................46 Emergency Medical Services.......................................................................................................................48 Obstetrics and Gynecology.........................................................................................................................50 Pediatric Emergency Department...............................................................................................................52 Pediatric Intensive Care Unit (PICU)...........................................................................................................59 PEM Research...............................................................................................................................................63 Emergency Psychiatry..................................................................................................................................65 Reading Electives..........................................................................................................................................67 Toxicology......................................................................................................................................................68 Trauma............................................................................................................................................................73 Ultrasound......................................................................................................................................................76 Program Contacts.......................................................................................................................................................79 Procedures..................................................................................................................................................................80 Sample Procedure Log.................................................................................................................................81 PEM Fellow Delineation of Competencies...............................................................................................................84 Institutional Oversight/Monitoring of Resident/Fellow Duty Hours......................................................................87 Institutional Policy on Resident/Fellow Duty Hours...............................................................................................89 PEM Fellows Work Hours Policy..............................................................................................................................90 Sample Virasert Contract...........................................................................................................................................92 Virasert Guidelines.....................................................................................................................................................93 PEM Fellowship Evaluation Process........................................................................................................................95 Core Competencies.......................................................................................................................................95 Sample Evaluation Forms............................................................................................................................98 Credentialing Standards..........................................................................................................................................105 Policy on Moonlighting............................................................................................................................................108 Sample Moonlighting Request Form........................................................................................................110 Sample Moonlighting Hours Tracking Form............................................................................................111 Professional Liability Insurance.............................................................................................................................112 3
  4. 4. Resident and Fellows Benefits...............................................................................................................................114 University Leave of Absence..................................................................................................................................116 Disability ..................................................................................................................................................................118 Substance Abuse......................................................................................................................................................120 Patient Safety Policy................................................................................................................................................121 Sample PEM Fellowship Contract..........................................................................................................................123 Dress Code Policy....................................................................................................................................................125 HIPPA ..................................................................................................................................................................126 Disciplinary Procedures and Appeals Policy........................................................................................................127 4
  5. 5. INTRODUCTION The Pediatric Emergency Medicine (PEM) Fellowship Program at the University of Rochester is an accredited training program, with tracks for graduates of either Pediatrics (3-year program) or Emergency Medicine (2-year program) residencies. The program is primarily administered by the University’s Department of Emergency Medicine, with close ties to the Department of Pediatrics. The Pediatric Emergency Department of Golisano Children’s Hospital at Strong is located adjacent to the Adult Emergency Department at Strong Memorial Hospital. The Pediatric ED has approximately 28,000 visits per year, while the Adult ED has 95,000 annual visits. The Pediatric ED serves as the tertiary care referral center for 14 counties surrounding the Rochester area, totaling over 1 million people. The Emergency Department is the Regional Level 1 Trauma center for the Finger Lakes Region. Dedicated pediatric ED nurses are specialists in the care of ill and injured children. The Golisano Children’s Hospital, has 51 general pediatric inpatient beds, an intermediate care unit, a 22-bed critical care unit, a normal newborn nursery, and a 52-bed intensive care nursery Our interdisciplinary team includes members of all pediatric subspecialties. The patient population is heterogeneous, with regard to social background, place of residence (inner city, suburban, and rural), and medical needs (acute illness care, diagnostic evaluation, and management of chronic medical problems). The Division of Pediatric Emergency Medicine consists of six boarded Pediatric Emergency Medicine physicians and four fellows. Division research centers on the health services issues, including the interface between primary care and emergency medicine, care of children in poverty, injury prevention, prehospital care, improving the quality of emergency care, decision analysis, head injuries, asthma, and toxicology. In addition, the Division is one of the study sites involved in the national PEM research network referred to as the Pediatric Emergency Care Applied Research Network (PECARN). The Pediatric Emergency Medicine Fellowship has been in existence at the University of Rochester since 1992. In addition to providing excellent clinical training, and superb research training, the PEM Fellowship offers the opportunity to pursue a Master’s in Public Health. PEM fellows are an integral part of our faculty, and they are provided with the tools and support necessary to be successful pediatric emergency medicine physicians. This is your Fellowship! Suggestions for improvements in the program are encouraged. About This Manual Fellows are expected to be familiar with the contents of this manual at the beginning of the fellowship. Throughout the year, additional important information will be communicated to fellows via regular mail and/or E-mail. E-mail is the primary mode of communication, thus, fellows are expected to check their E-mail frequently and to keep up to date. 5
  6. 6. PROGRAM GOALS The goal of the University of Rochester Pediatric Emergency Medicine Fellowship Program is to train pediatricians and emergency medicine physicians for full-time faculty positions in Pediatric Emergency Medicine (PEM). We place an emphasis on excellent academic training. Fellowship training prepares the physician to: 1.Provide excellent patient care. 2.Have thorough knowledge of pediatric emergency medicine and related fields. 3.Conduct independent research studies. 4.Teach the principles and practices of pediatric emergency medicine. 5.Competently administer of pediatric emergency medicine programs. Graduates of the program are typically eligible to sit for the pediatric emergency medicine subspecialty board examination. PROGRAM OBJECTIVES Train Pediatric Emergency Medicine physicians to: A. Achieve a high level of competence in the evaluation and treatment of infants, children, and adolescents who present to the Emergency Department. Graduates should be proficient in the management of medical, surgical, traumatic, psychiatric, psycho-social, and other conditions of childhood. An emphasis is placed on the management of acute problems. In addition, we aim to train Pediatric Emergency Medicine physicians to have familiarity with the evaluation and management of common adult emergencies, and of common non-emergency aspects of in-patient Pediatrics. B. Achieve a high level of understanding and competence in the management of a tertiary care referral center's Pediatric Emergency Department in the context of the continuum of management of sick or injured children. Also including the family, primary care physicians, the 911/prehospital system, poison control center, community emergency departments, in-patient units, other specialists, and community resources. C. Achieve familiarity and competence with prioritizing the emergency care of multiple patients. D. Develop and refine effective interpersonal skills through patient care, staff and multidisciplinary interactions. E. Instill and model a high degree of ethical conduct. F. Develop an awareness of the cost-effective and time-efficient use of diagnostic studies in pediatric emergency medicine while maintaining quality of care. G. Develop an understanding of prehospital practices and the interactions between prehospital providers and the Pediatric Emergency Department. H. Develop an understanding of medico-legal aspects of the practice of pediatric emergency medicine. I. Appreciate the role of preventive medicine and its interaction with pediatric emergency medicine. J. Appreciate the role of academic excellence and leadership in the practice of pediatric emergency medicine, including mentorship by current pediatric emergency medicine academicians. K. Develop the skills and motivation necessary to continue self-education in pediatric emergency medicine beyond the completion of residency training, including reading and critical evaluation of the relevant literature. L. Provide training for personal techniques for physician wellness while pursuing a career in pediatric emergency medicine. M. Effectively function as a member of the emergency medicine, pediatrics, and pediatric emergency medicine professional communities. N. Develop skills to become an effective researcher, including research design, administrative management of research projects, the conduction of research, interactions with study subjects, research ethics, presentation of research, and manuscript and abstract authorship. O. Develop a high level of understanding in biostatistics, epidemiology, research ethics, and related disciplines through university graduate courses. 6
