Download preface to the 12th edition

Table of Contents
PREFACE TO THE 12TH EDITION ....................................................................................................... 4
CHAIRMAN’S WELCOME ........................................................................................................................ 5
RESIDENCY DIRECTOR’S WELCOME.................................................................................................. 6
ACGME CORE COMPETENCIES ............................................................................................................. 8
KCH ADULT ED....................................................................................................................................... 11
KCHC PEDIATRIC EMERGENCY DEPARTMENT........................................................................... 20
UHB EMERGENCY SERVICES.............................................................................................................. 30
AFFILIATE ROTATIONS – CONTACT NUMBERS………………………………………………………….42
THE BROOKDALE HOSPITAL ED...................................................................................................... 43
STATEN ISLAND UNIVERSITY HOSPITAL ..................................................................................... 46
VAMC – NYHHCS (BROOKLYN CAMPUS) ....................................................................................... 52
EMERGENCY DEPARTMENT .............................................................................................................. 52
EDUCATIONAL OBJECTIVES – PGY 1 .............................................................................................. 58
EDUCATIONAL OBJECTIVES – PGY 2 .............................................................................................. 61
EDUCATIONAL OBJECTIVES – PGY 3 .............................................................................................. 64
EDUCATIONAL OBJECTIVES – PGY 4 .............................................................................................. 67
PGY-1 OFF SERVICE ROTATIONS ..................................................................................................... 71
JUNIOR ULTRASOUND ROTATION ............................................................................................................ 72
ED-BASED TRAUMA ........................................................................................................................................ 75
OBSTETRICS ....................................................................................................................................................... 78
MICU ...................................................................................................................................................................... 80
INTERNAL MEDICINE AT THE VA ................................................................................................................ 82
PGY-2 OFF SERVICE ROTATIONS ..................................................................................................... 85
AIRWAY MANAGEMENT ............................................................................................................................... 86
CCU ......................................................................................................................................................................... 88
NICU ....................................................................................................................................................................... 92
ENT ......................................................................................................................................................................... 94
SICU ........................................................................................................................................................................ 97
NEUROLOGY .................................................................................................................................................... 101
EMERGENCY ORTHOPEDIC/FAST TRACK ROTATION .................................................................................. 103
PGY-3 OFF SERVICE ROTATIONS ................................................................................................... 105
EMS...................................................................................................................................................................... 106
TOXICOLOGY ................................................................................................................................................... 116
RESEARCH ........................................................................................................................................................ 118
EMERGENCY ULTRASOUND ROTATION.............................................................................................. 122
PGY-4 OFF SERVICE ROTATIONS ................................................................................................... 126
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ELECTIVE .......................................................................................................................................................... 127
INTERNATIONAL ELECTIVE CURRICULUM ..................................................................................................... 130
MEDICO-LEGAL .............................................................................................................................................. 133
MEDICAL EXAMINER ................................................................................................................................... 134
DERMATOLOGY ............................................................................................................................................. 135
ORAL SURGERY .............................................................................................................................................. 136
ADMINISTRATION ROTATION .......................................................................................................................... 137
MEDICAL EDUCATION ROTATION……………………………………………………………………………....140
EDUCATION........................................................................................................................................... 144
READING ........................................................................................................................................................... 145
TOPIC REVIEW ............................................................................................................................................... 146
MODEL OF CLINICAL PRACTICE OF EM ............................................................................................... 147
IN-SERVICE EXAMINATION ...................................................................................................................... 148
BOARD REVIEW GROUP ............................................................................................................................. 150
WEBTESTS ........................................................................................................................................................... 152
EMERGENCY MEDICINE BOARD EXAMINATION ............................................................................. 153
USMLE EXAMINATION REQUIREMENTS ............................................................................................ 155
DEPARTMENT CONFERENCES ........................................................................................................ 156
CONFERENCE CONTACTS .......................................................................................................................... 157
MORNING REPORT ....................................................................................................................................... 158
WEDNESDAY CONFERENCE ..................................................................................................................... 160
ED CONFERENCE ATTENDANCE POLICY ............................................................................................ 163
INDEPENDENT STUDY ................................................................................................................................ 163
PRESENTATION PREPERATION POLICY ............................................................................................. 164
ICU CONFERENCE ......................................................................................................................................... 168
MORTALITY AND MORBIDITY CONFERENCE ................................................................................... 169
TRAUMA CONFERENCE .............................................................................................................................. 170
POSSIBLE CONCLUSIONS FROM JOURNAL CLUB ...................................................................... 172
SENIOR RESIDENT LECTURES ................................................................................................................. 174
MISCELLANEOUS POLICIES AND PROCEDURES ....................................................................... 175
RESIDENT RESPONSIBILITIES AND DUTIES ..................................................................................... 176
POLICY ON ELIGIBILITY AND SELECTION OF RESIDENTS............................................................................. 177
PROMOTION/GRADUATION CRITERIA ............................................................................................... 178
SUPERVISION OF RESIDENTS ............................................................................................................................ 181
POLICY ON RESIDENT DUTY HOURS AND WORK ENVIRONMENT.............................................................. 182
CLINICAL PROCEDURES ............................................................................................................................. 184
RESIDENT PORTFOLIO ............................................................................................................................... 188
TRAVEL PLANS & REIMBURSEMENT PROCEDURES...................................................................... 193
DUE PROCESS AND GRIEVANCE PROCEDURES ................................................................................ 194
FACULTY ADVISORS..................................................................................................................................... 196
SICK CALL POLICY ......................................................................................................................................... 197
ED CONFERENCE ATTENDANCE POLICY ............................................................................................ 200
WORK ATTIRE POLICY ................................................................................................................................ 201
MOONLIGHTING ............................................................................................................................................ 202
POLICY ON CHIEF RESIDENT SELECTION .......................................................................................... 203
ON CALL ROOMS AT KCHC ......................................................................................................................... 204
EMPLOYEE HEALTH SERVICE (EHS)..................................................................................................... 205
NEEDLESTICK/BODY FLUID EXPOSURE PROTOCOL..................................................................... 206
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INSTITUTIONAL POLICY ON DISCRIMINATION & SEXUAL HARASSMENT .......................... 207
FAMILY MEDICAL LEAVE ACT ................................................................................................................. 208
THE IMPAIRED PHYSICIAN ....................................................................................................................... 209
EMERGENCY/DISASTER PREPAREDNESS 2010-2011 ............................................................................... 210
STUDENT EDUCATION ................................................................................................................................ 215
DEPARTMENT WEBSITE / INTERNET RESOURCES / .................................................................... 217
EMAIL / COMPUTERS / HANDHELDS ................................................................................................... 217
SCHEDULES ........................................................................................................................................... 221
MONTHLY SCHEDULES ............................................................................................................................... 222
TOPIC REVIEW 2010-2011........................................................................................................................ 226
PRESENTER SCHEDULE 2010-2011.............................................................................................................. 233
CHIEF ON CALL SCHEDULE 2010-2011 ....................................................................................................... 236
3
PREFACE TO THE 12TH EDITION
Welcome to the updated 2010 Edition of our Emergency Medicine Residency Handbook!
Please read this handbook carefully since it contains information about the residency, our
Department, the affiliates, various rotations, protocols, guidelines, and policies.
This handbook was written not only for the residents, but also for faculty members,
attendings, students and anybody involved in our department. It contains vital
information for the smooth operation of the department and successful completion of
your residency.
We would like to thank everyone who has contributed to this new edition. Please feel free
to contact us about any discrepancies, questions, comments and suggestions.
It is important that you read through the handbook carefully. As always, several changes
have been initiated. Please note changes in policies, rotations and affiliates. We have
decided to publish the handbook in a loose-leaf format. As changes occur in the future,
you will be able to pull old sections out and replace them with updated information. In
addition, we have published this edition on the web under the following web address:
http://www.downstate.edu/emergency_medicine
We wish you the best of luck!
Christopher Doty, MD
Residency Director
Mark Silverberg, MD
Associate Residency Director
Antonia Quinn, DO
Assistant Residency Director
Robert Gore, MD
Assistant Residency Director
Claritza Rios, MD
EM/IM Residency Co-Director
4
CHAIRMAN’S WELCOME
Welcome! We are all very pleased that you will be spending the next four or five years of
your career in the Emergency Department of SUNY-Brooklyn at Kings County Hospital.
You have chosen to train at one of the busiest Emergency Departments in the country.
We are a full academic department (1 of 61 in the country). Our residents rotate through
four of the twenty-one affiliated emergency departments in the SUNY-Brooklyn system.
While rotating through these facilities, you will be working with the finest emergency
medicine physicians in the New York City area. The combined census for these four
emergency departments is nearly 550,000 patients/year, more than double of any other
residency program in the nation. You will be exposed to an arena of pathology rivaled by
no other program in the United States. From the critical care and infectious disease at
Kings County and University Hospital of Brooklyn, to the cardiovascular disease at the
Brooklyn VA Medical Center, as well as an unparalleled community hospital experience
in Staten Island, you will “see…do…then teach”, as your peers merely read.
This does not come without a price. I expect you to work hard, be a caring physician, and
to teach. As a resident in one of the finest university systems in the country, you have the
responsibility to teach your colleagues, your students, your staff and your patients. Our
goal is to turn you into academicians and lifetime teachers. We are looking to train the
future leaders in the field of emergency medicine.
I look forward to our bedside presentations, lively discussions at Wednesday conference
and searches for the diagnosis at 2am. We, together are about to grow… it’s the reason
why I’m here.
Welcome, and good luck.
Michael P. Lucchesi, M.D
Chairman of Emergency Medicine
Chief Medical Officer, UHB
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RESIDENCY DIRECTOR’S WELCOME
Welcome to the Combined EM-IM & Categorical Emergency Medicine Residency at
SUNY Downstate Medical Center/Kings County Hospital and its affiliates.
The faculty and I believe that this residency will provide the best and strongest learning
environments in the field of Emergency Medicine. My job as program director is to be
the facilitator and guarantor on your way to becoming a superb Emergency Physician.
Your role shall be that of a professional, with a desire to learn while providing excellent
and compassionate care. Residency is not always an easy strait to travel and there are a
myriad of obstacles to navigate before reaching the final destination. We will do this
together. Let us be always mindful of the fact that we must keep high expectations of
ourselves and others; this will lead us to be ever-working to achieve excellence of
ourselves and for our patients.
This resident’s handbook shall serve as one of the roadmaps on your travel to success. It
contains many useful tips as well as some very basic rules. Please read the manual
carefully. It is implied that by signing a receipt for this book that you are familiar with its
content.
I wish you success in your residency as a starting point of a wonderful and fulfilling
career.
Christopher I. Doty, MD FAAEM FACEP
Assistant Professor
Program Director
Department of Emergency Medicine
SUNY Downstate Medical Center & Kings County Hospital
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Vision Statement
The residents in the program will be leaders in the department, leaders in the university,
leaders in the community, and eventually leaders in Emergency Medicine. We will be a
culturally aware and ethnically diverse center of excellence in Emergency Medicine
education. The overall goal of this program is to provide outstanding and compassionate
patient care while fostering critical thinking and curiosity as well as implementing
advances in the care of the emergency patient. We will strive to transform our residents
into role models in the provision of patient-centered healthcare beyond our own
institution but with a global reach.
Work Environment
The department will create an environment for our residents that is conducive to learning;
intellectually stimulating; personally satisfying; safe from physical and emotional harm;
and free of discrimination based on the residents’ sexual orientation, spiritual beliefs,
race, ethnicity, identified gender, or socioeconomic background.
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ACGME CORE COMPETENCIES
Criteria by which residents’ performance will be judged is outlined below:
PATIENT CARE (PC)
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the promotion of health. Residents are
expected to:









Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients and their families
Gather essential and accurate information about their patients
Make informed decisions about diagnostic and therapeutic interventions based on
patient information and preferences, up-to-date scientific evidence, and clinical
judgment
Develop and carry out patient management plans
Counsel and educate patients and their families
Use information technology to support patient care decisions and patient
education
Perform competently all medical and invasive procedures considered essential for
the area of practice
Provide health care services aimed at preventing health problems or maintaining
health
Work with health care professionals, including those from other disciplines, to
provide patient-focused care
MEDICAL KNOWLEDGE (MK)
Residents must demonstrate knowledge about established and evolving biomedical,
clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the
application of this knowledge to clinical decision making. Residents are expected to:



Demonstrate analytic thinking and a systematic approach to clinical situations
Know and apply the basic and clinically supportive sciences that are appropriate
to the Emergency Dept.
Develop an appropriate differential diagnosis.
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PRACTICE-BASED LEARNING AND IMPROVEMENT (PBL)
Residents must be able to investigate and to evaluate their patient care practices, appraise
and assimilate scientific evidence, and improve their patient care practices. Residents are
expected to:






Analyze practice experience and perform practice-based improvement activities
using a systematic methodology
Locate, appraise, and assimilate evidence from scientific studies related to their
patients’ health problems
Obtain and use information about their own population of patients and the larger
population from which their patients are drawn
Apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness
Use information technology to manage information, access on-line medical
information; and support their own education
Facilitate the learning of students and other health care professionals
INTERPERSONAL AND COMMUNICATION SKILLS (C)
Residents must be able to demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their patients families, and
professional associates. Residents are expected to:



Create and sustain a trusting and effective relationship with patients and family
members
Use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
Work effectively with others as a member or leader of the health care team
PROFESSIONALISM (P)
Residents must demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse patient population. Residents
are expected to:



Demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supercedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development
Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices
Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities
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SYSTEMS-BASED PRACTICE (SBP)
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care and the ability to effectively call on system resources to provide
care that is of optimal value. Residents are expected to:





Understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and the larger society and
how these elements of the system affect their own practice
Know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources
Practice cost-effective health care and resource allocation that does not
compromise quality of care
Advocate for quality patient care and assist patients in dealing with system
complexities
Know how to partner with health care managers and health care providers to
assess, coordinate, and improve health care and know how these activities can
affect system performance
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KCH ADULT ED
I. Introduction
Welcome to the Kings County Hospital Center Emergency Department. At over 125,000
patient visits per year, it is one of the largest Emergency Departments in the country.
This patient volume and the high acuity will serve as the classroom for one of the most
hands-on, educational experiences you will have during your training. When you start
your first clinical shift, you should ask the senior resident for a tour of the ED and a
description of the available resources and supplies.
Our E.D. is subdivided into several areas based upon triage and patient age:
1. CCT - Critical care and trauma
2. Suite A/B – General medical/surgical illness/Obstetrics/Gynecology
3. Pediatric ED
4. Fast track
I. CCT-Critical Care Trauma
This area is what makes your residency experience at Kings County so special. It is
essentially an ICU based in the ED where the most acute patients are stabilized and
treated. This includes both medical and trauma patients. One attending with a senior and
a junior resident staffs the CCT. You will be expected to perform procedures including
but not limited to lumbar punctures, central lines, CVP lines, and arterial lines. There is
good nursing staffing and a PCT in the CCT but be expected to put in IV lines if the
patient is in extremis. Juniors, it is expected of you to arrive to your shift at least 15 to 20
minutes early to check the resuscitation bay and stock your airway equipment and IV
equipment, prepare the level one infuser and make sure you are ready to handle anything
that comes in. Use your time in the CCT to learn from your attendings, seniors, and
patients.
II. Suite A/B
The majority of cases will challenge your knowledge of basic medicine and recognition
of potential emergencies, such as acute myocardial infarction, pulmonary embolism,
diabetic ketoacidosis, sickle cell crisis, and impending respiratory failure in asthmatics.
Here too, you will experience a good degree of independence. Reading for this area
should be focused on interesting cases that you see. Our advice is to pick one topic each
day to review or learn, based on what you saw during your shift.
There are usually several nurses in this area, physician assistants, who see patients, a
respiratory therapist, who will cover the asthma room during the day, and patient care
techs. You will frequently be responsible for IVs and blood work, however we now have
dedicated phlebotomists. ECGs and patient transport to X-Ray are the PCTs’
responsibility, but it may be necessary to assist with these tasks as well. If you require
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blood draws or transport, write the patient’s name, task and room number in the PCT task
log place one the care provider desk in each of the 2 pods. Currently, the CT transporters
will come and pick up your patient when they are ready to perform the study.
Teaching opportunities by the attending staff is abundant in this area. Please ask
questions! This is an excellent time to learn from the attending staff, many of who
have sub-specialized in various areas of medicine. You will be asked questions about
your choice of management during close out rounds, so make sure you know why you
are managing a patient a certain way. Also, challenge yourself to practice your
differential diagnosis skills.
III. FAST track-As part of the ortho/FT rotation
A day in the Fast track, as with other areas of the department, starts off with sign out
rounds. Although done a bit informally, as compared to its counterparts, it is not unusual
to do bed side rounds. The fast track area offers an excellent opportunity to manage
minor trauma, laceration repair, I&D, orthopedics, ophthalmology and countless
gynecological cases. You will be given a great deal of independence in this area and the
majority of your cases will be managed to completion. The fast track may be one of our
less acute areas; however, don't be fooled, many times very sick patients present to the
treatment room.
Expect to do all blood draws. In addition, you may need to get or deliver your patient to
X-Ray and CT scan to expedite matters. There is usually a patient care technician
assigned to the treatment room and the tech will be the one to accompany the patients that
need evaluation at other areas of the hospital (i.e. for official sonography,). There is only
one nurse assigned to this area and he/she will administer all medications. If
consultations are needed, phone the page operator at x3141, give her the requesting
service and your call back number. Once you and the attending have reached a
disposition, you can ask the clerk to schedule an appointment if the patient is being
discharged or put the patient in for admission.
IV. Roles and Responsibilities of Resident Physicians
Morning Report: Morning report is the opportunity for our department to discuss cases
in a more formalized manner. This conference is held after morning rounds on Mondays,
Tuesdays, Thursdays, and Fridays. Residents will present a case for discussion.
Attendance is mandatory for all residents working the day shift and residents who
worked the previous overnight shift.
Wednesday Conference: Conference for EM residents will be held each Wednesday in
the department conference room, unless posted otherwise. Attendance is mandatory.
The conference is composed of various didactic lectures covering the core curriculum of
Emergency Medicine, specialized case discussions pertaining to Pediatrics, the MICU,
12
Trauma, Journal club, morbidity and mortality conference, a CPC, and monthly grand
rounds.
Sign Outs: If you are leaving the ED for lunch, lecture or at the end of your shift, all
patients assigned to you must be signed out. The attending that has reviewed the
patient with you should be aware that you are leaving. Always inform the most
senior person if you are leaving the clinical area.
V. Consults
Specialty consultations are available in all services. All consults must be ordered in the
computer. If, as the Resident Physician, you are having difficulty contacting a given
service, you are to discuss this immediately with the attending of record for the case.
OB-GYN consultation for all stable patients and pregnant patients less than 20 weeks
will take place in the ED in Suite A/B. All pregnant patients greater than 20 weeks who
arrive via EMS must first be triaged in the ED, if they are ambulatory they can be guided
directly to S5 (L&D).
VI. Admitting process
At the time it is determined that a patient requires general admission to the hospital, you
must discuss the case with an attending physician. The clerk and nurse should be notified
of the admission. Complete a “disposition note” in the Quadramed system once the
decision to admit has been reached. This will place the patient on the bed board and
notify admitting so that a bed can be procured. All medical admissions are then
discussed with the medical senior who will call in the admission to the floor team. All
admissions to the ICU or specialty services must first be discussed with the appropriate
contact person.
VII. Radiology Services
The Department of Radiology provides efficient, full-service radiological services. Please
be aware that CTs do not need to be approved by the radiologist before the technician
will perform them. Preliminary readings of films may be obtained by the radiology
resident by calling or walking over to the radiology department (x1406). All head and Cspine CT’s are read by virtual radiology. All plain films are to be reviewed by yourself
and the Attending Physician of record on the PACS system, located on each computer.
The radiology senior should be contacted via the UHB page operator (270-2121) to
discuss all off-hour specialty studies.
IX. Physician Documentation
Currently, we utilize the T-system charting tool. Please become familiar with it. It is
expected that you will complete the patient chart, providing all pertinent historical,
physical, and laboratory/radiological/EKG interpretive information—both positive and
negative—prior to patient disposition. Since T-sheets often get separated from the main
13
chart, it is advisable to also document any important findings, test results, lab results or
other significant patient information in the “ED quick note” under MYSIS. You must
sign and stamp all charts for patients you care for. ALL charts must be signed and
stamped by an attending physician prior to patient disposition. It is your responsibility to
note on the chart, in the designated area, which attending was involved in your
supervision of the care of this patient (i.e. “d/w Dr. Smith). In addition, all patients must
also have the following information noted on the chart: time/date seen by MD,
disposition (including time/date), and final diagnosis. If a patient is to be discharged, all
patients must have specific discharge instructions, including time and place of follow up
appointments, return instructions, and any medication/care instructions. Micromedex
Aftercare Instructions should be used for discharge instructions.
X. Follow-up Appointments
Follow up appointments can be obtained by asking the clerk in your area. The general
clinic appointment number is 245-3325. The discharge template in MYSIS also has an
area for documenting follow-up appointments. A clinic appointment must also be
ordered in MYSIS.
XI. Clinical Schedule
The Scheduling Chief Resident is responsible for the making and distribution of the
monthly KCH ED schedule. The Chief Resident on-call is the most important person with
respect to the intricacies of the daily schedule and is the first person to approach with
scheduling questions and requests. All schedule changes must be approved by Chief
Resident on-call. The following is a brief outline of policies related to the monthly
schedule.


Any late requests will not be accepted.
Please check the schedule, even if you requested certain days off. Requests are
not guaranteed, but every effort will be made to honor them.
Please refer to the “Resident Schedule” section for details.
XII. Educational Objectives
Emphasis will be placed on orientation to the different emergency department
environments. Residents should learn to document a chart appropriately (C,PC,MK,P),
prioritize and organize activities, perform basic procedural skills, work with
EMS(C,P,PC), deal with friends and families of patients (particularly those who are
critically ill or dying (P,PC,C,SBP) and deliver quality patient care(P,PC,MK). The
resident should demonstrate accurate and appropriate history and physical exam skills,
practice generating differential diagnoses and care plans and exhibit the appropriate
usage of x-rays and labs (PC,SBP,MK). A PGY 1 should evaluate no more than one to
two new patients at a time. They should not accept responsibility for more patients until a
14
senior staff member has evaluated his present patient. Their total caseload will be
determined by their need for supervision, as well as patient acuity. PGY 2 and PGY 3
residents will be expected to further develop their clinical acumen, sharpen their physical
exam techniques and hone their procedural skills. Their organizational abilities are
expected to be more refined and they should be able to manage more patients
simultaneously. PGY 4 residents are expected to “run the room” and act as junior
attendings. They should know all the patients in the ED, facilitate their management and
disposition, and supervise and teach junior residents and medical students.
At the completion of this rotation, residents should be able to demonstrate competency in
and be able to:
 Decide which patients require admission, transfer, or discharge (MK,PC,SBP)
 Perform histories and physicals on Emergency Department patients (MK,PC)
 Understand the necessity for prioritizing patients (PC,SBP)
 Prioritize their activities (SBP,PC)
 Formulate differential diagnoses on their patients (PC,MK)
 Plan appropriate work-ups based on their differential diagnoses (PC,MK)
 Plan admission, transfer and discharges (PC,MK,SBP)
 Appropriately order and utilize laboratory data and ancillary studies (PC,SBP)
 Carefully understand and utilize universal precautions (MK,SBP)
 Appropriately utilize specialty consultation (P,C,PC)
 Function as a team member during resuscitations (P,C)
 Maintain patient follow up and rotation evaluation (PBL)
15
KCH Important Phone Numbers
S-ED Areas
Suite A
Suite B
CCT
Fast Track
Peds
4616, 4617, 4618
4619, 4620, 4621
4601-04
4610
3638, 3643, 3860
Reception
Triage - EMS
Triage - Walk-In
3183, 3185, 3187
1426
4638
Labs
Chemistry
Hematology
Micro
Blood Gas
Blood Bank
5342
5373
5354
4632
4897
Radiology
CT
ED
S-2
XR Control
MRI
Reading Rm
Ultrasound
Paging
KCH
Downstate
Overhead Paging
*9 for waiting
rooms (front and
radiology)
Zone paging
Suite A
Suite B
CCT
FT
Peds
Reception
Rads Read
Offices
Dept. EM
fax
Head RNs
Medical Records
Messenger
Patient Rep
Pharmacy
Respiratory
Social work
3378 / 1408
3733 / 4985
4645
5585
1406, 1407
1405, 4699
Inpatient Svcs
Med RED Team
Med BLUE Team
347-231-5922
347-231-5851
Med Senior
347-386-5976
Peds GREEN
Peds RED < 4yo
917-760-0068
917-760-1301
Behavioral Health
BH ER
BH - Internist
Psy Consult - bpr
office
2310-12
347-992-7938
917-760-0786
5209
3141, 3142
718-270-2121
Environment
of
Care
Biomed
(ECG,
etc.)
Facilities - daytime
off-hour
electrical
plumbing
IT Help Desk
Linens
Telecom
Units
16
dial *0, then…
24
25
26
27
15
28
13
4790
4799
4200
4268
3917
7129
4526
4628
4011
(ED),
2932
2943
2952
5138
2941
4357 (HELP)
4673
3333
Outside #s
FDNY Dispatch
FDNY Help Team
Medical Examiner
NYC Poison CC
CCU
Labor & Delivery
MICU
Morgue
OR
PICU
SICU
718-422-7395
347-865-8658
212-447-2030
212-764-7667
17
7580-2
4571
7583
5313, 5423
4040
7028
7003
Clinic
ADULT Primary Care
Days
M-F
SAT
M-Fri
SAT
TUES, FRI
ADULT WALK-IN
ALLERGY
ARTHRITIS
Time
08-2000
08-1600
08-1700
08-1600
08-1200
TUES, WED 08-1200
THURS
09-1600
Loc
E-7
E-1
E-1
E-1
E-5
Ext.
3422
3422
3363
3422
5176
E-1 3363
E-1 3363
ATAC
M, W-F
Alternate to Acute Care
CARDIOLOGY
WED, Th
08-1200
E-1 3363
13-1600
E-7 2273
CARDIOLOGY (Medical)
M-W, FRI
08-1200
E-7 2273
CHEST
WkDs X W
WED, Th
TUES
13-1600
08-1200
08-1200
E-7 3525
E-7 3525
E-7 2273
DIALYSIS
TUES
WED
MON - SAT
TUES, FRI
MON ,Thurs
TUES
THURS
MON - SAT
13-1600
08-1200
08-1630
08-1200
13-1600
08-1200
13-1600
06-2400
DOT
MON - FRI
08-1600
E-7 3422
E-7 3422
E-1 4914
E-7 3470
E-7 3470
E-1 3363
E-1 3363
C-6 (718)
613-8161
E-7 3525
ENT
M-W, FRI
13-1600
E-5 5176
GERIATRICS
MON - FRI
08-1600
E-1 3200
GI
WED
08-1600
E-7 3470
GI malignancies
HEMATOLOGY
1st FRI
TUES
MON
09-1200
13-1600
13-1600
E-9 3471
E-9 3471
A-2 2847
HEPATOLOGY (LIVER)
MON, TUES 14-1600
E-7 3470
IMMUNOLOGY
ADOLESCENT
ADULTS (Ctr 4 Hope)
PEDIATRICS / (FCC)
NEUROLOGY
M, W, F
WD x Thrs
MON-Th
WED, Th
13-1700
various
09-1700
13-1600
E-4
E-4
E-4
E-8
NEUROSURGERY
THURS
13-1600
E-8 3462
ONCOLOGY (MEDICAL)
BREAST
LYMPHOMA
Myeloma/Gammopathy
OPHTHALMOLOGY/
OPTOMETRY
ORTHOPEDICS - Hand
ED FOLLOW-UP
ADULT FRACTURE
Adult Ortho/Recon
TUES
WED
THURS
MON
M-W, FRI
THURS
MON
WED
TUES
TUES
THURS
FRI
MON
WkDs X W
13-1600
13-1600
13-1600
13-1600
08-1600
08-1200
0830-1200
0800-1200
08-1200
13-1600
0800-1200
0930-1200
13-1600
08-1200
A-2
A-2
A-2
A-2
E-8
E-8
E-8
E-8
E-8
E-8
E-8
E-8
E-8
A-2
CHF
COUMADIN
DENTAL
DERMATOLOGY
DIABETES
PEDS ORTHO
PEDS FRACTURE
PAIN MANAGEMENT
18
5369
2800
2563
3462
2847
2847
2847
2847
3462
3462
3477
3477
3477
3477
3477
3477
3477
2847
Clinic
Peds PRIMARY CARE
Days
M - FRI
SAT
MON - FRI
Time
08-2000
08-1600
13-1600
Loc
E-5
E-5
E-5
Ext.
2982
2982
3650
TUES
THURS
MON-FRI
TUES, W
qo WED
MON
MON, Th
WED
FRI
MON
TUES
FRI
MON
TUES, Th
TUES
MON, Th
qo FRI
THURS
qo WED
M - SAT
MON - FRI
13-1600
13-1600
08-1600
08-1200
09-1200
13-1600
08-1200
08-1200
08-1200
08-1200
08-1200
08-1200
03-1600
16-2000
09-1200
09-1200
08-1200
08-1200
09-1200
08-1900
08-1800
E-1
E-1
E-1
E-5
E-1
E-1
E-5
E-5
E-5
E-5
E-5
E-5
E-5
E-5
E-1
E-1
E-1
E-5
E-1
E-1
E1
2891
2891
2891
3650
2891
2891
3650
3650
3650
3650
3650
3650
2982
3650
2891
2891
2891
3650
2891
2891
PLASTIC SURGERY
MON
09-1200
E-6 3471
PODIATRY
REHAB
T, W, T, F
MON
MON - W
08-1600
08-2000
08-1200
E-8 3465
E-8 3465
C-1 7295
RENAL
MON, WED 13-1600
E-1 3363
SICKLE CELL Day Hospital
M - FRI
SICKLE CELL Clinic
TUES
THURS
FRI
08-1600
C-4
718.613.8188
08-1200
C-4 see
16-1900
C-4 day hosp
08-1200
E-8 3477
Cardio-Thoracic
Hemo-Access
RECTAL
TRAUMA
VASCULAR
THYROID
TUES, FRI
WED
MON - Th
FRI
MON, Th
WED, Th
1st&3rd W
TUES
MON, Thrs
MON
WED
FRI
13-1600
08-1200
08-1600
13-1600
09-1200
13-1600
13-1600
13-1600
09-1600
13-1600
09-1200
08-1200
E-4
E-4
E-9
E-9
E-9
E-9
E-9
E-9
E-9
E-9
E-9
E-7
UROLOGY
M, W, F
08-1600
E-9 4110
MON-TH
MON
TUES, WED
THURS, FRI
1st&3rd Sat
MON - FRI
various
10-1800
08-2000
08-1700
08-1600
08-1600
E-6
E-6
E-6
E-6
E-6
E-4
CONTINUITY
PEDIATRICS
ADOLESCENT
ADOLESCENT/GYN
ASTHMA CENTER
CARDIOLOGY
CHEST
CHILD/ SEXUAL ABUSE
DERMATOLOGY
DIABETES
ENDOCRINOLOGY
GI
HEMATOLOGY
NEONATES
NEUROLOGY
OBESITY
PEDS ALLERGY
PEDS ASTHMA
PEDS RENAL
PEDIATRIC SURGERY
SLEEP APNEA
PEDIATRIC WALK IN
Phlebotomy(LAB)
SPINE CENTER
STD
walk in service
SURGERY General
BREAST
WOMEN'S HEALTH
Family planning / UCG
OB/GYN
WOMEN'S OPTIONS
19
2800
2800
3471
3471
3471
3471
3471
3471
3471
3471
3471
3422
3502
3267
3267
3267
3267
4990
KCHC Pediatric Emergency Department
A Message from the director
Pediatric Emergency Medicine (PEM) is a division of Department of Emergency
Medicine. The Pediatric ED at KCHC is the only state –designated level 1 trauma center
in Brooklyn, and operates 24/7. The Pediatric ED is a gold mine of pathology and
provides tremendous opportunity to serve the children of central Brooklyn. The purpose
of this outline is to provide brief administrative aspects of the functions of the Pediatric
ED. It is a privilege to serve children and we hope you will enjoy exercising this
privilege!
Administration
Dr. Konstantinos Agoritsas is the Director of the Division of Pediatric Emergency
Medicine. Ms. Rosamond Payne is the Administrative Nursing Director for the Dept. of
Emergency Medicine. Pediatric and EM faculty staff the Pediatric ED. Pediatric
Emergency Medicine Fellows, residents from the departments of EM, Pediatrics, Family
Medicine and the combined EM/IM program rotate through the Pediatric ED. 3rd year
and 4th year medical students as well as PA students also rotate through the Pediatric ED.
About 30,000 sick and injured children are seen in the Pediatric ER annually.
In-patient wards
Pediatric In–patient wards (total beds: ) are D-6 south and D-6 North (in-patient tower /
“D” building 6th floor). PICU (8 beds) is located also on the D-6 north. There are also 3
observation beds (“stepped –down” unit) located on the D-6 north.
Neonatal ICU is located on D-5 (“D” building 5th floor) along with regular nursery.
Medical/Surgical patients
All patients should be seen by a triage nurse who will help deterimine if they need to be
seen immediately or in time order/ based on their ESI category. If there are questions
about which patients should be seen next, please ask a fellow or attending.
All rooms may be used to see any type of patient, but certain rooms are preferable for
certain types of patients. Room #1 is equipped for critical patients, Rooms 3-5 are
preferable for longer stay, more acute patients. Room # 6 is well suited for procedural
sedation and analgesia and room # 7 for surgical procedures. Room 8 is equipped for gyn
exams. Room 12 is an isolation room equipped with negative pressure its own bathroom.
Any patient with exposure to measles, chickenpox or other infectious disease will be
placed in the isolation room and evaluated there by the physician.
20
Surgical patients are seen by the PED staff, and pediatric surgery is available for
consultation up to 18 years of age for surgical and blunt trauma, and up to 13 years of age
for penetrating trauma. For patients with penetrating trauma over the age of 13 and
surgical disease over the age of 18 the adult surgical team should be consulted.
Critical patients




If a patient is critically ill, they may be taken to the Pediatric CCT area, or
resuscitated in the PED area based on attending preference.
The charge nurse and the attending, Pediatric EM fellow or the senior EM resident is
responsible for assigning the roles during the resuscitation.
Please visit the CCT Pediatric Trauma Room and get to know where equipment and
materials are located. In the CCT Pediatric Trauma Room, there is a Broselow cart
that contains all necessary airway equipment.
After patient stabilization, if needed, patient can be escorted to the X-Ray room.
However, portable X-Ray is available in the CCT area.
OB
Less than 20 weeks gestation is to be seen in the Pediatric ED. More than 20 weeks
gestation to Labor and Delivery Suite after initial triage and ED stabilization in the ED,
Telephone advice
We do not give advice over the phone. Parents calling from home seeking advice are
advised to seek treatment at the KCHC walk-in clinic, ED or their primary medical
doctor.
Age-limit criteria


Please use age limit criteria as just guidelines and do not let patient suffer because
patient is presenting in a “wrong ER with a wrong age”.
a) Medical emergencies up to 19 years of age = Ped ER
b) Minor blunt trauma up to 19 years of age = Ped ER
c) Major blunt or penetrating trauma up to 13 years of age = Ped CCT
d) Major blunt or penetrating trauma after 13 years of age = Adult CCT
e) Surgical Emergencies up to 18 years of age = Consult Pediatric surgery
f) Surgical emergencies in patients older than 18 years of age = Consult Adult
surgeons
If a patient is followed-up regularly by one of our subspecialty clinics (e.g. asthma or
sickle-cell clinic), then we will see such patient who may be even older then 18 years
of age (usually we will see such patients up to their 21st birthday).
21

For all cases, where there exists a question as to the appropriateness for triage, the
Pediatric ED attending will be consulted and the attending on call will then use
his/her discretion to accept or transfer the patient.
 Under NO circumstances, patients should be moved between the adult ER and Ped
ER just because they are “slightly” either older or younger than the age limit criteria
(e.g. a common scenario: a 19.5- year- old patient not followed by any pediatric
subspecialty clinic presents to Ped ED with fever and sore throat—please just take
care of patient in Ped ED and DO NOT send him/her to adult ED!).
 There is a policy book in the Nursing Office. Please refer to it for any policy
questions. Several policies are also available on the HHC intranet.
Age of consent



Any person 18 years or older, a parent of a child/ pregnant, who is married, seeking
care for a sexually related illness or substance abuse/ mental illness over the age of
16, may give consent for medical, dental, health and hospital services for
himself/herself and for his/her child.
In an emergency, consent is not required if a delay would lead to immediate life
threatening events to the person’s health or life. This must be documented on the
medical records and signed by the physician.
A “Minor” is defined as an individual under the age of 18 years who has not been
emancipated.
Nursing
A Charge Nurse is assigned 24 hours a day. She is responsible for knowing the general
status of the ED at all times. She can help coordinate admissions, discharges and
transfers. The nursing staff is comprised of clinical nurses, nursing support technicians
and unit assistants. Each patient, once registered, is evaluated and a primary nurse is
assigned. Emphasis is placed on collaborating with the nursing team for patient care and
decision-making. This will definitely lead to cordial work environment and best patient
care. Remember, nurses, clerks and the support people do not rotate at the end of the
month and have an interest in providing excellent care. If they suggest a particular way of
doing something, most often it is the way it has worked best in similar situations in the
past.
Presenting patients
After fully evaluating a patient with a thorough history and physical, every patient must
be presented to and physically seen by a fellow or attending.
Discharge instructions
Before each patient is discharged, they must have an exit interview that will help
reinforce your discharge instructions with the family. Computerized Discharge
22
Instructions and patient education materials can be printed out directly from the
Micromedex R system and MD consult R available through the computers at caregiver
stations. The parent should sign a copy of disposition note before being discharged.
Statements like “preprinted discharge forms given to mother - she understands” shows
that communications did occur.
It is very important that you document the following on all discharge instructions:
1) When to Follow up: Many discharged patients require mandatory follow up.
These include fractures, pregnancy, wound or burn care, or first urinary tract
infections. Other patients do not warrant mandated follow up and thus the
disorder will simply run its natural course. However, it is important to advise “as
needed” follow up when it is appropriate to do so. If the condition improves as
expected, no follow up is necessary. However, the instructions must clearly and
specifically state that if the condition persists or worsens or some other problem
develops, follow up is necessary.
2) With Whom and where to follow up: Specify a date, time, location and with
which specialty the patient is to follow up. Depending on specific insurance
issues, the patient may require a referral. Please advise the parent to seek
additional assistance with their primary care provider regarding the referral
process.
3) Provide instructions in plain, simple language.
4) Avoid the use of medical abbreviations and medical lingo. Please write in a clear
language that the patient or parent can understand. For example, instead of “q”
write “every” and for ‘P.O.’ write “by mouth”.
5) Provide discharge instructions in the language of the speaking patient/parent.
6) Document that a translator was utilized when discharging a patient with the
assistance of a translator. Always record the name of the translator on the
discharge instructions or in the medical record of the ED visit.
7) Document a discharge diagnosis, even if it is an impression.
8) Provide specific instructions regarding home care for the patient’s injury or
illness. These instructions can range from brief instructions such as PRICE
(Protect, Rest, Ice, Compression, Elevation) after an orthopedic injury to
extensive information with computerized discharge instructions. When you
provide a patient/parent with instructions from Micromedex R system or MD
consult R , then document in the ED discharge instructions that the parent was
provided with them. (Ex: Micromedex instructions on asthma in children given)
Social work
Remember: Social worker can call ACS (Administration for Child Services). There is
NO RULE that only physician can call ACS !!!. Social worker can also help in providing
referral to community resources and agencies. Usually a 24-hour coverage and
assessment is available for child abuse and neglect cases. If a social worker is not
available (e.g. mid night-AM shift), please page AOD and they will get a social worker
on the phone to assist / guide you.
23
Physical and sexual abuse