  7. 7. P. Develop skills as an effective teacher of other health professionals at all levels. Q. Successfully complete the pediatric emergency medicine subspecialty board examination. R. Obtain an appropriate job placement. EXPECTATIONS FOR THE PEM FELLOW The PEM fellow has a complex job, with many expectations. The following is a list of the expectations. Remember: The only dumb question is the one that isn’t asked. When in doubt, please ask. Clinical 1. Arriving on time for all clinical shifts is an important courtesy in emergency medicine. 2. Prompt and reliable attendance at all activities of “outside” rotations; remember you are our ambassador! 3. Schedule requests must be filled out for every month and are due on the 15th day two (2) months proceeding the scheduled month. Work with the schedule maker to help him/her understand where you will be during that month – do not simply assume that, because you will be on an outside rotation, you will not be scheduled. Outside rotations are generally devoted to that rotation, with few or no ED shifts; this applies most notably but not exclusively to your PICU, OB, and Trauma rotations. Please see detailed description of rotations within this manual for specifics. 4. The bulk of you clinical PED shifts should be scheduled during your PED blocks. 5. When you are working in the Pediatric ED during your first year, you are expected to primarily evaluate patients. This allows you the opportunity to “cherry pick” cases that are challenging and unique in order to expand your knowledge and procedural skills. In the years two and three, you will be expected to assume leadership and precepting roles. 6. You are expected to learn as much as possible about being in charge during clinical shifts. Strive to develop a sense of all the patients in the Pediatric ED whenever possible. Learn to develop a “sixth sense” of patient or systems problems either before they start, or early in the problem resolution process. 7. All ED clinical shifts will be either worked, or appropriate substitution will be arranged. Coverage arrangements are your own responsibility. Schedule changes must be noted on the master schedule in the Pediatric Emergency Department, and you must notify the support staff responsible for scheduling. 8. Procedure logs must be completed for all relevant procedures. Currently, a computer-based system is in use. (For details, refer to the “Procedures” section of this manual.) 9. During PED block, PEM fellows are expected to be available during the day for interesting procedures and cases. Please contact the PED day shift attending about your availability. 10. PALS, ACLS, ATLS are required. Teaching/Conferences 1. Provide clinical “bedside” teaching of trainees while on ED shifts. 2. You are expected to give presentations at several PEM conferences each year, including, case conference, core PEM topics, morbidity and mortality conferences and journal clubs. 3. The fellow will lead 3 EM Departmental Teaching Fellow Conferences per year. This hour of resident lectures is a shared responsibility amongst the PEM Fellows, the Sports Medicine Fellows and the EMS Fellows. 4. The fellows may prepare and present several teaching sessions at the EM core conferences each year. 5. You are also encouraged to participate in the Department of Pediatrics’ conferences. 6. Being a PALS instructor is not required but is strongly encouraged. Similarly, ATLS, ACLS, PEPP, etc. teaching may be beneficial, but is not required. 7
  8. 8. EXPECTATIONS FOR THE PEM FELLOW, CONT’D Research 1. Completion of at least one research project is required. Ideally, this will be published and presented at a national scientific meeting. 2. You should schedule regular meetings with your research advisor over the course of your research efforts. If you are encountering problems with your research, you should notify the program director as early as possible. 3. Note that those expecting Pediatric Emergency Medicine sub-board certification through the American Board of Pediatrics (ABP) have a “research requirement.” You should familiarize yourself with the terms of this requirement. Details are provided in this manual 4. Five (5) public health courses, including research ethics, biostatistics, and epidemiology. Your grades are generally your business, but grades below B- should be reported to the fellowship director, as they will require repeating the course and reimbursement to the department. 5. Enrollment in the Master of Science program is available but is not required. You do not have to be accepted into the Master of Science program to take public health courses. The opportunity to purse a Master of Science (with the University of Rochester tuition benefits) is a unique feature of our program, conferences and clinical shifts will be rearranged so you can complete the required coursework for the Master of Science. 6. Occasionally, offers to write book chapters come up, or you encounter cases that are appropriate for publication as a “case report.” These experiences are valuable, but should not get in the way of more important activities. Many fellows do 1-2 of these sorts of things during their training. You should discuss these opportunities with your faculty advisor, or fellowship director who can help you decide if there’s time in your schedule, compared to the academic value of the proposed project. 7. Significant “facetime” is expected during your research blocks. Administration/Division Affairs 1. Regular attendance at division meetings and teaching sessions is mandatory. 2. Be active in a few areas of practice improvement of system based practice in the Pediatric ED. 3. Keep abreast of research and other activities are going on among faculty and other fellows; you will learn a lot and may end up getting active in some things, yourself. Regular attendance at the ED Research meetings is mandatory. Administration/Departmental Affairs: ED 1. Regular attendance at Grand Rounds is strongly encouraged. 2. Attendance at relevant department teaching conferences is encouraged. Administration/Departmental Affairs: Pediatrics 1. Participation in Department of Pediatrics activities is generally optional, but encouraged. These include Grand Rounds and Morning Report. 2. Giving an occasional noon Pediatrics residents conference is nice, too, but not required. Evaluations 1. Fellows must evaluate each block. 2. Fellows must evaluate the PEM faculty on an annual basis. 3. Fellows will be evaluated by responsible faculty following each block and semi-annually by PEM faculty 4. Semi-annual updates with the fellowship director must be scheduled and attended. 8
  9. 9. EXPECTATIONS FOR THE PEM FELLOW, CONTD Personal Conduct 1. We expect professional behavior at all times. 2. Negative comments about colleagues, consultants, prehospital personnel, or private practitioners are to be avoided, whether in our own ED, other ED’s and ESPECIALLY in the presence of patients or their families. Real problems may be dealt with through the existing QA process. 3. We expect a high level of diligence, energy, and enthusiasm from our fellows. 4. Regarding scheduling, fellows must do what attendings do: work with the fellowship director, ED departmental scheduler and work with those making the schedules for the outside rotations. 5. We adhere to the NYS and the ACGME resident work hour rules. These are clearly outlined in the moonlighting section of this manual. Please know these rules. If you believe you are in violation of these rules, you must contact the fellowship director immediately. Action will be taken to modify your schedule so you can be in compliance with the rules. 6. For courses, you must sign up yourself and work the schedule to make things fit. When problems arise, make them known to us early, so that we may deal with them effectively. 7. Significant “face time” is expected: when not required elsewhere, fellows should be present in their office fairly regularly, where they can participate in the day-to-day goings-on of an academic division and department. However, taking days off for needed home life, when not in conflict with the job, is allowed. 8. You will be required to do certain tasks at regular intervals, such as diversity training, getting a physical, filling out evaluations, work hours surveys, getting fitted for protective equipment, etc. Although sometimes onerous, doing these things promptly makes life easier and is part of professional life. 9. Fellows will remain in Rochester, and participate in usual Fellowship activities, through the end of the training period. Leaving early detracts from the training experience, (even if clinical requirements have been met), and will not be allowed. An off-site elective may be arranged, with permission of the fellowship director. 10. Fellowship contracts typically begin July 1st and end June 30th 3 years later. (Or 2 years for EM residency graduates). Although, clinical hours may be completed prior to June 30th of this third year. Fellowship training is not done until 33 months have been completed for graduates of PEDS residency, and 22 months for graduates of EM residency. 11. Fellows should carefully read and be familiar with the admission requirements to sit for Pediatrics EM subspecialty boards. 12. Fellows should be very familiar with the contents of the PEM fellow’s manual. 9
  10. 10. IMPORTANT PHONE NUMBERS Program Director for Pediatric Emergency Medicine: Anne F. Brayer, MD Office 463-2934 Home 473-0827 Beeper 275-1616: 3843 Secretary: Tawni Biggins 463-2942 PEM Fellowship Coordinator Jessica Mead Office 463-2926 Division Chief Director of Pediatric Emergency Medicine: Colleen O’Neil Davis, MD, MPH Office 463-2931 Home Beeper 275-1616:1137 Secretary: Tawni Biggins 463-2942 Program Director for Emergency Medicine Residency: Flavia Nobay, MD Office 463-2935 Home Beeper 275-1616:4319 Secretary: Michelle Abraham 463-2940 Department of Emergency Medicine Chair: Latha Stead Office 463-2970 Home Beeper 275-1616: Secretary: Tawni Biggins 463-2970 HOSPITAL PHONES AND PAGING If you know the beeper number of the person you wish to reach, dial 275-1616 and the appropriate number. The hospital also maintains paging operators around the clock, with whom you can reach from any hospital phone by dialing 275-2222. Most of the telephones in the hospital are for local calls only. The ED secretary phones have long-distance capability. University telephones may not be used for personal long distance calls. 10
  11. 11. FACULTY PEDIATRIC EM CORE FACULTY All are Pediatric ED attending physicians, and all participate actively in teaching PEM fellows in several settings, including weekly PEM conferences and EM teaching conferences. In addition, there are several General Emergency Medicine attendings that work clinically in the PED, as well as participate in the teaching and research curriculum. Name Title/Position Training Research Interests Mohamed Badawy, MD Assistant Professor Pediatric Residency: New York Medical College, Valhalla, NY PEM Fellowship: University of Rochester, Rochester, NY Pediatric Trauma Head Injuries Ken Graf award for Research in EM Anne Brayer, MD Associate Professor PEM Fellowship Director Director of Injury Free Coalition for Kids Pediatric Residency: Children’s Hospital of Pittsburgh, Pittsburgh, PA PEM Fellowship: University of Rochester, Rochester, NY Injury Prevention Toxicology Closed Head Injury Tele-medicine Clinical research Colleen O’Neil Davis, MD, MPH Associate Professor Chief, Pediatric Emergency Medicine Aeromedical Liasion Pediatrics Residency: University of Rochester, Rochester, NY Pediatric Cardiology Fellowship: University of Rochester, Rochester, NY Pre-hospital Care Residency Education Clinical research Madelyn Garcia, MD Assistant Professor Pediatric Residency: University of Rochester Pediatric EM Fellowship: University of Rochester, Rochester, NY Sharon G. Humiston, MD, MPH Associate Professor Pediatric Residency: University of Iowa School of Medicine, Iowa City, IA International Expert on Childhood Immunizations Marc Lampell, MD Senior Instructor Pediatric Residency: The Children’s Hospital of Buffalo, Buffalo, NY Ann M. Lenane, MD Associate Professor Medical Director, Referral & Evaluation of Abused Children Clinic (REACH). Medical coordinator of the Monroe County Multidisciplinary Case Review Team Co-Chair AAP District I Committee on Child Abuse Pediatric Residency: SUNY Upstate Medical Center, Syracuse, NY Pediatric Ambulatory/Emergency Fellowship: Children’s Hospital Medical Center, Cincinnati, OH Evaluation of Abused Children 11
  12. 12. EMERGENCY MEDICINE CORE FACULTY All take part in EM teaching conferences by lecturing and/or actively participating. Name Jeffrey Bazarian, MD, MPH Runs Monthly Evidence-based Journal Club Brian Blyth, MD Teaches the Neurology Block for EM residents Eric Davis, MD Regional EMS Director; Director, EME Fellowship, Co-preceptor for prehospital elective Rollin (Terry) Fairbanks, MD, MS, NREMTP EMS rotation preceptor, coordinator on the annual board review series, resident research advisor/preceptor; instructor for the resident PALS, ACLS, and ATLS classes; member of EM resident advisory board; teaches EMS, critical care, and patient safety/medical error topics; attending for pediatric and adult ED’s Charlie Inboriboon, MD Assistant Residency Director, EM. Coordinates EM residency lecture schedule and Grand Rounds Michael Kamali, MD Vice-Chair of Emergency Medicine, and Chief of Emergency Department Clinical Affairs Kate O’Hanlon, MD Outline curriculum and organizes the teaching schedule for the EM residents Joel Pasternack, MD Runs EM / Orthopedics QA Conference; teaches suturing practicum; Attending in Pediatric & Adult Emergency Department Sandra Schneider, MD Previous Chair of Emergency Medicine Runs toxicology rotation and EM Administrative rotation. Manish Shah, MD Director, EMS Research; teaches in EMS, research, and Geriatrics Matthew Spencer, MD Assistant Director, EM Residency Program, coordinates clinical EM rotations (trauma bay) Linda Spillane, MD Previous director, EM Residency Program; Assistant Dean of Medical Simulation, coordinates simulation sessions Kenneth Veenema, MD, MBA Director, Sports Medicine Fellowship; lectures on sports medicine / orthopedic topics. 12
  13. 13. FELLOWS Fellow Fellowship Dates Medical School Residency/Postdoctoral Education Elizabeth Murray, DO 2007-2010 University of New England College of Osteopathic Medicine Biddeford, ME Dartmouth Medical Center, Children’s Hospital at Dartmouth Lebanon, NH Kirsten Rindal, MD 2008-2010 Oregon Health Sciences University School of Medicine Portland, OR University of Rochester Dept. EM, Rochester NY Asim Abbasi 2009-2012 The University of Toledo College of Medicine University or Rochester Dept Pediatrics, Rochester NY Kiran Raman 2009-2012 University of Massachusetts Medical School University or Rochester Dept Pediatrics, Rochester NY ALUMNI Our graduates have achieved success in a variety of practice settings: Name Position Location of Practice Sallie P. Mady, MD 1992-1994 Instructor of Pediatrics Attending Physician Pediatric Emergency Medicine Framingham Union Hospital 115 Lincoln Street Framingham, MA 01702 Teresa Herbert, MD 1993-1995 Attending Pediatrician Private Pediatric Practice 4 Brook Forest Drive Arden, NC 28704 Marita Rafael, MD 1993-1995 Attending Pediatrician, Pediatric Emergency Medicine Children’s Medical Center of South Texas Corpus Christi, TX Anne F. Brayer, MD 1994-1996 Associate Professor Emergency Medicine & Pediatrics Department of Emergency Medicine University of Rochester, Strong Memorial Hospital 601 Elmwood Ave., Box 655 Rochester, NY 14642 Wendy Sacks, MD 1992-1996 Not currently practicing Summer A. Smith, MD 1995-1998 Director, Pediatric Emergency Medicine Swedish Medical Center 510 East Hampden Avenue Englewood, CO 80110 13
  14. 14. Name Position Location of Practice Mark A. Hostetler, MD, MPH 1997-1999 Associate Professor & Director Pediatric Emergency Medicine Pediatric EM Fellowship Director University of Chicago One Children’s Place St. Louis, MO 63110-1077 Mohamed K. Badawy, MD 1999-2002 Assistant Professor, Emergency Medicine & Pediatrics Department of Emergency Medicine University of Rochester, Strong Memorial Hospital 601 Elmwood Ave., Box 655 Rochester, NY 14642 Dante A. Pappano, MD 2001-2004 Senior Instructor, Emergency Medicine & Pediatrics Department of Emergency Medicine University of Rochester, Strong Memorial Hospital 601 Elmwood Ave., Box 655 Rochester, NY 14642 Madelyn Garcia, MD 2002-2005 Senior Instructor, Emergency Medicine & Pediatrics Department of Emergency Medicine University of Rochester, Strong Memorial Hospital 601 Elmwood Avenue. Box 655 Rochester, NY 14642 Kevin O’Gara, MD 2003-2006 Assistant Professor, Rochester General Hospital Rochester General Hospital Colleen E. Markevicz, MD 2004-2007 Attending Physician, Pediatric Emergency Medicine Rochester General Hospital Micheyle Goldman, DO 2005-2008 Attending Physician Joe DiMaggio’s Children’s Hospital 1000 Joe DiMaggio Drive Hollywood, FL 33021 Seema Bhatt, MD 2006-2009 Assistant Professor of Clinical Pediatrics Cincinnati Children’s Hospital Medical Center 3333 Burnett Ave ML 2008 Cincinnati, OH 45229 Robert Deutsch, MD 2006-2009 Attending Physician, Pediatric Emergency Medicine Saint Barnabas Medical Center Emergency Medical Associates 651 West Mount Pleasant Avenue Livingston, NJ 07039 14
  15. 15. CURRICULUM OVERVIEW The curriculum consists of a wide variety of rotations to ensure a complete range of training that is required of a Pediatric Emergency Medicine physician. The year is divided into 13 blocks, each consisting of four weeks. Attached is an outline of the curriculums. Graduates of pediatric residencies will need a three-year program, and graduates of emergency medicine residencies will require a two-year curriculum. 13 blocks – 4 weeks each Vacation – Total 4 weeks [out of PED/Research blocks only] For Graduates of a Pediatrics Residency (3 Year Program): Year 1 ¼ block of orientation 6 ½ blocks ED 1 block Anesthesia 1 block PICU 1 block Toxicology 1 block Trauma 1 block Research ¾ block Ultrasound ¼ block Emergency Psychiatry ¼ block Reading Elective Required Courses: Fall Semester: Epidemiology, Statistics Spring Semester: Other course(s) offered by the Department of Community and Preventive Medicine, approved by the Fellowship Director Year 2 6 ½ blocks ED 1 block Emergency Medicine Orthopedics/ Pediatric Orthopedics/Sports Medicine 1 block Elective ½ block OB/Gynecology ½ block EMS ½ block Child Abuse/REACH Clinic 2 blocks Research 1 block Ultrasound Required Courses: Fall Semester: Ethics Spring Semester: Other course offered by the Department of Community and Preventive Medicine, approved by the Fellowship Director Year 3 6 blocks ED 2 blocks Electives 1 block Administration/Teaching 4 blocks Research 15
  16. 16. For Graduates of an EM Residency (2 Year Program): Year 1 ¼ block Orientation ¼ block Reading Elective 8 blocks ED 1 block Anesthesia ½ block Pediatric 1 block PICU 1 block Research 1 block Elective Required Courses: Fall Semester: Epidemiology, Statistics Spring Semester: Other course(s) offered by the Department of Community and Preventive Medicine, approved by the Fellowship Director Year 2 7 blocks ED 1 block Pediatric Clinic 1 block Elective 1 block NICU ½ block Administration ½ block Child Abuse/REACH Clinic 2 blocks Research Required Courses: Fall Semester: Ethics Spring Semester: Other course(s) offered by the Department of Community and Preventive Medicine, approved by the Fellowship Director TRAINING GOALS, BY YEAR AND CATEGORY The following are the minimum training goals for trainees, and are also the requirements for promotion and graduation. Specific policies regarding promotion, probation, graduation, and termination, are also published annually by the University of Rochester’s Office of Graduate Medical Education, in such publications as the “Resident Manual for Medical and Dental Programs.” If they are in conflict, the University’s policies should take precedence. Research Year 1 Identification of a research mentor, and an area of special research interest. Background reading in this area well underway. Has RSRB approval for conducting research. Year 2/3 Research project completed. Hypothesis-driven paper submitted for peer-reviewed publication; meets research requirement for ABP PEM sub-board certification. Preferably: Abstract submitted for presentation to professional scientific meeting. Teaching Year 1 Has taught a variety of learners in several settings: clinical, conferences, labs. Has learned from constructive feedback how to improve teaching. Year 2/3 Continue to improve teaching skills. Has gone outside his/her “comfort zone” either by teaching topics not in areas of most expertise or learners not in usual categories. Has taught EMS personnel, nurses, students, residents, fellows, and faculty. Is an effective teacher. Teaching evaluations uniformly favorable. 16
  17. 17. Clinical Knowledge and Procedures Year 1 Has mastered the large majority of the subject material of Pediatric Emergency Medicine, as demonstrated in patient interactions, faculty evaluations, and in-service exam scores. Has performed a variety of procedures required/noted by PEM sub-board (and noted them on procedure log). Has passed (defined as no 1/5 and no more than two 2/5 areas on rotation evaluation) all clinical rotations; rotations not passed have been or will be made up. Year 2/3 Well-versed in all areas of Pediatric Emergency Medicine. No major knowledge deficits. Familiar with critical evaluation of clinical literature. In-service exam scores suggest ability to pass PEM sub-board exam. Has performed nearly all procedures required/noted by PEM sub-board (and noted them on procedure log). Has passed (defined as no 1/5 and no more than two 2/5 areas on rotation evaluation) all clinical rotations and made up any that have not been passed. Administrative Year 1 Has participated in PEM division meetings and some administrative activities. Aware of administrative and ethical issues confronting the Pediatric ED attending physician. Year 2/3 Has successfully completed (passed, as defined above) the required administrative and EMS rotations. Understands EMS issues. Good understanding of the administrative component of the job of a PEM physician. Academic Year 1 Has successfully begun coursework in epidemiology / research design / biostatistics. Can participate meaningfully in journal club. Year 2/3 Has successfully completed (C or better grades) all required coursework in epidemiology / research design / biostatistics and research ethics. Skillful critical reader of the medical literature. Citizenship/Other Year 1 Participates in departmental, divisional, and fellowship affairs as requested. Completes required tasks, such as evaluations, physical exam forms, and TB mask fittings, among others. On-time for clinical shifts. Professional behavior. Meets University requirements for trainees. Year 2/3 Continues to participate in departmental, divisional, and fellowship affairs as requested. Completes required tasks, such as evaluations, physical exam forms, and TB mask fittings, among others. On-time for clinical shifts. Professional behavior. Meets University requirements for trainees. Continues functioning as a trainee until training program is completed. 17
  18. 18. SAMPLE OF YEARLY BLOCK SCHEDULES PEM FELLOWS SAMPLE PEM FELLOWSHIP PROGRAM SCHEDULE 2009-2010 Blocks ROTATION PERIOD ROTATIONS 1ST YEAR FELLOW 2ND YEAR FELLOW 3RD YEAR FELLOW 1: 6/24/09-7/23/09 Orientation/ Peds ED Orthopedics Research 2: 7/24/09-8/20/09 Peds ED Research Research 3: 8/21/09-9/17/09 Peds ED Peds ED Peds ED 4: 9/18/09-10/15/09 Peds ED Elective Peds ED 5: 10/16/09-11/12/09 Toxicology Peds ED Peds ED 6: 11/13/09-12/10/09 Peds ED Peds ED/OB Peds ED 7: 12/11/09-1/7/10 Peds ED Peds ED Elective 8: 1/8/10-2/4/10 Anesthesia Research Elective 9: 2/5/10-3/4/10 Peds ED Peds ED Research 10: 3/5/10-4/1/10 PICU Ultrasound Administrative 11: 4/2/10-4/29/10 Research Peds ED Peds ED 12: 4/30/10-5/27/10 Psych/Ultrasound Peds ED Research 13: 5/28/10-6/23/10 Trauma EMS/Child Abuse Peds ED * Vacation – Total 4 weeks [out of PED/Research blocks only] 18
  19. 19. PEDIATRIC ED SCHEDULE Daily schedule of attending physicians and fellows in the pediatric emergency medicine department. 19