Patient 18 years and younger fall under child protective services/specialist (CPS) laws
and therefore, should have a pediatric consult. The Pediatric ED must ensure proper
referrals to CPS, Social Services and appropriate counseling.
 There is a digital camera available in the Ped ED to document the signs of abuse.
Please speak to the head nurse for assistance. You must document the name, MR#
and who took the picture after it is uploaded in Quadramed. Also, if you are
documenting signs of physical abuse, place a ruler or another object (quarter) next to
the physical finding in order to provide a perspective on the severity of the injury.
 From the ED, all the patients (especially sexual abuse cases) are required to follow up
at the sexual abuse clinic.
 Dr. Dipasquale is also available at beeper (917)-760-1156 if you need a second
opinion regarding any case.
 Child Abuse Follow- up Clinic
1. ALL patients with suspected child abuse must have an appointment made
through the clerical staff of either Ped ED or registration
2. Tel # of clinic: (718)- 245-3612
3. If you have difficulty making an appointment, ask the social worker for
assistance
Sexual Assault in patients over the age of 13yo.
 Consult Sexual Assault Response Team through the page operator (# 3141). A
general history and physical should be done, lab work drawn as per SART protocol.
Social work should be consulted.
 On discharge the patient must fill out a “Family Care” form found in the file cabinet
to the right side and instructed that they will receive a phone call for a follow up
appointment within 5 days. If the receive HIV prophylaxis, please be sure to tell
them that although they receive medications/ prescriptions for 5 days, the entire
course is 30 days.
Consults




Most consultants may be reached by asking the operator (3141) to page them. In the
event that they are unable to page them, the information bulletin bears the name and
beeper number of the fellow/resident on call for different sub-specialties.
The attending/resident will type the consultation note in the computer after direct
communication with the ED staff.
If the patient is to leave the ED for consults to dental, ophthalmology, ENT, Gyn, the
chart will remain in the ED, and make sure that patient is sent with a nurse’s aid.
Please make sure also that patient does not get discharge directly by the sub
specialist. You must co-ordinate discharge and follow-up with the consultant service.
Psychiatry consultations

There is child psychiatry consultation to the Pediatric ED at Kings County
24



between 9 a.m.- 5 p.m. Instructions on how to contact psychiatry are in the binder.
Patients need to be medically cleared before psychiatry consult is called. If the
patient is to be transferred to R-ER for admission, the psychiatry internist is to be
called to make them aware that the child is “medically cleared”.
If the child can go home, it is important that we refer them to the walk-in clinic in the
R Building, open M-F 9:00a.m. – 2:00 p.m.
REMEMBER: Medical clearance in the Ped ED does not automatically mean routine
blood tests like CBC and CMP. Patient can be medically cleared just by a history, and
well-performed physical examination. Blood tests are ordered only when indicated.
Admitting Process


Once you have decided to admit, let the child’s nurse know.
Communication with the referring physician, if indicated, is very crucial. Please
notify the unit clerk to request the bed for this patient.
 Patients are generally admitted to the pediatric team, except for orthopedics and
surgery
 Call the admitting senior resident on the assigned floor and give your sign-out. All
diagnostic work-up, including labs, intravenous access, and first dose of antibiotics,
(if indicated) are to be done in the ED. However, there is nothing like a routine lab
tests that are required for admission except Hgb/Hct (thus, a child getting admitted for
Status Asthmaticus who is not dehydrated does not need BMP just because you are
admitting him or you have extra blood drawn by a nursing staff).
 Admission to the ICU requires speaking to the PICU attending on call. The PICU is a
closed unit, and all admissions are under the PICU attending.
 All the admissions to PICU need to be accompanied by the nurse and a physician. A
physician-to-physician communication and nursing –to- nursing communication
must be done in detail at the time of admission.
Remember: NO one from the in-patient service or PICU has a right to refuse an
admission (provided there is a bed available). If you think that patient needs an
admission, and if in-patient team disagrees with you, it is still ultimately your decision.
You can discuss differences of opinion in a non-threatening manner with the in-patient
team, but ultimately YOU ARE RESPONSIBLE FOR THE PATIENTS who are in
the ED. No one from in-patient team should ever make a decision without actually
examining the patient.
Transfers

All calls should be directed to the attending or pediatric emergency medicine fellow.
Documentation
25





Your documentation in the ED chart has been called “the final letter to the Jury.”
Please make it legible. You may be the best physician but if you don’t document, no
one will believe you. YOU MUST USE YOUR STAMP to sign all your notes.
Please ensure that all residents and medical students write the name of the attending
that have discussed the patient with (e.g. “discussed with Dr. -------“). Since there are
usually two attendings working in the Ped ED majority of the times, it is very hard to
figure out who was the attending involved with the case from a chart lacking such
documentation.
All the spaces in the chart have some meaning to it. Please, complete all applicable
areas before the patient goes home.
Document any difficulties, altercations or interaction between Parent or
Guardian/patient and you. It will help if a complaint arises later on. Please write the
time the patient was seen and the time patient was sent home.
Follow up- pediatric clinic





DO NOT schedule patients to return to ER for follow-ups.
If patients are to be recalled in 24 hours for follow-ups, they can be asked to return to
the Pediatric Urgent Care or PMD.
Appointment for PCP can be made by the clerical staff of Ped ED or by calling the
clinic appointment desk at telephone # 245-3651.
The PCP can only make all sub-specialty follow-ups. Patient needs a referral paper
(prior authorization) from the PCP. Thus, always refer the patient back to the PCP
(e.g. a patient with chest pain who needs cardiology clinic follow-up for Holter –send
such patient to PCP first who will in turn will make an appointment with cardiology).
There is a schedule (time/day) of all the clinics with their telephone numbers posted
in the ED.
Follow up- Culture






Follow up- Culture
The cultures for that day will print out at approximately 4 am on the computer
printer
Please do not throw this away
The 7am attending will assign someone to look up these culture reports.
All patients with positive cultures should be called back whether they are being
treated appropriately or not. Whether there is a change in management based on
the culture results- a record should be made that the patient was contacted- or an
attempt to contact them was made.
Under the patient name please click on "documentation/notes" under the visit
number that the culture was taken. Click on Recall Note and then the reason
for the recall (Micro result). Click either in person or telephone- put down the
person's name that you spoke with and it will go to "word" where you can put
26






down further documentation like: antibiotics prescribed, the pharmacy where you
called, or parent will pick up rx etc. If contact was made and the issue is resolved,
mark as "resolved".
If the phone numbers are not working- a telegram must be sent. If 2 attempts
have been made to call the family and they have been unsuccessful, a telegram
must be sent. If it is warranted that another attempt be made, after describing
your attempt in the Recall note, mark it “needs follow up tomorrow”, and it will
re-appear on the next day's culture list.
If you need a telegram sent- please ask the clerk to provide the telegram form, and
send it for you. Document in the Recall note that the telegram is sent, and the
issue can then be marked as “resolved”.
Please place the completed printout sheet in the culture notebook.
To make the above process as painless as possible, when seeing a patient and
sending any culture off:
You should confirm the phone number in the chart/computer is the correct one or
enter it in the discharge note so it can be pulled up again in case the number in the
registration is incorrect.
If you send off PCR studies for Chlamydia or Gonorrhea in the ED and then treat
the patient with oral antibiotics and a “shot”, you must document that the patient
was treated in the ED. This will allow the follow up of the positive culture to be
aware of what happened in the ED.
Helpful hints






There is NO “SIGNING OUT AGAINST MEDICAL ADVICE” in Ped ED. Be
advocate for a child and always try to resolve the differences of opinion with parents
in such a way that a child’s health does not suffer.
Parents are not allowed to leave children of any age alone. We will try to relieve
them, if possible.
The computer generates all lab slips. Each specimen must be labeled and placed in
individual bags. Almost all specimens can be sent to the lab via the pneumatic
system.
Procedure notes must be written for each procedure done. Always obtain consent
prior to performing procedures (e.g. Procedural sedation). Always document Time
Out when indicated.
Residents or attendings performing the procedure are expected to discard the used
items after the procedure.
Please notify the attending/fellow/ nurse about any equipment failure that needs to be
addressed.
27
IMPORTANT PEDIATRIC PHONE NUMBERS
Pediatric ED
3638/3860/3866
Page Operator
3142/43
Admitting
4326/4488 (after midnight)
PICU
7028/7029
D6 South
7033/7034
D6 North
7023/7024
NICU
7020/7016/7048
Social work
3661/62/63
Peds ED
3636/3638
Peds Chief
917-760-0089
Peds admitting pager
917-760-1301
28
Pediatric Core Faculty
1. Dr. Konstantinos Gus Agoritsas; Director Ped ED, Program Director, Peds ED;
pager (917) 395-4036, Cell 917-923-6600
2. Dr Jennifer Chao, Associate Program Director, Peds ED
3. Dr. Rachel George; Assistant Professor; pager (917) 879-7903
4. Dr. Ambreen Khan; Assistant Professor; pager (917) 761-1286
5. Dr. Michael Falk
6. Dr June Lee
7. Dr Anjali Singh
8. Dr. Noordin Tejani; Director ACRC, SUNY Downstate Medical Center; cell (917)
923-6600
29
UHB EMERGENCY SERVICES
Introduction
The purpose of this orientation manual is to orient you to the UHB Emergency Services
and to help you prepare for your rotation through our department. It is assumed that by
this time you have received your clinical shift schedule and spoken with/met with Dr.
Kifaieh or Dr. Flood to prepare for the rotation. You will receive a tour of the facility
highlighting the physical plant and a description of the available resources and supplies
(including airway medications and supplies, resuscitation carts, etc.). In addition, you are
expected to be familiar with the UHBES Policy and Procedure Manual, a copy of which
can be found on the unit or in the Medical Director’s office.
The University Hospital of Brooklyn
UHB is a 400-bed tertiary care hospital located in the Flatbush section of Brooklyn, New
York. The hospital is affiliated with SUNY--Downstate Medical School, with a
graduating medical school class of 200 physicians/year. The hospital’s capabilities
include all surgical sub-specialties, dialysis, cardiac catheterization, OB/GYN, NICU,
and transplant surgery.
Description of Unit
UHBES is a comprehensive Emergency Department . Our physical plant has expanded
to a 9,000 square-foot unit with dedicated pediatric, adult and fast track areas. The
annual census of the department is approximately 65,000 patients generating greater than
13,000 admissions to the inpatient wards. The unit is a FDNY EMS-designated 911
receiving center and is able to accept both BLS and ACLS ambulances from both the
FDNY and private ambulance companies.
Roles and Responsibilities of Resident Physicians
The role of the Resident Physician in the ED is to provide excellent, timely and courteous
medical care to our patients. In return, the resident can expect to experience fast-paced
Emergency Medicine with a focus on quality medical care. The resident will encounter a
“community-type” setting amidst a tertiary care atmosphere. Residents are expected to
discuss all patient interactions with a faculty attending physician, and all medical
decision-making must be initiated in concert with the attending’s supervision.
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Patient Flow
All patients who present to UHBES will be triaged based on severity of illness and
receive an appropriate medical screening exam for their stated medical complaint. It is
the policy of UHBES that all patients are to be triaged within ten minutes of presentation.
Financial information may be obtained during the medical screening process but may not
impede the completion of the medical screening exam. All patients will receive a medical
screening exam to determine if an emergency medical condition exists. Patients who are
determined to have an emergency medical condition will be stabilized utilizing the full
resources of the institution irrespective of the patient’s ability to pay. After notification of
the inpatient service the attending physician may admit patients who require admission.
You must discuss all admissions with the faculty attending physician prior to initiating
the admission process. Patients who require services not provided at UHB will be
offered transfer to an appropriate facility.
Consults
Specialty consultations are available in all services offered by UHB. The consult policy
mandates that all emergency consultations be answered by phone within 10 minutes and
in person within 30 minutes. It is expected that the physician requesting the consult will
complete and sign the required green consultation form (UHB 44). Urgent consults may
be seen within 3 hours. If, as the resident physician, you are having difficulty contacting a
given service, you are to discuss this immediately with the ED faculty attending of record
for the case. Obstetric consultation for all stable pregnant patients will take place in the
Labor and Delivery unit (NS 33)—you do not need to inform the OB service prior to
sending stable pregnant patients upstairs. However, you must discuss the status of the
patient and the faculty attending must examine the patient prior to the patient leaving the
unit. The details of the consultation policy may be found in the UHBES Policy and
Procedure Manual. Patients may only be sent to outpatient suites [dental, ENT, GYN
(suite G)] for emergent consultations at the discretion of the attending physician, and only
if accompanied by qualified medical personnel. In addition, patients may not be sent for
follow-up care at outside institutions (i.e. KCHC, etc.).
Admitting Process
At the time it is determined that a patient requires admission to the hospital, you must
discuss the case with a faculty attending physician. EVERY admission needs to be
endorsed to the appropriate accepting service. The endorsement process starts with
electronic text paging via our “access admit log” which is on the desktop of most of out
PCs. You will be given a user name and password at the beginning of your rotation.
Upon inputting the name and diagnosis of the pt, an automatic page will be places to the
correct resident on call who will call back for a report. This will also created a permanent
record of the page. Patients without an attending physician at UHB are to be admitted to
the attending-on-call for the required service. Residents may act as proxy to accept
admissions but may not refuse admissions. All admissions must be discussed, either in
person or by phone, with the admitting attending of record or his/her proxy. No patient is
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to be admitted to any service without prior appropriate notification. Monthly call
schedules for all UHB services are to be found in the blue on-call book. The details of the
admissions policy may be found in the UHBES Policy and Procedure Manual. The
resident should document in the medical record with whom the case was discussed
(Private Attending, On-call house-staff, consults, etc). The Department of Medicine has
in place a hospitalist program to provide medical coverage for patients who are to be
admitted who do not have a personal physician.
Chest pain unit: Patients with mild to moderate probability for chest pain should be seen
by cariology and considered for chest pain observation admission. This is a process that
optimizes and expedites the work-up and disposition of those patients by the cardiology
service. Please refer to the admission criteria posted in the ED.
Progressive care unit: Patients with new onset CHF, exacerbation of CHF, new onset
a.fib…etc. should be seen by cardiology for evaluation and admission to PCU. Please
refer to the admission criteria posted in the ED.
Boarders
Patients who are admitted to the hospital but who do not have beds are to be cared for by
the admitting service. The transition to the in-patient team takes place at the time
admitting is called and the team notified, NOT at the time a bed is assigned. The
inpatient team is expected to write admitting orders and provide care. The ED attending
is expected to intervene if any emergency arises or the patient’s status changes. The
details of the boarder’s policy are in the UHBES Policy and Procedure Manual.
ICU Admissions
The respective unit must accept patients who require admission to either the MICU or
CCU. If a dispute arises about the ICU admission the discussion must be attending-toattending and all involved services must be part of the discussion. Currently there is an
intensivist in-house 24-hours daily. If the ICU cannot take the patient because of
operating above capacity, the ICU team may accept the patient as a boarder and care for
the patient in the ED. If the ICU will not care for the patient the director of the ICU, the
administrator on duty, and UHBES Medical Director are to be notified.
UHB Admitting Process
There are a number of inpatient admitting services at UHB that each have a process for
accepting ED admissions.
Family Practice:
The FP service cares for its clinic and private patients when they are admitted. For
patients that are followed in Suite B (resident and attending clinic) and Leffert’s Family
Health Services, call the FP resident on call. If necessary you can page the patient’s
attending as well but this is not always necessary. The FP service can be slow to accept
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admissions. When you have identified a pt of there’s that will likely require admission,
start the process early as they may want some consults before taking the patient on their
service.
Medicine:
The Internal Medicine department has three possible admission pathways:
1. Private patient-PA Service: There are five PA teams that cover a number of
private Downstate MD’s. The list is located above the computer in the physician
area of nursing station A. While you don’t need to memorize the teams, you need
to recognize the names of the private MDs that admit via the PA service. You
must speak with the physician as the PAs cannot accept an admission on behalf of
the attending. After discussing the patient with PMD and admission is agreed
upon, a brief call to the PA team is strongly recommended especially on ‘off
hours’ to endorse the patient but is not required.
2. Hospitalist service-Medicine admitting resident: Patients that do not have a
primary care MD with admitting privileges to UHB but require inpatient care are
cared for by the Hospitalist service. The UHB Hospitalist group admissions go
through the Medicine admitting Resident. There is a text page system ‘ERMED’,
which requires a userID/Password which alerts the admitting medical resident to
patients that require admission to the hospitalist service. The case is then endorsed
to the medical admitting resident who accepts the case on behalf of the attending.
3. Private patients-medicine resident: There are a few private MDs that do not use
the PA service. Dr Afflu and Dr John of Cardiology, Dr Demetis of Pulmonary,
for example have there inpatients cared for by the residents. These admissions go
through the same ERMED text paging service.
Subspecialty Services:
Cardiology has several inpatient services
1. Chest Pain Observation Unit: Has been open since 3/08 and accepts lowmoderate risk chest pain patients with a clearly defined exclusion and
inclusion criteria for a 23 hr observation stay on the fourth floor. In the
daytime, there is a single fellow, the CPU fellow that is responsible for
evaluating and accepting these patients. In the evening and overnight, the oncall cardiology Fellow is responsible for these evaluations
2. Progressive Care Unit: Inpatient cardiology service that can manage CHF
exacerbations, rapid afib, non-critical NSTEMIs, high risk chest pain patients,
etc. There is a fellow assigned to this service as well during the day and the
on-call cardiology fellow during off hours.
3. CCU: inpatient cardiac intensive care unit that has a cardiology fellow
assigned during the day and the on-call cardiology fellow on off hours.
Renal Service:
1. The renal service accepts admissions for patients that require inpatient care
who receive there dialysis at Parkside, the Downstate Ambulatory Dialysis
Center. These admissions go through the Renal Fellow who will endorse the
case to the MAR.
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Neurology:
1. There is a neurology inpatient service that accepts admissions for neurologic
diseases through the on-call neurology resident.
2. The Stroke Unit is the neurology step down service that accepts admissions
for Stroke patients and neurology patients that require monitoring.
Surgery:
General and all the surgical subspecialties require consultation prior to admission.
The surgical residents are supervised by the in-house Surgical Hospitalist
attending.
Orthopedics:
1. The orthopedic service can and should admit appropriate patients. There is an
agreement between the ED, Ortho, and Medicine departments regarding pts with
significant co-morbidities that will require orthopedic inpatient care. If the ortho
service is uncomfortable with a pt with uncontrolled medical issues, they can
request a Medicine consult. If it is determined by Medicine and the ED attending
that the patient is stable for ortho admission, they are admitted to Orthopedics. If
the patient has uncontrolled medical problems with a concurrent orthopedic
condition, they can be admitted to medicine with orthopedics as a consult service.
Transfer Agreements
Transfer agreements are in place and protocols approved for the following inter-facility
transfers once initial stabilization has been achieved:
Burn: Patients requiring burn unit admission are to be transferred to NY Hospital,
Cornell University or Staten Island University Hospital.
Hyperbarics: Patients requiring hyperbaric therapy are to be transferred to Jacobi
Hospital.
Trauma/Pediatric Psychiatry: Patients requiring admission to either of these services are
to be transferred to King’s County Hospital Center.
All transfers must be discussed with an accepting physician at the receiving institution,
and prior to transfer, all patients must have a transfer form (UHB #7-83) completed by
the Attending Physician, including reason for transfer and the name of the accepting
physician at the receiving institution. In addition, the UHB AOD is to be notified prior to
transfer.
Pediatrics
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Pediatric patients comprise approximately 30% of the UHBES patient census, and as
such will comprise a significant portion of your clinical duties. Our new facilities
provide a dedicated pediatric ED, including full-time pediatric triage, nursing and
physician and physician-extender coverage under the direction of Dr. Nooruddin Tejani,
Director of Pediatric Emergency Services. During periods when there is not a dedicated
pediatric attending or pediatric resident, you will be expected to care for pediatric
patients. Pediatric admissions (NS 42) are to be discussed with the pediatric resident oncall, who can be contacted by calling the pediatric unit. Any child who you feel requires
ICU or step-down monitoring must be discussed with the pediatric chief resident. A
large segment of our pediatric population is primarily cared for by Downstate Pediatric
Associates (718-998-5076) who request that they be notified of all patients affiliated with
their group who present to the ED for care. The pediatric ED also keeps a log of all
cultures that are taken on a daily basis. The residents will be expected to help follow up
the culture results and call back patients as needed.
UHB Administration
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John La Rosa, MD
Michael Lucchesi, MD
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Roger Holt, MD
Nooruuddin Tejani, MD
Nizar Kifaieh, MD
Russell Flood, MD
Judy Drummer, RN
Vikki Small
President, SUNY-Downstate Medical Center
Chairman, Emergency Medicine, Interim
Chief Medical Officer – SUNY Downstate
Director of Emergency Services
Director of Pediatric Emergency Services
Associate Medical Director
Assistant Medical Director
Assoc Director of Nursing, ED
Administrator
Ancillary Staff
Ancillary services in UHBES are provided by the EKG technicians and Healthcare
Assistants (HCA I and II). The EKG technicians’ responsibilities include phlebotomy
(but not intravenous access), performing EKG’s, patient transport and clerk relief. The
HCA’s responsibilities include patient transport, lab delivery, and patient care assistance.
As a Resident Physician, it is expected that your time here will be spent on direct patient
care, rather than ancillary duties. All IV access is to be obtained by either the RN or the
MD. Techs and HCA’s can NOT obtain IV access. In addition, there is a dedicated ED
phlebotomist in the ED from Noon-8p on weekdays (Ms. Lisa Dorce).
Information Systems
At present, UHBES employs several information technologies. We went live with an
electronic medical record (T-system) in September ’07. You are expected to complete
your training online via a link that will be emailed to you prior to starting your rotation.
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Please make sure you have all of your required passwords and training done PRIOR to
your rotation at UHB.
Please see Dr. Kifaieh or Dr. Flood if you have any questions about the use of this
system. The CERNER system is for lab entry and retrieval, and RIS for radiological
procedure entry and retrieval. Prior to your starting in the ED, you should obtain your IS
in-service. For RIS, see Mike Vaughn (x4613), and for CERNER see Dr. Kifaieh. It is
absolutely imperative that you NOT share your log-in or passwords with your fellow
residents, as this is a serious breech of hospital and departmental policy. If you need to
renew or reset your password, please see Dr. Kifaieh or Dr. Flood.
Nursing
The UHBES nursing staff is composed of one charge nurse, two triage nurses and at least
eight RN’s per tour. UHBES nurses are all BLS/ACLS/PALS certified, and as such are
qualified to provide care for Emergency Department patients. Intravenous access is to be
obtained by the nurse assigned to that patient. Please be diligent in actively involving the
nursing staff in your on-going management decisions regarding patient care. Many of the
newly-hired staff are young and eager to learn, but may need guidance in Emergency
Medicine patient management.
Radiology Services
The Department of Radiology has made a commitment to our department to provide
efficient, full-service radiology services. “Wet readings” of films may be obtained by
paging the radiology resident on call during off hours or calling the radiology department
during the day. We currently have an “ED radiologist present in the reading room by CT.
This radiologist is physically present for reads between the hours of 8am-5pm MondayFriday. The number to reach him is posted on the board in the clinical areas.
All plain films are to be reviewed by yourself and the attending physician of record on
the PACS system, located in the ED. The radiology department is in the process of
transitioning to a 24-hour unit and there may be times on off-hour tours that a technician
may need to be called in to perform certain studies. Recently, the nuclear medicine
division has pledged 24-hour coverage for emergent nuclear studies (V/Q, HIDA, etc).
The senior radiology resident on call should be contacted to discuss all off-hour specialty
studies, and the page operator should be utilized to page the technician. If there is
difficulty contacting the technician, the AOD is to be notified and the radiology
administrator is to be paged. Any persistent difficulties in obtaining studies should be
referred to the attending radiologist on-call. All radiological studies are available 24
hours a day, 7 days a week, 365 days a year.
Laboratory Services
Lab studies are available 24-hours daily. It is your responsibility to discuss all lab test
results with the faculty attending of record prior to disposition of the patient. Whole
blood analysis for blood gases, chemistries, metHb and COHb are presently available on
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a STAT basis (turnaround time in minutes) 24 hours daily. In addition, BNP is available
(must be sent in a separate lavender tube).
Physician Documentation
All patients who present to UHBES are required to register and undergo triage, at which
time a chart will be generated. Currently, we utilize the electronic T-system charting
tool. It is expected that you will complete the patient chart, providing all pertinent
historical, physical, and laboratory/radiological/EKG interpretive information—both
positive and negative—prior to patient disposition. All patients must be discussed with a
faculty attending physician. It is your responsibility to note on the chart which attending
was involved in your supervision of the care of this patient (i.e. “d/w Dr. Smith, etc). If a
patient is to be discharged, all patients must have specific discharge instructions (“exitwriter”), including time and place, return instructions, and any medication/care
instructions. All charts must be locked by the end of your shift or no later than 24 hours
after seeing the patient.
CPOE: computertized physician order entry. We currently input our orders for
medications, labs, and any ancillary tasks electronically in T-system. Radiologic studies,
however, will need to be put in a separate system called Fox.
Follow-up Appointments
UHB utilizes the EAGLE system for clinic/outpatient appointment scheduling. Any
patient who does not have a PCP or any patient for whom you feel a follow-up
appointment is necessary should be given a specific outpatient appointment scheduled in
the EAGLE system prior to discharge from the ED. All clerks have been in-serviced on
this system and are capable of making appointments for all clinics currently on the
EAGLE system. The only clinics not using the EAGLE system are General Surgery,
Urology, and Orthopedics. These patients are to be given a specific appointment
scheduled by the consultant service prior to patient discharge. Several of the outlying
satellite clinics (Suite B, Midwood and Throop) are actively recruiting patients for their
services, and have very short (one or two day) lag times. In addition, Dr. Zenilman,
Chairman of Surgery, asks that any patient requiring a surgical follow-up appointment be
given his phone number (x1421) so that the patient may schedule an appointment through
his office.
Protocols
Code H: We have a STEMI pathway (called “code H”) that is to be initiated
IMMEDIATELY upon presentation of any patient with a STEMI. Initiation of the
cascade is to be signaled upon notification by FDNY EMS that a patient is en route with
a suspected STEMI. The pathway is posted in the ED (outside the resus room). Please
make sure that the attending is involved immediately in any STEMI case.
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Code S: This is the pathway for stroke patients. Initiation of the cascade is to be signaled
upon notification by FDNY EMS that a patient is en route with a suspected CVA within
the 3 hours window.
For both situations, please DO NOT call the operator yourself. Please ask one of our
clerical staff as they are required to complete a log book with the sequence of events and
the times they occur.
Scheduling
ALL SCHEDULE REQUESTS ARE DUE AT LEAST FOUR (4) WEEKS PRIOR
TO YOUR STARTING DATE. This is to ensure timely completion of your schedule
and maximum clinical benefit from your rotation. All schedule requests should be
emailed to [email protected]. No written or verbal requests will be honored. You
will be assigned a number of clinical shifts (usually ten hours in length, 8 hours for
overnight) in accordance with your clinical requirements as dictated by the Department of
Emergency Medicine. (Please note any religious commitments well in advance when
making your schedule requests).
Of course, you are expected to be on time and to stay in the clinical area at all times.
You must stay in the clinical area until your relief has arrived to ensure appropriate
patient “sign-out”. The Director or Assistant Director of UHBES must approve all
scheduling changes and “covered shifts” in advance. In addition, in the case of a
personal emergency or illness, you MUST contact Dr. Holt or Dr. Kifaieh, as soon as you
know you will not be able to attend your shift. You must also contact Ms. Stephanie
Lane, the Chief Resident on-call and the Residency Director, Dr. Doty. All missed shifts
will be made up.
Dress Code
As a representative of UHBES, it is expected that you will dress professionally in the
clinical area. As such, “scrubs” are not permitted during daytime shifts (but are permitted
on overnights).
PMD Notification
UHBES is committed to fostering a close, professional, and efficient relationship with the
primary care physicians in our community. In an effort to enhance this partnership, you
are asked to be diligent in your effort to discuss your care and disposition plans of all
patients with known PMD’s who present to the ED. This includes both admissions and
discharges. Please document on the medical record the name and time of the attending
with whom you discussed the case. Please pay particular attention to the patients who are
followed by the Family Practice service. They do have an inpatient service at UHB, and
are almost always willing to accept admissions for their patients. The FP outpatient
service is located in Suite B.
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Ground Floor Response
In accordance with the EMTALA regulations, UHBES has accepted the responsibility to
respond to all calls for assistance originating from the basement, ground floor of the
hospital/medical school, and within a 250-yard perimeter of hospital/medical school
grounds. The attending physician is expected to provide medical coverage for these calls
in conjunction with the “code team” response unit. This policy is outlined in the UHBES
Policy and Procedure Manual. You may be asked to accompany the attending physician
on one of these calls during your rotation.
Resources
UHBES is dedicated to providing the resident physician with the most up-to-date,
clinically relevant Emergency Medicine resources available. To that end, internet access
is available in the clinical area to allow you to research current guidelines in diagnostics
and therapeutics.
Summary
In summary, we welcome you to our rapidly expanding ED and look forward to working
with you to develop your clinical skills and to facilitate patient care in our ED. We feel
that our facility will provide you a unique Emergency Medicine experience, combining a
community atmosphere with a tertiary care setting. Please remember that we are very
open to suggestions on ways to improve our rotation—we want to work with you. Your
feedback is very important to the success of your rotation, especially if you discuss your
concerns in real-time--please do not wait until the end of your rotation to voice a concern
or raise a suggestion. Again, welcome to UHBES.
Useful Phone Numbers
Roger Holt, MD
Bpr: (917) 760-1994
Email: [email protected]
Nizar Kifaieh, MD
Bpr: (917) 761-1287
Email: [email protected]
Nooruddin Tejani, MD
Bpr: (917) 760-0800
Email: [email protected]
Russell Flood, MD
Bpr: 917 219-6411
Email: [email protected]
UHB Chief Resident
Email: [email protected]
Aquila Lewis
(718) 270-4442
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Page Operator
Xt-2121
UHBES IMPORTANT NUMBERS
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CATH LAB x4282, x4278
Chest pain unit (NS 41) x8716
Vascular ultrasound (daytime, weekdays, 5th fl.) x2515. Send pt with green
consult sheet.
o Off-hrs (Mon-Fri till 9p) call x2515 leave message or page tech Diana
Palterman 917-219-4749
GYN ultrasound (weekdays 9-4) speak with Dr. David Sherer, Director of MFM
at x3901 or page at 917-761-1039. Please be sure to speak with Dr. Sherer prior
to sending patient upstairs.
ON CALL SCHEDULES are located in the BLUE ON-CALL BOOK
MICU consults x2701 to speak with resident/fellow/attending
Neurosurgery: Mon-Fri 8a-5p (PA on-call) 917-760-1374. Other times contact
attending directly.
General Surgery follow up appointments:
o Zenilman x1421 (Marisa)
o Schwartzman x1791 (Lana)
o Breast Health Partnership 718-270-8846
Urology appointments
o Adult x2554, x1406, x2429, x4448, Dr. Macchia—Chair x3237 or 917760-1075 any problems
o Peds x1958
Dental clinic Dr. Susan Pugliese. x1884 (dental clinic, behind Suite H); (bpr)
888-341-6219
OMFS Dr. John McIntyre cell (preferred) 718-809-7712, beeper 917-219-8164
Hospitalist’s Office x7303
GI clinic appointments 718-282-7234
PA service Office x2549, x2999
Radiology reading rooms: Dr. Shwarzberg office x1603, Radiology resident
on-call beeper 917-760-1124
Room
MD and/ or Service
Telephone
B2-324
Neuro, Dr Nath
7212
Body CT, Dr. H. Zinn
7209
Chest, Dr Waite
5061
Body, Dr. Choi
Resident Stations
7211, 5081
A2-610
Body CT, Dr. H. Zinn
4134
Neuro, Dr. Nath
4645
A2-605
Sono
(6730)
Peds, Dr. Amodio
(6730)
Mammography, Dr. Corsaro
4273
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Resident Station (on Wall) 4133
A2-621
Nuclear, Dr. Strashun
1902
Blood Bank for all EMERGENT blood products x4630. In addition, page the
on-call blood bank resident. Attending: Dr. Gloster 917-760-1428; Supervisor:
Irene Swiderski 917-218-2407
ED Psychiatry on call (24/7) 917-218-1353
o DMHA (outpatient psych) 287-4806
Staten Island University Hospital Burn Unit (718) 226-1506; appt desk (718)
226-6988
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AFFILIATE ROTATIONS – CONTACT NUMBERS
Each non-KCH ED and Off-service rotation will have a designated contact person to
coordinate resident activities on the rotation. The following is a list of important
telephone numbers for residents on non-KCH ED rotations. The person with the asterisk
(*) by their name is the contact person for the clinical schedule.
Staten Island University
Hospital
Jennifer Cohen- Coordinator
Dr. Dara Kass-Site Director
(718) 226-8556/9158
Fax- 226-6964
[email protected]
C-917-817-0078
H- 347-689-9073
Brookdale EM
EMS
VA Medical Center
New York Poison
Control (NYCPCC)
UHB
Dr. Lewis Marshall - Chairman
(718) 240-6899 or
pager :(917) 433-8018
[email protected]
Dr. Glenn Valladares* Site Program
Director – (Scheduling)
(718) 240-5499 – or
pager (917) 433-8624
[email protected]
fax 718-240-6655
Yvonne Henry (GME)
Olethea Wernersbach
Dr. Bradley Kaufman, Director EMS
Educ.
Dr. Antonio Saliba
(718) 240-6146
(718) 281-8463
[email protected]
Dr. Lewis Nelson
Dr. Roger Holt
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[email protected]
718-630-3606/3607
(212) 447-8150
[email protected]
(718) 270-4442 or 245-4790
Pager 917-760-1994
[email protected]
THE BROOKDALE HOSPITAL ED
Meeting Place: Brookdale ED
One Brookdale Plaza
Brooklyn, NY 11212
Daily Rounds: 7am and 7pm daily
Shifts: The Brookdale ED shifts should be the same in number and length as at KCH.
Introduction:
The Brookdale Hospital Medical Center is a 595 bed urban teaching institution and a
fully integrated site for the Emergency Medicine Residency Program at SUNY
Brooklyn. The Emergency Department is a designated Level I Trauma Center with
approximately 104,000 visits per year.
Working in the Emergency Department at Brookdale Hospital is both challenging and
rewarding. The atmosphere is highly charged and the spectrum of illness and pathology is
staggering. Although a private hospital, the Emergency Department experiences are
similar in volume and congestion to typical other public, inner city hospital. The
Brookdale Hospital Medical Center serves a minority and immigrant population from the
Brownsville and East New York sections of Brooklyn.
The Emergency Department
The Emergency Department underwent renovations. The new 36-bed treatment center
contains a critical care area, a trauma room, a Pediatric Emergency Department, and a
fast track area. The Emergency Department also has a its own radiology suite. Our
emergency radiology area is a state of the art digital installation with a dedicated staff of
radiology technicians and a CT technician. The Department of Diagnostic Radiology
provides 24-hour Attending Coverage, either in-house or through Teleradiology (NightHawk).
The Fast Track facility and the Pediatric Emergency Department are staffed by a
physician as well as a physician extender (typically a physician assistant). The Pediatric
Emergency Department is staffed by either an Emergency Medicine Attending Physician,
or a Pediatric Emergency Medicine Attending Physician. The Fast Track area sees over
33,000 visits per year of which nearly 15,000 are minor trauma related. Minor trauma
entities seen in the Fast Track area include: Abrasions, bites, burns, contusions, fractures,
dislocations, Lacerations, sprains, and foreign bodies. The main Emergency Department
functions as Three separate teams, each with a Physician Assistant or Resident and an
Attending Physician, and two to three nurses.
Team A is responsible for all critically ill patients as well as victims of trauma.
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Team B covers all Medical/ Surgical patients within a defined geographical area of the
Emergency Department as well as patients with obstetric/gynecological complaints.
Team C is responsible for patients within a defined geographical area of the main
Emergency Department, as well as for patients whose main complaint is asthma.
Each resident will have the opportunity to rotate through all areas of the Emergency
Department. There is no required rotation to the Pediatric Emergency Department.
Teaching Curriculum
Attendance is mandatory for all the following conferences at Brookdale Hospital.
 Morbidity and Mortality Conference: Monthly
 Trauma Conference: Monthly
 Tuesday / Thursday morning lecture: Weekly
 There will also be short morning report conferences to be held three to four times per
week in the Emergency Department
Resident Responsibilities
Scheduled shifts are 12 hours long starting at either 7:00 am or
7:00 pm . All residents are expected to be punctual and
professionally dressed ( minimum matching scrubs)
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Prior to the start of the rotation, each resident will be contacted for schedule requests,
orientation and conference schedules.
If you cannot report for an Emergency Department shift, the Site Director Dr.
Valladares, as well as Ms. Stephanie Lane, and the EM Chief Resident on call
must be notified.
All conferences are mandatory with the exception of a reported illness or unless
otherwise granted by the Site Director Dr. Valladares. Morning report attendance is
mandatory only for those residents who are presenting for or departing from an
Emergency Department shift.
If there are any questions or problems involving any rotation at the Brookdale
Hospital Medical Center, it is imperative that the Site Director Dr. Valladares at
Brookdale Hospital be contacted.
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BROOKDALE ED FACULTY
Glenn Valladares, MD, MBA, FACEP (Site Residency Director)
Pierre Dodard, MD
Collie Oudkerk, MD
Omiel Powell, MD
Philip Puthumana, MD
Walter Raza, MD
Emmeline Kwon, MD
Arlene McTeer, MD
Allen Cherson, DO (Assistant director)
Lewis Marshall, MD, JD (Chairman)
Phil McPherson, MD
Leoncio Dilone, MD
Walter Raza, MD, FACEP
Danielle Gilman, MD, FACEP
Kathy Garner, MD, FACEP
Emmanuel SaintJean, MD, FACEP
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Staten Island University Hospital
Orientation Packet
2010-2011
I. Introduction
Welcome to the Staten Island University Hospital Emergency Department. At
over 75,000 patient visits per year, and the only Level I Trauma Center on Staten Island,
it is the busiest ED in the borough. It is also a cardiac catheterization, regional stroke and
burn center. The patient volume and high acuity will serve as a great clinical experience
for your training. At the same time, because it is a community hospital, it will serve as a
valuable opportunity to learn Emergency Medicine in a small community setting.
Our Emergency Department (ED) is subdivided into:
1. Critical Care/ Trauma
2. ED 1
3. ED 2- which is comprised of:
a. Urgent Care
b. Pediatrics- All patients under 20
The Nursing Care Coordinator (NCC or “charge nurse”) supervises all patient
flow within the ED. He or she manages the tracking board, determines patient location
and also assigns the nurse to care for the patient. One standout quality of our ED is our
nursing staff. They are extremely dedicated and hard working and have often seen the
patient prior to any physician or mid-level provider (MLP). Often, after their initial
assessment, the nurse caring for the patient will feel that the patient is more acute than
previously thought and will approach a physician or PA to see that patient. In this case,
you should physically go and see that patient if possible. Our nurses are a valuable
resource with years of experience, and their opinions are often extremely accurate and
astute.
Critical Care/ Trauma
Our new ED has an area designated for the most acutely ill patients. The Critical
Care/ Trauma area has 12 individualized patient rooms with the capacity to hold up to 24
patients. Residents assigned this area will be primarily responsible for ambulance
evaluation, initial diagnostic and therapeutic intervention, patient follow through and
disposition. In this area the resident will have the opportunity to work closely with an
attending following through on our sickest patients. Reading should be focused on
interesting cases that you see.
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ED 1
The ED 1 area is where we see most of our patients. Patients seen in this area
may be having (for example) an active MI, acute cholecystitis or diabetic cellulitis. In this
area you will receive a good degree of independence, approaching the undifferentiated
patient first, then formulating your own patient care plan and disposition. Reading
should be focused on interesting cases that you see. Pick one topic each day to review
based upon something you saw during your shift. We promise you will see something
worth reading about!
ED 2
The ED2 area is subdivided in to UCC and Pediatrics. For patient flow purposes
the areas are to be combined, seeing the most acute patient first, but then seeing all
patients in time order regardless of complaint. The combination of both areas affords our
patients and our doctors the opportunity to utilize all available resources for each area, as
it is required. Under this model residents get to see a wide variety of cases during each
shift.
UCC
The Urgent Care area is open 24 hours a day. The urgent care area offers an
excellent opportunity to manage minor trauma, small surgical procedures (laceration
repair, I and D), orthopedics, ophthalmology, ENT and OB-GYN. You will be given a
great deal of independence in this area and the majority of your cases will be managed to
completion. In this area you will work along side other residents and physician assistants.
You will also be able to assess your ability to see a higher volume of lower acuity
patients.
Pediatric ED
The pediatric E.D. has an annual census of approximately 15,000. It is open 24
hours a day, 7 days a week and serves all patients less than 20 years of age, regardless of
complaint.
II. Roles and Responsibilities of the Resident Physician
PGY-2
At this point in their training, the second year resident should feel comfortable
evaluating any patient who presents to the E.D. To this end, we would like to focus on the
resident’s organizational ability. (PBL, MK, C) He or she should be able to manage at
least 3-4 patients simultaneously. The resident will work closely with the attending to
assess, manage, admit or discharge the patient. An appropriately credentialed senior
resident or faculty member should directly supervise all procedures performed by the
resident. All charts will be co-signed by a faculty member.
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Although primarily assigned to ED1, if there is a need, the resident may be shifted
to ED2 for a short period of time. This will be utilized to facilitate speedy and appropriate
patient care in times of unusual demand.
PGY-3
At this point in training the resident should feel comfortable seeing patients
independently. Furthermore, the resident should start to demonstrate increased
competence in managing critically ill patients. To this end, the PGY-3 resident will spend
the majority of his/ her rotation, managing patients that require a monitored setting.
(MK) The resident will be asked to run codes and resuscitations while under the
supervision of the faculty attending physician.
The third year resident will have the ability to make admission, transfer and
discharge decisions after discussing the case with a faculty attending physician. (MK, C,
P, SBP) All charts must be co-signed by a faculty member.
If primarily assigned to ED1, the resident may be shifted to ED2 for a short period
of time. This will be utilized to facilitate speedy and appropriate patient care in times of
unusual demand. The converse is true if primarily assigned to ED2.
In ED2 the PGY-3 resident will function as a senior resident: directing
resuscitations, performing all procedures, and taking presentations from medical / PA
students all under the direct supervision of the attending.
PGY-4
In the last year of training the resident must be able to demonstrate progressive
responsibility for the overall clinical and operational management of the E.D. In essence,
the PGY-4 should be ready to assume an attending-like position. With the guidance of the
faculty attending physician, the senior resident will help manage patient flow (SBP, PBL,
C, P, MK, PC), train and assist junior residents (MK, C, P, PC), run codes and
resuscitations, and see patients independently (MK, PBL, P, PC). Senior residents will
be able to independently admit, transfer or discharge patients after informing the
attending physician. All charts must still be co-signed by a faculty member.
Although primarily assigned to ED1, if there is a need, the resident may be shifted
to ED2 for a short period of time. This will be utilized to facilitate speedy and appropriate
patient care in times of unusual demand.
In addition to the above responsibilities, all residents from Kings County Hospital
will serve as senior residents to the incoming Staten Island University Hospital interns. It
is expected that all KCH residents will act professionally and appropriately when
supervising an SIUH intern.
Resident Dress Code
EM residents are reminded that professional, appropriate attire is expected when
working clinically at SIUH. Blue jeans, T shirts, sweatpants, and other inappropriate and
unprofessional attire are never acceptable. A white lab coat and an identification badge
are required at all times. For all shifts during the week men are expected to wear a tie.
For all shifts on the weekends or overnight, residents are permitted to wear scrubs
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(matching tops and bottoms) and/ or sneakers. Neatness, cleanliness, and modesty are
appropriate when representing the department. Failure to comply with this standard will
result in the resident being sent home with the expectation that the shift will be made up
at a later date. This mandatory make up shift will be scheduled at the discretion of Dr.
Kass and the KCH residency directors.
Sign Outs
If you are leaving the E.D. for any reason, including the end of your shift, all
patients assigned to you must be signed out. The attending that has reviewed the
patient with you should be aware that you are leaving.
III. Consults
Specialty consultations are available in all services, 24 hours a day. The clerks
maintain a log of all on call physicians. If you need to reach a consultant, simply write it
on an orders sheet and the clerk will page the physician for you. If you are having
difficulty contacting a given service, you are to discuss this immediately with the faculty
attending of record for the case. (P, C)
IV. Admitting process
At the time it is determined that a patient requires general admission to the
hospital you must discuss the case with the faculty attending. You should then contact the
patient’s private physician. If the patient does not have a private physician, or if their
physician does not admit to the hospital, the patient should be admitted to the hospitalist
service. Then, you should sign the patient out to the Medical Admitting Resident (MAR),
who accepts all floor and telemetry admissions. He/ she can be reached directly by
calling 9182. All admissions to the ICU, CCU, telemetry, or specialty services must first
be discussed with the appropriate contact person. (P, C). Record the name of each person
you spoke to, and the time at which you spoke to them, and then hand the chart to the
clerk to admit the patient.
V. Radiology Services
The Department of Radiology provides efficient, full-service radiology services.
There is an emergency x-ray department is located within the ED1. CT Scans are
performed in an area adjacent to the E.D. An ultrasound technician is available 24 hours a
day. Readings of all films by an attending radiologist or radiology resident are done 24
hours a day. We also have our own ultrasound machine within the department, and
resident are encouraged to utilize it whenever possible.
VI. Physician Documentation
It is expected that you will complete the patient chart, documenting all pertinent
historical, physical, and laboratory information prior to patient disposition. Both the
resident and attending physician must sign and stamp all charts. In addition, all patients
must also have the following information noted on the chart: time/date seen by M.D.,
disposition (including time/date), and final diagnosis. If a patient is to be discharged, all
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patients must have specific discharge instructions, including time and place of follow up
appointments, return instructions, and any medication/care instructions. (P, SBP)
VII. Follow-up Appointments
We provide the patient with the contact information of the physician they will be
following up with. This may include their private physician, an on call specialist, or a
preferred provider. Any information not in Exit Care is available from our clerical staff.
VIII. Clinical Schedule
Dr. Bauer is responsible for making and distributing the SIUH ED schedule. The
schedule for all residents is made at one time, and often in 12-week segments. Therefore,
you may be asked to submit requests between 1 and 3 months prior to the beginning of
your rotation. Please let Dr. Bauer know as soon as possible if you have any specific
needs or requests. Requests are not guaranteed, but every effort will be made to
honor them.
The PGY 2 resident rotates for 4 weeks in T/CC and ED 1, working 17 shifts
including 2 full weekends.
The PGY3 resident rotates for 4 weeks in ED 2, working 15 shifts including 2
weekends.
The PGY 4 resident rotates for 4 weeks in T/CC and ED 1, working 14 shifts
including 2 weekends.
Residents will be scheduled a combination of 7am, 11am and 7pm shifts, as
deemed necessary by Dr. Bauer.
IX. Sick Call Procedure
If you are going to be unable to make a shift, for whatever reason, please follow
the guidelines that have been set up by the directors of your program. In addition, please
contact Jennifer Cohen and the lead physician in the clinical area. It is expected that a
resident who must call out sick will do so in a timely manner in order for our staff to
provide adequate coverage in the clinical area. An email or voicemail are unacceptable
forms of communication when calling out sick.
X. Directions & Parking
Traveling by car take the BQE (278) westbound toward the Verrazano-Narrows
Bridge. Go over the bridge taking the lower level. Get off the second exit, Lily Pond
Avenue. Circle around the exit and go straight for 6 lights. Along the way, Lily Pond
turns into Father Capodano Boulevard. At the 6th light, make a left turn onto Seaview
Avenue. The hospital is approximately ¼ mile down on the right hand side. Turn right
into visitor parking. On your first day park in visitor parking you will be given an ID card
that will allow you to park for free.
If you are taking the ferry, take either the 1/9 to South Ferry or the 4/5 to Bowling
Green and get on the ferry. Be advised that in the morning, the ferry runs on the half
hour. After getting off the ferry, there is a sign to take the train (don’t worry it only goes
in one direction). Take the train to the Dongan Hills stop. Exit the train go down stairs
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onto Seaview Avenue. You will go underneath an overpass. Cross over Hyland
Boulevard and walk another 2 blocks. The hospital will be on your right.
The express bus also runs between Staten Island, Brooklyn and Manhattan.
Review http://www.mta.info/nyct/bus/index.html for any pertinent bus information.
Additionally, we can make attempts to share rides with other residents, PA’s and
attending physicians if Dr. Kass is notified in a timely fashion.
Bridge tolls are reimbursed by the Residency. Contact Stephanie Lane for further
information.
XI. Contact Numbers/Email
Jennifer Cohen
718 226 1548
[email protected]
Dr. Bauer
[email protected]
Dr. Kass
718-226-1152 (office)
917-817- 0078 (mobile)
[email protected]
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VAMC – NYHHCS (Brooklyn Campus)
Emergency Department
VHA is the largest integrated healthcare delivery system in the nation. On an annual
basis, VHA provides medical care services on a national basis to over six million unique
veterans at over 150 hospitals, 800 outpatient clinics, and 120 nursing homes. VHA
mission is to ensure that the health care needs of these veterans are met by providing
them with primary care, specialized care including emergency care, and related medical
and social support services.
The VA Hospital at Fort Hamilton, Brooklyn, New York serves as a University Hospital
for SUNY Downstate University. The veterans are one of the most special communities
in the US, deserving the best emergency care .
VA Brooklyn, is located in Fort Hamilton Park at the base of the Verrazano Bridge., with
one of the most spectaculars views over the bridge and the New York Bay. Conveniently
located to the belt parkway, subway lines and constant shuttle buses from 23rd street and
second avenue in Manhattan.
Statistics
65-85 patients’ daily visits; 22,000 annual visits
12-16 acute care patient admissions daily
Low-intermediate acuity patients. 2-3 daily admissions to critical care.
Resident’s admissions Teams from Medicine, Surgery, Podiatry
VA Medical Center is a tertiary care medical facility caring for eligible veterans. The
Emergency Department sees over 23,000 patient visits. For the past 50 years, the
Brooklyn Campus, a part of the New York Harbor Healthcare System, has provided state
of the art cardiac, intensive care, medical and surgical services as well as a broad range of
both medical and surgical subspecialties. The new expanded ED is fully operational
since January 2006.
Contact Information:
Antonio J. Saliba MD, FACEP, MPH
Chief Emergency Department
Brooklyn VA Campus
O (718) 630-3607
F (718) 630-2821
C (347) 831-5346
Getting to VAMC
We are located at 800 Poly Place. If you are driving, take the BQE (278 East), and get off
at the last exit before the Verrazano Bridge (92nd Street). At the light, make a left onto
92nd street. Go straight (2 lights), until you hit the end of the street (7th avenue). Victory
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Memorial Hospital will be on your left and Poly Prep Academy will be on your right.
Make a right onto 7th avenue, and take it straight to Poly place. Make a left onto Poly
place. The Hospital entry/parking lot will be on your right. You must show a photo ID
to enter the hospital property. The Emergency Department is located on the ground floor.
From Long Island & Queens:
Take the Belt Parkway to Bay 8th Street/14th Avenue exit. Make a left at the first light
onto Cropsey Avenue. Make a left at the second light onto 14th Avenue. Follow 14th
Avenue as it curves and turns into Poly Place. Make left at the next light into the parking
lot.
From Staten Island:
On the Verrazano Bridge, stay in the right lane and exit at 92nd Street. Make a right at
the first traffic light onto 92nd Street and drive to 7th Avenue. Make a right onto 7th
Avenue and continue around the golf course to the Medical Center on your right. Make a
right into the parking lot entrance at the next light.
Public Transportation;
By Subway: From Manhattan or Coney Island, take the "N" train to 8th Avenue, then
take the #70 bus to the Medical Center.
Computer Access, ID, Human Resources processing, and Pharmacy Privileges
The above must be completed one to two weeks prior to your start date. Please
contact our office directly, Ms. Mary Lucas (ED assistant manager) at (718) 630-3606 for
scheduling a date for processing. Processing Packets are available at SUNY, through
Stephanie Lane, however, a package can be sent directly to your home address if
necessary by requesting one from Ms. Lucas.
Scheduling
Working in the ED scheduling is unique, flexible and under the supervision of a board
Certified Emergency Physician. Shifts are either 10 or 12 hours long. Residents are
expected to attend the weekly seminars at Kings County Hospital.
Special schedule requests can be make through Ms. Mary Lucas (ED Assistant
manager) at (718) 630-3606. These must be made two months prior to your start date.
Clinical Orientation
It will be the day of your first shift in the ER (the first Monday of the new block). It will
include a tour of the facility, introduction to staff, an overview of the computer system,
and a brief discussion on what’s expected.
Evaluation and Feedback
You will be evaluated based on 6 core competencies: medical knowledge, patient care,
professionalism, communication and interpersonal skills, system-based practice (knowing
the big picture), and practice-based learning (eagerness to learn new information and gain
new clinical experiences).
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We encourage you to voice your opinion regarding the quality of your rotation at the
VAMC. Please feel free to contact any of the faculty listed above for any problems or
suggestions. In addition, you will be required to evaluate each of the teaching faculty
members that you work with at the end of the rotation.
Educational Objectives:
PGY-1 Emergency Medicine Residents will rotate for a four-week block on the in-patient
Medical Services at the Brooklyn VA. The Emergency Medicine Residents will be
integrated into the schedule of the Department of Medicine by the respective Chief
Medical Residents. The Emergency Medicine Residents will function in the role of a
PGY-1 Internal Medicine Resident, and will have direct patient care responsibility. They
will be under the direct supervision of a PGY-3 Medical Resident and Internal Medicine
Attending Physician. Residents will also attend daily attending rounds, daily educational
conference, weekly Medicine Department Grand Rounds and the monthly Morbidity and
Mortality Review.
At the completion of this rotation the resident will be familiar with and demonstrate
competence in:
 Performance of a comprehensive history and physical examination on acutely and
chronically ill patients(PC,MK)
 Development of an integrated problem list for patients, including detailed differential
diagnoses.(MK,PC)
 Management of complex medical problems on an acute and chronic
basis.(MK,PC,SBP)
 Transfer and discharge planning.(SBP,PC,P)
 Utilization of laboratory data and ancillary studies in the care of internal medicine
patients(MK,PC)
 Blood and body fluid precautions(MK,SBP)
 Necessary precautions for Tuberculosis and other airborne pathogens(PC,MK,SBP)
 Appropriate utilization of specialty consultation(C,P,PC,MK)
Medical Knowledge and Patient Care:
 Understanding the model of a Universal Health Care System in the US
 To have experience with the oldest and most comprehensive Computerized Patient
record system (CPRS) in the country.
 Understanding how to improve Patient Safety as a pillar for Joint Commission of
hospital accreditation (JCAHO) system
 How to intuitively recognize and surpass benchmarks for Performance Measures as a
requirement for JCAHO.
 Recognizing and managing the emergency needs for geriatric patients in the ED.
 Recognizing and promptly managing walk-in emergencies
 Understanding the process for accepting and transferring emergencies for definite
management.
 Understanding the operation of the Fast track Clinic.
 Evaluation and admission of low risk patient into the ED Chest pain Unit
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Using the 23 hours observation beds as an option for patient disposition
Management of congestive heart failure
Management of asthma/COPD
Management of gastrointestinal bleeding
The evaluation and management of fluid and electrolyte disorders
The evaluation and management of hypothermia and hyperthermia
The evaluation and treatment of suspected spinal cord compression
Management of diabetes: its acute (DKA, Hyperosmolar Coma), and chronic (leg
ulcers, renal failure, neuropathy, retinopathy) manifestations
The evaluation and treatment of acute and chronic renal failure
Initial management of myocardial ischemia
Recognition and treatment of the initial stages of septic shock
The differential diagnosis of wide-anion gap and non-anion gap metabolic acidosis
Management of pneumonia
Diagnosis and management of patients with CNS and systemic infections
Development of the Doctor-Patient relationship as the resident interacts with patients
and their family’s during the stress of illness and death
Description of clinical experiences:
Residents should have experience and demonstrate competence in the following
procedures on this rotation:
 Advanced Cardiac Life Support
 Emergent airway management
 Diagnostic lumbar puncture.
 Abdominal paracentesis
 Peripheral blood smear analysis
 Thoracentesis
 Arterial blood gas sampling and its analysis
 Lymph node aspiration for cytology diagnosis
 Peripheral IV catheter placement
 Central IV placement and care
 Urinalysis
 Blood and tissue culture techniques
 Viral culture techniques
 Nasogastric intubation
 Debridement of decubitus ulcers
Description of didactic experiences:
The resident will attend all lectures offered by the Internal Medicine department.
The following topics should be covered in the resident’s reading during this rotation:
Hypertension
Diabetes insipidus
Diabetes mellitus
Pulmonary embolism
Deep vein thrombosis
Malignancy
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Diabetic ketoacidosis
Diabetic hyperosmolar state
Electrolyte disturbances
Acute and chronic renal failure
Anemia
Hemolysis
AIDS
Brain abscess
Connective tissue disorders
TTP
Acid-peptic disorders
Pancreatitis
Upper GI bleeding
Congestive heart failure
Atrial fibrillation
Sarcoidosis
Paraneoplastic syndromes
Lymphoma/leukemia
Metabolic acidosis
Asthma/COPD
Pneumonia
Sepsis
TB
Infectious diarrhea
Vasculitis
ITP
Spinal cord compression
Hepatitis
Lower GI bleeding
Myocardial ischemia
Atrial tachycardias
FACULTY
Antonio Saliba, MD, MPH
Aleksandr Gleyzer, MD
Gerard Casey, MD
Abel Cherian, MD
Joseph Chirayil, MD
Jay Itzkowitz, MD
Ethan Cowan, MD
Paul Leo, MD
Zhiang Lu, DO
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EDUCATIONAL OBJECTIVES
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EDUCATIONAL OBJECTIVES – PGY 1
Emphasis during this year will be placed on orientation to the different emergency
department environments. By the end of the year, the resident will demonstrate the ability
to prioritize and organize activities; chart documentation; perform basic procedural skills;
work with hospital staff; deal with friends and families of patients (particularly those who
are critically ill or dying); and most importantly, perform quality patient evaluations. The
resident should demonstrate accurate and appropriate history and physical exam skills;
how to generate differential diagnoses and care plans; and the appropriate usage of x-rays
and lab exams. A PGY-1 should evaluate no more than one or two new patients at a
time. They should not accept responsibility for more patients until he or she presents the
patient to a senior resident or attending. Their total caseload will be determined by their
need for supervision, as well as patient acuity. The PGY-1 should expect their evaluation
to be repeated by their supervisor. A PGY-1 cannot make independent admission,
transfer or discharge decisions, but they should formulate and offer their plan for the
aforementioned. A faculty member must co-sign all charts.
At the completion of this training year, the resident will demonstrate competence in and
be able to:
 perform histories and physicals on Emergency Department Patients: adults and
children
 understand the necessity for prioritizing patients
 prioritize their activities
 formulate differential diagnoses on their patients
 plan appropriate work-ups based on their differential diagnoses
 plan admission, transfer and discharges
 appropriately order and utilize laboratory data and ancillary studies
 carefully understand and utilize universal precautions
 appropriately utilize specialty consultation
 function as a team member during resuscitations
Description of clinical experiences:
First Year Residents should have experience and demonstrate competence in the
following procedures:
 physical examination
 oxygen administration
 bag-valve mask device usage
 closed chest compression
 oropharyngeal and nasopharyngeal airways
 pelvic examination
 phlebotomy
 peripheral intravenous lines
 Foley catheter placement
 arterial blood gas sampling
 nasogastric tube placement
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thoracentesis
vaginal deliveries
central line placement
lumbar puncture
arthrocentesis
paracentesis
basic wound management
incision and drainage of simple abscesses
basic suturing of uncomplicated (non-facial, non-hand) lacerations
splinting of strains and sprains
anterior and posterior nasal packing
Core Competencies
Patient care
 Procedural practice
 Physical exam
 Formulate treatment and disposition plans
 Triage of patients and prioritization
 Practice experience
 Skills labs
 Simulator time
 SDOT
Medical Knowledge
 Conference attendance and participation
 Topic review groups
 Webtests
 Inservice exam
 Bedside teaching rounds
 Responsibility for preparing case conferences
 Participation is skills labs
 Simulator time
 SDOT
Professionalism & Interpersonal
 Modeling of behavior by faculty
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Responsibility for presenting case conferences
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Communication
 Modeling of behavior by faculty
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
System based practice
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Participation in CQI committee
 Participation in M&M committee
Practice based learning
 Simulator time
 Participation in CQI committee
 Participation in M&M committee
 Participation in weekly conference
 Resident portfolio and reflective statement
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EDUCATIONAL OBJECTIVES – PGY 2
After successful completion of the PGY-1 year, the second year resident should be
comfortable evaluating any patient who presents to the Emergency Department. During
this year, the residents will be expected to develop their clinical acumen, sharpen their
physical exam techniques and hone their procedural skills. Their organizational abilities
should improve to the point that at least three to four patients can be managed
simultaneously. Emphasis will also be placed on the importance of patient follow-up.
The PGY-2’s demeanor should be calm and professional, reflecting their increasing
competence and confidence in their abilities and in those of the staff around them. They
will be expected to develop their teaching abilities at this stage as well. They will
supervise PGY-1’s during procedures for which they have been credentialed; they will
teach medical students, Physician Assistant students, and EMT students in the clinical
setting.
PGY-2 residents will take active part in the presentation of cases in the weekly clinical
case conferences, journal club, and M&M conferences. Research projects will begin
during this academic year.
PGY-2 residents will be directly supervised by PGY-4 residents and faculty members,
and will require their superior’s authorization for the admission, transfer or discharge of
patients. A faculty member must sign all patient charts.
At the completion of this training year, the residents will demonstrate competence in and
be able to :
 refine their history and physical exam skills
 document the medical record accurately and concisely
 recognize patients with potentially life-threatening conditions
 institute immediately life-saving therapy when necessary
 improve their ability to prioritize their activities
 formulate more extensive differential diagnoses on their patients
 plan appropriate work-ups based on their differential diagnoses
 plan admission, transfer, and discharges for their patients
 more appropriately utilize laboratory data and ancillary studies in the care of their
patients
 carefully understand and utilize universal precautions
 more appropriately utilize specialty consultation
 function as a team member during resuscitations, and may act in leadership positions
in supervised situations
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Description of clinical experiences:
Second year residents should have experience and demonstrate competence in the
following procedures:
 all procedures previously delineated for PGY-1’s
 tube thoracostomy
 arterial line placement
 endotracheal intubation
 venous cutdown
 closed diagnostic peritoneal lavage
 plastic suture techniques
 closed reduction of non-fractured displaced joints
 abdominal and pelvic ultrasound
 slit lamp examination
 removal of otic foreign bodies
 fracture reduction
 casting and splinting of non-displaced fractures
 intra-osseous infusion
 management of second and third degree burns
 rape-victim evaluation
Core Competencies
Patient care
 Procedural practice and teaching of these procedures
 Honing and demonstrating of physical exam skills
 Formulate treatment and disposition plans
 Triage of patients and prioritization of resuscitative efforts
 Participation in resuscitations
 Practice experience
 Skills labs
 Simulator time
 SDOT
Medical Knowledge
 Conference attendance and participation
 Topic review groups
 Webtests
 Inservice exam
 Bedside teaching rounds
 Responsibility for preparing case conferences
 Participation is skills labs
 Simulator time
62