  20. 20. JUL.09 PEDS PEDS PEDS PEDS-FACULTY PEDS-FELLOWS TRAUMA O/N Date 0700-1500 1500-2300 2300-0700 1730-2330 1500-2300 2330-0730 1-W BADAWY BRAYER FAIRBANKS ABBASI MURRAY 2-Th GARCIA BADAWY BRAYER RAMAN 3-F LAMPELL GARCIA BADAWY ABBASI 4-S SPILLANE LAMPELL BADAWY LENANE RINDAL 5-S BRAYER FAIRBANKS LAMPELL LENANE RINDAL 6-M BRAYER HUMISTON LAMPELL YAWMAN ABBASI 7-T SPILLANE DAVISC GARCIA MURRAY 8-W HUMISTON DAVISC BRAYER ABBASI MURRAY 9-Th 7-11:30Spillane/Humiston 11:30-3 LAMPELL MURRAY RINDAL 10-F Humiston LAMPELL HUMISTON LENANE RAMAN 11-S BRAYER SPILLANE DAVISC LENANE ABBASI 12-S HUMISTON BRAYER BADAWY LENANE RAMAN 13-M LAMPELL DAVISC BADAWY RINDAL ABBASI 14-T LAMPELL SPILLANE GARCIA MURRAY 15-W LAMPELL DAVISC BRAYER ABBASI MURRAY 16-Th HUMISTON BADAWY LAMPELL RAMAN 17-F GARCIA BADAWY LAMPELL RINDAL 18-S HUMISTON GARCIA DAVISC ABBASI 19-S BADAWY HUMISTON O'GARA RINDAL 20-M BADAWY KAMALI SPILLANE YAWMAN RINDAL 21-T BRAYER LAMPELL O'GARA Dawson MURRAY 22-W PASTERNACK LAMPELL BRAYER ABBASI MURRAY 23-Th HUMISTON DAVISC BADAWY ABBASI 24-F LAMPELL PASTERNACK BADAWY RAMAN 25-S BRAYER PASTERNACK BADAWY RAMAN 26-S HUMISTON BRAYER LAMPELL MURRAY 27-M FAIRBANKS DAVISC LAMPELL MURRAY 28-T BRAYER PASTERNACK BADAWY RAMAN Peds Grads Curriculum # of Blocks # of Weeks PED Shifts/Block Adult Shifts/Block** Conference Attendance Year 1 Orientation 0.25 1 2 0 Peds EM Conference ED 6.5 26 12 to 13 2 Peds EM Conference Anesthesia 1 4 2 0 Anesthesia PICU 1 4 0 0 PICU Toxicology 1 4 4 to 6 0 Toxicology, PEM Conference^ Trauma 1 4 0 0 PICU Research 1 4 6 to 8 1 Peds EM Conference, EM Research Ultrasound 0.75 3 1 0 Peds EM Conference Emergency Psychiatry 0.25 1 1 0 Peds EM Conference^ Reading Elective 0.25 1 0 0 Required Classes Fall: Epidemiology, Statistics Spring: Other Courses Year 2 ED 6.5 26 11 or 12 3 Peds EM Conference EMO 1 4 0 0 Peds EM Conference Elective 1 4 4* 0 Peds EM Conference OB/Gynecology 0.5 2 0 0 OB/Gynecology EMS 0.5 2 1 0 Peds EM Conference^ Child Abuse/REACH Clinic 0.5 2 1 0 Child Abuse / Peds EM Conference Research 2 8 6 to 8 1 to 2 Peds EM Conference, EM Research Ultrasound 1 4 3 to 4 0 Peds EM Conference Required Classes Fall: Ethics Spring: Other Courses Year 3 ED 6 24 11 to 12 3 Peds EM Conference Electives 2 8 4* 0 Peds EM Conference Administration/Teaching 1 4 4 0 Peds EM Conference Research 4 16 4 to 6 1 to 2 Peds EM Conference, EM Research * One elective may be free of shift responsibilities ^Pediatric EM Conference when available and if no conflicts PED total time = 90 shifts/year ==> 270 shifts/ 3 years Adult ED total time - 9 shifts (year 1) + 14 shifts (year 2) + 19 shifts (year 3) ==>42 shifts **Mosts of Adult Shifts should be done in ED or Research months, however under some circumstances these may needed to be done during other rotations 20
  21. 21. EM Grads Curriculum # of Blocks # of Weeks PED Shifts/Block Conference Attendence Year 1 Orientation 0.25 1 2 Peds EM Conference Reading Elective 0.25 1 0 Peds EM Conference ED 8 32 14 Peds EM Conference Anesthesia 1 4 2 Anesthesia Pediatric 0.5 2 Peds EM Conference PICU 1 4 0 PICU Research 1 4 8 to 10 Peds EM Conference, EM Research Elective 1 4 6* Peds EM Conference Required Classes Fall: Epidemiology. Statistics Spring: Other courses Year 2 ED 7 28 14 Peds EM Conference Pediatric Clinic 1 4 Peds EM Conference Elective 1 4 6* Peds EM Conference NICU 1 4 0 NICU Conference Administration 0.5 2 2 Peds EM Conference Child Abuse/REACH Clinic 0.5 2 1 to 2 Child Abuse Research 2 8 8 to10 Peds EM Conference, EM Research Required Classes Fall: Ethic Spring: Other Courses * One elective may be free of shift responsibilities ^Pediatric EM Conference when available and if no conflicts PED total time = 110 shifts 1st year ==> 100 shifts 2nd years Required Courses: Epidemiology, Biostatatistics, Ethics, and 2 other courses Vacation: Total of 4 weeks/year out of ED or research only 21
  22. 22. EMERGENCY DEPARTMENT POLICY FOR SCHEDULING VACATION/CME AND TIME-AWAY Graduates of an emergency medicine residency program must complete total of 22 months of training in order to be eligible to graduate from the fellowship and sit for the PEM ABEM boards. It is important that graduates of a pediatric residency must complete a total of 33 months of training in order to be eligible to graduate from the fellowship and sit for the PEM ABP boards. The fellow is encouraged to discuss any potential problems that may interfere with their responsibilities as fellows with the fellowship director. If a leave from work in necessary, the fellowship director can help guide the fellow through the various types of leave. Rationale • Providing adequate ED clinical coverage in an organized and predictable manner is a core requirement in the Department of Emergency Medicine. • Providing predictable Time-Away for academic and personal activities is also extraordinarily important. • Requirements for advance travel planning for Time-Away necessitate lead time longer than the current 8 week cycle for requests and 4 week cycle of notification. • This policy applies to all ED attending coverage scheduled by Dept. EM. Procedures 1. A Time-Away request schedule will be maintained as a calendar made available to Faculty to request blocks of time free of clinical shifts. 2. No more than 3 faculty can request Time-Away for vacation for any given week. 3. Time-Away request is inclusive ONLY of the shifts on the dates noted (0800 to 2400). If early am travel on the first vacation day is expected, please cross-off night shift on the schedule request—do not have to request as a vacation day. 4. During periods of key national meetings (SAEM, ACEP, AAP), no vacation or other time-away can be expected to be scheduled (can be considered after the clinical schedule has been finalized). Personal Time-Away before OR after (but not both) a meeting can be scheduled in the usual manner. 5. Priority to attend a key national meeting will be: a. Key national officer b. Presenting author or lecturer c. Committee member d. Mentor to presenting author or lecturer e. Inability to attend previous year’s meetings 6. A separate request will be in place for the following periods, with requests made by August 10 of each year (with October schedule request). a. November/December holidays: Thanksgiving, Christmas, New Years i. Only 1 of the 3 can be requested off. ii. Holiday travel cannot span both Christmas and New Years. b. President’s Week i. Preference given to Faculty with school-age children, and to those same Faculty who did not get time off the previous year. ii. Only 1 of the 2 weekends can be requested. 7. Flexibility of all the above is at the discretion of the Scheduler. 8. Policy can be modified at the discretion of the Chair.
  23. 23. SAMPLE PEM FELLOWS SCHEDULE REQUEST Physician Name ______________________ Rotation name Dates # ED shifts 1._________________________________________________________ 2. _______________________________________________________ 3. _______________________________________________________ 4. _______________________________________________________ Vacation Dates __________________ September 09 PEM FELLOWS SCHEDULE REQUESTS SUN MON TUE WED THUR FRI SAT -1 -2 -3 -4 -5 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 -6 -7 -8 -9 -10 -11 -12 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 -13 -14 -15 -16 -17 -18 -19 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 -20 -21 -22 -23 -24 -25 -26 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 -27 -28 -29 -30 15-23 23-07 15-23 23-07 15-23 23-07 15-23 23-07 Please return to Jessica by July 15, 2009 Comments:
  24. 24. THE EDUCATIONAL PROGRAM I PEM CLINICAL EXPERIENCE PEM fellows will be expected to work significant clinical time in the Pediatric ED. Majority of the shifts will be in the evenings, concentrated during Pediatric ED rotation blocks, although some shifts are likely to occur during other rotations. Fellows will also work some additional shifts during the Pediatric ED blocks in a supervisory role, with an attending backup. During the last year, there are opportunities for the fellow to be the sole supervising attending. II OTHER CLINICAL EXPERIENCE The University of Rochester’s fellowship in PEM is based at the Golisano Children’s Hospital, which is part of Strong Memorial Hospital. Extensive clinical time is spent in the Pediatric Emergency Department. Other required rotations consist of Adult Emergency Medicine, Pediatric ICU, Trauma, Toxicology, Pediatric Anesthesia, Orthopedics/Sports Medicine, Child Abuse, and EMS. A wide variety of electives in Adolescent Medicine, Allergy/Immunology, Dental, Dermatology, Endocrine, ENT, General Pediatrics/Private Pediatric Practice, Genetics, Hematology/Oncology, Infectious Diseases, Immunology, Neurology, Ophthalmology, Pulmonology, Renal, Surgery; may also be arranged. III TEACHING / CONFERENCES Fellows participate in special experiences to learn how to teach. They are expected to teach medical students and residents in formal settings and at the bedside. They are expected to lead several PEM conferences/year, one PICU/ED conference/year, two journal clubs/year and three ED departmental teaching fellow conferences/year. In addition to these are teaching requirements, the fellow may seek out additional teaching opportunities in a variety of settings including suture labs, cadaver labs, and the Department of Pediatrics. 1) PEM Fellows Conferences The weekly PEM Conferences are geared toward PEM Fellows and are intended as training conferences. Each PEM Fellow is expected to present regularly at these conferences. There is a rotating format for the conferences: PEM Journal Club, core medical topic, core surgical/trauma topic, and PEM research. At each conference, one fellow is also responsible for presenting a recent case, including the history, physical exam, results, diagnosis, and any journal articles related to the case. In addition, the fellow discusses one interesting complex case/year at the combined PICU/ED conference held every other month. Below is a sample agenda a PEM Fellows conference. Day of week and time changes periodically as to avoid conflicts with other activities. 2 hours/week Sample Agenda 12:00 PM– 12:15 PM Weekly Staff Update 12:15 PM – 1:00 PM Fellows Case Conference 1:00 PM – 2:00 PM PEM topic / Journal Club / Research Presentation Fellows’ Conferences (Types of Conferences): • Case Presentation • M & M • Jeopardy • Lecture • Journal Club
  25. 25. • SOCS (Scholarly Oversight Committee) Meeting*  Changed to FELLOWS’ RESEARCH UPDATE * NOTE CHANGES Scheduling/Conflicts: The schedule for 2009-2010 has been made with consideration given to each fellows’ rotation blocks and vacations, as well as so that each fellow is assigned an equal number of conference presentations. ONLY JESSICA MAKES CHANGES TO THE SCHEDULE which is saved on the S drive. While it is understandable that conflict may arise and fellows may want to “trade” or “switch” conferences, THE DATES/TIMES FOR ANY GIVEN CONFERENCE IS NOT NEGOTIABLE. THEY ARE SET IN STONE. If you cannot give a conference that you are assigned, you may ask a colleague to give that conference for you, and must set up a trade that you both consider fair. You CANNOT switch the date/time/type of conference, ONLY the person presenting the conference. (Example: Murray is giving Journal Club on 8/5/10, but can’t do it. She can ask others to give it for her and they can decide if she has to “pay them back later” or they can be nice and do the extra presentation “for free”. But regardless, on 8/5/10 a Journal Club should be presented!!! ) Developing Your Career Portfolio: Please make sure you E-mail Jessica a copy of EVERYTHING you do so that she can save a paper copy of it in your fellowship binder. You will review these with Anne at your evaluations. Plus, it’s a great way to see all that you’ve done in the 3 years of fellowship (and a safety net in case your computers crash to have a copy of your work). 1. Case Presentation a. A case you have personally been involved with. b. Format – PowerPoint presentation to include the following: i. Chief complaint ii. HPI/PE/labs/imaging – Copy the ED chart and have printouts of all pertinent documentation – e.g. labs/EKGS/Outside ED workups/consultant notes. iii. Allow group to participate in generating differential diagnosis and plan iv. Patient follow-up  i.e. What ended up happening to them? This means getting printed up Op-notes, PICU paperwork, etc.
  26. 26. v. Take home points  Each case should have a “Pearl” associated with it, or why you were drawn to the case in the first place. This can be a clinical pearl, interesting physical exam finding, unusual EKG tracing, discussion about management (you decide). At minimum there should be some work done for the presentation that makes this point. Thus, at least look up the diagnosis on e-medicine or UpToDate and review for the group. 2. M & M a. A case you have personally been involved with AND you think provides a starting point for a group discussion. (Examples from the past have included issues with long EMS resuscitations, or treatment of DKA patients with incorrect IVF, cases where the consultant did not agree with the attending assessment/plan). When choosing a case for M & M, ask yourself, how will this presentation change our management as a group? What will be my “Take Home Points”? b. Format – same as above with more in depth review of the literature pertinent to your take home point. This means at minimum a review of the topic using e-medicine, UpToDate, MEDLINE, reference texts and review articles. c. Conference Outline - Provide a 1 page outline to use as a guide for conference. i. Patient name, MR number, date of ED visit, Diagnosis, Dispo (admit, admit ICU, D/C, died), Take Home Point(s) for discussion, reference article you give out to the group. d. Supporting Items - Make sure to bring supporting items in case questions arise – (e.g. arrhythmia cases- copy EKGs, EMS rhythm strips, hypotensive shock patients where the choice of pressor is the issue – copy the resuscitation ED chart or the PICU one. e. Article - Bring one article to distribute to the group - can be review article, or trial, or case series (you decide). 3. Jeopardy a. This is a scheduled conference that occurs 4-5 times a year (each fellow is responsible for one Jeopardy presentation a year). It serves the purpose of Board Review for topics that don’t lend themselves well to lecture format. b. Format - Please use the Jeopardy Template (Jessica to save a copy to the S Drive) so that they are all the same. i. Each Jeopardy will be on a certain topic (already assigned). ii. Include pictures, EKGs, etc to keep it interesting. Use PEM Board review books to get your questions, or design them yourselves.
  27. 27. iii. Please make sure to be familiar with ALL the answer choices on the multiple choice questions, as this is a board review and we want to maximize learning. 4. Lectures a. This is your chance to teach the faculty and your fellow colleagues about a given topic in depth. b. When you are done with your fellowship, these will become the “core lectures” you will take with you and re-use for years. Thus, choose wisely. Pick topics that will interest your audience. Ideas include: (1) using Fleisher and Ludwig chapter headings as a guide you could pick signs/symptoms as a lecture and review in general, or (2) Choose one topic from a case you cared for and really review the literature on it in depth. c. Format – PowerPoint ~ 45 minutes long with time for questions/answers at the end. i. You must review the literature for these lectures. ii. Include interesting pictures/imaging/tracings – remember, when you leave SMH you’ll want actual patient pictures (de-identified, of course) for future lectures. d. TIMELINE – You are responsible for looking at the conference schedule ahead of time and planning your time accordingly. You will be responsible for letting Jessica and I know your topic at least 1 month ahead of time. This will force you to commit and ensure that you have enough time to work on it and do a good job. IF no topic has been chosen at least one month prior to your scheduled lecture, then a topic will be assigned to you. 5. Journal Club a. In order to be useful to all, Journal Clubs must be prepared before hand and articles distributed to all (electronically as an E-mail attachment) at least the 1 week prior to scheduled presentation. Preferably, remind people about at the fellow’s conference the week before and if you have paper copies, distribute them at conference. b. Format – DOESN’T have to be PowerPoint, but must be a very structured exercise. i. DO NOT 1. Give out your article the day before 2. Open Journal Club with the comment, “This is a terrible study” 3. Allow participants to ramble on tangents and only criticize without giving constructive or insightful critique
  28. 28. 4. Say, “I have no idea what that statistical test is, let alone how to interpret it” If you picked the article, figure it out before you present! ii. DO 1. Introduce your Journal Club with an opening anecdote, “I chose this article because I had the following issue/question” 2. Bring an outline (can be for yourself) that we follow. 3. Please ask Mohamed or Colleen Davis to provide you a copy of their handouts that go over in detail how to critique any given type of article. 4. Pick a GOOD article –one that answers a question you or your colleagues had. 6. SOCS Meeting  changed to  Fellows’ Research Update a. As part of the ACGME requirements for PEM fellowship training, fellows are required to conduct “meaningful research/scholarly activity”, guided by faculty overseers that form the SOCS committee. These meetings (Fellow Research Update), which are on the schedule every 2 months, are to help keep your research on track. b. These are working meetings – i.e. the more you bring to the table, the more you get out of it, so come prepared. As they are scheduled one year in advance, no fellow should ever come to these meetings without at least a clear idea of where their research is. Even if you are a first year fellow, tell us what your interests are, who you’ve met with, etc. c. Format – Very shortly, you will be provided with the “Steps” required in order to fulfill your research requirement for fellowship/MPH/sitting for PEM boards. There will be a binder at this meeting where we track your progress and save whatever you have done to date (rough drafts, ideas, etc). d. Goals: i. Understand all the steps required by PEM fellowship/MPH program to fulfill requirements ii. Learn about dates/timelines – You should make sure to leave each meeting with a clear “next step” to pursue. e.g. When does the next ED research committee meet? Can I get my work done for that one? When is the next meeting (AAP, SAEM, ACEP) – when are those abstracts due? Can I get my work done for that? iii. Raise issues – if you can never meet with you committee, or are “getting lost” – speak up – use this as a trouble shooting session. Of course, Anne will want to know ASAP if this is happening to help you. iv. Get feedback – faculty at this meeting are captive audience – just think, you don’t have to set up an appointment to ask their opinions. Don’t be timid- share your ideas/bring drafts (no matter how rough). SOCS Committee Meetings You are responsible for setting up your own SOCS Committee and arranging these regular meetings. Given people’s time-commitments and how hard it is to coordinate schedules, you may have to meet with your SOCS committee members individually. YOU SHOULD GET A SIGN IN SHEET FOR EACH MEETING YOU HAVE and GIVE IT TO JESSICA TO
  29. 29. KEEP. SOCS Committee should be the same people as you have on your MPH committee. 2) Department of Emergency Medicine Conferences Department of Emergency Medicine has weekly teaching sessions for the EM residents. PEM Fellows are expected to attend topic-appropriate Emergency Medicine core conferences. They may also prepare and present several teaching sessions at these core conferences each year. They are expected to have an active role in the various M&M and QA conferences, if they were involved with the patients being presented. In addition, PEM Fellows are required to conduct 2 monthly Peds Hour Conferences/year. Conference Frequency EM Grand Rounds 2nd Thursday, Monthly EM Core Lectures/Conferences Weekly Morbidity & Mortality Monthly EM Resident Peds Hour Monthly, expected to give 2 conferences/year to EM Residents ED Research Conference Bi-monthly EKG/X-Ray Weekly Toxicology Teaching Bi-monthly EM Case Conference Weekly EM/Orthopedics QA Conference Monthly EM Trauma QA Conference Monthly EM Quality Conference Monthly EM Journal Club Monthly 3) Department of Pediatrics Conferences PEM Fellows are urged to participate in the Department of Pediatrics conferences. In addition, they contribute as consultants at Pediatrics morning report. PEM Fellows typically present at some Pediatrics noon conferences; these are the core topic teaching conferences for the Pediatrics Residency. 4) Pediatric Fellows Academic Core Curriculum Fellows in the Department of Pediatrics attend a series of conferences throughout the year on a variety of topics. Some (but not all) of the topics are not only pertinent, but required for PEM fellows. You will be notified of the schedule when it becomes available. IV RESEARCH A. Research Project 1) Overview Every Pediatric Emergency Medicine Fellowship Program is expected to engage fellows in specific areas of scholarly activity to allow acquisition of skills in the critical analysis of the work of others; to
  30. 30. assimilate new knowledge, concepts, and techniques related to the field of one’s practice; to formulate clear and testable questions from a body of information/data so as to be prepared to become effective subspecialists and to advance research in pediatrics; to translate ideas into written and oral forms as teachers; to serve as consultants for colleagues in other medical or scientific specialties; and to develop as leaders in their fields. All fellows will be expected to engage in projects in which they develop hypotheses or in projects of substantive scholarly exploration and analysis that require critical thinking. Areas in which scholarly activity may be pursued include, but are not limited to: basic, clinical, or translational biomedicine; health services; quality improvement; bioethics; education; and public policy. Fellows must gather and analyze data, derive and defend conclusions, place conclusions in the context of what is known or not known about a specific area of inquiry, and present their work in oral and written form to their Scholarship Oversight Committee (see below) and elsewhere. The Scholarship Oversight Committee (SOCS) in conjunction with the trainee, the mentor, and the program director will determine whether a specific activity is appropriate to meet the ABP guidelines for scholarly activities. In addition to biomedical research, examples of acceptable activities might include a critical meta-analysis of the literature, a systematic review of clinical practice with the scope and rigor of a Cochrane review, a critical analysis of public policy relevant to the subspecialty, or a curriculum development project with an assessment component. These activities require active participation by the fellow and must be mentored. The mentor(s) will be responsible for providing the ongoing feedback essential to the trainee’s development. 2) The Work Product of Scholarly Activity Involvement in scholarly activities must result in the generation of a specific written “work product,” which may include: • A peer-reviewed publication in which a fellow played a substantial role • An in-depth manuscript describing a completed project • A thesis or dissertation written in connection with the pursuit of an advanced degree • An extramural grant application that has either been accepted or favorably reviewed • A progress report for projects of exceptional complexity, such as a multi-year clinical trial 3) The Scholarship Oversight Committee Review of scholarly activity will occur at the local level. Each fellow must have a Scholarship Oversight Committee. The Scholarship Oversight Committee should consist of three or more individuals, at least one of whom is based outside the subspecialty discipline; the fellowship program director may serve as a trainee’s mentor and participate in the activities of the oversight committee, but should not be a standing member. This committee will: • Determine whether a specific activity is appropriate to meet the ABP guidelines for scholarly activity • Determine a course of preparation beyond the core fellowship curriculum to ensure successful completion of the project • Evaluate the fellow’s progress as related to scholarly activity