SDOT
Professionalism & Interpersonal
 Modeling of behavior by faculty
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Responsibility for presenting case conferences
Communication
 Modeling of behavior by faculty
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
System based practice
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Participation in CQI committee
 Participation in M&M committee
Practice based learning
 Simulator time
 Participation in CQI committee
 Participation in M&M committee
 Participation in weekly conference
 Resident portfolio and reflective statement
63
EDUCATIONAL OBJECTIVES – PGY 3
In the third postgraduate year the residents will grow in confidence while working
independently. They will have an increased role in Junior Resident supervision, will
refine their teaching skills, and carry out administrative tasks assigned by faculty
members. In addition, PGY-3 residents will demonstrate increased competence in
management of multiple critically ill or injured patients simultaneously. Research
projects will continue this academic year. The third year resident will have the ability to
make admission, transfer and discharge decisions, after discussing the case with a faculty
attending physician. All charts must be co-signed by a faculty member. By the
completion of this year of training they should be comfortable managing the full range of
pathology that can present to an Emergency Department.
At the completion of this training year, the resident will demonstrate competence in and
be able to:
 perform rapid, accurate histories and physical diagnoses on all patients presenting to
the Emergency Department
 create comprehensive differential diagnoses for their patients
 create and carry out treatment and disposition plans for all patients presenting to the
Emergency Department
 supervise the activity of more junior residents in their area
 conduct teaching/management rounds in all patient care areas, including the direct
supervision of care provided by PGY-1 and 2 residents
 be an effective member of the Continuous Quality Improvement system
 be comfortable directing all patient resuscitation situations, and managing the
critically ill and injured
 improve their lecturing and teaching skills
Description of clinical experiences:
Third year residents should have experience and demonstrate competence in the
following procedures:
 all procedures previously delineated for PGY-1 and 2
 pulmonary artery catheter placement
 extensor tendon repairs
 cricothyroidotomy
 umbilical catheterization
 supra-pubic bladder aspiration (pediatric)
 transthoracic echocardiography
 abdominal and pelvic sonography
 utilization of rapid-sequence and neuro-intubation techniques
 utilization of conscious sedation techniques
64
Core Competencies
Patient care
 Procedural practice and teaching of these procedures
 Demonstration of physical exam skills
 Supervision of junior practitioners
 Independent formulation of treatment and disposition plans
 Triage of patients and prioritization of patients
 Direction of resuscitative efforts
 Practice experience
 Skills labs participation
 Skills labs teaching
 Simulator time
 SDOT
Medical Knowledge
 Conference attendance and participation
 Supervision of select educational conferences
 Topic review groups participation
 Topic review groups mentoring
 Webtests
 Inservice exam
 Bedside teaching rounds
 Responsibility for preparing case conferences
 Participation in skills labs
 Simulator time
 SDOT
Professionalism & Interpersonal
 Modeling of behavior by faculty
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Responsibility for supervising case conferences
Communication
 Modeling of behavior by faculty
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Responsibility for supervising case conferences
65
System based practice
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Participation in CQI committee
 Supervision of M&M conference
Practice based learning
 Simulator time
 Participation in CQI committee
 Participation in M&M committee
 Participation in weekly conference
 Resident portfolio and reflective statement
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EDUCATIONAL OBJECTIVES – PGY 4
In this last year of training the resident will receive progressive responsibility for the
overall clinical and operational management of the Emergency Department. In essence,
the PGY-4 should be ready to assume an attending-like position. With the guidance of
Emergency Medicine faculty members, the Senior Resident will manage patient flow;
train and assist in the evaluation of Junior Residents, Medical Students, Physician
Assistant students and Pre-hospital personnel; assist with all admission, transfer and
discharge decisions in their patient care area; and lead resuscitation situations. PGY-4
Residents will prepare and present curricula lectures; present cases at weekly discussions;
run Morbidity and Mortality Rounds; and will assist Junior Residents in identifying cases
for presentation and case reports. PGY-4 Residents will be able to independently admit,
transfer or discharge patients after informing the faculty attending physician. All charts
must still be co-signed by a faculty member.
At the completion of this training year, the resident will demonstrate competence in and
will be able to:
 perform rapid, accurate histories and physical diagnoses on all patients presenting to
the Emergency Department
 create comprehensive differential diagnoses for their patients
 confidently and competently create and carry out treatment and disposition plans for
all patients presenting to the Emergency Department
 manage the activities of all more junior residents in their area, and be aware of all the
patients in that area
 be comfortable conducting teaching/management rounds in all patient care areas,
including the direct supervision of care provided by PGY-1 and 2 residents
 be an effective member of the Continuous Quality Improvement system
 be able to perform the administrative responsibilities of an Attending Physician
 be comfortable directing all patient resuscitation situations
 be comfortable managing critically ill and injured patients
 be an effective lecturer and teacher
Description of clinical experiences:
Fourth year residents should have had exposure and demonstrate competence in the
following procedures:
 All procedures previously delineated for PGY-1, 2 and 3
 Emergency Department thoracotomy
 Transvenous pacemaker placement
 Fiberoptic laryngoscopy/intubation
67
Core Competencies
Patient care
 Procedural practice and teaching of these procedures
 Demonstration of physical exam skills
 Supervision of care by junior practitioners
 Independent formulation of treatment and disposition plans
 Triage of patients and prioritization of patients
 Direction of resuscitative efforts
 Practice experience
 Skills labs participation
 Skills labs teaching
 Simulator time
 SDOT
Medical Knowledge
 Conference attendance and participation
 Supervision of educational conferences
 Topic review groups mentoring
 Webtests
 Inservice exam
 Bedside teaching rounds
 Participation in skills labs
 Simulator time
 SDOT
Professionalism & Interpersonal
 Modeling of behavior by faculty
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Responsibility for supervising case conferences
Communication
 Modeling of behavior by faculty
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Responsibility for supervising clinical encounters
68
System based practice
 Observation during clinical shifts
 Web-eval system
 SDOT
 Simulator time
 Participation in CQI committee
 Supervision of M&M conference
Practice based learning
 Simulator time
 Participation in CQI committee
 Participation in M&M committee
 Participation in weekly conference
 Resident portfolio and reflective statement
69
OFF SERVICE ROTATIONS
70
PGY-1 OFF SERVICE ROTATIONS
Emergency GYN at KCHC (part of ED month)
ED-based Trauma Experience at KCHC
Obstetrics at KCHC
MICU at KCHC
Medicine at VA
All residents completing an Off-service rotation are required to meet with that rotation’s
EM faculty liaison/coordinator for an exit interview in oral exam type format.
This shall serve as an evaluation of the rotation and the fulfillment of the educational
expectations.
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JUNIOR ULTRASOUND ROTATION
LENGTH: 2 WEEKS
YEAR OF TRAINING: PGY 1
LOCATION: KINGS COUNTY HOSPITAL EMERGENCY DEPARTMENT
FACULTY LIAISON:
Dr. Michael Secko Director, Emergency Ultrasound Division
Pager: 917-219-5094
Cell: 631-645-7200
Email: [email protected]
Coordinators of Gyn Rotation-Ultrasound Fellows
Dr. Maria Romney Cell: 646-261-1395
Email: [email protected]
Dr. Leah Bright
Cell: 917-544-7687
Email: [email protected]
OBJECTIVES:
To obtain clinical experience in managing emergent and urgent medical problems using
ultrasound as a diagnostic tool.
72
To learn the differential diagnosis, workup, and management of patients presenting with
common gynecologic complaints.
To become proficient at performing and interpreting the transabdominal and transvaginal
pelvic ultrasound exam.
To become proficient in performing the AAA and FAST ultrasound exams.
SCHEDULE:
Clinical shifts: generally 10am-10pm on Mondays/Tuesdays/Thursdays/Fridays.
Ultrasound didactic shifts: generally 9am-10am on Thursday (film review) and on the
first weekend (time TBD in conjunction with ultrasound faculty).
You are expected to go to weekly conference on Wednesdays.
YOU MUST E-MAIL THE ULTRASOUND FACULTY COORDINATOR AT
LEAST ONE WEEK PRIOR TO THE START OF YOUR ROTATION SO WE
CAN ADJUST OUR SCHEDULES TO MEET WITH YOU,
ROTATION DESCRIPTION: Before starting each rotation please obtain the study
materials from the Rotation Coordinator. Additionally there are still images and
videos available at: http://www.sunysono.com
(username: suny password: s0n0)
At the beginning of the rotation the resident will meet with the faculty for specific
instruction on the transvaginal and transabdominal pelvic ultrasound exam, the use and
maintenance of the ultrasound machines, as well as receive didactic material such as
books or image files.
During assigned clinical shifts in the KCH ER and under direct faculty supervision, the
resident will evaluate patients who are triaged with gynecologic chief complaints. The
resident will primarily pick up GYN-related charts. When there are no such patients to be
seen, the resident will help out with the room and see other patients, with an eye to
remaining available to pick up new GYN-related patients as they come in.
The resident will evaluate GYN patients during these clinical shifts as per usual clinical
care (i.e., H&P, differential diagnosis, ordering diagnostic tests and therapeutics,
obtaining and following consults, and disposition), with the addition of performing a
pelvic ultrasound exam whenever appropriate. These patients should be presented to and
followed by a faculty attending who is working clinically during the shift.
During one weekend, the resident will come to the KCH ED for non-clinical ultrasound
time, with the goal of performing 25 FAST and 25 AAA exams on consenting patients.
There will be a brief orientation and didactic session done with one of the Ultrasound
faculty, and the exams will also be supervised. It is expected that with intensive repetition
the resident will become proficient relatively quickly. The other weekend is normally off,
unless there are necessary schedule changes.
73
All studies MUST be done under the DIRECT SUPERVISION of a provider
credentialed in emergency ultrasound (faculty, fellow, or appropriate senior resident).
When done for a clinical indication, the results MUST be documented in Quadramed by
ED QuickNote or as otherwise directed. Additionally, ultrasound images should be saved
with results documented on the Ultrasound Data Sheet. These will be critiqued by the
ultrasound faculty during weekly film review sessions. The data sheets must be turned in
at the end of the rotation. We require at least 25 documented and approved in each
application of emergency ultrasound (AAA, FAST, and pelvic ultrasound –
transabdominal and transvaginal combined), so every exam should be documented.
The rotating intern will be responsible for maintaining all appropriate supplies and
keeping the Ultrasound machine clean and in its designated area. The machine should be
turned on and checked at the beginning of each shift. Any problems with the machine
should be immediately reported to the Emergency Ultrasound Attending on schedule that
day. If the attending cannot be reached, the Director of the Division (Dr. Secko) must be
contacted.
In case of an unexpected absence the resident must contact both the Chief Resident and
the Director of the Emergency Ultrasound Division.
EVALUATION:
Upon completion of the rotation, the resident will be evaluated based on his/her
attendance, motivation, didactic knowledge and procedural skills. There will be an exam
consisting of written questions and videos covering the assigned knowledge base (basic
ultrasound physics, general OB/GYN pathology, and AAA/FAST/pelvic ultrasound
exams). The resident will also receive feedback during the rotation. The evaluation will
be completed in new innovation will be reviewed by the residency directors. The resident
will have access to the evaluation through new innovations. The resident will be also
asked to evaluate the rotation and provide suggestions for improvement. All interns are
required to complete written examination at end of rotation.
TAPE REVIEW:
Each resident if to be present at tape review on Thursday at 9am
in the US conference room next to the simulator center. Each
resident is expected to have manual data sheets completed prior
to each tape review of all GYN pts seen. Furthermore, each
intern is required to present one article on gyn or aorta or FAST
at tape review.
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ED-BASED TRAUMA
Meeting Place: KCH ED
Contact Number: EM Chiefs
Daily Rounds: ED morning report
Schedule: The EM Trauma intern will be expected to function the same as our regular
EM interns but will have a different shift distribution. You will also be scheduled for an
intensive 2 day session of Trauma skills-stations and lectures.
One Thursday at 11am during month, the resident will participate in a combined
Emergency Medicine/Trauma Service simulation session in the simulation lab. Contact
the simulation division for further information the month prior to the start of the rotation.
EM Faculty Liaison: Dr. Bonny J. Baron
pager: 917-760-1344
Description of rotation:
During the Trauma rotation, the PGY-1 Emergency Medicine Residents will rotate
through the KCH ED for a 2 week time period. During that time, they will be responsible
for 5 CCT shifts and 4 Pod A shifts. They should try to focus on traumatized/injured
patients but can and should see any patient that presents to their area that needs to be
cared for.
In addition to this 2 week block, each PGY 1 will attend a “Focused Trauma Workshop”
spanning 2 days during your orientation month. During this time period, the resident will
have multiple activities to complete. The days will begin with a number of traumaoriented lectures. They will then participate in multiple hands-on small group learning
sessions involving critical trauma skill sets and will be exposed to multiple simulation
cases involving traumatized patients. Lastly, there will be a reading list made available on
the KCH EM web site where a number of trauma-oriented PDF papers can be
downloaded. The resident is responsible for reading these papers prior to the completion
of their PGY 1 residency year.
The Emergency Medicine Resident will have direct patient care responsibility: In the
Emergency Room, they will be doing what all of the other PGY 1’s are doing that month
with the exception being that they are supposed to be concentrating on traumatized
patients. Just like the other PGY 1’s in the ED that month, the resident rotating on
trauma will have to attend regular Wednesday EM Conference and morning reports
according to the usual rules for absence. During the shifts in the Main ED, the resident
75
will focus on injured patients. If no injured patients are waiting to be seen, then the
resident will see ED patients with any chief complaint.
At the completion of this rotation the resident will demonstrate competence in the
following:
MEDICAL KNOWLEDGE, PATIENT CARE
 Recognition of the various stages of traumatic shock, including its earliest
manifestations (PC,MK)
 The principles and endpoints of resuscitation, including the roles of:
-Crystalloid volume replacement
-Colloidal volume replacement
-Blood volume replacement
-Inotropic support (PC,MK)
 The initial assessment of the multiply injured patient (ABC’s) (PC,MK)
 Identification and treatment of immediately life-threatening injuries after the initial
assessment (PC,MK)
 The role of radiographic studies in the initial and subsequent management of the
injured patient (PC,MK)
 Common injury patterns associated with penetrating head trauma (PC,MK)
 Common injury patterns associated with blunt head trauma (PC,MK)
 How the presence of a closed head injury impacts management of a multiply injured
patient (PC,MK)
 Management of elevated intracranial pressure (PC,MK)
 The anatomic zone system of the neck, and appropriate work-up and management of
a penetrating injury to each of the zones (PC,MK)
 Indications for operation in penetrating chest trauma (PC,MK)
 Identification and management of patients at risk for pericardial tamponade (PC,MK)
 Recognition of a widened mediastinum on X-ray, its significance and work-up
(PC,MK)
 Physiologic scoring (PC,MK)
 Evaluation of blunt abdominal trauma including:
-Physical exam
-Diagnostic peritoneal lavage
-Abdominal CT scanning
-Abdominal sonography
-Laparoscopy
-Non-operative management (PC,MK)
 Classification of pelvic fractures and radiographic studies used for their diagnosis
(PC,MK)
 Diagnosis and management of the bleeding associated with pelvic trauma, including:
-external fixation
-angiography (PC,MK)
 Diagnosis and management of urologic complications associated with pelvic trauma
(PC,MK)
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


Evaluation and management of gross hematuria following trauma (PC,MK)
Signs of peripheral vascular injury and the indications for angiography and operative
management (PC,MK)
Special concerns in the care of patients with spinal injuries (PC,MK,SBP)
Special concerns in diagnosis and management of elderly injured patients
(PC,MK,SBP,P)
Importance of long bone fractures in the short and long term outcome of the multiply
injured patient (PC,MK)
Appropriate utilization of specialty consultants in the management of multiply injured
patients (PC,MK,C,P,SBP)
The concept of triage within the confines of available resources, including recognition
of non-salvageable patients (PC,SBP,MK)
Pulmonary artery catheterization for hemodynamic monitoring
Identification of potential organ donors and their management to maximize yield of
organ procurement(PC,SBP,P,C)
Patient discharge and transfer decisions, including formulation of long-term care
plans for patients with spinal cord injuries and major disability(PC,P,C,SBP)
Compassionately interact with patients and their families during the stress of illness
and death, including the ability to obtain DNR orders(PC,P,C)
The patterns and demographics of the urban trauma patient(PC,SBP,PBL)
Educational Expectations:
The following topics should be covered in the resident’s reading during this rotation:
ATLS
Neuro-intubation
Rapid sequence intubation
Intubation with cervical spine trauma
Intubation with facial trauma
Mechanical ventilation
Spinal trauma
Spinal shock
Penetrating and blunt thoracic trauma
Penetrating and blunt abdominal trauma
Penetrating and blunt neck trauma
Head trauma
Glasgow Coma Scale
Pelvic trauma
Facial trauma
Long bone fractures (open and closed)
Vascular injury
Hemodynamic monitoring
Volume resuscitation (crystalloid and
colloid)
Resuscitation with blood products
Inotropic support
SVO2 as a guide to resuscitation
Lactate and base deficit to monitor perfusion
deficit
Shock(hemorrhagic,neurogenic,cardiogenic)
Physiologic scoring
Tissue ballistics
Trauma in pregnancy
Trauma in the elderly
Pediatric trauma
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OBSTETRICS
Meeting Place: S building 5th floor
Daily Rounds: 9am
Schedule: Contact Ms. Stephanie Goeloe (OB residency coordinator) (718) 270-3320.
If unable to reach Ms. Goeloe, the Chief resident of OB at KCH should be able to help.
You can reach the OB Chief Resident through the KCHC operator at (718) 245- 3141
Educational Objectives:
PGY-1 Emergency Medicine residents will spend a two-week block on the Obstetrics inpatient service at Kings County Hospital. Residents will also rotate through the
outpatient clinics. The Emergency Medicine Residents will be under the direct
supervision of an Obstetrics/Gynecology Senior or Chief Resident and Attending
Physician. They will act in the role of a PGY-1 OB/GYN Resident, providing direct
patient care, and assisting with in-patient and Emergency Department consultation. They
will also assist in the operating rooms. The Emergency Residents will attend the
Department of Gynecology’s daily conferences and monthly Grand Rounds, as well as
Emergency Department Educational events, if patient care requirements allow. The
purpose of this rotation to perform at minimum the 10 deliveries required by the RRC for
graduation. All deliveries are to be documented in New Innovations for credit.
At the completion of this rotation, the resident will demonstrate competence in and be
able to:

Evaluate and treat the patient with pre-eclampsia/eclampsia (PC,MK)

Make admission, transfer and discharge decisions on OB patients
(PC,MK,C,SBP,P)

Utilize laboratory data and ancillary studies appropriately in the care of OB patients
(PC,MK)

Utilize in-patient consultation appropriately (PC,MK,C,P,SBP)

Compassionately interact with patients and their families during the stress of illness
and death (PC,C,P)
Description of clinical experiences:
Residents will have experience in and demonstrate competence in the following
procedures:
 Vaginal deliveries
 Assisting in C-sections
 Monitoring of patients in labor
 Management of the ecclamptic patient
 Management of episiotomies
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Culdocentesis
Assisting in the operating room
Pelvic sonography
Pelvic examination
Assisting with the treatment of incomplete and complete abortions
Appropriate bacterial and viral culture techniques
Repair of vaginal lacerations
Removal of vaginal foreign bodies
Description of didactic experiences:
The residents will participate in the daily, weekly, and monthly OB/GYN conferences as
well as the Emergency Medicine conferences if it is does not interfere with patient care
requirements.
The following topics should be covered in the Resident’s reading during this rotation:
Pelvic and abdominal pain
Ovarian cysts and rupture thereof
Spontaneous abortion
Endometriosis
Ectopic pregnancy
Ovarian torsion
Vaginitis/vaginosis/vulvitis
Sexually transmitted disease
Infertility
Sexual assault
Drug and radiation exposure in pregnancy
Nausea and hyperemesis gravidarum
Vaginal bleeding in early pregnancy
Contraception
Pelvic relaxation
Abnormal vaginal bleeding
Tubo-ovarian abscess
Threatened abortion
Pelvic inflammatory disease
Uterine incarceration
Mittelschmerz
Urinary tract infection
Atrophic vaginitis
Vaginal foreign bodies
Contraception
Diagnosis of pregnancy
Premature rupture of membranes
Molar pregnancy
Hysterectomy
Amenorrhea
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MICU
Meeting Place: KCH MICU D building
Contact Number: (718) 245-3774 (KCH) or (718) 270-1566 (SUNY)
Daily Rounds: Contact KCH Medical Chief Resident for the block
Schedule: Contact the KCH Medical Chief Resident at least 2-3 weeks before the
start of the rotation.
EM Faculty Liaison: Dr. Ian DeSouza
Cell: 917.903.1765
Special Considerations:
The Medical Intensive Care Unit at Kings County Hospital is a four week rotation for
PGY-1 Emergency Medicine Residents. The Emergency Medicine Resident will
function as a PGY-1 Internal Medicine Resident, providing direct patient care. The
Emergency Medicine Resident will be supervised by a Senior Medical Resident, Critical
Care Fellow and the Intensive Care Unit Attending Physician. The Emergency Medicine
Resident will attend daily Attending Rounds, daily lectures with the Department of
Internal Medicine, weekly Critical Care Conferences, monthly Internal Medicine Grand
Rounds, and participate actively in the monthly Emergency Medicine / MICU
interdisciplinary conference. The resident must attend the weekly Emergency Medicine
Departmental conference.
At the completion of this rotation, the resident will demonstrate competence in and be
able to:

Perform a comprehensive history and physical examination on critically ill
patients(MK,PC)

Develop differential diagnoses for life-threatening problems, and create cohesive
care plans based on these diagnoses(MK,PC,PBL)

Manage critically ill patients in an intensive care unit setting(MK,PC,PBL)

Make admission, transfer and discharge decisions for patients with life-threatening
and potentially life-threatening illness(MK,PC,C)

Appropriately utilize and interpret invasive monitoring(MK,PC)

Appropriately utilize and interpret culturing techniques, results and use of
antibiotics(MK,PC)

Utilize laboratory data and ancillary studies appropriately in the care of critically ill
patients(MK,PC,SBP)

Utilize in-patient consultation appropriately(MK,PC,C,P,SBP)

Compassionately interact with patients and their families during the stress of illness
and death(PC,P,C)
80
Description of clinical experiences:
Residents should have experience with and demonstrate competence in the following
procedures on this rotation: (MK,PC)
 Airway management and endotracheal intubation
 Placement and care of central venous catheters
 Placement and care of arterial catheters
 Placement and care of pulmonary artery catheters
 Interpretation of Swan-Ganz-catheter readings
 Utilization of oxygen delivery devices and mechanical ventilators
 Lumbar puncture
 Arterial blood gas sampling and analysis
 Abdominal paracentesis
 Thoracentesis
 Chest tube placement
 Placement of esophageal/gastric balloons
Description of didactic experiences: (MK,PC)
The Emergency Medical resident will actively participate in the interdepartmental
conferences.
The following topics should be covered in the resident’s reading during this rotation:
Airway management and endotracheal intubation
Mechanical ventilation
Interpretation of invasive monitoring
ARDS
Pneumonia
Opportunistic infection
Broad spectrum antibiotics
Hemodialysis/peritoneal dialysis
Intracerebral bleeding/CVA
Shock
Uremic encephalopathy
Pulmonary embolism
Cardiogenic pulmonary edema
Fever
Electrolyte abnormality
Disseminated intravascular coagulation
81
ACLS
Drug induced paralysis
Asthma/COPD
Meningitis
Super-infection
Acute renal failure
Gastrointestinal hemorrhage
Hepatic encephalopathy
Sepsis
Anticoagulant therapy
Coma/brain death examination
Dysrhythmias
Acid base derangements
Nutrition: parenteral and enteral
Hemolysis
INTERNAL MEDICINE at the VA
Meeting Place: VA Hospital 9th floor chief resident office on the 1st day of the rotation
Daily Rounds: Contact the Medical Chief Resident, 718-836-6600 ext. 6514, before first
day of rotation
Schedule: Contact medicine chief resident at least 2-3 weeks before the start of the
rotation.
EM Faculty Liaison: Dr. Antonio Saliba
Antonio J. Saliba MD, MPH
Chief Emergency Department
Brooklyn VA Campus
O (718) 630-3607
F (718) 630-2821
C (347) 831-5346
Educational Objectives:
PGY-1 Emergency Medicine Residents will rotate for a four-week block on the in-patient
Medical Services at the Brooklyn VA. The Emergency Medicine Residents will be
integrated into the schedule of the Department of Medicine by the respective Chief
Medical Residents. The Emergency Medicine Residents will function in the role of a
PGY-1 Internal Medicine Resident, and will have direct patient care responsibility. They
will be under the direct supervision of a PGY-3 Medical Resident and Internal Medicine
Attending Physician. Residents will also attend daily attending rounds, daily educational
conference, weekly Medicine Department Grand Rounds and the monthly Morbidity and
Mortality Review.
At the completion of this rotation the resident will be familiar with and demonstrate
competence in:
 Performance of a comprehensive history and physical examination on acutely and
chronically ill patients(PC,MK)
 Development of an integrated problem list for patients, including detailed differential
diagnoses.(MK,PC)
 Management of complex medical problems on an acute and chronic
basis.(MK,PC,SBP)
 Transfer and discharge planning.(SBP,PC,P)
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Utilization of laboratory data and ancillary studies in the care of internal medicine
patients(MK,PC)
Blood and body fluid precautions(MK,SBP)
Necessary precautions for Tuberculosis and other airborne pathogens(PC,MK,SBP)
Appropriate utilization of specialty consultation(C,P,PC,MK)
Medical Knowledge and Patient Care:
 Management of the immune-compromised patient
 Management of the patient with accelerated hypertension, and hypertensive urgencies
 Management of congestive heart failure
 Management of asthma/COPD
 Management of gastrointestinal bleeding
 The evaluation and management of fluid and electrolyte disorders
 The evaluation and management of hypothermia and hyperthermia
 The evaluation and treatment of suspected spinal cord compression
 Management of diabetes: its acute (DKA, Hyperosmolar Coma), and chronic (leg
ulcers, renal failure, neuropathy, retinopathy) manifestations
 The evaluation and treatment of acute and chronic renal failure
 The metastatic work-up
 Nutrition: parenteral and enteral
 Initial management of myocardial ischemia
 Recognition and treatment of the initial stages of septic shock
 The differential diagnosis of wide-anion gap and non-anion gap metabolic acidosis
 Management of pneumonia
 Diagnosis and management of patients with CNS and systemic infections
 Evaluation and treatment of patients with vasculitis and connective tissue disorders;
lupus, scleroderma, mixed connective tissue disorder
 Development of the Doctor-Patient relationship as the resident interacts with patients
and their family’s during the stress of illness and death
Description of clinical experiences:
Residents should have experience and demonstrate competence in the following
procedures on this rotation:
 Advanced Cardiac Life Support
 Emergent airway management
 Diagnostic lumbar puncture.
 Abdominal paracentesis
 Peripheral blood smear analysis
 Thoracentesis
 Arterial blood gas sampling and its analysis
 Lymph node aspiration for cytology diagnosis
 Peripheral IV catheter placement
 Central IV placement and care
 Urinalysis
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Blood and tissue culture techniques
Viral culture techniques
Nasogastric intubation
Debridement of decubitus ulcers
Description of didactic experiences:
The resident will attend all lectures offered by the Internal Medicine department.
The following topics should be covered in the resident’s reading during this rotation:
Hypertension
Diabetes insipidus
Diabetes mellitus
Diabetic ketoacidosis
Diabetic hyperosmolar state
Electrolyte disturbances
Acute and chronic renal failure
Anemia
Hemolysis
AIDS
Brain abscess
Connective tissue disorders
TTP
Acid-peptic disorders
Pancreatitis
Upper GI bleeding
Congestive heart failure
Atrial fibrillation
Sarcoidosis
Pulmonary embolism
Deep vein thrombosis
Malignancy
Paraneoplastic syndromes
Lymphoma/leukemia
Metabolic acidosis
Asthma/COPD
Pneumonia
Sepsis
TB
Infectious diarrhea
Vasculitis
ITP
Spinal cord compression
Hepatitis
Lower GI bleeding
Myocardial ischemia
Atrial tachycardias
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PGY-2 OFF SERVICE ROTATIONS
Airway Management/ENT
Research
CCU at SIUH
NICU at UHB
SICU at KCHC
Neurology at SIUH
Orthopedics/FT at KCH
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AIRWAY MANAGEMENT
Location:
KCHC OR
Faculty Liaison:
Dr. Christopher Doty
Contact:
Ms. Wharton, LRNA
245-4409
Structure:
The rotation takes place during a two-week block during the second year. During this
time the residents will report to the clinical instructor at 7 a.m. every weekday. The
resident will have the opportunity to develop his/her airway management skills under
close supervision in the controlled setting of the OR. The rotation is embedded with the
ENT rotation. In the afternoons, the resident will participate in scheduled ENT clinic
(see ENT section). One Thursday at 11am during month, the resident will participate in a
combined Emergency Medicine/Trauma Service simulation session in the simulation lab.
Contact Dr. Muresanu for further information the month prior to the start of the rotation.
The resident should also schedule a time with Dr. Doty, Silverberg, or Muresanu to do a
practical airway lab. It is not necessary to complete the lab during this 2-week period,
but should be completed. This workshop occurs in 2 stages and practices the mechanics
of intubation and LMA placement as well as the use of rescue devices.
Goals and Objectives:
1. The resident will develop and demonstrate competence in the following
clinical skills:
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Airway opening techniques.
Use of oral and nasal airways.
Bag valve mask ventilation.
Safe administration of sedatives and muscle relaxants.
Laryngoscopy anatomy and technique.
Orotracheal intubation.
Techniques for confirming endotracheal tube placement.
Basic ventilation parameters.
The use of the laryngeal mask airway for primary ventilation and airway salvage.
2. The resident will demonstrate competence in and detailed knowledge of
the following topics:
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Airway anatomy and physiology in adults and children.
The pharmacology of commonly used sedative and paralytic agents.
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Airway management in trauma.
Airway management in the patient with suspected intra-ocular of intra-cranial injury.
Airway management in children.
Indications for primary and salvage intubation with the laryngeal mask airway
(including the intubating laryngeal mask airway).
Familiarity with the combitube SA.
Reading Suggestions:
1. The text for this course is The Airway Cam Guide to Intubation and Practical
Emergency Airway Management, by Rich Levitan MD. This is a short paperback text
written by a national leader in the field of airway management. It covers all of the
areas germane to the rotation objectives. This book in the department library.
2. The residents will be expected to view the Airway Cam videos. These were also
developed by Rich Levitan, M.D. and take the resident through airway anatomy, use
of different laryngoscopic equipment, different intubation techniques, and the
management of the difficult airway. The total video time is approximately one and a
half hours.
Evaluation:
At the end of each rotation, the supervising faculty will complete the evaluation form
provided by the Department of EM and will discuss it with the resident. An evaluation of
the rotation from the resident will also be solicited. Both of these will be placed in the
resident’s folder and reviewed by the residency directors.
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CCU
Meeting Place: On the first day of the rotation go directly to the CCU, which is located
in the Heart Tower on the second floor.
Schedule: Contact the Luane Shaleesh (ext. 6205) ([email protected] with requests as
soon as possible. Then contact the Internal Medicine Chief Resident at least 2-3 weeks
before the start of the rotation to confirm your call schedule. Overnight call will occur
approximately every 3rd night.
Chief resident office: 718-226-9523
In-house page 1295
Lastly, please see Jennifer Cohen (ext. 1548) ([email protected]) in the
Emergency Department prior to the start of you rotation. She will help you with
acquisition of an SIUH ID that will allow you to park as well as get around the hospital.
For directions to SIUH (driving or ferry) consult the SIUH ED section of the resident
handbook.
EM Faculty Liaison: Christopher Doty
pager: 917-760-2005
Educational Objectives:
The Coronary Care Unit at SIUH will be the PGY-2 Emergency Medicine Resident’s
introduction to the cardiac patient. In this four week rotation the Emergency Medicine
Residents will act in the role of a PGY-1 Internal Medicine Resident. They will be
providing direct patient care in the CCU. Emergency medicine residents will be
supervised by either a senior resident (PGY-3), chief resident, cardiac fellow, pulmonary
fellow, pulmonary critical care fellow, hospitalist, intensivist, or a cardiology attending.
The Emergency Medicine Resident will attend daily Attending Rounds and all daily
lectures with the Department of Internal Medicine.
Day-to-Day Assignments:
1. Under the supervision of senior residents and the attending teaching staff, the
resident is responsible for the care of assigned patients in the CCU.
2. At 7:30 am the senior and junior residents assigned to the CCU meet in the
emergency room to review and accept sign-outs for all the patients admitted to
their service the night before by the on-call team. CCU bedside rounds begin at
8:00 am with the cardiologist and are followed by pulmonary rounds with Dr
Costellano, which start at 9:15am (1:00 pm on Mondays). You are expected to
prepare for rounds by updating yourself on your patients’ overnight courses
before the 8:00 am rounds with the pulmonologist.
3. The resident is responsible for creating daily progress notes (6 days/week),
reviewing all recommendations of the clinical staff, writing all orders and
developing an ongoing diagnostic/therapeutic plan.
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4. Bedside teaching is accomplished during the interaction with senior residents and
with the attending faculty.
5. During the day and on-call, the residents admit new patients, discharge patients,
evaluate change in status, review clinical data, coordinate the treatment plan and
perform procedures on their respective patients.
On-Call:
Residents are on call for a 24-hour period, at which point the rest of the team will take
over their patients’ care. The on-call residents should finish their work by 7:30 am and
must complete their sign-out within three hours and leave the hospital by 10:30 am.
Conferences:
The department of critical care medicine provides the residents with its own assortment
of lectures that are prepared by the attending faculty members. This occurs at 12 pm
Monday through Friday in the ICU conference room. The lectures span a multitude of
important topics related to critically ill patients.
Important Telephone Numbers:
1. ICU
2. CCU
3. ER
4. Dr. Maniatis (ICU Director)
718-226-9250
718-226-9240
718-226-9140 / 41 / 42
718 980 5700
At the completion of this rotation, the Resident should demonstrate competence in and be
able to:
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Perform a comprehensive history and physical examination on cardiac patients (PC,
PROF)
Develop differential diagnoses for chest pain and cardiac problems, and create
cohesive care plans based on these diagnoses (PC, MK, SBP)
Manage cardiac patients in an intensive care unit setting (SBP, PC, MK)
Make admission, transfer and discharge decisions for patients with cardiac disease
and potentially life-threatening illness (SBP, PC)
Diagnose and treat supraventricular and ventricular dysrhythmias (PC, MK)
Evaluate and treat hypertensive crisis (PC,MK)
Evaluate and manage myocardial ischemia (PC.MK)
Evaluate and manage acute myocardial infarction and its complications, including
wall rupture, valve failure, congestive failure, dysrhythmias and pericarditis (MK,
PC, SBP)
Evaluate and manage dissecting thoracic aortic aneurysm (MK,SBP,PC)
Evaluate and manage hypertrophic cardiomyopathy (MK,PC)
Evaluate and manage cardiogenic pulmonary edema (MK,PC)
Evaluate and manage class III and IV congestive cardiomyopathy (MK,PC)
Evaluate and manage infective endocarditis (MK,PC)
Evaluate and manage failed or infective prosthetic heart valves (MK,PC)
Evaluate and manage pericardial tamponade (MK,PC, SBP)
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Evaluate and manage pericarditis (MK,PC)
Run a cardiac arrest situation (MK,PC, PROF, COM, SBP)
Appropriately utilize thrombolytic therapy and manage its complications (PBL, SBP)
Interpret EKG’s quickly and accurately (MK,PC)
Appropriately utilize and interpret invasive monitoring (MK, SBP, PC)
Utilize laboratory data and ancillary studies appropriately in the care of critically ill
patients (MK, PC, SBP, PBL,)
Utilize in-patient consultation appropriately (COM, SBP, PROF)
Compassionately interact with patients and their families during the stress of illness
and death (PROF, COM)
Description of clinical experiences: (MK,PC)
Residents should have experience and demonstrate competence in the following
procedures on this rotation:
 Advanced Cardiac Life Support
 Airway management and endotracheal intubation
 Placement and care of central venous catheters
 Placement and care of arterial catheters
 Placement and care of pulmonary artery catheters
 Utilization of oxygen delivery devices and mechanical ventilators
 Arterial blood gas sampling and interpretation
 Exercise stress testing
 24 hour ambulatory monitoring
 Bedside echocardiography
 Alternative EKG lead placement for the diagnosis of dysrhythmias and infarction
 Internal and external temporary pacemaker placement
Description of didactic experiences: (MK,PC, PBL, SBP)
The following topics should be covered in the Resident’s reading during this rotation:
Chest pain (differential diagnosis of)
Hypertensive crisis
Coronary artery spasm
Acute myocardial infarction-diagnosis
Myocarditis
Pericardial tamponade
Restrictive cardiomyopathy
Congenital heart disease
Calcium channel blockers
Thrombolytic therapy
Dysrhythmias-supraventricular
ACLS protocol
Echocardiography
Stress testing
Invasive pressure monitoring
Coronary artery disease
Dissecting aortic aneurysm
Cardiogenic pulmonary edema
Treatment of AMI
Pericarditis
Congestive heart failure
Hypertrophic cardiomyopathy
Nitrates/Beta-blockers/Digoxin
Heparin/coumadin
Pacemakers
Dysrhythmias & Anti-dysrhythmics
Cardiac catheterization
Electrophysiologic studies
Nuclear cardiology
Intra-aortic assist devices
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Heart blocks
Wolff-Parkinson-White syndrome
All residents completing an Off-service rotation are required to meet with that rotation’s
EM faculty liaison/coordinator for an exit interview in oral exam type format.
This shall serve as an evaluation of the rotation and the fulfillment of the educational
expectations.
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NICU
Meeting Place:
7 am NS35, NICU, 3rd Floor UHB
EM Faculty Liaison: Dr. Antonia Quinn
Contact :
Services
Dr. Gloria Valencia, Director NICU, Vice Chair UHB Clinical
Schedule:
Email requests to Pediatrics Chief Residents
([email protected])
and Dr. Valencia ([email protected]) who makes the
NICU schedule (2 months ahead of time)
Educational Objectives:
As a PGY-2, the resident will rotate for four weeks in the NICU in the role of a junior
resident. The resident will work under the supervision of an Attending Neonatologist.
The resident will also be present at “difficult” or complicated deliveries and gain
experience in neonatal resuscitation and stabilization.
 To become competent in the initial resuscitation of the premature and term
neonate during both complicated and routine deliveries.
 To understand and manage the unique respiratory and nutritional needs of the
premature infant.
 To properly order and interpret laboratory and radiographic tests for the purpose
of diagnosis and treatment of the neonate in the intensive care unit.
Clinical Experience:
The resident will demonstrate competence in the evaluation and management of the
following neonatal disorders:
 Esophageal reflux
 Aganglionic megacolon
 Congenital GI lesions
 Acquired GI conditions (NEC)
 Hernias
 Malrotation of bowel
 Dysrhythmias
 Congenital heart disease
 Hypoglycemia
 Neonatal Jaundice
 Anemias
 Meningitis
 Neonatal seizures
 Hydrocephalus
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Congenital cysts
Bronchopulmonary dysplasia
Bacterial pneumonia
Perinatal and congenital infections
Congenital kidney abnormalities
Undescended testes
Vaccination
Pharyngeal – Tracheal lumen airway
The resident will understand and demonstrate competence in the mechanics of assisted
ventilation and the proper methods for monitoring adequate oxygenation:
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Mechanical ventilation
End-tidal CO2 monitoring
Pulse oximetry
The resident will demonstrate competence in the following procedures:
 Umbilical vein catheterization
 Umbilical artery catheterization
 Familiarity with chest tube placement in neonates
 Use of paralytic and sedation agents
 Orotracheal intubation
Description of didactic experiences:
The resident will attend all educational conferences and meetings while on the NICU
Service. The resident will be responsible for the list of suggested readings for the NICU
Rotation in addition to any provided by the NICU Service. The resident will be fully
incorporated into the NICU Care Team and participate in all rounds, conferences and
didactics including Perinatology Conference and Neonatal Morning Report weekly.
Attendance at the Wednesday Emergency Department Conferences will be at the
discretion of and with the permission of the NICU attending on service if patient care
needs allow.
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ENT
Meeting place:
ENT Clinic
Contact Number:
(718) 245-3470
Schedule:
1:00pm until clinic ends (usually 4pm),
weekdays except Thursdays
EM Faculty Liaison: Mark Silverberg
Educational Objectives for ENT rotation:
PGY-2 Emergency Medicine Residents will rotate for two weeks on the Otolaryngology
service at Kings County Hospital. (These are the same two weeks you will rotate on the
Airway service.) The Emergency Medicine Residents will be integrated into the clinic
schedule of the Department of Otolaryngology by the chief or Chairman of ENT.
The EM Resident will function in the capacity of a junior Otolaryngology Resident. The
resident will see patients in the clinic, in the operating room, as a consultant to the
Emergency Department, on the general floors and in the critical care units of the hospital.
The Resident will be under the direct supervision of an Otolaryngology Attending
Physician, and senior Otolaryngology residents. Residents will attend daily attending
rounds, daily educational conferences, and weekly Otolaryngology Grand Rounds. They
will also attend all Emergency Medicine Department Conferences and educational
events. Wednesday afternoons are to be spent in clinic/consults. Thursday afternoons are
free time to catch up on reading.
At the completion of this rotation the resident will be familiar with and demonstrate
competence in the following concepts:
 Examination of the head, ears, nose, throat and neck (PC)(MK)
 Normal and abnormal anatomy (MK)
 Management of nasal bleeding (PC)
 Management of trauma to the face (PC)(MK)
 Management of trauma to the ears (PC)(MK)
 Management of trauma to the nose (PC)(MK)
 Management of trauma to the mouth (PC)(MK)
 Management of trauma to the neck (PC)(MK)
 Recognition, identification and management of tumors of the head and neck (PC)
 The evaluation and treatment of hoarseness (PC)
 Management of airway emergencies (PBL, PC, MK)
 Evaluation of acute and chronic hearing loss (MK)
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Evaluation and treatment of the patient with extra-cranial infection of the head
including: sinusitis, otitis externa, otitis media, facial cellulitis, Ludwig’s angina,
pharyngitis, retropharyngeal abscess, and acute epiglotitis (PBL, MK, PC)
Evaluation and treatment of infections of the neck (PC, MK)
Care of the tracheostomy patient (PC, MK, SBP)
The role of an Otolaryngology Consultant on both emergent and non-emergent
patients (SBP, COM, PROF)
Appropriate admission of patients to the hospital on the Otolaryngology service (SBP,
PC, COM)
Develop the Doctor-Patient relationship as the resident interacts with patients and
their families (PROF, COM, PBL)
Description of clinical experiences: (PC, MK, PBL)
Residents should have experience and demonstrate competence in the following
procedures on this rotation:
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Control of epistaxis, including anterior cauterization
Anterior and posterior nasal packing
Topical anesthesia
Laryngoscopy: indirect (mirror)
Laryngoscopy: direct (fiberoptic nasopharyngolaryngoscopy)
Management of nasal lacerations
Management of nasal fractures and other nasal trauma
Management of injuries to the external ear
Management of injuries to the middle and inner ear
Management of common neck wounds
Incision and drainage of oral, pharyngeal and cervical abscesses
Description of didactic experiences:
The following topics should be covered in the resident’s reading during this
rotation:
Acute hearing loss
Otitis Media
Otitis Externa
Ear Foreign bodies
Epistaxis
Nasal Fractures
Rhinitis
Acute Upper Airway Obstruction
Emergency Tracheostomy
Post adenotonsillectomy Bleeding
Retropharyngeal Abscess
Pharyngitis
Ruptured Tympanum
Sinusitis
Facial Cellulitis
Ludwig’s Angina
Salivary Gland Problems
Maxillofacial fractures
Odontogenic Infections
Epiglottis
Cricothyrotomy
Endotracheal Intubation
Peritonsillar Abscess
Parapharyngeal Abscess
Upper Airway Foreign Bodies
Vertigo
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Tracheostomy
Cholesteotoma
Tumors of the head and neck
Tracheostomy Tube Placement
Mastoiditis
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SICU
Meeting Place: SICU D3
Contact Number: (718) 245-4522/3982
Daily Rounds: 6:30 am daily
Schedule: The on-call schedule is made by the Department of Surgery. EM residents will
have similar call responsibilities as surgical residents
Residents will NOT be required to attend the weekly ED educational conferences
EM Faculty Liaison: Dr. Bonny Baron
Educational Objectives:
PGY-2 Emergency Medicine Residents will spend four weeks in the SICU at Kings
County Hospital. The Emergency Medicine PGY-2 resident will function as PGY-2
Surgical Residents. They will have critical care patient responsibilities under the direct
supervision of a PGY-4 general surgery resident and general surgery/trauma/critical care
attending physicians. While on rotation they will attend daily patient care work rounds
and attend daily educational rounds. They will attend the weekly trauma conference.
At the completion of this rotation, the Resident will demonstrate competence in and will
be able to:
 perform initial ICU assessment of critically ill and injured patients using history and
physical examinations
 understand the indication for invasive monitoring and its goals and complications
 master the principles of shock resuscitation especially as defined by oxygen transport
parameters
 understand the indications and complications of inotropes, vasopressors, preload
reducing agents, and afterload reducing agents
 understand the proposed mechanisms of multiple organ failure including mediators of
the inflammatory response and therapies designed to modulate this response
 understand the modifications necessary in resuscitation of patients with closed head
injuries
 master the indications for, and use of mechanical ventilators including the ability to
wean a patient from a ventilator
 understand the indications for and use of enteral and parenteral nutritional support
 identify the signs and symptoms of early sepsis and the work-up necessary for full
investigation
 understand the rationale for antibiotic use in the Intensive Care unit: prophylactic and
therapeutic
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assess renal function in critical illness, including the use of creatinine clearance, free
water clearance and fractional excretion of sodium as diagnostic tools
understand the evaluation of hepatic function in critical illness
manage life threatening gastrointestinal bleeding
mange drainage tubes
understand the mechanism and treatment of common coagulopathies associated with
organ failure in critical illness
compassionately interact with patients and their families during the stress of illness
and death, including the ability to obtain DNR orders
Description of clinical experiences:
Residents demonstrate competence in the following procedures on this rotation:
 Cardiopulmonary resuscitation
 Airway management and endotracheal intubation (nasal and oral)
 Management of ICP monitors and ventricular drains
 Placement and care of central venous catheters
 Placement and care of arterial catheters in all sites
 Placement and care of pulmonary artery catheters
 Utilization of oxygen delivery devices and mechanical ventilators
 Lumbar puncture
 Obtaining cultures from all sites and tissues
 Placement of enteral feeding tubes
 Arterial blood gas sampling and analysis
 Abdominal paracentesis
 Thoracentesis
 Tube thoracostomy
 Placement of esophageal/gastric balloons
 Assisting in performance of peritoneal dialysis and continuous A-V hemofiltration
 Assisting in endoscopic examination of the upper and lower GI tracts
Description of didactic experiences:
The residents will attend daily, weekly and monthly surgical/critical care/ trauma
conferences.
The following topics should be covered in the resident’s reading during this rotation:
Airway management
Mechanical ventilation
Interpretation of invasive monitoring
Post-operative management
Pneumonia
Blood product usage
Broad spectrum antibiotics
Hemodialysis/peritoneal dialysis
Intracerebral bleeding/CVA
Shock
ACLS
High frequency ventilation
ARDS
Wound management
A-V hemofiltration
Super-infection
Acute renal failure
Gastrointestinal hemorrhage
Hepatic encephalopathy
Sepsis
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Uremic encephalopathy
Pulmonary embolism
Cardiogenic pulmonary edema
Fever
Electrolyte abnormalities
Disseminated intravascular coagulation
Sedation
Anticoagulant therapy
Coma/brain death examination
Dysrhythmias
Acid base derangements
Nutrition: parenteral and enteral
Hemolysis
Drug induced paralysis
Core Competencies addressed in this rotation
Patient Care
 Mastering surgical resuscitation.
 Experience with longitudinal care of the trauma patient
 Experience with the complications of severe fractures
 Experience with the complications of severe thorax injuries
 Experience with the complications of severe vascular injuries
 Experience with the complications of severe head injuries
 Experience with the complications of multi-organ dysfunction
 Post-operative care of the critical patient
 Ventilator Management
Medical Knowledge
 Learning and avoiding common errors in surgical critical care
 Gaining an understanding of the unique issues pertinent to surgical patients
 Gaining an understanding of the unique issues pertinent to post-op patients
 Pain control strategies
 Cognitive mastery of emergent trauma care
 Ventilator weaning protocols and procedures
Interpersonal and Communication Skills
 Working with surgical, trauma, orthopedic, nutrition, rehab, neurosurgical and
medical professionals
 Working with respiratory, Social Services, PT ancillary services
 Integration into an ICU team with critical injuries
 Patient/family communication and comfort
Professionalism
 Integration into an surgical critical care team
 Pain Management
Systems-Based practice
 Integration into the ancillary services of Social Services, discharge planning,
utilization review, OT and PT.
 Admission and transfer criteria for critical surgical patients
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Practice Based Learning and Improvement
 Participate in CQI system of surgical department
 Participate in trauma/surgical M&M case conferences
 Maintain resident portfolio
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NEUROLOGY
Meeting place: The Neurology office of the Brooklyn VA hospital, 14th floor. Rm 14120
Contact Number: (718) 630-3724
Daily Rounds: 9 am
Responsibilities: Please report daily at 9am to the Neurology office, Rm 14-120 (14th
floor). The direct phone number there is 718 630-3724. Rita Morales is the Neurology
Department secretary and she can be contacted should you have any sort of question
about the rotation. ([email protected]) George Grimley is an additional contact
person and is the administrative officer for the neurology department. His extension is
4747 and his email is [email protected]. Dr. Ann McNeal will be the attending in
charge of this rotation and she can be reached at x3724 or by email at
[email protected]. (Robert Schell will serve as a backup attending should Dr. McNeal
be unavailable. [email protected]
EM Faculty Liaison: Dr. Mark Silverberg
Cell: 917-822-4510
Educational Objectives:
PGY-2 Emergency Medicine Residents will rotate for two weeks on the Neurology
service at the Brooklyn VA. They should be there at 9am on Monday, Tuesday,
Thursday and Friday. Wednesdays they are to show up for the regular EM
conference at Kings County Hospital at 7am. While rotating at the BVA, residents
will work under the direction of the Neurology Attending staff as part of the Neurology
consultant team.
Each day that the residents are at the BVA on the neurology service, they should follow
the neurology attendings in their daily rounds, clinics and consults. In addition, the EM
resident will attend all Department of Neurology conferences and educational events.
At the completion of this rotation the resident will demonstrate competence in the
following concepts:
 Performance of a comprehensive neurologic history and physical exam. (MK,PC)
 Development of an integrated problem list for patients, including detailed
differential diagnoses. (MK,PC)
 Learn to localize neurological lesions in the CNS after performing a
comprehensive neurological history and physical examination. (MK,PC)
 Management of the neurologic manifestations of AIDS. (MK,PC)
 Management of different types of headache. (MK,PC)
 Management of stroke; ischemic and hemorrhagic. (MK,PC)
 Evaluation and treatment of the Transient Ischemic Attack. (MK,PC)
 Management of the seizure patient. (MK,PC)
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Management of multiple sclerosis exacerbations. (MK,PC)
The evaluation and treatment of pseudotumor cerebri. (MK,PC)
The evaluation and treatment of neuro-muscular diseases. (MK,PC)
Management of the neurologic manifestations of diabetes. (MK,PC)
Diagnosis and management of patients with CNS infections. (MK,PC)
Basic Head CT and MRI interpretation. (MK,PC)
Development of the Doctor-Patient relationship as the resident interacts with
patients and their families during the stress of illness and death. (PC,C,P)
Description of clinical experiences:
Residents should demonstrate competence in the following procedures on this rotation:
 Lumbar puncture
 Electroencephalography
 Electromyography
Description of didactic experiences:
The following topics should be covered in the resident’s reading during this rotation:
Cerebral aneurysm
Hemorrhagic stroke
Vertebro-basilar insufficiency
Subarachnoid hemorrhage
Trigeminal neuralgia
Neuro-intubation
CNS abscess
Myelitis
Guillain-Barré Syndrome
Peripheral neuropathy
V-P shunts
Pseudotumor cerebri
Seizure disorders
EMG
Head CT and MRI evaluation
Arteriovenous malformation
Ischemic stroke
Transient ischemic attack
Bell’s palsy
Amyotrophic lateral sclerosis
Multiple sclerosis
Meningitis/encephalitis
Neuritis
Myasthenia gravis
Spinal cord compression
Headache
Normal pressure hydrocephalus
Anti-seizure medication
EEG
Brain death and its examination
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Emergency Orthopedic/Fast Track Rotation
Orthopedics is a major component of the daily cases seen by Emergency Medicine
physicians. The goal of this rotation is to increase orthopedic exposure to the emergency
medicine residents so that they feel comfortable managing various orthopedic
emergencies.
The rotation is 4 weeks spent in the fast track emergency department at Kings County
Hospital. The resident is to evaluate every orthopedic emergency case that comes
through the emergency department in addition to seeing fast track cases. Residents are
allowed to cherry pick orthopedic cases from the call to treatment list. When orthopedic
cases are identified in Suite A and B, Fast track by other ED attendings or residents, the
ED orthopedic resident will be paged (there is an orthopedic pager – pick it up from
Stephanie or the previous resident on Ortho). If there are no orthopedic cases
(fractures/sprains), the resident should see musculoskeletal cases. If there are no
orthopedic or musculoskeletal cases the resident should see regular fast track cases.
Every orthopedic case and procedure must be placed in the residents’ personal logbook,
which will be collected at the end of the rotation and must be turned in prior to the exam.
If the orthopedic case requires surgical intervention, admission, requires additional
assistance or is beyond the scope or comfort of the Emergency Medicine attending, the
orthopedic resident should be called. When able to, the ED orthopedic resident should be
the one calling the orthopedic resident for the consult.
Emergency Medicine residents should also see pediatric orthopedic cases; however, the
orthopedic resident should be called to see these cases as well.
On days when the emergency medicine resident is working during the day, the resident is
to also go to morning orthopedic surgery resident rounds to go over the patients that were
formally consulted the previous day. Be prepared.
The resident work schedule is the following:
Monday and Tuesday 6a-6p (Morning report is at 6am in C – 3 and you are required
to be there)
Thursday and Friday 11a-11p (no morning report on these 2 days)
Contact Dr. Gore prior to the start of your rotation –
[email protected] or 312-399-3451
Orthopedic Examination Required Reading
1. General Principles of Orthopedic Injuries (from Rosen’s) – a copy will be
provided for you
2. Ankle and Foot – (from Rosen’s). A copy will be provided for you
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3.
4.
5.
6.
7.
Injury to the Hand and Digits – Tintinalli p1665-1674
Wrist Injuries – Tintinalli p 1674-1684
Injuries to the Shoulder Complex and Humerus – Tintinalli p1695-1702
Knee Injuries – Tintinalli p1726-1734
Leg Injuries – Tintinalli p1734-1736
On the last Wed conference of the block (before you switch) at 7am, the residents will
have a closed book examination. A passing grade will be 80% or above. The exam
will consist of multiple-choice questions and five essays. The essays will consist of
interpretation of orthopedic x-rays, including injury complications, correct orthopedic
fracture nomenclature and management of these various injuries. It should take ~1 hour
to 1 ½ hours to complete the entire exam.
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PGY-3 OFF SERVICE ROTATIONS
EMS
Toxicology
Ultrasound
Research
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EMS
Contact:
EMS – FDNY
Dr. Bradley Kaufman
(718) 999-1872
Olethea Wernersbach
(scheduling)
(718) 281-8463
Christopher Doty, MD
((917)760-2005
Contact:
Faculty Liaison:
Educational Objectives:
The EMS rotation will provide a general exposure to the medical, regulatory, legislative,
administrative, political, and organizational aspects of pre-hospital care. By completion
of this rotation, the resident will have developed the basic groundwork for understanding
the structure and function of Emergency Medical Services. The resident will spend two
weeks on this rotation. The base for the rotation will be the Fire Department of the City
of New York. The Emergency Medicine Resident will accompany EMTs and Paramedics
on ambulance runs. This will be supplemented with experience at the FDNY on-line
medical control center and at the EMS academy where residents will participate in
Paramedic and EMT training. Residents will be under the direct supervision of the
Medical Directors at the Fire Department’s Office of Medical Affairs.
At the completion of this rotation the Resident will demonstrate competence in the
following concepts:
 The history and development of EMS(MK)
 The political forces which impact on EMS(SBP)
 Hospital and departmental categorization(SBP)
 The principles of disaster management and preparedness(MK)
 The training of prehospital personnel(C,P)
 The role of the Emergency Physician and Department in the training of pre-hospital
personnel(P,C,PBL)
 The contributions of the various participants in an EMS system(MK,P,C)
 The various organizational structures of EMS systems(MK,SBP)
 The concepts of medical control(MK,SBP)
 The various EMS protocols and their applications(MK,SBP)
 The principles of EMS communication and 911(MK,SBP,C)
 Fiscal and regulatory issues related to EMS(MK,SBP)
Description of clinical experiences(MK,PC)
Residents should have experience and demonstrate competence in the following
procedures on this rotation:
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