  31. 31. • Meet with the fellow early in the training period and regularly thereafter • Require the fellow to present/defend the project related to his/her scholarly activity • Advise the program director on the fellow’s progress and assess whether the fellow has satisfactorily met the guidelines associated with the requirement for active participation in scholarly activities 4) Commitment 1. Each Fellow must sign a SOCS Fellow Contract and turned into the Program Administrator. 2. Each Faculty Member must sign a SOCS Faculty Contract and turned into the Program Administrator. 3. The fellow must meet with their members of their SOCS committee at least 4 times per year. At each meeting, a SOCS committee meeting form must be filled out and turned into the Program Administrator. These documents will be placed into your portfolio. 4. All the Fellows and the members of their SOCS committee will meet semi-annually with the Fellowship Director. 5. The Fellowship Director will not sign off on the ABP Scholarly Work Product Form which is needed for you to sit for the boards until a completed acceptable work product has been reviewed by each of the Fellow’s SOCS committee members. 5) Semi-Annual Presentations Each Fellow will discuss their career goals to the group in a 15 minute presentation with a 15 minute discussion period. Please present in the following format: • Clinical Progress • Education Progress • Administrative Responsibilities • Research Progress B. Formal Course Work Fellows are required to complete five courses: a. One semester of biostatistics b. One semester of epidemiology c. One semester of research ethics d. Two other electives in research methodology (e.g., questionnaire design, decision analysis, design of clinical trials) C. Masters of Science: Clinical Investigation Track Beginning in Fall 2007, the Department of Community and Preventive Medicine (CPM), as part of the recently awarded NIH Clinical Translational Sciences Institute grant, will offer a new Masters program that focuses on health services research training for clinicians. Those completing this program receive the degree, Master of Science (Clinical Investigation). The program focuses on clinical and population based research training for investigators with prior clinical training or for those enrolled in a clinical training program, such as medical school. The primary objective of this program is to train individuals to combine clinical knowledge and population-based research in an academic program that awards a recognized credential indicating expertise in clinical epidemiology, research study design, clinical decision-making, and the evaluation of health care
  32. 32. services. PEM Fellows may complete this program without tuition fees. Attached is the current curriculum. Additional information can be found on the department’s web site at: www.urmc.rochester.edu/cpm/education Individuals eligible for this program must have a post-graduate degree in medicine or another health- related discipline. The core courses required are epidemiology, biostatistics, health institutions, environmental and occupational health, and social and behavioral health. The degree is completed with a mentored research experience, usually in conjunction with a post-doctoral fellowship program in the student’s medical field. The mentored research project begins concurrently with coursework, and in most cases will extend beyond completion of courses until the project produces an article accepted for publication in a peer-reviewed journal. MASTER OF SCIENCE CURRICULUM Master of Science: Clinical Investigation Curriculum Course Credits Semester BST 463: Introduction to Biostatistics 4 I PM 415: Introduction to Epidemiology 3 I PM 482: Clinical Evaluative Sciences 3 I IND 503: Ethics in Research 1 I BST 525: Introduction to Health Informatics 3 I Elective 3 I PM 424: PC SAS 2 II BST 465: Design of Clinical Trials 3 II PM 484: Medical Research and Cost-Effectiveness Analysis 4 II PM 416: Advanced Epidemiologic Methods OR Advanced Biostats 3 I Elective 3 II Total 33 CORE REQUIREMENTS PM 415 Principles of Epidemiology This course provides an introduction to epidemiological concepts of disease and interventions to ameliorate them. The course discusses population-based aspects of disease, morbidity and morality statistics, basic study designs (cross-sectional, case-control, cohort and clinical trials), and the use of epidemiological data to draw conclusions about disease causation. At the end of the course, students
  33. 33. should have a broad view of denominator-based medicine and be prepared for higher-level courses in epidemiological methods. PM 429 PC-SAS This course will present an introduction to the SAS system for Windows. The focus of the course will be on data management and statistical analysis using SAS. The student will gain an understanding of SAS as a research tool through the completion of a research project of their own design. Prerequisites: BST 463 or equivalent and knowledge of MS Windows. IND 503 Ethics in Research This course covers a broad range of topics and attempts to address issues that many researchers are likely to face in their careers. A very practical approach is adopted in order to avoid deep philosophical debates, which, although of great interest, are unlikely to be helpful. A description of the University’s policies and procedures in dealing with misconduct in research is included. Attendance is mandatory. STATISTICS REQUIREMENT BST 463 Introduction to Biostatistics Basic statistical and data-analysis methods in medical research. Topics include summarizing and displaying data, elements of probabilities estimation, confidence intervals, hypothesis tests, and methods for comparing means and proportions, and regression analysis. The MINITAB statistical package is introduced and used. The course is strongly use-oriented, stressing practical understanding and interpretation. BST 525 Introduction to Health Informatics Computer applications in health care and biomedicine. BST 465 Design of Clinical Trials Design, conduct, and analysis of clinical trials. Sample size, power, and randomization. Coordination, data management, compliance, interim analysis, and reporting procedures. RESEARCH METHODS REQUIREMENT PM 416 Epidemiologic Methods This course is designed to provide an in-depth coverage of the quantitative methodological issues associated with population-based epidemiological research. Issues specific to study design, conduct, and analysis are emphasized. Topics to be covered include: issues in study design, topics in measurement, methods of data collection, confounding, effect-modification, and multivariate analytic techniques. Prerequisite: PM 415 Principles of Epidemiology and one semester of graduate level statistics or permission of the instructor. OR an advanced biostatistics course of the student's choice. PM 482 Clinical Evaluation & Outcomes This course covers the types of study design and settings available for original observations about clinical interventions and practice patterns. It focuses on the use of patient populations and databases as laboratories for the generation of new knowledge and information. Ways to improve the outcome and efficiency of personal health services through evaluating their effectiveness, quality, appropriateness, and cost are explored. The material covered will introduce the methods, databases and settings available for such studies. Prerequisite: one semester of graduate level statistics or of epidemiology. PM 484 Cost Effectiveness Research Decision analysis is increasingly used to evaluate alternative choices in clinical practice and to
  34. 34. enlighten and inform health policy determinations. In this course, students will be introduced to the concepts underlying the quantitative analysis of medical decisions. They will be provided with the basis to understand decision and cost-effectiveness analysis, which appear in the clinical and health services research literature as well as to be able to set up and perform such analysis themselves. Prerequisite: one semester of graduate level statistics.misconduct in research is included. Attendance is mandatory. ELECTIVES 2 one-semester courses with 3 credits.
  35. 35. RESEARCH Mentored Research Experience to culminate in research paper suitable for publication. ADMINISTRATION The fellows are exposed to multiple administrative functions within the Department of Emergency Medicine. They assume an active role within our division and are a vital part of our weekly staff updates, which focuses on issues such as census, staffing, communications, finances, complaints, protocols, and quality assurance. During one block, the fellows participate in a formal curriculum lead by the Department and Division Directors that tackle the tasks involved in managing an active department. In addition, the fellows are expected to participate in at least one departmental or hospital committee of their choice. TRACKS The Pediatrics Emergency Medicine Fellowship consists of two tracks. One is a Research Track, which is designed for those who plan on pursuing an academic research career, and obtaining their Master of Science. The other is a Clinical Educator Track, which is designed for those who plan to purse a clinical career. The first year will be the same for both the Research Track and the Clinical Educator Track. During the first year, it is expected that every fellow will complete a total of 4 courses. 1) Research Track This track will allow time for completion of the Masters of Science (Clinical Investigator) though the Department of Community and Preventive Medicine at the University of Rochester. During the second and third year, time is allotted for the completion of coursework. Clinical Requirements for Years 1-3 90 shifts/year Coursework Guidelines Year 1: Fall Spring Summer Introduction to Epidemiology and Biostatistics 2 Courses (elective or required) Introduction to SAS Year 2: Fall Spring Ethics and Other (elective or required) 2 Courses (elective or required) Year 3: Fall Spring 2 Courses (elective or required) 1 Course (elective or required), completion of research project 2) Clinical Educator Track This track will involve additional clinical time and additional responsibilities of teaching medical students and residents during the PED blocks. Clinical requirements for Clinical Educator Track Year 1: 90 shifts/year Year 2 & 3: 120 shifts/year
  36. 36. Coursework Guidelines Year 1: Fall Spring Introduction to Epidemiology and Biostatistics 2 Courses Year 2: Fall Ethics Year 2/3: Clinical Educator Symposium/Conference Additional Teaching Responsibilities in Year 2 and 3 • One lecture per PED/Research block to the Pediatric Residents • One lecture per PED/Research block to the Emergency Medicine Residents • One teaching project/year for years 2 and 3. CONTINUING MEDICAL EDUCATION The fellows are encouraged to attend several national meetings and conferences during their fellowship. Fellows are given a stipend $2000 annually to spend on continuing medical education. The Fellowship Director must approve these expenses.