Assessing scene safety
Functioning as off-line medical control
Functioning as on-line medical control
Providing medical care in the pre-hospital environment; including procedures as:
Extrication
Immobilizations and spine injury precautions
Airway management in the field
Vascular access in the field
Description of didactic experiences: (MK,PC,SBP)
The following topics should be covered in lectures or readings during this rotation:
A. Overview
1. History of EMS
2. National, state, and local
3. Various types of service
4. Level of care
5. Volunteer vs. hospital based vs. city/county based vs. commercial
B. Fiscal Aspects of EMS
1. Costs and resources, billing
C. Organizational Aspects of EMS
1. Levels of EMT training and skills; fire, police, MD, administrators
2. Equipment and vehicles
3. Local, state, and federal regulations
4. EMS Medical Director
5. Development of 911
6. Receiving and dispatch
7. Communications and telemetry systems
8. Field triage
9. Interface with other services (police and fire)
D. Categorization and designation of hospitals and hospital services
E. Medical Control
1. Centralized vs. decentralized
2. The role of the Medical Director
3. The role of the Emergency Physician
4. Development and implementation of protocols
5. On-line and off-line medical control
6. Call review and CME for the prehospital provider
F. Air Transport Systems
G. Disaster Planning and Management
1. Planning for prehospital disasters
a. The EMS role
b. The hospital role
2. Special disasters
a. Biological
b. Chemical
c. Radiation
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H. Education
1. CPR
2. EMT
3. AEMT
4. EMT-P
5. First aid and first responder training
6. Public education
I. The Role of EMS in Public Education
1. Issues of organization
2. Issues of medical treatment and level of care
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EMS Rotation Information
The EMS rotation starts on the Monday morning of the first week of the 2-week block.
Residents from Emergency Medicine programs throughout New York City meet at 9am
with one of the EMS Medical Directors at the Fire Department’s Headquarters at 9
MetroTech Center in Downtown Brooklyn (Office of Medical Affairs, 4th floor
conference room).
Enter the building from the courtyard side (not the entrance on Flatbush Avenue). You
will need a picture I.D. in order to get past the police checkpoint outside the building, and
also to obtain a visitors’ pass once inside the building (it is useful to have your hospital
I.D. with you in addition to your driver’s license). Once inside, you will need to pass
through a metal detector and will not be allowed upstairs with any knives, weapons,
explosives, etc. (so please leave any such items at home as there aren’t any lockers or
places for storage).
The morning of the first day includes a series of lectures and discussions about EMS in
New York City as well as various academic EMS-related topics. The schedule and
requirements for the rest of the rotation will be reviewed at that time. Usually there is a
lunch break followed by some more discussions and a visit to the 911-communications
center. The day is over by 4pm (and usually an hour or two earlier).
Each Resident will be given an individualized schedule for the 2-week block. Most days
will require ride-alongs with either ALS or BLS ambulances. One of the days will be an
observation at the On-Line Medical Control Facility (“Telemetry”) and there may also be
a day assigned to teaching or testing EMT’s or Paramedics at our training academy.
Most observations or ride-alongs are 8-hours long (e.g., 8am-4pm, 10am-6pm, 3pm11pm). Weekends are usually left unscheduled. You will be required to be signed in and
out each day.
There will be a few assignments for you to complete during the rotation. The
assignments often include a write-up of an interesting patient you encountered during the
ride-alongs or a simple research project on an assigned EMS topic.
The ride-alongs offer an opportunity for you to observe the capabilities of EMS providers
and to give you insight into the care provided to patients prior to their arrival at the
Emergency Department. The pre-hospital environment is less controlled than the E.D.,
and therefore you must always be cognizant of scene safety and the potential for
unsuspected situations to arise. The EMT’s and Paramedics are acutely aware of such
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things, and I always advise the Residents to stay close by your assigned providers at all
times.
You will find the EMT’s and Paramedics are eager to involve you in the assessment and
care of patients in order that they may gleam some of your medical knowledge and skills.
However, your role on the ride-alongs is officially as an observer only.
The rotation concludes on the Friday of the second week. On this day everybody again
meets at the Fire Department Headquarters (or another predetermined location) to discuss
the rotation, present the assigned topics, as well as review some other EMS issues. Your
attendance as well as performance on the assigned topics helps determine your grade for
the rotation.
One more point worth mentioning. The first and last days of the rotation will be at the
FDNY Headquarters building. As this is an office environment, you will be expected to
dress accordingly (pants/skirt, shirt/blouse, tie). Some of the Medical Directors are very
strict on the appropriateness of dress, and will not allow you to stay if you are wearing
scrubs, jeans, etc. (and if you are dismissed from the first day then you will not be able to
do the rotation for that 2-week block). When riding-along on an ambulance, you will be
expected to wear dark pants and a work shirt (e.g., long-sleeve button-down). It is
especially important to wear shoes that are comfortable to do a lot of walking in. Please
do not wear jeans, t-shirts, or sneakers on the ride-alongs. Of course, always have your
hospital I.D. with you.
If you would like to gain extra knowledge or experience, or if you are interested in doing
a Fellowship in EMS or Disaster Management, we also offer a 2 or 4-week EMS elective
rotation that you might consider. Additionally, we welcome Residents who are interested
in working on EMS research (either joining an ongoing project or developing one of your
own).
If you have any questions or require additional information, feel free to contact Dr.
Kaufman, the Resident Rotation Program Director (718-999-1872,
[email protected]), or Olethea Wernersbach, the Resident Rotation Coordinator
(718-281-8463, [email protected]).
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Bradley Kaufman MD, FACEP
Emergency Medicine Resident Emergency Medical Service rotation:

Didactic sessions:
o Two sessions conducted with Dr. Kaufman
o Session one is an introductory session to Emergency Medical Services. This
session reviews the following topics:
 The goals and objectives of the rotation
 The role of the emergency medicine physician in the
prehospital sector
 Review safety (including infection control) issues related to field EMS
observation
 Use of PPE
 Resuscitation practices and procedures
 Needle stick issues
 Discuss the history of EMS in New York City
 Discuss the operational characteristics (including limitations) of the
New York City FDNY/EMS 911 system
 Call receiving, CRO, and dispatching
 Operational statistics: daily and annual
 Integration of FDNY/EMS, and Voluntary 911 units
 Destination hospital receiving facilities and Specialty Referral
Centers
 The role of the Volunteer sector and commercial transport
system relative to 911 service
 Discuss the role of Telemetry
 Role and responsibility of the telemetry physician
 Issues related to audio documentation
 Real time contact requirements
 Discuss the system participants: levels of certification, training
requirements, on scene responsibilities
 CFR-D
 EMT-B
 EMT-A/Paramedic
 EMS-MD
 Review the role and general structure of Incident Command
 Role of the physician in transport decisions
 The relationship between the on-scene physician and incident
command function
 To discuss the issues of social customs and the field responder
 Its effect on EMS training and the EMS medical director
 To discuss the basics of disaster management and response
 Including EMS/USAR national responses
 14 th Street subway incident
 Basics of domestic (B-NICE) terrorism
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
Review the Tokyo Subway Sarin incident
o Its effect on the prehospital system in the US
o The hospital associated issues of the event
 Complete review of the S.T.A.R.T. (Triage) system
 EMS triage process: color coding designation
o Clinical expectancy issues
 Role of the emergency medicine (field) physician in the
different medical sectors
 Limitations of EMT and Paramedic triage
 Exercise in the START process: multiple case based exercise
 Assign final day presentations
 Five to ten minute PowerPoint presentation
 Selected topic on a prehospital/emergency medicine topic (see
attached)
 All topics in the same related area
 Internet based
 General administrative activities
 Review and distribute the resident schedule for the rotation
 Complete the necessary administrative Ambulance Observation
form
 Complete a resident demographic form
o Ambulance Field Rotations
 Residents are scheduled for ALS and BLS field observation
 Residents are scheduled (unless specifically requested) for
FDNY units in close proximity to their residencies
o To afford them to observe their patients in their home
environment
o Work with units that typically respond to their facility
 Scheduled rides are usually limited to units that have had
resident observers in the past and are accustomed to physician
observers
o Telemetry Rotation
 One day rotation
 Observe the telemetry physician as he/she manages incoming calls for:
 Cardiac arrest
 Transport decisions
 RMA field contacts
 Medication orders
o Session two is conducted on the final day of the rotation, this includes the
following:
 Rotation resident issues:
 Issues that need to be addressed
o Ambulance observation
o Telemetry
o Missed rotation sessions
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



o Recommendations for rotation change or modification
Review of Telemetry rotation:
 Telemetry session and the role of RMA’s, cardiac arrest, and
provision of medical care
 The documentation process and the need for physician contact
 The issue and rational of transportation decisions
Review of field operations:
 The interaction with patients in their homes
 The interaction with other emergency responders at the scene
 Transportation decisions
 Interaction and management of patients on the street (including
subways and offices)
 Use of equipment by EMS: EKG, pulse oximetry, etc.
 Reception and interactions at destination hospitals
Topic presentation and discussion
Dr. Kaufman review and summation of rotation
 Relevance to emergency medicine
 Final review and discussion of the assigned topic
o Its relationship to prehospital and Emergency
Department operations
o The relationship and potential public health issues
o “System” preparedness
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Directions to FDNY Headquarters
9 MetroTech Center is located on the SW corner of Flatbush Avenue and Tech
Place in downtown Brooklyn. The front entrance to FDNY Headquarters faces
Bridge Street in the MetroTech complex. Please note that there is no public
parking available at FDNY Headquarters, metered and commercial parking is
available nearby on Flatbush Avenue.
Directions by Car:
From the Brooklyn Bridge:
After crossing the Bridge make the first left turn onto Tillary Street. Proceed to
the second traffic light at Flatbush Avenue. Turn right onto Flatbush Avenue.
Proceed one block to Tech Place. FDNY will be on your right; parking is ahead
one block.
From the Manhattan Bridge:
Continue straight off the Bridge onto Flatbush Avenue. Proceed through the light
at the intersection of Tillary Street and Flatbush Avenue for one block to Tech
Place. FDNY will be on your right.
From the Brooklyn Queens Expressway West:
Exit at Tillary Street; turn left at the second traffic light onto Flatbush Avenue.
Proceed one block to Tech Place. FDNY will be on your right.
From the Brooklyn Queens Expressway East:
Exit at Cadman Plaza West. Make a left onto Cadman Plaza West. Make a left
at Tillary Street (second light) to Flatbush Avenue (third light). Turn right and
proceed one block to Tech Place. FDNY will be on your right.
Directions by Subway: Call 718-330-1234 for updated information.
A, C, or F subway to the Jay Street/Borough Hall station.
R or M subway to the Lawrence Street / MetroTech station.
Q or B subway to the DeKalb Avenue station; change to the R or M subway
(Manhattan bound) to the Lawrence Street / MetroTech station.
2, 3, 4 or 5 subway to the Court Street / Borough Hall station. Change for the R
subway (Manhattan bound) to the Lawrence Street / MetroTech station.
Directions by LIRR: Call 718-217-5477 for updated information.
From the Flatbush Avenue Station in Brooklyn, take the Q or B train one stop to
DeKalb Avenue (Manhattan bound). At DeKalb Avenue, go across the platform
for the R or M subway to the Lawrence Street / MetroTech station.
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From Lawrence Street:
Walk toward the Commons on Lawrence Street, then diagonally across the
Commons to 9 Metro Tech on the Flatbush Avenue side.
From Jay Street:
Walk diagonally across the Commons to 9 Metro Tech on the Flatbush Avenue
side.
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TOXICOLOGY
EM Faculty Liaison: Dr. Sage Wiener
Description and Goals of Rotation: The rotation at the New York Poison Control
Center (NYCPCC) is your opportunity to exclusively focus on medical toxicology.
During the rotation you should make an effort to become familiar with general
approaches to the poisoned patient and clinical presentations of common toxidromes.
You should also develop a basic understanding of poison prevention techniques,
pharmacokinetics, toxicokinetics, resuscitation of the poisoned patient and commonly
used antidotes.
Meeting Place: 8:15 AM in the Bellevue Hospital Emergency Department conference
room for morning report. After morning report, residents should go to the New York
City Department of Health/NYCPCC ground floor conference room. The address is 455
1st Avenue (corner of 26th Street). Check in with one of the toxicology fellows upon
arrival.
NYU/Bellevue Hospital Center
New York City Poison Control Center
Schedule: Weekdays: 8:15 AM - 4:00 PM
Contact: Dr. Lewis Nelson, Director, Fellowship in Medical Toxicology
Tel: (212) 447-8150
Special Considerations:
1. Attendance at the Bellevue Department of Emergency Medicine Morning Report is
mandatory.
2. The morning will be spent doing follow-up calls and the afternoon generally is
dedicated to didactic teaching rounds.
3. All residents rotating at the poison center are required to present a topic (project) that
interests them by the end of their rotation. When deciding on a presentation topic, ,
discussion with one of the toxicology fellows is imperative so that you may be
properly focused. The talk should be designed to educate the group (toxicology
attendings, fellows, residents and medical students) and attempt to answer a question
that has been raised regarding a specific clinical case. The talk should be at most 10
minutes in length. A handout may be helpful but a formal Powerpoint slide
presentation is excessive.
4. Once a month, there will be a Consultants’ Conference meeting scheduled on the first
Thursday at 2:00 PM. It is usually held in the ground floor auditorium of the
Department of Health building where the poison control center is located. You are
welcome to continue going to these conferences during other blocks if you are free.
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This is an especially good idea if you are considering applying for a toxicology
fellowship.
5. Take advantage of your time at the NYCPCC as other physicians from all over the
United States and other countries come to New York City to participate in the
elective. This is not the month to “blow off” days. Be on time and actively
participate in toxicology rounds.
6. Residents are required to attend weekly KCH Wednesday Emergency Medicine
Departmental Conference
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RESEARCH
Active participation in a research project is a requirement for all residents in the
Department of Emergency Medicine. Residents will receive a two-week period during the
second year of residency and a two-week period during the third year of residency
dedicated to their research projects. These research periods will be assigned during an
Emergency Department rotation at Kings County. In order for this time to be productive,
it is extremely helpful to have a project planned before you begin the initial two-week
period. The resources necessary to successfully complete your project, including
statistical and administrative support will be provided by the department.
Attendance at Wednesday conference is mandatory.
If the resident does not contact the research division at least 4 weeks prior to
beginning the research rotation, the resident will be scheduled for shifts in the ED.
One Thursday at 11am during month, the resident will participate in a combined
Emergency Medicine/Trauma Service simulation session in the simulation lab. Contact
the simulator division for further information the month prior to the start of the rotation.
How to Start?
On the first Wednesday of every month, ongoing projects are reviewed and new research
projects are presented during conference. This information is available on the ED website
in the Research Update newsletter. The Research Update is also posted monthly on the
research bulletin board outside of the conference room. All PGY II and III residents
should contact Dr. Zehtabchi ([email protected]) at least one
month prior to the start of their research rotation to setup a project. Residents are
strongly encouraged to start a new project, starting from literature search, study design,
planning the logistic aspects of the project, etc. However, they may join projects already
in development, and completing or helping to complete a research project of suitable
quality for publication may fulfill the requirement. For authorship in a manuscript,
residents need to meet the criteria outlined in the authorship policy that is published in
the monthly research update.
IRB Certification:
All attendings and residents are required to obtain the certification for “Human
Participants Protection Education.” To complete your certification, please sign on to CITI
(Collaborative IRB Training Initiative) computer based training program at
http://www.miami.edu/bb/sunyreg.
Didactic Research Lectures:
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The first Wednesday of each month, the research division will have a one hour lecture
dedicated to research methodology, biostatistics, and evidenced-based medicine. All
residents and faculty are welcome to attend these lectures. The topics of these lectures are
published at the beginning of each year in the annual research update handbook.
Research Office Hours:
Every Wednesday Dr. Sinert and Dr. Zehtabchi will be available in their offices (9 am to
4 pm) to meet with faculty and residents on research issues. Please contact them one
week in advance to set up a time.
How to Choose a Project:
The department of emergency medicine offers the residents research projects in a variety
of emergency medicine fields. Residents are welcomed to start their own projects or to
join the investigators of one of the active projects. The faculty and residents of the
department of emergency medicine have conducted several research projects in the field
of Trauma and Hemorrhagic Shock, Sickle cell Anemia, Toxicology, Evidenced-Based
Medicine, and Medical Student/Resident Education.
Academic Associates Program:
The Academic Associate Emergency Medicine Clinical Research Program teaches the
fundamentals of research to undergraduate pre-med students and medical students. This
course is modeled after the novel clinical research elective Dr. Hollander first developed
at SUNY Stony Brook. The Academic Associates work in conjunction with the ED staff
to help identify and enroll patients who meet the specific inclusion/exclusion criteria for
our clinical trials. The Academic Associates are responsible for the appropriate
paperwork and data processing within the required time frame for each of the studies.
Duties include data collection, collation, forms processing, and assisting in database
configuration, statistical analysis, and abstract and manuscript preparation. Coupled with
the “hands-on” data collection, a didactic program focusing on research design, and basic
statistics will be organized for the academic associates by the research division. This
program stresses professional responsibility, independent thinking, research design and
data collection methods. Non-medical student Academic Associates (college students)
are not permitted to draw blood, or handle laboratory specimens. Please remember
that they are college students with no formal medical training.
Please make them feel at home and do not hesitate to help them perform their tasks in any
way you can.
Policy: Authorship and Contributorship
Byline Authors
An "author" is generally considered to be someone who has made substantive intellectual
contributions to a published study, and biomedical authorship continues to have
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important academic, social, and financial implications. (1) In the past, readers were rarely
provided with information about contributions to studies from those listed as authors and
in acknowledgments. (2) Some journals now request and publish information about the
contributions of each person named as having participated in a submitted study, at least
for original research. Editors are strongly encouraged to develop and implement a
contributorship policy, as well as a policy on identifying who is responsible for the
integrity of the work as a whole.
While contributorship and guarantorship policies obviously remove much of the
ambiguity surrounding contributions, it leaves unresolved the question of the quantity and
quality of contribution that qualify for authorship. The International Committee of
Medical Journal Editors has recommended the following criteria for authorship; these
criteria are still appropriate for those journals that distinguish authors from other
contributors.





Authorship credit should be based on 1) substantial contributions to conception
and design, or acquisition of data, or analysis and interpretation of data; 2)
drafting the article or revising it critically for important intellectual content; and
3) final approval of the version to be published. Authors should meet conditions
1, 2, and 3.
When a large, multi-center group has conducted the work, the group should
identify the individuals who accept direct responsibility for the manuscript (3).
These individuals should fully meet the criteria for authorship defined above and
editors will ask these individuals to complete journal-specific author and conflict
of interest disclosure forms. When submitting a group author manuscript, the
corresponding author should clearly indicate the preferred citation and should
clearly identify all individual authors as well as the group name. Journals will
generally list other members of the group in the acknowledgments. The National
Library of Medicine indexes the group name and the names of individuals the
group has identified as being directly responsible for the manuscript.
Acquisition of funding, collection of data, or general supervision of the research
group, alone, does not justify authorship.
All persons designated as authors should qualify for authorship, and all those who
qualify should be listed.
Each author should have participated sufficiently in the work to take public
responsibility for appropriate portions of the content.
Some journals now also request that one or more authors, referred to as "guarantors," be
identified as the persons who take responsibility for the integrity of the work as a whole,
from inception to published article, and publish that information.
Increasingly, authorship of multi-center trials is attributed to a group. All members of the
group who are named as authors should fully meet the above criteria for authorship.
The order of authorship on the byline should be a joint decision of the co-authors.
Authors should be prepared to explain the order in which authors are listed. .
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For further information on this and other policies visit http://www.icmje.org.
Research Contact Numbers:
Dr. Richard Sinert:
Director of Research
Telephone extension 2973
E-mail: [email protected]
Dr. Shahriar Zehtabchi
Associate Director of Research
E-mail: [email protected]
Dr. Lorenzo Paladino
Assistant Director of Research
Beeper: (917) 219-6276
[email protected]
Chaiya Laoteppitaks
Chief Resident of Research
[email protected]
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EMERGENCY ULTRASOUND ROTATION
TRAINING LEVEL: PGY 3 AND/OR PGY 4
DURATION: 4 WEEKS (2 WEEKS as PGY-3 and 2 WEEKS AS PGY-4)
LOCATION: UHB and KCH ED
FACULTY:
Dr. Secko
Cell: (631) 645-7200
Email: [email protected]
Dr. Gullett
Cell: (205) 568-6463
Email: [email protected]
Dr. Gleyzer
Pager: (917) 761-1098
Email: [email protected]
Dr. Mehta
Cell: (917) 642-6139
Email: [email protected]
Dr. Papanagnou
Cell: (917) 596-3828
Email: [email protected]
FELLOWS 2010-2011:
Dr. Maria Romney Cell: 646-261-1395
Email: [email protected]
Dr. Leah Bright
Cell: 917-544-7687
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Email: [email protected]
OBJECTIVES:
1. To understand basic physics and instrumentation of medical ultrasound equipment
2. To learn how to use the ultrasound systems available in KCH and UHB
Emergency Departments
3. To review normal sonographic anatomy and pathophysiology of the thorax,
abdomen and pelvis.
4. To understand indications and limitations of bedside emergency ultrasound.
5. To learn how to perform the following studies:
a. Extended Focused Assessment with Sonography in Trauma (e-FAST)
i. Hemoperitoneum
ii. Hemopericardium
iii. Hemothorax
iv. Pneumothorax
b. Focused Gynecologic and Obstetric Ultrasound
i. Intrauterine pregnancy
ii. Ectopic pregnancy
iii. Threatened/Incomplete/Complete Abortion
iv. Ovarian cysts/adnexal masses
c. Focused Biliary Ultrasound
i. Gallstones
ii. Cholecystitis
iii. Choledocholithiasis
d. Focused Echocardiography
i. Pericardial effusion
ii. LV and RV function
iii. Gross valvular abnormalities
iv. Volume assessment
e. Focused Abdominal Aorta Ultrasound
i. Aortic aneurysm
ii. Aortic dissection
f. Focused Renal Ultrasound
i. Hydronephrosis
ii. Urolithiasis
g. Focused Vascular Ultrasound
i. Deep venous thrombosis
h. Focused Skin and Soft Tissue Ultrasound
i. Abscess
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ii.
iii.
iv.
v.
vi.
Foreign body
Cellulitis
Tendon injuries
Fractures
Dislocations
i. Focused Ophthalmic Ultrasound
i. Retinal detachment
ii. Vitreous hemorrhage
iii. Lens dislocation
iv. CRAO/CRVO
j. Ultrasound guided vascular access and additional US guided procedures
k. Regional anesthesia and musculoskeletal US
ATTENDANCE AND SCHEDULE: YOU MUST E-MAIL THE ULTRASOUND
DIRECTOR AT LEAST ONE WEEK PRIOR TO THE START OF YOUR
ROTATION SO WE CAN ADJUST OUR SCHEDULES TO MEET WITH YOU
During the rotation the resident is expected to be present in the Department Monday –
Friday 9am – 5 pm. Attendance is mandatory. Specific daily tasks will be assigned by
the individual Attending of the day. On the first day of the rotation the resident is to
report to the Kings County Emergency Department Offices to meet with Ultrasound
Faculty and/or Fellows for orientation at 0900AM. Attendance at Wednesday
Conference is mandatory. The residents must also meet on Thursdays at 9am for tape
review located in US room next to the simulation center.
DIDACTIC TRAINING: Before starting the rotation, make sure you obtain a copy
of the Guide to the Senior Resident Rotation for specific instructions on the use of
the machines and an introduction to Emergency Ultrasound and the Ultrasound
Curriculum
In the beginning of the rotation the resident will be assigned specific readings including
articles and chapters from several textbooks. Articles will be provided. All textbooks are
available at the Downstate Medical Library and in on-line format. Ultrasound Journal
Club will be conducted during the second week of the rotation and residents are required
to briefly discuss a paper from the recent literature relevant to Emergency Ultrasound.
Each resident must be prepared to present one ultrasound paper at tape review.
CLINICAL TRAINING:
During the rotation, a resident will be assigned to perform the following tasks:
1.
2.
3.
4.
Bedside US imaging under direct attending supervision
Bedside US-guided procedures under direct attending supervision
Independent bedside US imaging with weekly image review by division faculty
Responding to trauma codes for bedside e-FAST exams
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5. Daily machine checks, machine maintenance and restocking of supplies
6. Enrollment of patients into active ultrasound research trials
7. Instruction of co-residents, interns and students
EVALUATION:
Upon completion of the rotation, the resident will be evaluated based on his/her
attendance, motivation, didactic knowledge and procedural skills. The evaluation form
will be submitted to the residency directors and will be placed in the resident’s file. The
resident will have access to the evaluation. The resident will be also asked to evaluate the
rotation and provide suggestions on its improvement.
PRIOR TO STARTING THE ROTATION GO TO: http://www.sunysono.com
Then click on "Resources", then click on the Guide to Senior Rotation.
When prompted:
user = suny
Passwords = "s0n0" (to login to the website) and "s0n0graphy" (to open pdf) (those
are with zeros, NOT capital o's)
Note:
1. Currently at UHB all studies are stored to the internal hard drive on the
Philips HD11XE and MTurbo. At KCHC all studies are stored to the
internal hard drives of the SonoSite MTurbo and GE LogicQ P5 systems.
The Division faculty and fellows will orient you to image documentation on
the first day of the rotation.
2. Image interpretation. ALL STUDIES WITHOUT EXCEPTION MUST
CONTAIN THE FOLLOWING:
a. Sonographers’ last name(s)
b. Patient’s MR number
c. Interpretation in text on the screen (i.e. RUQ, no FF)
3. Do NOT log your studies into any procedures database. The Ultrasound
Division keeps an independent record of your ultrasounds for credentialing
and QA purposes.
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PGY-4 OFF SERVICE ROTATIONS
Free Elective:
Medico-legal
Medical Examiner
Dermatology
Oral Surgery
Others
Administration
Teaching Rotation
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ELECTIVE
EM Faculty Liaison: Dr. Christopher Doty
pager: (917) 760-2005
The elective rotation is an opportunity for residents in their final years of training to gain
experience in an aspect of Emergency Medicine that is not part of our formal residency
curriculum or in-depth study of a field of EM. In very general terms, the goal of the
rotation is for the resident to strengthen an area of clinical weakness or to learn more
about one of the subspecialty areas of Emergency Medicine. You are responsible for
setting up your own elective.
Rotations away from Kings County are acceptable but require planning on your part.
Possibilities for outside rotations include Hyperbarics, Radiology, Burn Unit, Ultrasound
training, International Emergency Medicine (South Africa, Lesotho, Mexico, Nepal,
Sweden, Haiti, Malawi, Botswana, Jamaica, Turkey, Romania and others), Research,
Rural Emergency Medicine, Sonography, EMS, Pediatrics, or Toxicology and many
others.
Creativity in planning your rotation is encouraged, but you must develop an education
plan for the rotation. Dr. Doty will want to see your Goals and Objectives for the rotation,
so plan them and put them in the planner. All rotations need to be approved by Dr.
Doty before arrangements are made with an outside institution. At least 28 days before
the rotation, please review your educational plan with Dr. Doty and fill out the elective
planner (available from Stephanie Lane and below). If you buy plane tickets or make
travel plans without having an approved elective, then YOU HAVE MADE A
GRAVE ERROR.
If you are going to be leaving Kings County, we need a letter from the outside
institution that states the dates you will be rotating and briefly outlines what will be
the expectations for the rotation. YOU MUST DO THIS.
If you are going to do an international elective, then you need to fill out an international
elective planner. See the next section.
If you are going to work in a clinical area, malpractice insurance coverage may be an
issue. Your standard residency malpractice coverage only applies to resident activities,
and your coverage will apply only to SUNY, its affiliates, and HHC hospitals. It is also
possible to apply for SUNY to cover/provide malpractice coverage. This takes time to
set up so start early. You can apply with the form below. Dr. Doty does not make the
decision to provide this coverage, but will help you set up the elective. Attached is a
simple form to be completed while planning your rotation. Finally, upon returning to
Kings County you will need a letter certifying proof of the rotation, and to submit a short
127
written synopsis of the rotation or prepare a brief oral presentation.
Please Note:
Omission or Failure to adequately plan your Elective as outlined above
will result in irrevocable loss of your Elective time. You will be
scheduled for clinical shifts instead. Please comply with this rule.
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ELECTIVE PLANNER WORKSHEET
Elective Planner
Name:
Elective site:
Subject of elective:
Dates of elective:
The goal for the elective:
Briefly below or on attached sheet outline your plan for the elective (please include
goals/objectives/evaluation methods for the rotation):
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International Elective Curriculum
One year ahead
1. Pick a place (general; or specific if you already know it)
a. Consult the SUNY/KCH international elective database
b. Talk to your contacts/make new contacts through networking
c. Talk to departmental faculty
d. Ask Dr. Bloem
2. Define your learning objectives
3. Consider doing a project (or part of one)
4. Plan your budget and look for funding if needed
a. Consult the SUNY/KCH international elective database
6 months ahead
5. Plan a meeting to discuss your elective plan with Dr. Bloem
6. Submit your Elective Plan sheet
By one month after the completion of your elective
7. Submit your reflective statement addressing your experience and how you met
your learning objectives, as well as at least one suggested way to positively
impact the health system (emergency or otherwise) of the place where you
worked. Please make sure to fill out the accommodations, budget, and
contact information section for the sake of future rotators and projects.
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International Elective Plan
Date: __________________________
Name of resident: ___________________________________________________
Location of planned international elective: _______________________________
Elective Point-Of-Contact Person and Title: ______________________________
Contact Address: ___________________________________________________
Contact Phone: _____________________________________________________
Second Elective Point-Of-Contact Person and Title: ________________________
Contact Address: ____________________________________________________
Contact Phone: _____________________________________________________
Accommodation Type (aka, house, apt, dorm): ____________________________
Address: __________________________________________________________
Phone: ____________________________________________________________
ESTIMATED BUDGET
Travel cost: ________________________________________________________
Accommodation cost: ________________________________________________
Food/daily expenses cost: _____________________________________________
Learning Objectives
Please describe below your objectives for your international elective. Include what you
hope to learn, how many hours you plan to work, what activities you will be involved
with, and whether this elective will be related to an International Division project.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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Reflective Statement
Please describe in at 1-2 pages what your experience abroad was like. Include what
your responsibilities were, what kind of activities you participated in, how their
system and patient population differed. State how you met or were unable to meet
your learning objectives (as per your Elective Plan).
Please list at least one suggested way to positively impact the health system
(emergency or otherwise) of the place where you worked. If you have an idea for a
project for the International Division (great!), please describe it here briefly.
Please make sure to fill out the accommodations, budget, and contact
information section below for the sake of future rotators and projects.
Resident name: _____________________________________________________
Location of international elective: ______________________________________
Point-Of-Contact Person and Title: _____________________________________
Contact Address: ___________________________________________________
Contact Phone: _____________________________________________________
Second Point-Of-Contact Person and Title: _______________________________
Contact Address: ____________________________________________________
Contact Phone: _____________________________________________________
Accommodation Type (aka, house, apt, dorm): ____________________________
Address: __________________________________________________________
Phone: ____________________________________________________________
EXPENSES
Travel cost: ________________________________________________________
Accommodation cost: ________________________________________________
Food/daily expenses cost: _____________________________________________
Other expenses (please describe): _______________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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MEDICO-LEGAL
Location:
Offices of McAloon & Friedman, P.C.
Contact:
Offices of McAloon & Friedman
123 Williams Street, New York, NY
212-732-8700
Contact person: Wayne Roth
Description of Rotation:
The resident will spend a 2 or a 4 week block with at McAloon and Friedman, the law
firm which represents HHC hospitals in most large malpractice cases. Work schedule is
5 days per week, Monday through Friday, excluding Wednesday morning.
Daily activities generally begin by 9:00am every morning, with residents acting as
medical experts for selected cases. Attendance at Wednesday Conference is
mandatory. The resident will work under the supervision of staff at McAloon &
Friedman.
Goals and Objectives:
The resident will demonstrate competence in:
1.
Definition and components of malpractice
2.
Process of discovery
3.
Review of the medical record from medico-legal perspective
4.
Use of expert witnesses
5.
Witness preparation
6.
Deposition process
7.
National Practitioner Data Bank
8.
Risk management and reduction
9.
Medico-legal issues revolving around consent and refusal of care
Evaluation:
At the end of the block, an evaluation form will be filled out by the supervising staff
member at McAloon & Friedman. The resident will also fill out and submit a rotation
evaluation form.
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MEDICAL EXAMINER
Location:
Office of the Medical Examiner
Contact:
Medical examiner
718-221-0600 (ext. 214)
The resident will spend a 2-week block with the Office of the Medical Examiner. Work
schedule is 5 days per week, Monday through Friday, excluding Wednesday morning.
On Wednesday morning the resident will be expected to attend the ED weekly
conference. The resident will work under the supervision of attending pathologist from
the Office of the Medical Examiner.
Goals and Objectives:
The resident will demonstrate competence in:
1. Strategies for work-up of cases
2. Communication with police, district attorneys and other clinicians
3. Clinical emergency department correlations with actual autopsy findings
4. Process of death certification
5. Greater insight into the workings of the medical-legal system
Evaluation:
At the end of the block, an evaluation form will be filled out by the supervising staff.
The resident will also fill out and submit a rotation evaluation form.
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DERMATOLOGY
Location:
KCHC & SUNY – Downstate Medical Center
Contact:
Alan Shalita, M.D., Chairman , Dept. of Dermatology
718-270-1229
Description of Rotation:
The resident will spend a 2-week block with the Department of Dermatology. Work
schedule is 5 days per week, Monday through Friday, excluding Wednesday morning.
On Wednesday morning the resident will be expected to attend the ED weekly
conference. The resident will work under the supervision of attending or senior residents
from the Department of Dermatology.
Goals and Objectives:
The resident will demonstrate competence in the evaluation and treatment of:
1. Cancers of the skin
2. Dermatitis, including but not limited to:
Atopic
Contact
Eczema
Psoriasis
Seborrhea
3. Infections, including but not limited to:
Bacterial
Fungal
Parasitic
Viral
4. Maculopapular lesions, including but not limited to:
Erythema multiforme
Erythema nodosum
Henoch-Schonlein purpura (HSP)
Pytiriasis rosea
Purpura
Urticaria
5. Papular/Nodular lesions, including but not limited to:
Hemangioma/Lymphangioma
Lipoma
6. Vesicular/Bullous lesions, including but not limited to:
Pemphigus
Staphylococcal scalded skin syndrome
Stevens Johnson syndrome
Toxic epidermal necrolysis
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ORAL SURGERY
Location:
KCHC & SUNY – Downstate Medical Center
Contact:
Stewart K. Lazow, M.D.
718-245-2987
917-253-0002 (pager)
Description of Rotation:
The resident will spend a 2-week block with the Department of Oral Surgery. Work
schedule is 5 days per week, Monday through Friday, excluding Wednesday morning.
On Wednesday morning the resident will be expected to attend the ED weekly
conference. The resident will work under the supervision of attending or senior resident
from the Department of Oral Surgery.
Goals and Objectives:
The resident will demonstrate competence in evaluation and treatment of:
1. Oral and dental anatomy
2. Tooth replacement
3. Plastics repair of lip lacerations
4. Odontogenic abscess I&D
5. Local and regional block anesthesia techniques
6. Sialolithiasis
7. Suppurative parotitis
8. Gingivostomatitis
9. Temporomandibular joint disorders
Evaluation:
At the end of the block, the supervising staff will fill out an evaluation form. The resident
will also fill out and submit a rotation evaluation form.
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Administration Rotation
Faculty Liaison: Dr. Rajesh Mittal
[email protected]
Cell 917-309-8456
Dr. Michael Lanigan
[email protected]
The administrative block of your fourth year is a month designed to give you some of the
tools and information you will need as you move ahead in your career from resident to
attending. Administration essentially boils down to meetings and paperwork, but there
are several aspects of this work that can be useful clinically- from documentation to ED
mortality review. The layout of this rotation has recently changed and the following
represents the current format.
Structure:
A four week block (EM) and a two week block (EM/IM) comprised of tutorials, chart
review, and meetings. On the first day of the rotation, please email the following list of
people, to inform them of the start of your rotation. CC me on this and any future emails
regarding any administrative duties-Doty, Stavile, Rinnert, Peacock, Brandler, An, Holt, Kifaieh, Flood, Lanigan, and
Lucchesi.
1. Chart reviewa. KCH ED Mortality Review- A Joint Commission requirement is that all
institutions analyze “in ED mortality” and complete a brief data sheet regarding the case.
Dr. Karen Stavile will be the point person for this activity. She will have a prepared list
daily of the mortalities that need to be reviewed and will describe the process for you.
This should take approximately 15 minutes to complete (if there are cases to be
reviewed).
b. UHB walk out/AMA call back- On the UHB side, you will be instructed how
to use the T-system to compile the patients walked out or left before being seen or left
AMA during the previous month. You are expected to call them back and check in about
their condition and offer them return to the ED if there are any concerns. This review has
been educational and relatively quick. Dr. Russell Flood will be the point person for this
responsibility.
3. Meetings- There are many meetings that cover on several varied topics. The
following calendar represents required meetings established by myself and Dr. Doty.
You may be informed with little notice about any administrative meeting that may be
pertinent and educational, but these should be very infrequent.
137
4. Morning report- You are expected to attend at least 2 morning report sessions per
week. There will be a ledger/handbook kept in the drawer under the printer in CCT to
record the date, topic and presenter for each of the sessions you attend.
5. Resident Documentation Program (RDP)—This program was established for several
reasons, including financial, medical-legal, and overall improvement of care. The
structure is as follows:
a. During the first week of the rotation, you will receive a tutorial from me
regarding ED documentation.
b. Give this tutorial to each of the rotating UHB residents (excluding residents
rotating through the pediatric ED). Please email me the names of each resident trained
and the date he/she was trained.
6. Meeting with chairman-- Dr. Lucchesi would like to meet with each of the graduating
resident during their administrative block. Please schedule this with his secretary Edna at
718-270-2407.
7. Expert Witness— You may be called upon by hospital counsel to act as an expert
witness for a case involving physicians within the Health and Hospitals Corporation. If
you are called to do so, please inform Dr. Mittal.
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Monday
Orientation
RDP
Mittal
RDP
Mittal
Tuesday
Any Tuesday
10:30a – 11a
KCH FT lecture
Wednesday
Every Wed
7a-12p
Conference
Friday
AMA call back
7a-12p
Thursday
Every Thursday
7a
Morning Report
8a-10a
REC
11:30a-1:30p
Steering
Committee
7a-1:30p as above
Mortality Review
3rd Tuesday
Stroke Meeting
3p-5p Stavile
7a-12p
7a-1:30p as above
3rd Friday
8a-9a
Performance
Improvement
Dr. Holt
Mortality Review
4th Wed
12:30p-3p Doty
Grad Medical
Education
7a-1:30p as above
Last Wed
12 noon
Provision of Care
Dr. Lucchesi
3p-6p
Faculty meeting
139
AMA call back
AMA call back
AMA call back
MEDICAL EDUCATION ROTATION
Meeting Place: UHB ED
Schedule: Contact Dr. Doty (917-597-0466) 2 weeks prior to starting the
rotation to get a brief orientation.
General Outline of Schedule
The rotation will last 2 weeks and the resident will work 8 shifts (8 hour swing shifts
from 11AM until 7PM on Monday, Tuesday, Thursday and Friday) over the course of the
rotation.
140
The resident will have meetings and teaching responsibilities on some
mornings and Wednesday afternoons after conference with the Program
Director and the directors of the skills labs.
First Monday— Please follow this link to take a brief online course prior to
beginning your 11AM shift.
http://www.hsl.unc.edu/services/tutorials/ebm/index.htm
Each Tuesday—
 The resident will help facilitate medical student simulation sessions
on Tuesday mornings. See Dr. Natal for details.
Each Wednesday—
 The resident is expected to attend Board Review conference (it
meets every other week) and can assist in group facilitation for that
conference.
 The resident will attend the Teaching Mini-Fellows meeting which
occurs on the second Wednesday of the month (as long as that
doesn’t interfere with Board Review Group) . Contact Dr. Doty for
details.
 The resident will take part in other educational activities as
identified by the program directors.
 The resident will assist Dr. Little in the running of any Skills Labs on
Wednesday afternoons. Contact Dr. Little for details.
One Thursday—
 The resident will give a medical student lecture at 10AM on one of
the 2 Thursday mornings during medical student educational
conference.
Each Thursday—

The resident will attend the REC meeting from 8-10 on Thursday
mornings in Dr. Doty’s office
Educational Objectives:
PGY-4 categorical residents and the PGY-5 EM/IM residents will spend a twoweek block serving as a teaching resident in the UHB ED and on various other
teaching projects in the department.
During this clinical time, they will not be responsible for rapid assessment of
general ED patients. Instead, they will be responsible for precepting general EM
141
cases in the UHB Fast Track, main ED and Peds ED. The idea of the rotation is
to help the senior residents develop skills and experience teaching bedside
Emergency Medicine and didactic teaching skills.
Summary of Responsibilities:
 The teaching resident should not see patients primarily
 The resident will report to the assigned shifts like any other workday and
stay for the entire shift. This is a shift in the ED like any other day.
 The resident will help lead sign-out rounds and work rounds.
 The resident will take responsibility for the junior learners in the area.
 The resident will precept medical students, PA students, and junior
residents.
 The resident will make an effort to attain medical literature (in real time)
pertaining to the cases they are precepting.
 Orient rotating residents & medical students in the ED
 Teach skills labs on both Wednesdays
 Fill out feedback forms with residents they have precepted
 Learn motor skills teaching strategies
 Practice didactic lecturing
 Develop small group leadership skills
142
At the completion of this rotation, the resident will demonstrate competence in
and be able to:

Evaluate learning styles and teaching techniques for teaching junior
residents and students. (PC,C,P,MK)

Engage in medical literature searches derived from real-time medical
questions and advise residents and students on methods to do the same
(PC,MK,C,SBP,P,PBL)

Work with consultants and model solid interpersonal and system-basedpractice behaviors. (C,P,SBP)

Compassionately interact with patients and their families during teaching
encounters (C,P)
Description of clinical experiences:
Residents will function as EM residents but will focus on teaching juniors. They
will NOT have primary patient care responsibilities per se. Any down time in the
clinical area should be used for literature searches and teaching. If there are
patients waiting to be seen in the clinical area, the resident will focus on
expediting work-ups and assisting the junior residents with balancing clinical
load.
Description of didactic experiences:
The residents will meet with the Program Director after conference to go over
teaching and education issues each week of the rotation. Residents will attend
meetings of the Medical Education mini-fellowship group during their rotation.
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EDUCATION
144
READING
“To see patients without reading is like a ship without a rudder, and to read and not see
patients is like never having gone to sea”
-Sir William Osler
“What one knows, one sees.”
-Goethe
Each resident is ultimately responsible for his or her education. Kings County
provides a rich environment to practice medicine, but it cannot be stressed enough the
importance of reading. Residents must develop a method for acquiring the myriad of
information required to competently practice Emergency Medicine. Some people find
success with a structured reading list, while others find it more fruitful to do focused
reading based on cases seen in the ED. The faculty at Kings County has allowed the
residents great autonomy in their clinical education and will not dictate which method of
study is best. Also, each of the major Emergency Medicine texts has strengths and
weakness. The resident should choose one of the texts and develop a method to
comprehensively go through it early in their residency. If you have questions about what
to read or methods for review, ask one of the senior residents or faculty members for
help.
145
TOPIC REVIEW
Topic review will be moderated by faculty, residency directors and chief residents. The
format may vary from small groups, open-ended questions, lecture etc, depending on the
moderators preference. Active resident participation is required to create the best
learning environment possible.
Residents will know the topic at least one week prior to Topic Review and must review
the relevant chapters in Tintinalli’s.
Each resident will be responsible for composing a set of open-ended questions if so
desired by the moderator.
Topic Review is to be only held in the Emergency Medicine conference room at 7 AM.
The weekly topics are listed on “Google Docs” and can be accessed with this link.
This link is also located at the bottom of every email sent by the education chief,
Jennifer Martin.
Topic Review schedule:
https://docs.google.com/Doc?docid=0AeqflXqH0E84ZGRmYjh0cWpfMTMyZGh2a25o
ZG4&hl=en
Please ask Dr. Doty, Dr. Morley or any of the residency directors if you have any
questions.
146
MODEL OF CLINICAL PRACTICE OF EM
The “old” SAEM core content for EM was felt to be too unwieldy and was thus replaced
by “THE MODEL OF CLINICAL PRACTICE OF EMERGENCY MEDICINE”. In
essence, it is a similar list as the Core Content but weighted in view of our daily
emergency medicine practice as analyzed from over 1300 EM physicians.
It contains three components:
1. An assessment of patient acuity
2. A description of tasks that must be performed to provide appropriate emergency
medical care
3. A listing of common conditions
This model was a collaborative effort by the following six organizations governing the
practice of EM:
ABEM (American Board of Emergency Medicine)
ACEP (American College of Emergency Medicine)
CORD (Council of Emergency Medicine Residency Directors)
EMRA (Emergency Medicine Resident’s Association)
RRC-EM (Residency Review Committee for Emergency Medicine)
SAEM (Society of Academic Emergency Medicine)
The actual document is too long to be printed here but may be easily accessioned at:
http://saem.org/download/practice.pdf
Reading this document gives you a good insight about what you should learn over the
next four years or what you should know when graduating from your residency
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IN-SERVICE EXAMINATION
The national emergency medicine in-service exam is held every year on the last
Wednesday of February. The exam format is similar to the ABEM written
examination.
The exam is a 4.5 hour-long multiple-choice exam containing
approximately 210 questions. While the exam is not perfect and does not necessarily
predict who will become a competent clinician, the exam is written by the same question
writers who contribute to the specialty board exam. Therefore, performance on the Inservice Exam correlates exceptionally well with success on the ABEM written exam (see
attached graph).
Proper preparation requires an ongoing effort of reading on core topics in Emergency
Medicine and reviewing board-type questions. A strong fund of knowledge will be
required to perform well on the in-service exam and the best preparation is to start early
in your residency with regular reading and review. Residents who do not perform well
on the examination when compared to the national average for their respective PGY year,
are not eligible for exemption from the In-training and Board prep conference. Please see
the section on that conference elsewhere in this book.
Please Note: No vacation or away electives can be scheduled during In-service exam
week. You MUST take this exam.
Recommended Reading:
Tintinalli – Emergency Medicine study guide
Rivers, Carol – Preparing for the Written Board Exam, text and questions
Peer VII questions
Koenig – Emergency Medicine Pretest Self-Assessment and Review
Pearls of Wisdom – Emergency Medicine Written Board Review
Rosen-- Text of EM
148
149
BOARD REVIEW GROUP
EM Faculty Liaisons:
Dr. Sigrid Wolfram (cell: 917-301-7222, email: [email protected]) - director
Dr. Joel Gernsheimer (cell: 917-750-1145, pager: 917-219-1976,
email: [email protected])
Dr. Binita Shah (email: [email protected])
Description and Goals: Participation in Board Review Group is an opportunity for
residents to enhance their preparation for the yearly in-service examination and for the
ABEM written board examination. All residents should attend. You may opt out of
attending this group if you meet any one of the following criteria:
You score above a 79% on the In-service exam.
You score above the national mean for your PGY level.
You are an EM/IM PGY1 and score above the 14th percentile of PGY1s nationally.
You are an EM/IM PGY2 and score above the 14th percentile of PGY2s nationally.
You are an EM/IM PGY3 and score above the 29th percentile of PGY3s nationally.
Topics are covered twice monthly and prepared by residents. The format is review of
board-style questions, test taking strategies and topic content.
Meeting place/time: The Board Review Group meets every other week from July until
the in-service exam in February for one hour immediately after Wednesday conference.
You may bring your lunch. A detailed schedule will be handed out at the first meeting
and may be revised throughout the year. If you are scheduled for a clinical shift
immediately after conference, you must let the attending in the clinical area know
prior to the beginning of your shift that you will be one hour “late”. Sometimes the
clinical attending will insist that you go to the clinical area immediately if it will affect
patient care otherwise. Any conflict should be discussed with Dr. Wolfram or Dr.
Gernsheimer.
If you cannot attend Board Review Group for whatever reason you must notify Dr.
Wolfram or Dr. Gernsheimer by email or phone or in person.
Attendance is mandatory for all residents in both programs (unless you are eligible to
opt out) and will be taken.
Structure:
Residents will be assigned their topic for review in July.
The resident will prepare 20 multiple-choice questions (using Peer VII, Rivers, Tintinalli
or other sources) and email them to the other Board Review Group participants at least
one week prior. This will allow for time to study and review of the topic. Everyone is
expected to read up on the topic prior to Board Review Group. Remember, the more you
put in, the more you will get out of this educational experience.
150
Answers to the questions with explanations should be provided to everyone on the day of
Board Review Group meeting. The resident will discuss the answers to the questions
he/she prepared. The attending present will provide additional insight into the subject
matter and attempt to resolve any "conflicts" regarding answers. This will require active
participation by everyone and create an environment conducive to learning.
Questions and answers must be given to Drs. Wolfram and Gernsheimer one week prior
to Board Review Group
Any questions or suggestions should be brought up to Dr. Wolfram.
151
Webtests
Test taking is an inevitable part of residency education and postgraduate certification.
There are multiple tools available for evaluating academic progress during your training.
As you know, you (the residents) are required to take a monthly exam from CORD
“Webtests.” These “webtests” are designed to test your knowledge and test taking skills,
with hopes of creating not only “monsters” in the clinical area but also providing the
confidence needed to do well on the in-service training exam and the Emergency
Medicine Board exam.
You are required to have a score of 75% on each webtest. If a score of 75% or greater is
not obtained, you will be required to retake that same webtest to achieve a score greater
than 75%. Dr. Quinn will reset the exam so that you can take it again if needed.
If you score receive a score of 80% or above on your in-service as a 3rd year EM resident
or a 4th year EM/IM Resident, YOU DO NOT HAVE TO TAKE WEBTESTS DURING
YOUR 4th or 5th YEAR, respectively. (Participation in Topic Review, however, is
NOT optional)
The Education division has modified the “Webtest” schedule listed on the CORD
website. The current schedule is on the residency board located in the Emergency
Medicine Office outside the conference room. Take the tests in the order that “we” have
listed.
You are allowed to miss 2 webtests per year. You are not allowed to miss the January
Inservice review test. 2nd year residents on the orthopedic rotation may choose to skip
the webtest of the month they are on the orthopedic rotation; this will count as one of the
2 webtests missed for the year.
If you do not complete your webtests by the final deadline (June 15th,2011), you will not
be promoted to the next PGY level. This means that you will be scheduled with the same
number of shifts, including 12 hour shifts, as your current PGY level.
If you have any questions regarding the monthly webtest topics please contact Dr. Morley
– [email protected]
If you need a test reset because you did not score the required 75% contact Dr. [email protected] or 718-938-4841 cell
For scores and explanations of the answers contact Sharissa [email protected]
152
EMERGENCY MEDICINE BOARD EXAMINATION
The American Board of Emergency Medicine certification exam is the final exam hurdle
to full board certification in EM. The exam is a two-part exam taken upon completion of
an accredited residency training program in EM. The first part of the exam is a written
test given in the fall (typically the first week in November) at a national computer testing
center. The written exam is a six and a half (6.5) hour, 340 criteria referenced question
exam. The candidate must answer 80% of the questions correctly to pass the exam. The
scope and depth of the exam is similar to that of the annual in-service exam.
The oral certification exam is offered to candidates who successfully complete the written
exam. The exam is offered in the spring (late April) and the fall (early October).
Assignment to the spring or fall exams is completely random. The exam is a three and a
half (3.5) hour test consisting of seven patient encounters (single or multiple patients)
lasting 15 to 40 minutes in duration.
Residents will receive an information packet from ABEM in the spring of their final year
that contains an application and fee schedule. The written exam is about $1,000 (this
includes a $290 application fee), and the oral exam is approximately $960.
The big question is how and what to study. The good news is that most people who
graduate from an EM residency will pass the exam (last year’s pass rate was 93%). One
may be able to roughly predict their degree of preparedness based on the yearly in-service
exam. To restate from the previous sections of this handbook, the best method of
obtaining the required information to pass the exams is to develop good reading habits
early in residency. Most people spend a considerable amount of time in the fall after
graduation preparing for the exam but the four years of residency is the time to obtain the
Core knowledge required to be a competent EM physician. Details about the exam are
probably best referred to the residency directors or recent graduates who are taking the
exam.
Contact:
American Board of Emergency Medicine (ABEM)
3000 Coolidge Road
East Lansing, Michigan 48823-6319
Tel: 517-332-4800
Fax: 517-332-2234
www.abem.org
153
ABEM WRITTEN EXAM CONTENT
Signs, Symptoms and Presentations
Abdominal & GI disorders
Cardiovascular disorders
Cutaneous disorders
Endocrine/metabolic/ nutrition disorders
Environmental disorders
ENT disorders
Hematologic disorders
Immune disorders
Systemic infectious disorders
Musculoskeletal disorders (not trauma)
Nervous system disorders
Obstetrics and Gynecology
Pediatrics disorders
Psychobehavioral disorders
Renal and Urogenital disorders
Thoracic/respiratory disorders
Toxicology
Trauma disorders
Administrative
EMS/disaster
Clinical Pharmacology
Procedure/Skills
9%
9%
10%
2%
3%
3%
5%
2%
2%
5%
3%
5%
4%
8%
3%
3%
8%
4%
11%
2%
3%
2%
6%
154
USMLE EXAMINATION REQUIREMENTS
Residents must have passed USMLE step I & II before matriculation in residency and
most will take and pass part III during the early years of residency. Applications may be
acquired from NY State Board of Education by calling (518) 474-3817.
Passing Step III will be required by the end of your 2nd year of residency and is part of
your promotion criteria into the PGY3 year in the categorical and the combined
programs.
Passing Step III is required for obtaining a medical license in every state.
SUNY has set up an institution-wide policy. If for some reason you have not PASSED
Step 3 by the end of your PGY-3 year, then SUNY GME will terminate your contract.
This means you are no longer a part of the residency. I am not kidding.
If you have not passed Step-3 by the beginning of your PGY-3 year, you will be given a
notice of non-renewal in November of your PGY-3 year, which I can have rescinded if
you pass Step 3 before the end of the academic year.
You do not have to apply for a New York state medical license in order to be promoted,
but you are strongly encouraged to. A NYS medical license is required to be a chief
resident and is required to moonlight outside of our system.
New York (NY) State no longer requires licensing fees and NY state application at the
time of registration for the exam (about $600), i.e. you may sit for Step III without
applying for NY state licensure. CIR will reimburse your costs of getting a license.
155
DEPARTMENT CONFERENCES
156
CONFERENCE CONTACTS
ICU-monthly
Conference Leaders: Dr Karen Chase ([email protected]) and Dr Liz
Brothers ([email protected])
Faculty Advisor: Dr DeSouza, Dr Rios
Date of First Conference: 7/28/10 (Fan/Meister)
M&M-monthly
Conference Leaders: Dr Nurain Nadir ([email protected]) and Dr Miller Pearsall
([email protected])
Faculty Advisor: Dr Rios
Date of First Conference: 7/28/10 (Willis/Scheer)
Trauma-bimonthly
Conference Leaders: Dr Cynthia Benson ([email protected]) and Dr
Audrey Tan ([email protected])
Faculty Advisor: Dr Baron/Dr. Stavile
Date of First Conference: 7/14/10 (Benson/Tan)
Adult Journal Conference-bimonthly
Conference Leaders: Dr Anika Backster ([email protected]) and Dr Diane
Scheer ([email protected])
Faculty Advisor: Dr Sinert
Date of First Conference: 7/7/10 (Semenovskaya/Maurelus)
Peds Journal Conference-bimonthly
Conference Leaders: Dr Mathew Timberger ([email protected]), Dr Nathalie
Mathieu ([email protected])
Faculty Advisor: Dr Tejani
Date of First Conference: 8/18/10(Aherne/Guy)
Peds Case Conference-monthly
Conference Leaders: Dr Kelly Maurelus ([email protected]) and Dr Kevin
Adeleke ([email protected])
Faculty Advisor: Dr Shah
Date of First Conference: 7/28/10 (Melendez)
Evidence Based Medicine-monthly
Conference Leaders: Dr Walter Valesky ([email protected])
Faculty Advisor: Dr Paladino, Dr. Lanigan
Date of First Conference: 7/14/10 (Cioe/Mathieu)
Core Content-monthly
Conference Leader: Dr Erica Bang ([email protected])
Faculty Advisor: Dr Rios
Date of First Conference: 7/7/10 (Thompson/Yeo)
157
MORNING REPORT
Morning report gives the opportunity to discuss interesting cases that present to the ED in
a relatively formalized manner. It is an excellent educational forum for the residents and
faculty and a time for a brief discussion of both core topics in emergency medicine as
well as evolving medical therapies.
Faculty Liaison: Dr. Chris Doty
pager: 917.760.2005
Time and Place:
Morning report is to be held following morning rounds on Mondays, Tuesdays,
Thursdays, and Fridays in a location designated by the attending physicians (usually adult
or pediatric trauma bay in CCT).
Structure:





Only third and fourth-year residents will be asked to present a case for
discussion. One resident should be required to do no more than two morning
reports during a single ED block. The resident scheduled to present will be
designated by bold face type on the schedule.
On Fridays the incoming Pediatric ER attending will give the morning report.
All residents scheduled to work at KCHC at 7 AM or coming off the
overnight shift are required to attend. Residents scheduled at UHB at 7 AM
are encouraged to attend at the discretion of the UHB Attending. Residents must
first report to UHB for rounds and are to report back promptly at the
conclusion of the case.
The fourth-year administrative resident is required to attend half of all morning
reports, to take attendance and to note the topic and presenter. This information
must be given to Dr. Mittal each week.
The resident presenting the morning report is required to submit a one page
write-up to his/her Portfolio (give to Stephanie) on each topic that he/she
presents. The write-up should consist of a brief summary of the case with the
pertinent teaching points highlighted.
The purpose of the exercise is to provide the presenter an opportunity to present a case
that he/she was personally involved with and to educate his/her colleagues. The objective
of the presenter is to extract the most essential Emergency Medicine teaching points and
convey these to the group. In order to accomplish this goal, we have decided to initiate
some guidelines to follow in preparing your morning report:
158
1) This is NOT an Oral Board review format. (that will be covered in
Wednesday conference)
2) The total presentation time should not exceed 10-15 minutes depending on
patient needs. Remember there are residents and faculty that worked
overnight and do not want to hear a long presentation.
3) The first 5 minutes are devoted to a case presentation by the presenter. This is
not a history-taking lesson nor is it a free-for-all guessing game. The
presenter will provide all pertinent positive and negative historical facts at
his/her discretion. He/she can stop at any time to elicit specific interventions
at any time—life-saving procedures, etc—but the primary focus of this
portion is to provide all the necessary information for the second part of the
case.
4) The group should then be pressed to provide a differential diagnosis—either
round-robin or by picking specific audience members, preferably the most
junior first (MS3, MS4, PGYI, etc). Obviously, focus on any life- or limbthreatening injuries, diagnoses, or interventions first, and be as complete as
possible.
5) Finally, the presenter will spend no more than 5 minutes highlighting the most
important points that each person in the room should walk away with (at least
three). This should be concise and to-the-point, and SHOULD BE
ACCOMPANIED BY SOME TYPE OF HANDOUT OR STIMULUS
(copies of EKG’s, X-RAY’s, diagrams etc).
6) If morning report has not finished by 8am, the individuals that worked the
previous overnight shift that are in attendance are excused and may leave to
head home irregardless of when the morning report started.
159
WEDNESDAY CONFERENCE
The Wednesday conference is the traditional EM academic conference that attempts to
cover the core topics in emergency medicine over approximately a two-year period.
Conference for EM residents will be held each Wednesday in the department
conference room from 7am – 12pm, unless otherwise noted. The schedule will be
published monthly by Education Chief. The conference is composed of various didactic
lectures covering the core curriculum of emergency medicine, specialized case
discussions pertaining to pediatrics, the MICU and trauma, journal club, a morbidity and
mortality conference, an annual CPC competition, and monthly grand rounds.
The following is a brief description of the various conference topics and policies and
procedures related to Wednesday conference. Each topic has a resident coordinator and
questions about specific topics should be directed to that person or the Education Chief
resident.
Residents are expected to actively participate in Wednesday conference. Residents will
be responsible for presenting many of the case conferences. The education chief resident
will coordinate the schedule for resident presentations with the resident responsible for
the individual conference.
Attendance at Wednesday conference is encouraged throughout residency. This dedicated
time is a valuable part of your education. To graduate, residents are required to attend
70% of Wednesday conferences throughout their 4 years (35% in 5 years for EM/IM);
however, it is expected that your attendance will far exceed these numbers. Missing or
being late to a conference is the equivalent of being late to a shift – it is inexcusable.
Additionally, leaving conference prior to its completion is considered a lateness.
Persons who are repeatedly late will be marked as absent (3 latenesses=1 absence).
Please refer to the latest Conference Attendance Policies for detailed requirements based
on clinical shifts.
ALL RESIDENT LECTURES MUST BE E-MAILED TO THE
CONFERENCE LEADERS FOR REVIEW ONE WEEK BEFORE
CONFERENCE. ADDITIONALLY DR. MORLEY SHOULD BE
CC’D ON THE INITIAL EMAIL ([email protected]).
160
Special Shifts and Wednesday Conference
Junior residents (PGY 1 and PGY 2) will have the majority of Tuesday PM shifts off to
enable their attendance at conference. Residents have to report to the clinical area
immediately after conference. Senior residents may be scheduled for one Tuesday
overnight, one Wednesday AM and/or Wednesday PM shifts as coverage dictates. The
scheduling chief resident may have the residents scheduled for shortened shifts after
conference as coverage dictates. Senior shifts scheduled 11AM – 7PM and Junior shifts
scheduled 7AM-7PM begin at 12 Noon.
The following are the updated requirements for conference attendance that take into
account resident work hours and current ACGME and NY State guidelines. If you have
any questions as to whether or not you need to attend conference please contact me as
soon as possible.
KCH
Tuesday Shift
Wednesday Shift Attend Conference
Off
3PM-11PM
7AM-Noon
Off
11PM-7AM
7AM-11AM
Off
7PM-7AM
Off
7AM-3PM
3PM-11PM
7AM-Noon
7AM-3PM
11PM-7AM
7AM-Noon
7AM-7PM
7AM-7PM
7AM-Noon
7AM-7PM
7PM-7AM
Off
9AM-9PM
Off
7AM-Noon
11AM-11PM
Off
9AM-Noon
11AM-11PM
11AM-11PM
9AM-Noon
11AM-11PM
7PM-7AM
Off
3PM-11PM
Off
9AM-Noon
3PM-11PM
3PM-11PM
10AM-Noon
3PM-11PM
11PM-7AM
9AM-Noon
7PM-7AM
Off
7AM-9AM
7PM-7AM
7PM-7AM
Off
11PM-7AM
11PM-7AM
7AM-9AM
11PM-7AM
Off
7AM-9AM
UHB
Tuesday Shift
7AM-5PM
7AM-5PM
7AM-5PM
7AM-5PM
11AM-9PM
11AM-9PM
11AM-9PM
Wednesday Shift
Off
12PM-7PM
3PM-11PM
11PM-7AM
Off
12PM-7PM
3PM-11PM
Attend Conference
7AM-Noon
7AM-Noon
7AM-Noon
7AM-Noon
7AM-Noon
7AM-Noon
9AM-Noon
161
11AM-9PM
1PM-11PM
1PM-11PM
1PM-11PM
11PM-7AM
11PM-7AM
11PM-7AM
Off
12PM-7PM
11PM-7AM
Off
11PM-7AM
7AM-Noon
9AM-Noon
9AM-Noon
9AM-Noon
7AM-9AM
7AM-9AM
BROOKDALE
Tuesday Shift
7AM-7PM
7AM-7PM
7PM-7AM
7PM-7AM
11AM-11PM
11AM-11PM
11AM-11PM
Wednesday Shift
Off
7PM-7AM
Off
7PM-7AM
Off
7PM-7AM
11AM-11PM
Attend Conference
7AM-Noon
Off
Off
Off
9AM-Noon
Off
Off
STATEN ISLAND
Tuesday Shift
Wednesday Shift
7AM-5PM
Off
7AM-7PM
Off
7AM-7PM
7AM-7PM
9AM-9PM
Off
11AM-9PM
Off
11AM-9PM
1PM-11PM
11AM-11PM
Off
11AM-11PM
11AM-11PM
1PM-11PM
Off
Attend Conference
7AM-Noon
7AM-Noon
Off
7AM-Noon
7AM-Noon
Off
9AM-Noon
Off
9AM-Noon
VA
8AM-8PM
Off
7AM-Noon
8AM-8PM
1PM-8PM
8AM-Noon
Every effort will be made to allow residents maximum conference attendance
without compromising patient care.
Off-service Rotations:
For non-KCH sites and off-service rotations, please refer to the Clinical Responsibilities
section of this handbook under the specific rotation heading for specific schedule
information. In general, on the non-ED off-service rotations during the first two years
residents will act as full members of the off-service clinical staff and have similar clinic
and call schedules. For all off-service rotations at KCHC, excluding the SICU rotation,
the resident is expected to attend conference for at least 2 hours – this is a required part of
education and should be excused by the off-service team.
162
ED CONFERENCE ATTENDANCE POLICY
In an effort to give the residents more autonomy, we are instituting a new attendance
policy for conference. It is a national benchmark that every EM resident must be present
for 70% of the Wednesday conferences that we sponsor. (35% for EM/IM residents)
With that thought in mind, we would like to leave it up to you, the residents, to make sure
that you are making this RRC requirement. Therefore, the directors will not be worried
about your reasons for missing conference. It is your responsibility to be there. The
attendance statistics will be posted on the conference room door on or around the first of
every month. You must be there for the full 5 hours to get credit for the day if you are
not scheduled to work that day or the night before. If you leave early or come late
outside of the current handbook policy on Wednesday conference attendance, you
will not get credit for that conference day.
Realize that this 70% of conferences includes everything. (Sick day, I worked overnight,
my car got towed, my Granny was in town, I was on vacation, my dog ate my
metrocard..EVERYTHING.)
If you come more than 5 minutes late, it will be recorded. If you are late 3 times, it will
count as one full missed day of conference. It is your responsibility to keep track of your
conference attendance and know how close you are to that 70% level. This number can
be reviewed with a residency director at your 6 month evaluation meeting or you can
make an appointment with a director to discuss this at any time.
If by some terrible chance of luck, graduating residents are below your required 70%
(35%), they will have to attend conference during their elective or during July to make
the minimum requirement in order to graduate the program. The 70% ( or 35% for
EM/IMs) RRC conference attendance requirement is not negotiable and you can not
graduate from ANY EM residency with out fulfilling it.
INDEPENDENT STUDY
You will have the opportunity to get conference credit by performing
independent learning activities. Each activity will count as 1 hour of
conference time. You can get credit for a maximum of 15 hours (3 full
days) per year. A list of acceptable activities will be kept by Dr Morley
([email protected]). You will be required to e-mail Dr Morley
or one of the residency directors with a question regarding the learning
activity and print the accompanying CME certificate.
163
PRESENTATION PREPERATION POLICY
In a never-ending quest to improve the quality of our residency and our educational
conference, the Program Directors have developed the following resident requirements
for conference presentations.
Resident lectures are clearly a huge part of the educational component of the residency.
Furthermore, presenting in our conference is an opportunity for growth as an educator
for each resident. For these reasons, it is imperative that these lectures are polished and
reviewed by faculty preceptors prior to Wednesday conference.
It has been a long-standing policy that residents will forward any lecture or presentations
to be given in Wednesday or EM/IM Combined conference many days ahead of time to
the conference coordinator, faculty coordinator or faculty advisors. This is critical in
order to have your slides reviewed and incorporate feedback into your presentation.
A period of 1 week should provide ample time for feedback and adjustment. This not
only is key to assure a high yield presentation, but also a great way to learn not only
about the topic but also, about how to lecture.
Unfortunately, when this does not happen, the quality of the resultant lectures are below
the standard of we all expect. This is unfair to the presenter, the fellow residents and the
faculty. Since this is important and prior compliance has been poor, we have added an
incentive for compliance. Residents are required to submit their preliminary presentation
to a faculty member/conference preceptor 7 days prior to the presentation date.
Any resident who has not complied with the lecture review policy will be asked to create
an education project with one of the Program Directors for the educational files of the
program.
We realize that you may have other obligations the month before or the month of your
presentation. Therefore, you will need to plan ahead to make sure you have adequate time
to prepare your presentation and have it submitted for review 1 week (7 days) prior to
your presentation. The yearly schedule of presentations is published on the residency
bulletin board and can also usually be found below Dr. Martin’s "signature" on her
emails. Please stay on top of your presentations and feel free to ask any of the Residency
Directors for help with your preparation. We are here to help you.
Please email the Program Directors and/or Dr. Morley with any questions.
164
Presenter Schedule 2010-2011
Month
Adult
Journal Club
Coordinators Backster/Scheer
SInert
/Faculty
JULY
7-Jul
Semenovskaya
Maurelus
18-Aug
Aherne
Guy
AUGUST
SEPTEMBER
3-Sept
Cioe
Tan
20-Oct
Melendez
Maurelus
OCTOBER
NOVEMBER
10-Nov
Joshi
Adeleke
15-Dec
Harriot
Scheer
DECEMBER
JANUARY
5-Jan
Harriot
Timberger
3-Mar
Kazzi
Nadir
21-Apr
Regan
Chapman
APRIL
MAY
JUNE
28-Jul
Willis
Scheer
18-Aug
Auerbach
Timberger
29-Sept
Meister
Backster
28-Oct
Ritchie
Mathieu
24-Nov
Yeo
Brothers
29-Dec
Semenovskaya
Valesky
26-Jan
Christopher
Guy
17-Feb
Auerbach
Valesky
FEBRUARY
MARCH
Peds
M&M
Journal
Timberger/Mathieu Nadir/Pearsall
Tejani
Rios
5-May
White
Mathieu
16-Jun
Lau
Nadir
165
Peds Case
ICU
Conference
Maurelus/Adeke Chase/Brothers
Shah
DeSouza/Rios
28-Jul
Melendez
18-Aug
Joshi
22-Sept
Harriot
20-Oct
Kazzi
24-Nov
Caputo
15-Dec
White
19-Jan
Lau
28-Jul
Fan
Meister
18-Aug
Kong
Julie
29-Sept
Desmond
Aherne
28-Oct
Bradby
Semenovskaya
24-Nov
Melton
Lau
29-Dec
Bon
Joshi
26-Jan
Al-Zahrani
Cioe
16-Feb
Meister
30-Mar
Melendez
Tan
16-Mar
Cioe
30-Mar
Paulson
Harriot
27-Apr
Julie
Cheng
25-May
Adeleke
Chase
22-Jun
White
Benson
20-Apr
Willis
27-Apr
Basilla
Kazzi
25-May
Louis
Caputo
22-Jun
McMillin
Willis
18-May
Aherne
15-Jun
Julie
MONTH
EBM
Coordinators/
Faculty
JULY
Valesky
Benson/Tan
Lanigan/Paladino Baron/Stavile
14-Jul
Coie
Mathieu
4-Aug
AUGUST
Nadir
Suess
8-Sept
SEPTEMBER
Adeleke
Chase
OCTOBER
Trauma
29-Sept
Benson
Tan
13-Oct
Timberger
Nata
11-Nov
Valesky
Lira
11-Nov
Benson
Tan
DECEMBER
8-Dec
Benson
Martin
26-Jan
Pearsall
Goldenberg
22-Dec
Benson
Tan
9-Feb
Maruelus
Daphnis
9-Mar
Scheer
Bowen-Spinelli
13-Apr
Guy
Cobb
2-Feb
Benson
Tan
23-Mar
Benson
Tan
27-Apr
Benson
Tan
FEBRUARY
MARCH
APRIL
Junior
14-Jul
Benson
Tan
NOVEMBER
JANUARY
Senior
166
8-Sept
Yee
15-Sept
Tsang
6-Oct
Schechter
13-Oct
Goldenberg
28-Oct
Suess
24-Nov
Patel
22-Dec
BowenSpinelli
19-Jan
Estephan
26-Jan
Natal
9-Mar
Laoteppitkas
6-Apr
Martin
13-Apr
Naik
20-Apr
Johnson
27-Apr
Core
Content
Bang
Rios
15-Sept
Backster
Guy
7-Jul
Thompson
Yeo
4-Aug
Chase
Daphnis
1-Sept
Regan
Auerbach
13-Oct
Cobb
Edelstein
6-Oct
Brown
Jackson
10-Nov
Nordstrom
Chapman
8-Dec
1-Dec
Goldenberg Coquillon
Estephan
Cheng
6-Jan
DiMare
Yeo
9-Mar
Valesky
Adeleke
3-Feb
Berzon
Yee
2-Mar
Thompson
Schechter
7-Apr
Hussain
Christopher
MAY
JUNE
18-May
Backster
Johnson
8-Jun
Brothers
Backster
Edelstein
18-May
Cobb
15-May
Jackson
8-Jun
Benson
Tan
TOPIC REVIEW SCHEDULE
July
7- Goldenberg
August
4- Tsang
September
1- Laoteppitkas
8- Ruabno
15- Bowen-Spinelli
October
6- Martin
13- Johnson
November
10- Naik
December
1- Natal
8- Suess
15- Cobb
January
5- Edelstein
19 - Schechter
February
2- Estephan
9March
29- Patel
1623- Yee
April
6-Jackson
13-
167
22-Jun
Rubano
8-Jun
Timberger
Mathieu
4-May
Jegede
Bang
1-Jun
Lira
Naik
ICU CONFERENCE
Contact Persons: Drs. Ian deSouza and Claritza Rios
Cell: (917) 903-1765/(917) 693-4429
E-mail: [email protected]/[email protected]
Resident Coordinators: Karin Chase: [email protected]
Elizabeth Brothers: [email protected]
The ICU conference is held monthly where two junior residents will present interesting
critical care cases. This may include patients that were admitted to the MICU, SICU, or
CCU. One assigned junior resident will be responsible for presenting the patient’s
history, physical exam, ED evaluation, and hospital clinical course. He or she will be
given a Powerpoint template by the resident coordinators to ensure a standardized format
and facilitate audience participation. The 2nd resident will present a review of the disease
entity, including current patient management issues, which are to be identified through an
extensive literature search and review. It is imperative for both residents to know the
entire clinical course of the patient. The presenter should also have a firm understanding
of the patient’s disease and be ready for questions related to diagnosis, differential
diagnosis, treatment, and pathophysiology. There will be ample senior resident as well as
faculty guidance in preparation for the presentations. There will also be a senior resident
moderator and a faculty presence (Dr. deSouza and/or Dr. Rios) for each conference.
Presentation slides must be submitted for review to the ICU conference attendings no
later than a week prior to presenting. Any questions should be directed to the senior
resident coordinators or Drs. deSouza or Rios.
The schedule for ICU conference and resident presenters will be posted and
distributed by the education chief resident. Please contact the resident coordinators
early in your assigned month to review your responsibilities.
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MORTALITY AND MORBIDITY CONFERENCE
Faculty liaison: Dr Claritza Rios ([email protected])
Resident Coordinators: Dr Miller Pearsall ([email protected]) and Dr Nur Ain
Nadir ([email protected])
M & M will be held monthly in the ED conference room. One 2nd year and one 3rd year
resident will be responsible for researching the cases as well as a brief discussion (2-3
slides maximum) after the case is presented on salient aspects relating to the case.
Presentation slides must be submitted to the M&M conference attending for review no
later than one week prior to presenting. Charts to be reviewed for the conference will be
divided among the presenting residents and can be obtained from either King’s County or
Downstate Emergency Department Cases. Cases should be discovered and selected by
the presenting residents prior to the month they present and ideally be involved in the
patients’ initial care. Cases should be selected for adverse outcome as well as to highlight
differing management strategies and/or systems based problems. In addition to reviewing
cases for CQI/QA and education purposes, 1 to 2 interesting cases may be discussed in
detail. If possible, the EM resident who initially cared for the patient in the ED will be
responsible for presenting the case at M&M, however recent cases which are selected as
worthwhile may be assigned to the presenters of the month. The presenting resident will
be responsible for notification of residents and any attendings involved in the cases will
be notified by the conference director prior to the presentation, so they may be present to
add details to enhance the discussion. Presentation slides must be submitted for review to
the M&M conference attending no later than a week prior to presenting. Cases not
presented in detail will be typed up and discussed to highlight Q/A issues as time permits.
Questions about the conference should be directed to the M&M conference attending or
the resident coordinator.
The schedule for M&M and resident presenters will be posted and distributed by
the educational chief resident.
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TRAUMA CONFERENCE
Conference Leaders: Dr Cynthia Benson ([email protected]) and Dr
Audrey Tan ([email protected])
Faculty Advisor: Dr Baron/Dr. Stavile
The Kings County Hospital Trauma Conference is scheduled bi-monthly. Attendings,
residents, medical students, and any interested staff involved in the care of trauma
patients are encouraged to attend. Trauma topics are presented as case based discussions
with review of the relevant literature. In addition, guest speakers with expertise in trauma
are invited to lecture throughout the year.
The schedule for trauma conference will be posted and distributed by the education chief
resident. All resident lectures must be reviewed by the Trauma Conference attending, Dr.
Bonny Baron, at least one week prior to each conference.
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Peds Case Conference
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ADULT JOURNAL CLUB
Coordinators:
Residents: Dr Anika Backster ([email protected]) and Dr Diane Scheer
([email protected])
Faculty: Dr. Sinert
Adult Journal Club will be presented by a second and third year resident on the first
Wednesday of every other month. The articles will only be handed out during the
conference and 15 – 20 minutes will be allotted for reading and analyzing each article.
To encourage active participation of the group an evidence-based worksheet will be filled
out by all the residents and faculty attending the meeting. The residents assigned to those
articles will lead the discussion of the merits or biases contained in each article. With the
group’s participation a consensus will be developed to determine if the conclusions of the
article(s) will change clinical practice.
The presentation must be reviewed by Dr. Sinert must review the presentation 1
week prior to the conference.
Introduction:
Journal Club is an integral part of residency training. We have developed a model of
journal club based upon the principles of evidence-based medicine.
Goals:
 Improve resident and faculty participation
 Teach critical reviewing skills
 Validate and/or update clinical practice
 Integrate clinical and didactic teaching
 Reinforce research / statistics curriculum
 Practical experience in literature searches
 Encourage critical thinking in clinical arena
 Identify potential areas of future research
Choosing an Article:
 Articles will be chosen from the recent medical literature. Emergency Medicine
articles will be featured, but other medical or surgical specialty journals may also be
reviewed.
Possible Conclusions from Journal Club



Question is answered, validating current practice or suggesting change
Leads to further questions and journal club subjects
No answer found in literature, possible future research topic
The schedule for Journal Club and resident presenters will be posted and
distributed by the education chief resident. Please contact the resident coordinators
at least 1 month in advance for topic and article assignments
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Useful URL’s to begin AJC topic search.
http://keepingup.org
http://plus.mcmaster.ca/EvidenceUpdates/
http://www.freemedicaljournals.com/
http://www.emjournalclub.com/
https://emed.wustl.edu/em_journal_club.html
http://sinaiem.wordpress.com/
http://sitemaker.umich.edu/emjournalclub/cover_page\
http://www.ncemi.org/
http://academiclifeinem.blogspot.com/search?updated-max=2010-0204T03%3A00%3A00-08%3A00
http://www.medicine.ox.ac.uk/bandolier/
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SENIOR RESIDENT LECTURES
All 3rd and 4th year residents will give lectures. The topics and material will be geared to
junior residents or all academic years. The topics should be selected at the beginning of
the Academic Year with the assistance of the Education Chief Resident.
It is expected that preparation will be far in advance. In order to present a high quality
lecture, the residents will be expected to utilize current literature as well as textbooks and
position papers. The residents must contact a faculty member, their advisor or any of
the residency directors at least 1 week prior to the scheduled presentation time in order
to go over the lecture slides. If the resident fails to contact a faculty member additional
lecture or clinical duties will be assigned.
Practice is important, and it is therefore expected that the resident has had several
practice sessions in order that the material is presented in a smooth and well-rehearsed
fashion. Handouts will also be appreciated. In addition, the residents should arrive early
to set up the AV equipment, so that the lecture may start on time.
The schedule for Senior Resident Lectures and resident presenters will be posted
and distributed by the education chief resident
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MISCELLANEOUS POLICIES AND PROCEDURES
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RESIDENT RESPONSIBILITIES AND DUTIES
In accordance with the recommendations of the Accreditation Council for Graduate
Medical Education (ACGME), and the SUNY-Downstate Graduate Medical Education
Committee, the resident will be provided with an opportunity to:
1) Develop a personal program of self study and professional growth with guidance from
the teaching staff.
2) Participate in safe, effective, and compassionate patient care, under supervision,
commensurate with their level of advancement and responsibility.
3) Participate fully in the educational scholarly activities of their program and, as
required, assume responsibility for teaching and supervision of other residents and
students.
4) Participate in institutional programs and activities involving the medical staff and
adhere to established practices, procedures, and policies of the institution.
5) Participate in institutional committees and councils, especially those that relate to
patient care review activities.
6) Participate in evaluation of the quality of education provided by the program.
7) Develop an understanding of ethical, socioeconomic, and medical/legal issues that
affect graduate medical education and of how to apply cost containment measures in the
provision of patient care.
8) Residents shall perform their duties and at all times conduct themselves in compliance
with all applicable departmental rules and regulations, as well as applicable Hospital
policies and procedures, both personnel and operational, and such specific rules and
regulations.
It is therefore expected that the resident always acts in a professional manner.
Dishonesty, disinterest, and unkindness are serious offenses and may be grounds for
dismissal from the program.
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Policy on Eligibility and Selection of Residents
Candidates for residency will have graduated an LCME-accredited medical school or a
medical school approved by the program director. Candidates will have passed the
USMLE step 2 or the Complex Step 2 prior to entry into the training program. Residents
will hold a medical degree from an allopathic or osteopathic medical school or an
equivalent degree if from a foreign medical school.
All applications for PGY1 positions are accepted through the ERAS program. At the
discretion of the Program Director, residents may also enter the program through special
international education programs. These residents may function outside or as part of the
main residency program. The Residency Director and the Assistant Directors screen
completed applications for specific criteria. Interviews are offered to approximately 185
applicants based on their personal statement, letters of recommendation, board scores,
transcripts and dean’s letter. Interviews are held twice a week, with 10 applicants per
session. Applicants are given an introductory slide presentation, which describes the key
aspects of the program including the length of the program. Usually, the residency
director, and the assistant residency directors, and a resident; interview candidates. The
interviews are one on one or two on one and run approximately 20 minutes each. During
the interview day, applicants are offered an opportunity to meet with residents for a
question/answer session and tour of the facilities. Recruitment for the combined program
was done similarly in concert with the Internal Medicine Program Director.
The Interviewers rank the applicants based on their prior academic performance and
future growth potential, their interview presence and interpersonal skills, their
commitment to Emergency Medicine, ethnic and cultural diversity, and the desire to work
and learn in an inner city hospital environment.
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PROMOTION/GRADUATION CRITERIA
Education in emergency medicine is a lifelong journey, not a destination. We, as a
program, will teach you the fundamental skills, knowledge and humanistic qualities that
constitute the foundations of emergency medicine practice. Under the guidance and
supervision of qualified faculty, residents need to develop a satisfactory level of clinical
maturity, judgment and technical skill. On completion of this program, residents should
be capable of practicing emergency medicine, able to incorporate new skills and
knowledge during their careers, and be able to monitor their own physical and mental
well being and that of others.
This program has established specific educational and administrative criteria for
promotion to the next program level and graduation from this program. Educational
requirements are outlined for each program year in the “Educational Objectives”
section in this handbook. Furthermore, ACGME core competencies criteria by which
residents’ performance will be judged, is outlined in the “Evaluations” section in
this handbook. Please read these over carefully.
Other promotion/graduation criteria include, but are not limited to:
 Procedure and Resuscitation log: Residents must document all procedures via
the procedure tracking program online. All procedures and resuscitations must be
put into the web-based procedure-tracking program. Remember to log every
resuscitation in your online procedure log—the RRC thinks we don’t do
enough resuscitations. Procedure and resuscitation log review will be performed
by the Residency Directors or faculty advisor at regular intervals and your 6month evaluation. One resuscitation per year must be logged in the competencybot program. Please pay special attention to logging pediatric medical and
trauma resuscitations and make sure to document your role in these resuscitations.
 Competency-bot: Every resident must complete 5 chief complaints per year in
the online competency-bot program. You must also log 3 procedures and 1
resuscitation as competency procedures. This is an extensive evaluation that the
attending must fill out for all 9 of these competencies so please do not leave this
to the last second. See the competency-bot section of the handbook for more info.
 Patient Care Follow-up: Residents will be required to keep online
documentation of patient care and clinical questions encountered for EM patients.
You must do 4 follow-ups per year and each one will require a lit review and an
answer to some clinical question. You must complete 4 per year. No exceptions.
These will be recorded in the New Innovations online software. You may start
them in the second block of each academic year when they are "opened."

Six-month evaluation: Twice yearly the Residency Directors will review each
resident’s performance and discuss progress, achievements, advancements,
problems, and projects with the resident. Residents must fill out an extensive
self–evaluation package prior to their six-month evaluation. This is obtained
from the residency coordinator.
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
Morning Report: All residents scheduled to work at KCHC at 7 AM or
coming off the overnight shift are required to attend. Residents scheduled at
UHB are encouraged to attend at the discretion of the UHB Attending. Residents
must first report to UHB for rounds and are to report back promptly at the
conclusion of the case. The resident presenting the morning report is required to
submit a one-page write-up to the residency coordinator for his/her Portfolio on
each topic that he/she presents. The write-up should consist of a brief summary
of the case with the pertinent teaching points highlighted.

Wednesday conference attendance: The RRC mandates at least 70%
conference attendance by all residents. Therefore, all residents are required to
attend Wednesday conference, unless they are excused because of ACGME work
hour requirements (see “Monthly Schedules” section in this handbook).
Remember, you will already miss a significant portion of conference during
vacation and off-service rotations. If you need to miss a conference, speak to Dr.
Silverberg.
 Webtests: Residents must complete monthly webtests; this is part of your
residency. In order to receive a score for that month, you must complete the
webtest by the deadline of each month (the 25th unless otherwise noted).
Residents who persistently have low scores or do not take the exam MIGHT
receive other remediation. In order to graduate you can miss no more than 2 tests
and one of these cannot be the mock in-service exam. All residents must
complete the mock in-service test.
 USMLE Step 3: Passing Step III will be required by the end of your 2nd year in
your residency training.
 Summary of Resident portfolio: Residents are required to write a summary of
their resident portfolio in order to be promoted to the next PGY level or to
graduate. Please see the portfolio section of the handbook for more information

Faculty advisor: Your faculty advisor should meet with you at least every 3
months. Although this will occur more or less frequently depending on the
advisor, it is your responsibility to approach your advisor. Every meeting
must be documented in the resident’s folder. There are Resident Evaluation
Forms (see “Faculty Advisor” section of this handbook) that may be used as a
guideline for resident-advisor meetings to address certain issues and to document
regular meetings. This form must be given to the residency coordinator to be
placed in the resident’s file. Please inform the Residency Directors if there are
any problems with meeting with your advisor or if you wish to be assigned to a
different advisor for any reason.
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PLEASE BE AWARE: Compliance with the fulfillment of these regulations has
been a problem in the past, especially during the last months of the final year.
Please follow these rules carefully - it is ultimately the Program Director’s decision
on whether to promote or graduate you.
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Supervision of Residents
Residents working in the ED will be supervised by ABEM board-eligible or board
certified attending physicians who are licensed in the state of their practice. When
residents rotate on non-EM services, they will be supervised in accordance with the
ACGME/RRC faculty supervision guidelines for that specialty. Residents rotating in the
Pediatric Emergency Department may be supervised by faculty boarded in Pediatric
Emergency Medicine.
Residents rotating in the Pediatric Emergency Department may also be immediately
supervised by fellows enrolled in an ACGME-accredited Pediatric Emergency Medicine
fellowship. However, these residents will also have immediate access to a faculty
member who is board-certified/board-eligible in EM or Peds EM.
All EM residents are ultimately under the supervision of the Program Director of
Emergency Medicine regardless of what specialty they are working on.
Each patient encounter MUST be presented to an faculty member prior to disposition.
All charts MUST countersigned by an attending in a timely manner.
Junior residents can be supervised by senior residents in the specialty under which they
are rotating, but must ultimately be under a supervising faculty meeting the above
criteria. Residents must be under direct supervision during all procedures until they are
credentialed in that procedure. After that time, they will perform all procedures under
general supervision. In the ED, there is always an attending in the clinical area to
supervise all procedures. Faculty will not provide coverage from outside of the clinical
area. As the residents progress in their level of training, they are given more autonomy in
regards to patient management plans, procedures, and disposition.
Senior residents will be responsible for supervising the junior residents working in their
assigned clinical area. Residents are also responsible for supervising and monitoring
medical students. As residents progress, they may precept medical students. However,
all patient encounters must ultimately be presented to the faculty in the clinical area.
Residents will also work in conjunction with the nurse and clerical staff to assure that
optimum patient care is given.
Further delineation of supervisory policies can be found in the resident handbook under
that rotation summary.
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Policy on Resident Duty Hours and Work Environment
The EM Residency adheres religiously to the duty hours restrictions. Residents will
adhere strictly the ACGME and New York State Health Code duty hour rules. Any
potential violation of these rules shall be reported to the Program Director immediately.
If the Program Director does not correct the issue, then the resident should address the
issue with the DIO of SUNY Downstate.
Residents will work in an environment that is safe from physical harm and free
discrimination based on the residents’ sexual orientation, race, ethnicity, identified
gender, or socioeconomic background.
Residents will be required to dress and act professionally while on duty.
Work Hours Rules:
Duty hours are defined as all clinical and academic activities related to the program; i.e.,
patient care (both inpatient and outpatient), administrative duties relative to patient care,
the provision for transfer of patient care, time spent in-house during call activities, and
scheduled activities, such as conferences. Duty hours do not include reading and
preparation time spent away from the duty site.
As a minimum, residents shall be allowed an average of one full day in seven days away
from the institution and free of any clinical or academic responsibilities, including
planned educational experiences;

While on duty in the emergency department, residents may not work longer than
12 continuous scheduled hours. There must be at least an equivalent period of
continuous time off between scheduled work periods;

A resident should not work more than an average of 60 scheduled hours per week
seeing patients in the emergency department and never more than 72 duty hours
per week.

Duty hours comprise all clinical duty time and conferences, whether spent within
or outside the educational program, including all on-call hours.
On-call Activities
1. In-house call must occur no more frequently than every third night, averaged over a
four-week period.
2. Continuous on-site duty, including in-house call, must not exceed 24 consecutive
hours. Residents may remain on duty for up to six additional hours to participate in
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didactic activities, transfer care of patients, conduct outpatient clinics, and maintain
continuity of medical and surgical care.
3. No new patients may be accepted after 24 hours of continuous duty.
a) A new patient is defined as any patient for whom the
resident has not previously provided care.
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CLINICAL PROCEDURES
The purposes of procedure documentation are multiple. First, our program is required by
the Resident Review Committee (RRC) section of the ACGME to ensure residents
complete a certain number of procedures prior to completing their Emergency
Medicine residency training. The RRC language is vague on the number of procedures
required in most cases but is very strict about programs providing documentation of
residents’ performing certain procedures. You will be supplied with a list of procedures
that MUST be documented throughout your residency. The other major reason for
requiring documentation of residents’ procedures is that after completion of residency
training, hiring institutions will require documentation of competence in certain
procedures before Attending Physician privileges are granted. Over the last several
years, many hospitals have become more rigorous with respect to verification of
procedural competence during the credentialing process. Thus, it is important for the
resident to receive credit for all procedures performed or supervised during training.
The SUNY-Downstate system has gone exclusively to web-based tracking of procedures
and resuscitations. During your orientation you will be given information about how to
log onto the New Innovations system to record your procedures.
Please realize that there are two different “requirements” for the number of procedures
you will need to document. You will be given a purple procedure book that lists all of
the major procedures we do in the ED and how many you must log before you are
considered “credentialed” to do that procedure by yourself in the hospital. Once you are
“officially credentialed by our hospital” to do that procedure, you will be able to perform
that procedure without direct supervision at KCH and the other hospitals you rotate
through. However, at that time, you may still need to log more of that procedure in order
to meet the RRC’s expectations of how many procedures you must do in order to
graduate from any EM residency program. Both of these sets of numbers will be
provided to you.
Keeping an accurate record is not only important for your future employment
credentialing process, but is also imperative to maintain our program’s RRC
accreditation. Furthermore, keeping an updated procedure log is also part of your
promotion/graduation requirements. If you have any problems or questions about the
tracking program, please do not hesitate to contact Dr. Silverberg.
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EVALUATIONS and FEEDBACK
Residents will be evaluated on each clinical and non-clinical rotation using the following
evaluation & feedback mechanisms. The six (6) core competencies will be addressed in
these evaluations as they apply to the individual rotation.
Evaluation process:
A. Resident Evaluation
Multiple tools are used in the evaluation of the residents. They include oral feedback,
written monthly evaluations, the EVALBOT computerized system, 6-month reviews with
the Residency Directors, faculty advisor meetings, self-evaluation forms and a
computerized SDOT (Standardized Direct Observational Tool), which is located on-line
in the COMPOTENCYBOT computer program.
 Oral feedback should be provided by the supervising faculty during or after each
clinical shift.
 Written evaluation will be completed at the end of each rotation by supervising
faculty and the Resident Education Committee. When in the ED, Senior Residents
will fill out electronic evaluation forms for Junior Residents and vice versa, which
will be reviewed by the Resident Education Committee. These evaluations are all
open to review by the resident and faculty at all times. Residents review and sign all
of these evaluations regularly but no less often than at their 6 month
evaluations.(Next bullet)
 Twice yearly, one of the Residency Directors will review each resident’s performance
and discuss progress, achievements, advancement, problems and projects with the
individual resident.
 Residents fill out an extensive self-evaluation package prior to each six-month
evaluation.
 Residents are responsible to meet with their faculty advisor at least once quarterly for
evaluation and feedback on performance. Advisors have full access and may look at
their resident’s personal files including their portfolio, procedure certification and
their “problems and concerns” file if any issues have been placed in this location.
 EVALBOT is a web-based computer program that allows all attendings to
anonymously evaluate each resident as often as the individual attending likes. It can
be daily after each shift working with a resident or whenever the EVALBOT program
sends out a weekly reminder that certain residents are in the department. Each
evaluation has 2 parts; first, the attending can submit any written comment that they
want concerning the resident’s performance, skills or areas of concern. The second
section is a 5 point scale used to rank the resident in each of the elements of the 6
core competencies.
 The COMPOTENCYBOT computer program requires direct observation by a faculty
member in the clinical setting for approximately 10-20 minutes per encounter. The
resident is required to get an attending to observe 5 patient interviews of different
chief complaints, 3 procedures (including 1 sonogram) and 1 resuscitation each
academic year. These numbers can be manually altered for certain residents that the
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Resident Education Committee feels needs to be evaluated more or less often than the
general resident population. The goal is to evaluate the residents with specific
attention paid to the elements of the 6 core competencies. Both faculty and resident
are able to provide immediate feedback about that specific clinical encounter.
B. Feedback mechanisms:
 Residents will be required to keep electronic documentation of patient care followups. This can include but is not limited to: ward/ICU visits with chart review,
discussion with consultants who managed the patient after ED care, follow-up phone
calls, procedure/operative/biopsy and autopsy reports and samples of discharge and
transfer summaries. Each follow-up should conclude with a detailed search of the
literature reviewing the pathology and pathophysiology surrounding each patient
followed up and should also discuss the most up-to-date treatment guidelines found in
the literature. The resident will be required to fill out one internet based in-depth
follow up form 4 times per year. A web-based computer program will keep track of
how many each resident still needs to complete each academic year. This program is
currently New Innovations (www.new-innov.com)
 Resident charts will be reviewed on a random basis as part of the Emergency
Department’s ongoing Quality Assurance Program
C. Faculty Evaluation:
 All residents are required annually to evaluate all faculty members at
KCH/Downstate and the affiliates using New Innovations. These evaluations are
anonymous. This set of forms is electronically released at the start of block 7 to
every resident for completion prior to May 15th. If you have not finished these
evaluations prior to that May 15th date, you may not be eligible for promotion into
the next year of residency including graduating from the program.
 Residents have the opportunity to evaluate faculty during their six month evaluation
with the program directors
 The EVALBOT program can also be used to evaluate the attendings in an
anonymous fashion similar to how the attendings evaluate the residents with
comments.
D. Rotation Evaluation
 Residents must evaluate each of their rotations at the end of the block. Evaluations
are done on line in New Innovations. They are generated each time a rotation ends.
These forms will become part of the resident electronic file in New Innovations and
will be reviewed by the program directors regularly.
E. Program Evaluation
 The program’s ability to achieve its stated goals and objectives is evaluated on a
yearly basis by both faculty and residents through specially designed forms available
from the residency coordinator.
PLEASE BE AWARE: Compliance with the fulfillment of these requirements has
been a problem in the past. We will therefore treat non-compliance very strictly.
Residents in non-compliance will have to meet with one of the residency directors in
person. They may be given extra assignments, have their clinical areas moved to
186
undesirable locations or may even be prevented from advancing to the next year of
their residency training (even graduating) if these goals have not been fulfilled.
187
RESIDENT PORTFOLIO
The resident portfolio is a useful tool to document all of your educational activities, assist
you in the development of expertise and promotion and will give you a sense of
satisfaction and accomplishment. In addition, the portfolio will help you evaluate your
own performance in a self-reflective manner.
This is the first step on your lifelong journey as a teacher and educator, and setting up
your personal portfolio will help you gather and document all the educational activities
throughout your career. At some point in your career you will have to present the same
or similar information to your chairman when negotiating promotion and tenure as a
faculty member.
The Portfolio should contain enough detail to allow evaluation of teaching and
scholarly activity and yet be concise and selective as outlined. It should consist of
two parts:
Part I: Summary - This is a summary of the teaching/scholarly activity documentation
and should contain the following:
1. A narrative statement (a teaching/scholarly activity philosophy):
This statement could be as short as one paragraph but shouldn’t exceed two
single-spaced pages. It should include your clear goals, how you prepared to
be an educator, what methods you used, what significant results you
achieved, effective presentation of teaching materials, and reflective selfcritique that allows you to improve. It is not supposed to be an existential
statement on your progress or your life; It intended to be based on the
contents of your portfolio. It should indicate what you believe is important
about teaching/scholarly activity and how you put these believes into practice
with specific regard to the five dimensions:





Expertise in Content
Instructional Design (what materials do you design to reach various types
of learners, such as physician assistants, medical students, residents,
fellows, attendings)
Instructional Delivery (how do you communicate information to learners,
i.e. lecture, workshop, facilitated discussion)
Course Management Skills (how do you tell the learner how to be
successful)
Evidence of Student Learning (student/resident evaluations, passing
exams, success of students/residents in their career, increased proficiency
in examining and treating patients)
2. A quantitative summary of teaching/scholarly activities:
This information may be presented in a summary format (sample provided as
attachment).
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189
Teaching/scholarly activities may include :

formal didactic presentations (all lectures to faculty, seniors, juniors,
medical students, journal club, CPC, Grand Rounds etc.)

workshops (EKG/Radiology/Splinting workshop, ACLS, etc.)

seminars

panels

informal discussions (focus group, topic review, literature battles, morning
report, journal club, ultrasound teaching to juniors/students)

advising/mentoring of medical students and residents

teaching during clinical hours

bedside teaching.
Other scholarly activities may include:

research (grants, published research papers, abstracts, poster presentation)

published articles

textbook chapters

editing journals/books

written course material such as syllabi or outlines/handouts

products of educational merit (videos, CD-ROM’s, computer based
instruction, websites, exams)

curriculum/courses designed/coordinated

committee involvement/service activity

educational courses attended (ACEP, SAEM, etc.)