  37. 37. PEM TRAINING PROGRAM ROTATIONS Rotation: Administration Location: Department of Emergency Medicine, Strong Memorial Hospital Year Of Training: Year 3 Rotation Length: 4 weeks Contact Person: Anne Brayer, MD PED Shifts: Required – (one 8hr shift per week) Call: None Required Clinic: None Required Conferences: Peds Ed Conference Required Projects: Directed readings assigned by Dr. Schneider Educational Goals and Objectives: Upon completion of this rotation the PEM fellow will be able to: 1. Plan and carry out an administrative project. 2. Develop an understanding of quality assurance. 3. Discuss capitation and managed care and the effect on the Emergency Department. 4. Demonstrate an understanding of physician contracts. 5. Assist with the day-to-day management decisions with the Chair and Clinical Director of the Department of Emergency Medicine. 6. Assist with the financial management decision making of the Department. 7. Describe the day-to-day interactions with hospital administration and the medical staff. 8. Develop an understanding of cost containment and health care financing 9. Understand the basics of medical-legal and risk-management concerns in the ED. 10. Demonstrate an understanding of systems factors that contribute to medical errors. Description of Didactic Experiences: The administrative rotation consists of a series of meetings with various administrators and a series of discussions/exercises under the direction of Sandra Schneider, MD. The purpose of the rotation is to learn from administrators what their job is, how they got there, how to be them, and gleam any pearls of wisdom about leadership and administrative roles in medicine. The PEM fellow will attend meetings of the Management Team, the Quality Assurance Council, Morbidity & Mortality Review, SMH Department Heads & Supervisors Meeting, as well as the Rochester Area ED Director’s meeting. The trainee also has individual discussion time with the Chair of Emergency Medicine, the Medical Director of Emergency Medicine, the Program Administrator of Emergency Medicine, and the (Pediatric) Nurse Manager of Emergency Medicine. During this rotation, each trainee is given a “paper”
  38. 38. emergency department to “run”. The trainee experiences administrative responsibilities including schedule making, negotiation, budgeting, and contracting with managed care. The PEM fellow may be required to develop, implement and assess a project to improve clinical care, under the supervision of the Director of Clinical Operations. Trainees are also required to attend regular Pediatric Emergency Medicine teaching conferences during this rotation. You are to meet weekly with the fellowship director to discuss experiences. It is expected that you attempt to set up meetings with the following individuals: Anne Brayer– PEM Fellowship Director Colleen Davis– Chief, Division of PEM Sandra Schneider– Former Chair of EM, ACEP Flavia Nobay– EM Residency Director William Varade– Peds Residency Director Spencer Studwell– Legal Nina Schor– Chair of Pediatrics Patsy Pangia– Nurse Manager Heather Hare– Public Relations Karen Eisenberg– Development Office Suggested reading for the rotation includes: Aghababian, RV., et.al. Emergency Medicine, The Core Curriculum, 1998. Section 20. Fisher, R., Ury, W., Getting to Yes (Residents are supplied with a copy at the beginning of the rotation. Evaluation and Feedback Process Trainees are evaluated in writing at the end of each rotation using a standardized evaluation form by the supervising faculty. Evaluations of the fellow’s performance are compiled for the fellow review at the semi- annual meeting with the program director. Each fellow is also asked to evaluate the educational value of each rotation in writing, at the completion of the rotation. Fellows are asked to refer to the goals and objectives of the rotation when filling out these evaluations. If a rotation coordinator identifies a performance problem, he/she is encouraged to discuss the problem with the trainee directly prior to the end of the rotation such that the trainee has time to correct the problem and successfully complete the rotation. Problems of an urgent nature regarding an individual trainee on a particular rotation are immediately brought to the attention of the program director. These issues are addressed by the program director with the trainee concerned without delay. Fellow performance evaluations are routinely reviewed with each fellow at the time of semi-annual evaluations. If significant performance issues not previously addressed are encountered, they are addressed at that time. Rotation evaluations that are completed by the trainees are reviewed by the Program Director. Feedback about rotations is also solicited at annual program reviews. If a consistent problem or concern is identified, the program director contacts the responsible rotation director about any concerns as well as ways in which the rotation might be improved.
  39. 39. Rotation: Adult Emergency Medicine Location: Department of Emergency Medicine; Strong Memorial Hospital Rotation Length: 42 shifts over 3 years Year Of Training: Year 1, 2, and 3 Contact Person: EM Chief Resident PED Shifts: None Work Hours: Wednesday overnight in the Trauma bay, 11:30pm-7:00am Required Clinic: None Required Conferences: Peds ED Conference Role: Physician in the Trauma Bay Educational Goals and Objectives Upon completion of this rotation, the PEM fellow will be able to: 1. Recognize life-, limb- and organ-threatening diseases and injuries in the adult patient. 2. Expand his/her knowledge base through clinical encounters, didactic teaching, case discussion and a program of self-study, of the specific disease entities represented by the following chief complaints in both pediatric and adult patients: a. Abdominal Pain & Distention, Nausea & Vomiting, Hematemesis, Hematochezia, Dysphagia, Jaundice, Hiccups, Rectal Pain, Constipation, Diarrhea, Melena. b. Cardiac Arrest, Chest Pain, Palpitations, Edema, Hypertension, Hypotension, Syncope c. Rash, Pruritus & Urticaria d. Burns, Bites & Stings, Hyperthermia, Hypothermia & Cold Injury, Drowning, Foreign Bodies e. Earache, Epistaxis, Sore Throat, Dental Pain, Diplopia, Vision Loss, Ocular Pain, Tinnitus & Hearing Loss f. Anemia, Abnormal Bleeding, Lymphadenopathy g. Allergic Reactions h. Fever & Infections i. Musculoskeletal Pain, Neck Pain, Extremity Pain j. Altered Mental Status, Seizures, Ataxia, Headache, Coma, Dysesthesia, Dysphasia, Tremors k. Substance Abuse, Elder Abuse, Domestic Violence l. Dysuria, Hematuria, Urinary Retention, Urinary Incontinence, Testicular Pain & Masses, Sexually Transmitted Diseases m. Stridor, Dyspnea, Wheezing, Coughing, Cyanosis, Hemoptysis, Smoke Inhalation n. Trauma, Shock, Fractures & Dislocations o. Poisoning & Overdose p. Dehydration, Fatigue, Weakness, Weight Loss 3. Expand his/her knowledge base through clinical encounters, didactic teaching, case discussion and a program of self-study, of the presentation and management of the following specific disease entities in adult patients: a. Abdominal & Gastrointestinal Disorders including:
  40. 40. Esophageal Spasm & Reflux, Varices & Mallory-Weiss Syndrome, Hepatitis, Cholecystitis & Cholelithiasis, Acute Pancreatitis, Gastritis & Peptic Ulcer Disease, Small Bowel Obstruction, Appendicitis, Ulcerative Colitis, & Hemorrhoids Mesenteric Vascular Disease, Ulcerative Colitis, Regional Enteritis, Diverticular Disease, Volvulus, Infectious Bowel Disorders, Spontaneous Bacterial Peritonitis. b. Cardiovascular Disorders including: Ischemic Heart Disease & Cardiac Failure, Pericarditis, Arrhythmias, Thromboembolism & Thrombophlebitis, Cardiomyopathy, Endocarditis, Pericardial Effusion & Tamponade, Arrhythmias & Conduction Blocks, Congenital Abnormalities in Adulthood, Thrombolytic Therapy, Cardiovascular Pharmacological Agents, Pacemakers & Implantable Defibrillators. c. Cutaneous Disorders including Cellulitis, Abscesses and Erysipelas, Fungal Infections, Infestations, Pityriasis, Purpura & Petechiae and Urticaria d. Endocrine and Metabolic Disorders including: Acid-Base Disturbances and Diabetic Ketoacidosis, Hyperosmolar Coma and complications of Diabetes Mellitus, Hyper- and Hypothyroidism, and Thyroiditis e. ENT Disorders including Epistaxis and Peritonsillar Cellulitis and Abscess f. Environmental Disorders including Electrical and Lightning Injury, Smoke Inhalation, and Temperature-Related Injuries g. Eye Disorders including Blepharitis, Chalazion and Conjunctivitis, Corneal Abrasions and Burns, Foreign Bodies, Hyphema, Iritis and Periorbital Cellulitis h. Hematologic Disorders including Sickle Cell Disease i. Neurologic Disorders Including Stroke and Subarachnoid Hemorrhage, Meningitis and Spinal Cord Compression j. Immunologic Disorders including Sarcoidosis, SLE, Anaphylaxis, Angioneurotic Edema and Drug Allergies k. Infectious Disorders including Gram-Negative and Positive Sepsis, Meningococcemia, Toxic Shock Syndrome and Mycobacterial Infections, HIV Syndromes and Other Viral Diseases l. Musculoskeletal Disorders including Septic Arthritis and Gout, Low Back Syndromes, Overuse Syndromes and Soft Tissue Infections m. Neurologic Disorders Including Stroke and Subarachnoid Hemorrhage, Meningitis, Bell's Palsy, Guillain-Barre Syndrome and Myasthenia Gravis n. Disorders Related to Pregnancy including Ectopic Pregnancy, Hyperemesis Gravidarum, Endometritis and Mastitis, Eclampsia and Pre-Eclampsia o. Psycho behavioral Disorders including Organic Syndromes, Alzheimer's Disease, Intoxications and withdrawal p. Renal Disorders Including Urethritis and Pyelonephritis q. Respiratory Disorders Including Upper Airway Obstruction, Pneumothorax, Asthma and Obstructive Lung Disease, Aspirated Foreign Bodies and Pulmonary Infections, Upper Airway Obstruction, Pneumothorax, Asthma and Obstructive Lung Disease, Pleural Effusions, Hyperventilation Syndrome and Pulmonary Infections r. Toxicology including General Principles and Poisonings Involving Acetaminophen, Alcohols, Anticonvulsants, Antidepressants, Caustic Agents, Cocaine, Iron, Sedatives and Hypnotics and Stimulants s. Traumatic Conditions including Cervical Spine Fractures and Other Spinal Cord Injuries, Corneal Abrasion and Foreign Bodies, Hyphema, Rib Fractures, Flail Chest, Aortic Rupture and Pulmonary Contusion, Intra-Abdominal Organ Injury, Skull Fractures and Intracranial Hematomas, Aortic Rupture and Pulmonary Contusion, Intra-Abdominal Organ Injury, Injuries Of The Female and Male Genitalia, Trauma In Pregnancy and Injury Prevention
  41. 41. t. Urogenital and Gynecological Disorders including Ovarian Cyst and Torsion, Vaginitis, Endometriosis and Dysfunctional Uterine Bleeding, Cervicitis, Pelvic Inflammatory Disease and Salpingitis, Epididymitis, Prostatitis and Genital Lesions 4. Be able to properly chart Emergency Department patient encounters and visits. 5. Be able to present complete relevant patient summaries. 6. Effectively utilize information from the Emergency Department Nursing records as part of the patient assessment. 7. Communicate effectively with pre-hospital care providers and integrate into the clinical database information from both pre-hospital care records and providers. 8. Utilize appropriate diagnostic studies in a time-efficient and cost-effective manner. 9. Maintain and submit to the PEM Program Director a record of all procedural skills performed. 10. Have been taught/performed the following procedures: a. Fracture/Dislocation Immobilization Techniques including Splinting, Spine and Cervical Immobilization and Management of Patients on Backboards b. Defibrillation c. Arthrocentesis d. Thoracentesis e. Laryngoscopy and Intubation f. Regional Nerve Blocks and IV Anesthesia g. Control Of Epistaxis including Anterior Nasal Packing and Cautery h. Hemodynamic Techniques including Central Venous Access (Femoral, Jugular, Subclavian) i. Thoracostomy 11. Have observed and participated as a team member in the following: a. Adult Cardiopulmonary resuscitation b. Multiple trauma resuscitation 12. Understand and use appropriate interpersonal skills to work collaboratively with other ED staff in managing patients through a team approach in the emergency department. 13. Simultaneously manage and give accurate sign-out when appropriate, while ensuring both compassion and vigilance in patient care. 14. Properly activate and interact with the trauma team. 15. Perform safe and appropriate patient disposition including patient education, advocacy, risk management and follow-up arrangements. 16. Recognize clinical situations that require preventive strategies and be able to initiate those strategies. 17. Be able to initiate appropriate consultation and referrals in a timely and professional manner. 18. Become familiar with the use of available information resources, including traditional references, on-line databases, medical literature databases and specialty consultants to identify and institute the most appropriate management for clinical problems. 19. Establish a practice of on-going self-education in emergency medicine. 20. Become familiar with and develop personal techniques for stress management, physical and mental health, and critical incident stress debriefing to promote wellness through the emergency medicine career. Description Of Clinical Experiences Pediatric Emergency Medicine fellows will work shifts in the Adult ED at Strong Memorial Hospital, a Level I Emergency Department with a census of about 70,000 patients per year. The Strong Memorial Hospital is the primary clinical site for the ACGME-accredited University of Rochester Emergency Medicine residency program. They will primarily work overnight shifts in the critical care/trauma bay area of the ED. Shift assignments will adhere to New York State and ACGME guidelines for resident work hours. The fellow will
  42. 42. care for a wide range of patients of all ages, conditions and acuities while functioning at the level of an upper level EM resident to fulfill the objectives listed above. PEM fellows perform invasive diagnostic, therapeutic and monitoring procedures indicated for patients under their care as appropriate for their level of skill and competence. The PEM fellow will not have a supervisory role in this setting, but will be expected to teach and share his/her expertise with colleagues and medical students. On-site 24-hour supervision is provided by board certified or board prepared physicians with faculty appointments in Emergency Medicine. All cases are presented to the EM Attending prior to the patient's discharge. Evaluation And Feedback Process: PEM fellows, through the program coordinator, will be responsible for distributing standard evaluation forms to at least two Emergency Medicine faculty members semi-annually. These evaluations will be reviewed by the Program Director, with the PEM fellow at the semi-annual evaluation. PEM fellows are also encouraged to ask the attending on duty for feedback about his/her performance at the end of each shift. He/she will be required to keep a log of all procedures. The log will be reviewed at each semi-annual evaluation to be certain that the fellow has ample experience to perform invasive procedures and to participate in resuscitations. If a faculty member identifies a performance problem, he/she is encouraged to discuss the problem directly with the fellow prior to the end of the rotation so that the trainee has time to correct the problem and successfully complete the rotation. Problems of an urgent nature regarding an individual trainee on a particular rotation should be brought to the immediate attention of the program director. These issues are addressed by the program director with the PEM trainee without delay. PEM fellows are also asked to assess each emergency medicine rotation during the semi-annual evaluation (or immediately if there are significant or specific problem areas). This feedback is used by the program director to identify and correct problems.
  43. 43. Rotation: Anesthesia Location: Strong Memorial Hospital Year Of Training: Year 1 Rotation Length: 4 weeks Contact Person: Ashwani Chhibber, MD PED Shifts: Required –(2 shift per block) Work Hours: 7 am-4pm Call: None Required Clinics: None Required Conferences: Anesthesia Required Projects: None Educational Goals and Objectives Upon completion of this rotation the PEM fellow will be familiar with: 1. Airway Management a) Hands-On Experiences i) Endotracheal Intubation ii) Bag-Valve-Mask iii) LMA b) Education i) Rapid Sequence Intubation (1) Definition/Goals Of RSI (2) Drugs (a) Appropriateness (b) Doses ii) Approach To The Difficult Airway 2. Anesthesia a) Hands-On Experiences i) Actual Experience With Various Types Of Cases Requiring Anesthesia b) Education i) Definitions – Anesthesia, Analgesia, Induction, Etc. ii) Commonly Used Anesthetic Agents iii) Conscious Sedation From The Anesthesiology Point-Of-View iv) Approach To Anesthetic Emergencies Description Of Clinical Experiences 1. Clinical Expectations: a. General expectation is that fellows will be present for weekday OR schedule and required teaching conferences b. Trainees may need to be excused for graduate coursework or EM Dept. needs – these are to be kept to a minimum
  44. 44. c. Scheduling should be arranged between trainees and supervising attending physician in advance, so that expectations are clear 2. Supervision: a) General supervision by anesthesia residents or nurse anesthetists expected, but overall supervision is to be by anesthesiology attending physician b) Immediate feedback should be given if problems are identified c) Unresolved or major problems should be brought to PEM program director’s attention. Evaluation And Feedback Process: PEM fellows, through the program coordinator, will be responsible for distributing standard evaluation forms to one to two anesthesia faculty members for the block. These evaluations will be reviewed by the Program Director, with the PEM fellow at the semi-annual evaluation. PEM fellows are also encouraged to ask the attending on duty for feedback about his/her performance at the end of each shift. He/she will be required to keep a log of all procedures. The log will be reviewed at each semi-annual evaluation to be certain that the fellow has ample experience to perform invasive procedures and to participate in resuscitations. If a faculty member identifies a performance problem, he/she is encouraged to discuss the problem directly with the fellow prior to the end of the rotation so that the PEM trainee has time to correct the problem and successfully complete the rotation. Problems of an urgent nature regarding an individual trainee on a particular rotation should be brought to the immediate attention of the program director. These issues are addressed by the program director with the PEM trainee without delay. PEM fellows are also asked to assess the anesthesia rotation during the semi-annual evaluation (or immediately if there are significant or specific problem areas). This feedback is used by the program director to identify and correct problems.
  45. 45. Rotation: Child Abuse (REACH) Location: Department of Emergency Medicine, Strong Memorial Hospital Year Of Training: Year 2 Rotation Length: 2 weeks Contact Person: Ann Lenane, MD PED Shifts: Required – (1 shift per block) Work Hours: Per Dr. Lenane Call: No first call Required Clinics: 9:00 AM – 1:00 PM, Tuesdays, Wednesdays and Fridays, REACH Clinic located in Child Advocacy Bivona Center 275 Lake Avenue, Rochester Required Conferences: Child Abuse/ Peds EM Fellows Conference Required Presentations: None Educational Goal and Objectives Upon completion of this rotation the PEM fellow will be able to: 1. Identify risk factors for child physical and sexual abuse 2. Obtain an appropriate medical and psychosocial history from the parents of a child being evaluated for sexual abuse. 3. Understand the process of the forensic interview of children being evaluated for sexual abuse 4. Perform an appropriate examination for sexual abuse. 5. Utilize culposcopy for evaluation of child sexual abuse. 6. Describe the significance of the various types of physical findings in sexually abused children. 7. Describe the interactions between the systems/agencies that become involved in cases of child abuse. 8. Understand the rights of adolescents as both perpetrators and victims of sexual abuse. 9. Collect forensic evidence in cases of sexual assault. 10. Interact appropriately with families in cases of sexual abuse Description of Clinical Experiences: The REACH Program provides social and medical assessments for children and families of children for sexual abuse. This will include learning to use a culposcope for the medical examinations. The PEM fellow will “shadow” the REACH attending physician/nurse practitioner in the medical assessment of these children. The PEM fellow will also “shadow” the social worker in her interactions with the families including observing the forensic interviews of children. The PEM fellow will also accompany the REACH physician on call in assessments of any inpatients admitted with concerns of child abuse including analyzing the radiological, laboratory evidence, communicating with the protective and law enforcement personnel as well as the floor team and other medical consultants. Work hours will adhere to the New York State and ACGME guidelines for resident work hours. A faculty member faculty will supervise the fellow at all times.
  46. 46. Evaluation and Feedback Process: Trainees are evaluated in writing at the end of each rotation, using a standardized evaluation form, by the supervising REACH program attending.. The pediatric emergency medicine training program director personally reviews the evaluations as they are returned. Evaluations of trainee performance are reviewed at the semi-annual meeting between the trainee and the program director. Each trainee is asked to evaluate the educational value of each rotation in writing, at the completion of the rotation. Trainees are asked to refer to the goals and objectives of the rotation when filling out these evaluations. Should problems arise, supervisory REACH personnel will make them known early to the trainee, to allow time for remediation during the rotation. The PEM program director will be notified immediately should serious problems arise.

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