awards and honors

evaluations (recommendation letters, lecture evaluation form, thank you
letters)
Whenever possible, you should include proof of quality of teaching/scholarly activity
including awards and evaluations or letters by faculty, peers, and medical students.
Part II: Appendices – Supporting documents for the Portfolio should be kept in a
binder or folder documenting the activity, material produced and evaluation of the
activity and material.
190
There are a few items you should include in your portfolio (some are in addition to the
ones mentioned above):
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all printed and labeled ultrasound images
one-page write up of your morning report
lecture/journal club/presentation printouts, CD’s and/or handouts
patient encounter follow up form (one per month)
focus group questions and answers you prepared
topic review questions and answers you prepared
PLEASE NOTE: The portfolio should be given to the residency coordinator and
must be updated after every educational activity. It should be available and will be
reviewed during the 6-months evaluation by the Residency Directors.
If you have any questions or need help, please contact Dr. Doty.
191
PORTFOLIO – SCHOLARLY ACTIVITIES WORKSHEET
1. Teaching Awards and Honors
2. Educational Committees
3. Curricula Developed
4. Lectures
5. Workshops
6. Seminars
7. Panels
8. Mentoring/Advisees
9. Grants
10. Research
11. Publications
12. Educational Materials Produced
13. Educational Courses Attended
14. National Activities
192
TRAVEL PLANS & REIMBURSEMENT PROCEDURES
The following outlines the procedure to follow
regarding travel/conference reimbursements.
1.
Complete travel approval form (located in rack outside of residency office) and
return to Martha Patella for approval by Residency Director, Chairman and/or
Dean.
a. Attach documentation legitimizing conference. i.e. front page of the brochure
or blank registration form.
b. This is for any type of travel that you anticipate getting reimbursed for.
When in doubt, ask Ms. Patella prior to the event..
2.
Once you receive the approval notice (usually in less than 2 weeks), see Ms.
Patella to make airline/rail reservations. through the SUNY travel agent. There
will be no out of pocket for airlines or rail travel. It will be paid directly through
SUNY. (Please note that you will not be reimbursed should you book and pay
for your air/rail travel on your own.)
3.
After you receive the approval notice, you can register and pay for conferences
and hotel reservations. After the conference bring your original receipts to Ms.
Patella and complete a travel voucher form. SUNY will reimburse directly to
your home. They will also reimburse for cab fare, breakfast and dinner (no
lunch) only with original receipts. If you intend to rent a car, a letter justifying the
expense will be required.
193
DUE PROCESS AND GRIEVANCE PROCEDURES
A. Departmental Resident Due Process and Grievance Policy
Residents who do not meet departmental academic or professional requirements as set
forth in this handbook, and accordingly are judged by the Residency Directors to have
failed to maintain satisfactory performance resulting in disciplinary action and/or
dismissal or termination of contract prior to completion date, may challenge this decision
by appealing to the Departmental Resident Grievance Committee.
This committee is chaired by the chairperson of the department and includes the
resident’s faculty advisor, a member of the departmental steering committee, one of the
Chief residents, and a resident representative.
A request for review of any disciplinary action by this committee has to be done in
writing to the Chairperson of the department. The committee then convenes and will
review the case in a timely fashion. Results of this review will be forwarded to the
Residency Director and the institutional GME committee for further action.
If the unfavorable issue is upheld or not resolved by this committee, the institutional
GME Committee may be contacted for review of the action.
In the case of a violation of departmental academic and/or professional standards and/or
serious patient care issues by a resident, the program director will issue a written
warning. This warning will also outline expected corrections, suggestions how to achieve
them, and in which time frame. The resident will be given a copy of the warning, the
signed original will stay in the resident’s file, and another copy will be forwarded to the
GME office. In the unlikely event of a repeated negative action, the resident will be
placed on probation. If a performance review after the specified time or a third negative
action occurs, and if the resident has been given proper due process, the resident will be
dismissed from the program.
However, certain serious patient care issues as judged by the departmental leadership,
may lead to immediate dismissal.
B. Institutional Due Process
The resident agrees that the continuation of his residency depends upon the satisfactory
performance of assigned duties, and that failure to maintain a satisfactory performance, in
the judgment of his Program Director, may result in termination of this Agreement and
dismissal of the Resident from the Residency Program prior to the completion date. In
the event of resident grievance, academic discipline or dismissal from the Residency
Program, the Resident shall be entitled to due process in accordance with the policies and
procedures adopted by the Graduate Medical Education Committee (GMEC) and the
HSCB standard.
194
Due Process in all SUNY-HSCB programs will be based on department specific
educational requirements and expectations for resident performance. Departmental
guidelines and procedures for resident review and evaluation must be explicit and in
written form, consistent with RRC requirements, and must meet the HSCB standard set
below:
A. The GMEC must be notified by the Department Chair or Program Director of any
action leading to the suspension, probation or dismissal of a resident. In all instances
documentation of evaluations and attempted intervention must be in place prior to any
action.
B. Residents who challenge an evaluation of their academic performance in a required
educational activity, or who challenge an unfavorable academic standing or status
assigned to them because of inadequate evaluations of their performance may request a
review of the evaluation or of the academic status, or both.
Each residency program has established procedures for considering such requests.
Residents who wish to request a review of an academic grievance should submit such a
request in writing to the program Director. If the issue is not resolved through completion
of the program’s grievance procedure, residents may then address a petition to the GMEC
for a review of their case and of the program’s decisions on it. The GMEC may appoint
and refer such petitions to an Ad Hoc Resident Grievance Sub-committee. In reviewing a
resident’s petition of redress of an academic grievance, the Ad Hoc Resident Grievance
Sub-committee may utilize a variety of procedures. The procedures adopted are those
which the committee believes will provide the parties involved with an opportunity to
present their sides of the issues to the committee and for the committee to gather
information and evidence as it deems necessary to make its decision. Action taken on
resident grievances by an Ad Hoc Resident Grievance Sub-committee is reported to the
GMEC. Action accepted by the GMEC is final and is not subject to further formal
review within the University.
C. Departmental due process procedures must be consistent with SUNY HSCB Resident
Evaluation Policies and Procedures.
D. SUNY-HSCB Due Process and Grievance Policies and Procedures are independent
(and complementary) to those set forth by HHC-Collective Bargaining Agreement, the
Brooklyn VA and other affiliated hospital procedures.
195
FACULTY ADVISORS
Each resident will be assigned a faculty advisor. The role of the advisor is to facilitate the
resident’s progress through the residency. The resident is encouraged to utilize his or her
faculty advisor with all aspects of resident life. Faculty advisors should be a source of
feedback and inspiration for the residents. The faculty advisor may be particularly helpful
in assisting the resident to achieve set academic goals. It is required that the faculty
member and the advisee meet at least every three months to review the resident’s
progress. The faculty advisor is also required to review the monthly patient follow-ups.
Residents may ask their advisors to be present during their bi-annual evaluation with the
residency director and during any remediation discussions with the residency directors.
It is the resident’s responsibility to approach his/her advisor. If there are problems
scheduling a meeting with your advisor or you would like to change your advisor for
any reason, please let the Residency Directors know.
However, the role of the advisor shall not be limited to mandatory meetings but shall be
proactive and visible in the resident’s academic development.
This can be accomplished in a variety of ways and should consist of, but not be limited
to, some of the following:
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Literature review
Reading assignments
Meetings with oral board type scenarios
Case review
Review of advisee’s follow-up sheets
Round table discussions
Question & answer settings
Review of multiple choice questions
Review of ethical and administrative issues
Review of resident’s procedural skills and help in achieving excellence
Review of the resident’s ethical and professional growth and guidance towards
excellence
Mentoring during times of personal duress or stress
Resolution of conflicts with the department or other staff
NOTE: A Resident Evaluation Form (located outside Ms. Lane’s office) may be used as
a guideline for resident-advisor meetings to address certain issues and to document
regular meetings. This form must be given to the residency coordinator to be placed
in the resident’s file.
Please inform the Residency Directors (specifically, Dr. Quinn) if there are any problems
with meeting with your advisor or if you wish to be assigned to a different advisor for
any reason.
196
SICK CALL POLICY
The Department of Emergency Medicine has set up a sick call beeper system to cover the
ED when residents are ill or unable to work scheduled shifts. During the PGY-2 and
PGY-3 years residents will be assigned two separate two-week blocks of sick call.
Historically, these rotations have been during non-ICU and non-ED rotations, such as
ENT, Ultrasound, and Research/Airway. While on sick call, the resident will generally
cover any sick EM resident scheduled for the UHB & KCH adult or pediatrics EDs.
Typically, PGY-2 residents cover junior residents and PGY-3 residents cover senior
residents. However, at the discretion of the EM Chief or residency directors, any sick
call resident may be activated for any sick resident irrespective of year or parent
department.
The sick call resident will carry the sick call beeper for the entire time on sick call
and is expected to be available and free from the influence of any mind altering
substance at all times during their call period, including weekends and nights. The
resident must also stay within beeper range of the hospital. If you need to leave the NYC
area then arrange coverage from a peer. The resident who is receiving the pager at the
time of turn over is responsible for obtaining the pager. Not having been given the pager
is not an excuse to miss a call. Any resident who is unavailable during their sick call will
be held accountable for the missed clinical time.
The sick call beepers are usually used when another EM resident calls in sick, the ED is
busy, and extra help is required to ensure adequate patient care. Do not abuse the Sick
Call System. It is not to be used for recreational or personal needs.
The only people who are authorized to activate the sick call resident are the Chiefon-call or one of the Residency Directors. If the sick call resident is called in by
another person, the called resident is to immediately refer the matter to the Chief
Resident on call or one of the residency directors.
The following is the procedure for an ill resident to activate the sick call system:
PLEASE NOTE:
NOT ADHERING TO THESE PROCEDURES HAS CAUSED MAJOR
PROBLEMS IN THE PAST. THEREFORE, STRICT ADHERENCE IS
MANDATORY AND WILL BE ENFORCED.
197
Sick Call Procedure: KCH ED
1. This procedure has to be followed for all rotations, not only KCH-ED
2. Check to see if there is anyone who can switch with you. Contact that person. You
must call the Chief-on-call either way. If you can find coverage for yourself, call the
chief-on-call and tell the chief who will be covering your shift. If not, you need to
call the chief-on-call and tell them that you will require sick call coverage.
3. You must call the Residency Director on call (pager no.: 1-917-219-0650,
and the chief on call (1-917-761-1405.) If you cannot reach a director via pager, then
feel free to call the directors cell phone (see below) and leave a message on their cell
phone voicemail. NOT CALLING IS UNACCEPTABLE UNDER ANY
CIRCUMSTANCE UNLESS YOU ARE INTUBATED.
4. You must leave a message with the Residency Coordinator (718-245-3318)
5. A Residency Director and/or the Chief-on-call will decide IF the sick call resident
will be called after evaluating who is calling in sick and the state of the clinical area
that is about to be short-staffed. We only use sick-call when absolutely necessary.
6. If sick call coverage is required, then YOU must call the sick call person to cover for
you; the chief on call may volunteer to do it for you, but it is ultimately YOUR
responsibility.
7. **Only the Chief-on-call or one of the Residency Directors can activate the sick call
coverage system.**
Sick Call Procedure: Off-service and Affiliate EDs
Same as above, in addition:
 You must notify the clinical site director for ED rotations and the Chief residents for
off-service rotations.
 Residents will adhere to established sick call policies at these sites.
 Any difficulties with sick call policies should be referred to the Residency Directors.
 You must call the Residency Director on call (pager 917-219-0650).
 You must leave a message with the Residency Coordinator (718-245-3318)
Sick Call Procedure Conference Days
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You must make 70% of conference days. There is no negotiation on this point. If
you are sick, don’t come in. If you miss more than 30% of all conference days for
ANY reason, then you can not graduate the program until this is rectified.
198
Cell Phone numbers
Doty
917-597-0466
Rios
917-693-4429
Silverberg
917-822-4510
Quinn
718-938-4841
Gore
312-399-3451
199
ED CONFERENCE ATTENDANCE POLICY
In an effort to give the residents more autonomy, we have instituted the following
attendance policy for conference. It is a national benchmark that every EM resident must
be present for 70% of the Wednesday conferences that we sponsor. (35% for EM/IM
residents) With that thought in mind, we would like to leave it up to you, the residents, to
make sure that you are making this RRC requirement. Therefore, the directors will not
be worried about your reasons for missing conference. It is your responsibility to be
there. The attendance statistics will be posted on the conference room door on or around
the first of every month. You must be there for the full 5 hours to get credit for the day if
you are not scheduled to work that day or the night before. If you leave early or come
late outside of the current handbook policy on Wednesday conference attendance,
you will not get credit for that conference day.
Realize that this 70% of conferences includes everything. (Sick day, I worked overnight,
my car got towed, my Granny was in town, I was on vacation, my dog ate my
metrocard…EVERYTHING.)
If you come more than 5 minutes late, it will be recorded. If you are late 3 times, it will
count as one full missed day of conference. It is your responsibility to keep track of your
conference attendance and know how close you are to that 70% level. This number can
be reviewed with a residency director at your 6-month evaluation meeting or you can
make an appointment with a director to discuss this at any time.
If by some terrible chance of luck, graduating residents are below your required 70%
(35%), they will have to attend conference during their elective or during July (after
graduation) to make the minimum requirement in order to graduate the program. The
70% (or 35% for EM/IMs) RRC conference attendance requirement is not negotiable and
you can not graduate from ANY EM residency with out fulfilling it.
We are examining the possibility of asynchronous learning (doing some portion of your
educational time outside of conference time). We will publish some guidelines for this in
the future after we agree with the RRC on what is possible.
200
WORK ATTIRE POLICY
We all realize that the hospital is not the cleanest place in the world. Therefore, wearing
fancy clothes can become taxing on the wallet when dry cleaning bills and replacements
for destroyed garments start to stack up. However, as dirty as the ED may be, we still
need to look professional. While we do not want to enforce a strict dress code, we would
like to set a standard.
When working clinically at Kings County, scrubs are acceptable although we encourage
professional casual dress when working in the non-procedure oriented areas such as Pod
A. Jeans are never acceptable and neither is any shirt that does not cover the entire
abdomen. When working in UHB, men should try to wear khaki pants or slacks and a
button down shirt while women can wear a similar ensemble or something equally as
professional. Additionally, we should also think about what we wear to our academic
Wednesday conferences. This is especially true when an outside speaker is going to be
present. When giving a lecture, looking the part is very important. If you are giving a
lecture, you should have professional attire or business casual. This means:
1. No scrubs when giving a lecture. If you are working at 12 noon or worked the
overnight, you can change into your scrubs before or after your lecture
2. No jeans, t-shirts or sweatshirts when giving a lecture
3. The lecturer should wear business casual which means an ironed shirt, pants, blouse,
dress etc.
If you have questions, you can check out the link below for some additional examples.
http://www.career.vt.edu/Jobsearc/BusCasual.htm
You put a great deal of effort into your presentations. Look the part and complete the
package. If you have any questions, please feel free to contact your faculty advisor or
any one of the residency directors with additional questions.
"The difference between greatness and mediocrity is in the detail."
201
MOONLIGHTING
Moonlighting during residency is a controversial topic in Emergency Medicine. A
number of residents moonlight to make some extra money and the added clinical
experience of practicing in a different environment. Supporters of moonlighting feel it
can be an important transition towards practicing solo. The department’s stand on
moonlighting is neutral; however, residents who moonlight will have to get approval
from Dr. Doty. This approval is contingent on satisfactory clinical and academic
performance (including the in-training exam).
Moonlighting at other institutions is only allowed in the graduating year and CAN NOT
BE IN A SINGLE COVERAGE ED. There must be a board-eligible EM attending
working with you, even if you are functioning as the attending.
There will occasionally be opportunities to “moonlight” at KCH or UHB and sometimes
our other affiliates. These shifts are paid, cannot be in conflict with your other residency
responsibilities, and are under the supervision of EM faculty. You function as a resident
during these shifts, not as an attending. These shifts are allowed at the discretion of and
with the agreement of the residency directors and the medical directors. This approval
also is contingent on satisfactory clinical and academic performance (including intraining exam).
All moonlighting schedules have to be reviewed with the program directors prior to the
beginning of the month. The purpose of this is to ensure moonlighting does not
compromise any resident’s departmental duties as well as educational obligations.
Moonlighting may also not interfere with ACGME or the New York State DOH 405
regulations, which state that a resident may not work more than six consecutive days in
the ED, including conference days.
Please note, that failure to adhere to this policy may result in loss of moonlighting
privileges and/or other adverse actions.
202
POLICY ON CHIEF RESIDENT SELECTION
Being a chief resident is a challenging and rewarding experience. Chiefs will gain a
tremendous amount of supervisory and administrative experience in that year. Chief
residents in the program are graduating year residents and are selected by the Program
Director, the faculty, and the residents for service.
Our chief resident selection is very close to a completely democratic process. However,
the Program Director reserves the right to make final decisions and alterations in this
selection process that he/she feels is in the interest of the program and the department.
The normal procedure for chief selection is as follows:
1. Residents of the appropriate year will have an opportunity to add or remove their
name for consideration for chief resident.
2. This list will be approved by the Program Director in consultation with the
residency and departmental leadership.
3. The Program Director can remove candidates from the list if he/she feels that that
candidate cannot serve effectively in the chief resident role.
4. The final list becomes a ballot and is voted on by the entire department with 1
vote for each physician. The residency coordinator also has 1 vote.
Chief residents can be selected from either program. The combined resident with
the most votes will become a chief. Additionally, the four residents with the most
votes will become chiefs. Only 2 EM/IM residents can be selected as chiefs. If
there are more than two EM/IM residents in those top 5 candidates, then the next
categorical resident will be selected until the chief complement is full, and the top
2 EM/IM residents will serve as chiefs in this event. The chief of the EM/IM
program will always be an EM/IM resident. This process can be altered by the
program director if he/she feels it is in the best interest of the program.
Chief candidate qualifications:
1. Model resident
2. History of strong contribution to the residency and department
3. Academically solid
4. Superior leadership skills
5. Strong interpersonal and communication skills
6. Has not been on probation or formal remediation during the program
7. Holds a valid NYS medical license
203
ON CALL ROOMS AT KCHC
There are two on-call rooms available to KCH EM residents. The rooms are located in
the T-building on the 8th floor and are available on a per day basis for the residents. The
rooms are for all EM residents to use and squatters will be asked to move out their
belongings if they prevent other EM residents from access to the rooms. Room keys are
available from the residency coordinator.
If keys are needed for the weekend, please contact the residency coordinator in advance.
204
EMPLOYEE HEALTH SERVICE (EHS)
In addition to your provided health care coverage each affiliate institution maintains an
employee health service center. The health service center is responsible for a number of
resident related issues. Each resident must obtain and maintain health clearance from the
institution responsible for their salary. This usually entails an initial health screening
exam and verification of PPD status and immunizations. Periodically employee health
services may request repeat PPD testing and other occupational health care related
training (e.g. respiratory isolation mask fitting). The other time employee health service
may be utilized is with respect to illness or injury at work. One important injury that
EHS is responsible for is follow up on all occupational exposure to blood borne
pathogens. All needle sticks at Kings County irrespective of resident pay source are
referred to KCH EHS after initial care is provided in the Treatment Room. KCH EHS is
to forward all needle stick paperwork and laboratory results to the residents’ payroll
institution after the initial follow up visit.
Employees Health Contact Numbers:
Kings County
Brookdale
Our Lady of Mercy
Staten Island
UHB
(718) 245-3536
(718) 240-5541
(718) 920-9174
(718) 226-9158
(718) 270-1995
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NEEDLESTICK/BODY FLUID EXPOSURE PROTOCOL
Occupational exposure to infectious disease is an obvious concern at Kings County and
its prevention is a priority of the department. Recently, the Centers for Disease Control
has issued a recommendation concerning occupational exposure to infectious bodily fluid
and the possible use antiviral medications. Please review this material and be familiar
with what to do if you or a colleague suffers a body fluid exposure or needle stick.
Please remember to check your Hepatitis antibody status and take appropriate steps when
indicated.
All employees, residents, students, or visitors to Kings County Hospital who sustain an
exposure are to be seen in the Emergency Department (24 hours a day). The needle
stick packet is available at all time in the ED and has to be completed by the
attending physician or an ED resident. The recommendations for antiviral medications
are enclosed in the needle stick packet and if antiviral therapy is initiated the first dose
will be distributed from the supply in the Treatment room.
Dr. Jacques, the ID specialist, should also be paged (917-486-2623, or office x 3716)
to follow up on all needle stick prophylaxis.
At discharge the exposed patient should be given a prescription for a five-day supply.
The prescription should be filled without charge in the pharmacy for all residents. Needle
stick packets should be filled out completely and given to the ED Administrator on
duty. Also exposed patients and agreeing source patients should have “needle stick”
bloods drawn at the time of injury. The computer has a predetermined panel that may be
selected that includes all needed blood test except HIV testing.
Both the source patients and exposed health care workers can be counseled and consented
for HIV testing using the consent forms in the needle stick packet.
Please follow the instructions affixed to the packet for proper processing.
All employees and residents are to follow up in employee health services the
following working day.
Any questions, please contact Dr. Doty at: 718-245-3318/20 or x4790 (office) or 917760-2005 (beeper) or cell 917-597-0466
206
INSTITUTIONAL POLICY ON DISCRIMINATION & SEXUAL
HARASSMENT
Discrimination: SUNY-HSCB does not discriminate on the basis of race, sex, color,
chosen gender, religion, age, national origin, disability, marital status, status as a disabled
veteran or veteran of the Vietnam era, or sexual orientation in the recruitment and
treatment of students and residents.
Sexual Harassment: In keeping with the University’s efforts to establish an
environment in which the dignity and worth of all members of the institutional
community are respected, sexual harassment of students and employees at the HSCB is
unacceptable conduct and will not be tolerated.
Sexual harassment may involve the behavior of a person of either sex against a person of
the opposite or same sex, when that behavior falls within the following definition:
Sexual harassment of employees, residents, and students at the HSCB is defined as any
unwelcome sexual advances, requests for sexual favors, or other verbal or physical
conduct of a sexual nature, when: (a) Submission to such conduct is made either
explicitly or implicitly a terms or condition of an individual’s employment or status as a
student; (b) Submission to or rejection of such conduct is used as the basis for decisions
affecting the employment or academic status of that individual; (c) Such conduct has the
purpose or effect of unreasonable interfering with an individual’s work performance or
educational experience, or creates an intimidating, hostile or offensive work or
educational environment. A hostile environment is created by, but not limited to,
discriminatory intimidation, ridicule or insult. It need not result in an economic loss to
the affected person.
Complaint Procedures: Persons who feel that they have been subject to prohibited
discrimination or who have been sexually harassed under the above definition and wish
further information, or assistance in filing a complaint, should contact the Affirmative
Action Officer at (718) 270-1738, Room #5-82 C, Basic Science Building. Any resident
that feels they have a complaint can also bring that issue to the Program Directors or the
Departmental Chairman.
207
FAMILY MEDICAL LEAVE ACT
Effective February 5, 1994, all employees are eligible to request unpaid leave charged to
leave credits under certain circumstances, for a period of up to 12 work weeks in a 12month period due to: 1) the birth of a child or the placement of a child for adoption or
foster care; 2) the employee’s need to care for a family member (child, spouse, or parent)
with a serious health condition; or 3) the employee’s own serious health condition which
makes the employee unable to do his or her job. Under certain conditions, this leave may
be taken on an intermittent basis.
Employees are also entitled to continuation of health and certain other insurance,
provided the employee pays his or her share of the premium during this period of leave.
Upon return from FMLA leave, most employees must be restored to their original or
equivalent positions with equivalent pay, benefits, and other employment terms. FMLA
makes it unlawful for any employer to 1) interfere with, restrain, or deny the exercise of
any right provided under FMLA, or 2) discharge or discriminate against any person for
opposing any practice made unlawful by FMLA or for involvement in any proceeding
under or relating to FMLA. The U.S. Department of Labor is authorized to investigate
and resolve complaints of violations. An eligible employee may bring a civil action
against an employer for violations. For additional information, contact SUNY Labor
Relations at x3019.
Please note, that since residency is a structured educational process requiring a
minimum number of months of training for Board eligibility you may take FMLA
but you will need to make up the months. In other words you may end your
residency at a later date.
208
THE IMPAIRED PHYSICIAN
Physician impairment through alcohol and drugs is a widely recognized problem.
Residents in high acuity, high stress environments are particularly prone to fall victim to
alcohol and drugs. The University has outlined guidelines in its SUNY Resident
Handbook on how to deal with impairment. Please refer to the appropriate pages of the
SUNY Resident Handbook.
If you should notice any impairment in yourself or your peers and need help in dealing
with it, please contact your faculty advisor, your Residency Directors, or your Chief
Residents.
Since we are in a highly visible field of service AOB (=Alcohol on Breath) is viewed as
absolute unprofessional behavior and an early sign of a possible underlying problem.
Physicians appearing to having a drug or alcohol problem will be referred to the NYS
Committee for Physician’s Health.
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Emergency/Disaster Preparedness 2010-2011
Preparation for emergencies is a well-developed sub department at SUNY Downstate and
Kings County Hospital Medical Center. The New York Institute /All Hazard
Preparedness has been a funded part of the Emergency Medicine Department since 2002.
We work with other departments at SUNY, nationally and internationally on various
research projects including but not limited to, Community Wide disaster drills and
creating policies for treating Pediatric and Geriatric Patients in a Disaster. We have
contingency plans for ensuring that the Medical Centers would continue to operate in
times of disasters.
The hospital’s plans are updated and maintained by the Emergency Preparedness
Committees of University Hospital and Kings County Hospital they can be found on the
web at:
http://138.5.102.101/emergency_medicine/disaster.html
The Emergency Management Plans are “All Hazard Plans” as required by Governmental
and Joint Commission Standards. The Plans also address how the Medical Centers will
respond to Nuclear/Radiologic, Biologic and Chemical and Mass casualty incidents. The
Medical Centers have committed significant resources towards the development of a
Hazardous Material (HAZMAT) Decontamination System, which includes
representatives from the Emergency Department, University Police, facilities and
Environmental Services. All incoming interns are trained in HAZMAT protocols. In
addition, we recertify resident classes 2, 3 and 4 every July. There is an ongoing effort to
enroll and train the nursing staff as well. This team is trained and certified in emergency
decontamination procedures. In addition, we are committed to awareness level training in
HAZMAT for all employees.
As part of our emergency preparedness efforts, the Emergency Department has conducted
a number of tests/drills of our Emergency Management Plan and disaster related
educational programs:
All residents participate in these drills. Through these drills we continue our research in
disaster response systems.
The SUNY/KCH Fellowship in Emergency Preparedness started in July 2005. This is the
only hospital based disaster preparedness fellowship in the United States. The fellowship
is a 1 or 2 year program.
Goals for the future: At both hospitals we are committed to large ongoing educational
programs for all departments of the hospital. We work with each department on their
disaster plan and insure that it integrates well with the hospital-wide plan. We have
enacted The Hospital Incident Command System (HECS) and on-going education
continues. At the same time EM residents are actively involved in the Disaster
210
Committees. They participate in local, state, national and international conferences in
emergency medicine representing the disaster committees of both hospitals. Research
continues on how best to prepare for disaster in two hospitals that share resources. We
will be continuing to forge a community response in Brooklyn with additional drills and
education. Current resident projects include: surge capacity research, equipment
management, hospital disaster training and education, and participation in the
management of the Medical Student Support Team to name a few. We participate in
INDUS-EM collaboration with All India Medical Institute, Medical College of Boroda
and the University of South Florida. We were part of the preparedness activities for the
2010 World Cup.
Terrorism continues to be a threat in the United States and large accidents or natural
disasters occur daily. These events can drain the resources of even the most prepared
hospital. As members of the Medical Center community, we all have important roles in
our disaster plan. It is important that you know your role in the plan as well as our
department’s responsibility in times of an emergency. This will help ensure that we will
always be able to provide the best care for our patients. A basic outline of the steps to
take if a disaster is declared is attached for review. Please read this document and review
your specific Emergency Management Plan.
Thank you.
Bonnie Arquilla, DO
Director Emergency Preparedness
211
WHAT TO DO IF A DISASTER IS
DECLARED

Your department has a plan. Do not leave your
regular post/job unless you are instructed to do so by
your departmental plan or supervisory personnel.

Do not under any circumstances speak to news
media. Refer them to the Office of Institutional
Advancement of UHB or Media Relations of KCHC.

No visitors are allowed in the hospital during a
disaster. Send all visitors to the Family Reception Area
in the Cafeteria of UHB or T-Building of KCHC.

Activation of the plan occurs in phases:
Potential: Limited departmental notification – no staff changes.
Actual: Limited or complete notification –possible staff changes.

The Hospital plan is an All Hazard Plan: Any disaster
inside the hospital or on campus that endangers patients or
staff and creates a possible need for evacuation or
relocation.

Anyone who learns of an occurrence that might
constitute a disaster should attempt to obtain the following
information and contact the Administrator on Duty
immediately: In the emergency department the CCT
attending or UHB Main ER attending can declare a disaster
for a Mass Casualty, if unable to contact the AOD.
What was the occurrence?
212
What is the location of the occurrence?
How many casualties are estimated?
What are the types of injuries?
How many people were injured?

4-4-4-4 Bells or CODE D means an Actual Disaster
is in progress in UHB.

2-2-2-2 Bells or CODE Yellow means an Actual
Disaster is in progress in KCHC.

The Emergency Operations Center coordinates all
resources during a declared disaster.

The Disaster Cabinet and Mass Casualty Incident
(MCI) Packets are in the Emergency Department
Ambulance Entrance.

All patients/victims will enter through the
designated areas for primary triage. Direct all victims to
that location to assure that they are evaluated and treated in
order of need, given the best and fastest care possible and
prevent hospital contamination.
 Where will overflow patients at KCHC be evaluated
and treated?
D Building Lobby
Trauma
Peds E building
Minor
R Building
Minor Medical & Minor
Peds Medical and Peds
Behavioral Health
213

Where will overflow patients at UHB be evaluated
and treated?
Adult Emergency Department
Major Casualty
Pediatric Emergency Department
Peds Major Injury
Suite A
Minor Medical
Suite B (Waiting area)
Minor Trauma
Suite D
Peds/Medical Minor
Trauma
Suite I
Behavioral Health
Suite J
Eye Trauma

After the evaluation and treatment of minor patients is
complete, they must go the Family Reception Area to
complete the proper paperwork arrange for follow up and
be discharged. The Family Reception Area is in the
Cafeteria at UHB. It is in the T-Building 1st floor at
KCHC.

The Nursing Staff Resource Pool is in the Nursing
Office.

De-escalation and Stand Down: At UHB the All
Clear signal is 1-1-1-1 Bells. At KCHC the All Clear
signal is a verbal overhead announcement, “This is an all
clear.”

Debrief: Report helpful comments recommended
changes to your Department Head.
214
STUDENT EDUCATION
As you learned during the SUNY-Brooklyn orientation, you will be part of a resident
development program. The program is designed to help you gain the skills, which are
necessary for you to excel in emergency medicine in a teaching forum. Our
University system is an academic institution, which is dedicated toward fulfilling the
mission of patient care, education and research. Patient care will come with
experience, research will go on all around you, but education is something we all
must actively pursue.
It will be a rare clinical moment when you find yourself entirely without a single
student. Whether they are physician assistants, nursing, military or medical students,
they depend on you for their education. You have the unique opportunity to impact
the career development of your colleagues and future health care providers of our
nation. We expect you to take this responsibility seriously. Teaching students is part
of our job. It’s not a burden; it’s a privilege.
We all “carve out” a piece of time during our busy day to teach. Hopefully, you will
become proficient at it and even enjoy teaching. Teaching is as rewarding as a
handshake from a patient or a smile from a child. It is one of the reasons why we put
on that stethoscope each day.
Look out for the students when they are in the clinical area and get them involved in
good cases. They should be able to see most cases by themselves, but if you see them
getting hung up on a particularly difficult case----bail them out. In general, residents
are primarily responsible for the patients they supervise with the students. However,
in the case of senior elective students who are working with the faculty, senior
residents may hear student case presentations, and then help them organize the case
for formal presentation to the attendings. Although the Senior resident will be
charged with identifying and distributing the students evenly between residents and
Faculty, the Attending and Senior resident should communicate with each on how
best to do this depending the physician coverage and # of patient in the area. (See
guidelines below).
Residents are asked to guide students through the SUNY Downstate/Kings County
system (i.e., how to send labs, where supplies are, how to get medications, etc.).
Senior residents and attendings will be asked to help with the didactic portion of the
student rotation.
Our department offers the following student rotations in the next academic year:
1st Year Students:
215




Doctoring experience: each MS 1 will spend one evening in the ED, preceded by
a short introductory lecture and followed up with a experience summary
Emergency Medicine (observational) elective: a selected number of first year
students spend one evening a week for 6 weeks shadowing physicians in the ED
EM Ultrasound curriculum in development
Patient Simulator curriculum in development
2nd Year Students:
 Emergency Medicine (observational) elective: a selected number of second year
students spend one evening a week for 6 weeks shadowing physicians in the ED
Mandatory EM Clerkship:
 As of 2000 every medical student has a mandatory 2-week Clerkship rotation in
the ED (generally MS3, but some deferred to their MS4 year). Students on this
rotation should present primarily to residents, but depending on ED staffing they
may also present to the attendings.
4th Year Students:
 Four week EM elective: these students are interested in EM. They may present
primarily to the faculty, as they are interested in LORs. However, depending on
ED staffing, they may occasionally have to work with a senior resident.
 Two week advanced EM elective (CCT)
 EM research elective
 Peds EM elective (2 or 4 weeks)
 Advance Preceptorship elective - “Follow an Attending”
 EM Ultrasound elective
 EM Brooklyn VA elective
Other departmental medical student involvement:
 First year anatomy lab clinical correlation
 Second year phlebotomy labs
 Participation in the first year mentoring program
 Participation in the problem based learning program
 Participation in the Preparation for Clinical Medicine Course - First Year
 Participation in Essentials of Clinical medicine Course (lectures, small group
facilitators)
 Emergency Medicine lectures for the Physician Assistant Program
 Serve as mentors for the Sophie Davis Educational Program (Advanced
placement Minority Student Program)
 Frequent lectures to the Emergency Medicine Club
 Pre–med college student observational clerkship
 First/Second year suture lab
 Second year physical examination course
216
DEPARTMENT WEBSITE / INTERNET RESOURCES /
EMAIL / COMPUTERS / HANDHELDS
SUNY Downstate / Kings County Emergency Medicine Website
To get to the department home page, start at www.downstate.edu. Then use the left sided
navigation and click Education > Residency Programs > Emergency Medicine.
URL: www.downstate.edu/emergency_medicine
Our webpage strives to be an electronic repository of information during your residency.
Use the left sided navigation bar to get to different areas within the site.
217
All clinical and academic schedules (Schedules) can be found online. In addition, there
are many resident-oriented resources catalogued on the site. Go to the Resident
Resources section for more links and information.
A copy of the Residency Handbook is available online. It is in the Resident Resources
section.
Many of the online resources are password protected. The password is always “suny”.
Clinical Information Systems
You will have a training session for the clinical information systems used at Kings
County Hospital and SUNY Downstate. The product used at Kings County is
CPR/MISYS. The product used at SUNY Downstate is the TSystem.
Internet Access at Kings County Hospital
Every resident is authorized to have Internet access at Kings County Hospital. You will
receive a username and password, which will be prompted when you attempt to access
most sites outside of the Kings County Intranet. Internet access through Kings County is
limited without a username and password. Restrict your browsing to clinically relevant
domains. Completely close your web browser windows when you are finished, as your
Internet activity is monitored. Without a password, you should still be able to access your
Downstate, Yahoo, Hotmail, and Gmail e-mail accounts and most clinically relevant
sites.
Internet Access at SUNY Downstate Hospital
Every resident is authorized to have Internet access at SUNY Downstate Hospital. There
is no username or password required to get online, however some sites are blocked by the
firewall. Again, please restrict your browsing to clinically relevant domains.
Email Account
All residents need to maintain at least one e-mail account and keep Ms. Lane up to date
with that address. Your e-mail address should be used for membership to the SUNY EM
Yahoo! Group (a mailing list) and you should check it on a regular basis for departmental
communications.
218
Online Educational Resources
The Downstate Library website serves as a portal to a host of medical journals (Serials
List) and a variety of evidence based-medicine resources (EBM Resources).
For access from Kings County or home, most Downstate library resources will prompt
you for a username and password. Your username is your full name as printed on your
Downstate ID and your password being the 16-digit number immediately below your
name (not the Lib#).
Computers
In addition to the computers in the clinical areas, there are computers in the resident’s
lounge/trailer with the Microsoft Office suite and Internet access.
Handhelds
Faculty and residents use a variety of personal digital assistants (PDA’s). Feel free to ask
individuals about their thoughts on what they use.
Website/Technology Development
We are looking for help in further development of our website and electronic resources.
Any resident with interest in medical informatics is encouraged to contact our Medical
Informatics Director, Dr. Peter Peacock.
219
Miscellaneous
There is a slide maker and scanner in Dr. Sinert’s office that residents may use for
presentation preparation. A digital camera for departmental photos is kept in Dr. Doty’s
office.
220
SCHEDULES
221
MONTHLY SCHEDULES
KCH ED/Peds ED:
The Scheduling Chief Resident is responsible for the making and distribution of the
monthly KCH ED schedule. He/she is the most important person with respect to the
intricacies of the daily schedule and is the first person to approach with scheduling
questions and requests. The Scheduling Chief Resident must approve all schedule
changes. Late requests will not be honored. Requests are a consideration, NOT
guarantees. Exceptions are to be discussed in advance with residency directors and chief
resident.
Considerations for schedule requests:
 All requests for health and educational leave will be granted first.
 If going away, request travel days as well as days away off.
 There is a limit of three separate requests per month. They will be honored on a
priority basis, so choose your top choice carefully. There will be a maximum of 3
days off in a row depending on coverage. If any request for greater than 3 days is
received it will be disregarded unless it has been approved by the residency
directors. The only exceptions are academic meetings and conferences.
 Note that the schedule historically goes through revisions in the first weeks of the
month, so check it frequently. Once revised, the new copy will be posted on the
bulletin boards in the ED Administrative area and one in the clinical area.
 Please check the schedule, even if you requested certain days off. Requests are
not guaranteed, but every effort will be made to honor them.
Nights
All residents will work 40-50% night shifts in the KCH ED and 50-60% nights in the
Peds ED. Every effort will be made to group the night shifts together.
Weekends
All attempts will be made to give residents at least one Saturday and one Sunday off per
clinical rotation – scheduling permitting.
Distribution of shifts
 The ratio of shifts in each clinical area will be grossly equal across PGY level.
Coverage may dictate that this balance varies somewhat.
 PGY 3 and PGY 4 residents will do KCH Pediatric and Adult shifts during the same
month. Junior residents will have month long rotations in Pediatric EM at KCH.
Special Shifts and Wednesday Conference
222
Junior residents (PGY 1 and PGY 2) will have the majority of Tuesday PM shifts off to
enable their attendance at conference. Residents have to report to the clinical area
immediately after conference. Senior residents may be scheduled for one Tuesday
overnight, one Wednesday AM and/or Wednesday PM shifts as coverage dictates. The
scheduling chief resident may have the residents scheduled for shortened shifts after
conference as coverage dictates. Senior shifts scheduled 11AM – 7PM and Junior shifts
scheduled 7AM-7PM begin at 12 Noon.
The following are the updated requirements for conference attendance that take into
account resident work hours and current ACGME and NY State guidelines. If you have
any questions as to whether or not you need to attend conference please contact me as
soon as possible.
KCH
Tuesday Shift
Wednesday Shift Attend Conference
Off
3PM-11PM
7AM-Noon
Off
11PM-7AM
7AM-11AM
Off
7PM-7AM
Off
7AM-3PM
3PM-11PM
7AM-Noon
7AM-3PM
11PM-7AM
7AM-Noon
7AM-7PM
7AM-7PM
7AM-Noon
7AM-7PM
7PM-7AM
Off
9AM-9PM
Off
7AM-Noon
11AM-11PM
Off
9AM-Noon
11AM-11PM
11AM-11PM
9AM-Noon
11AM-11PM
7PM-7AM
Off
3PM-11PM
Off
9AM-Noon
3PM-11PM
3PM-11PM
10AM-Noon
3PM-11PM
11PM-7AM
9AM-Noon
7PM-7AM
Off
7AM-9AM
7PM-7AM
7PM-7AM
Off
11PM-7AM
11PM-7AM
7AM-9AM
11PM-7AM
Off
7AM-9AM
UHB
Tuesday Shift
7AM-5PM
7AM-5PM
7AM-5PM
7AM-5PM
11AM-9PM
11AM-9PM
11AM-9PM
11AM-9PM
1PM-11PM
Wednesday Shift
Off
12PM-7PM
3PM-11PM
11PM-7AM
Off
12PM-7PM
3PM-11PM
11PM-7AM
Off
Attend Conference
7AM-Noon
7AM-Noon
7AM-Noon
7AM-Noon
7AM-Noon
7AM-Noon
9AM-Noon
7AM-Noon
9AM-Noon
223
1PM-11PM
1PM-11PM
11PM-7AM
11PM-7AM
12PM-7PM
11PM-7AM
Off
11PM-7AM
9AM-Noon
9AM-Noon
7AM-9AM
7AM-9AM
BROOKDALE
Tuesday Shift
7AM-7PM
7AM-7PM
7PM-7AM
7PM-7AM
11AM-11PM
11AM-11PM
11AM-11PM
Wednesday Shift
Off
7PM-7AM
Off
7PM-7AM
Off
7PM-7AM
11AM-11PM
Attend Conference
7AM-Noon
Off
Off
Off
9AM-Noon
Off
Off
STATEN ISLAND
Tuesday Shift
Wednesday Shift
7AM-5PM
Off
7AM-7PM
Off
7AM-7PM
7AM-7PM
9AM-9PM
Off
11AM-9PM
Off
11AM-9PM
1PM-11PM
11AM-11PM
Off
11AM-11PM
11AM-11PM
1PM-11PM
Off
Attend Conference
7AM-Noon
7AM-Noon
Off
7AM-Noon
7AM-Noon
Off
9AM-Noon
Off
9AM-Noon
VA
8AM-8PM
8AM-8PM
7AM-Noon
8AM-Noon
Off
1PM-8PM
Every effort will be made to allow residents maximum conference attendance
without compromising patient care.
Off-service Rotations:
For non-KCH sites and off-service rotations, please refer to the Clinical Responsibilities
section of this handbook under the specific rotation heading for specific schedule
information. In general, on the non-ED off-service rotations during the first two years
residents will act as full members of the off-service clinical staff and have similar clinic
and call schedules. For all off-service rotations at KCHC, excluding the SICU rotation,
the resident is expected to attend conference for at least 2 hours – this is a required part of
education and should be excused by the off-service team.
224
If the resident encounters a problem with the off-service schedule or conference
attendance, the resident should first present this to the site director at the affiliate hospital.
If the resident continues to have difficulty with this issue, the resident will present their
difficulties to the chief residents who will facilitate the problem or refer the matter to the
EM residency directors.
225
TOPIC REVIEW 2010-2011
Topic
Review #
1
2
3
4
5
6
7
8
9
Tintinalli 6th ed
Resuscitation
11-16
Resuscitation
17-21
Resuscitation
22-26
Resuscitation (blood
gas, fluids &
electrolytes,
Disturbances of
cardiac rhythm and
conduction)
26-28
Resuscitation &
Shock
(Pharmacology of
Antidysrhythmic and
vasoactive meds,
Approach to the
Patient in shock)
29-31
The Normal Child,
fever, bacteremia,
SIDS, ALTE
114-119
Shock (Septic,
cardiogenic,
anaphylaxis,
neurogenic)
32-35
Trauma (Initial
approach, peds,
geriatric, pregnancy,
head injury)
251-255
Trauma (Spinal cord,
maxillofacial, neck,
Pages
# of
Pages
61-98
38
Just the
Facts
2nd ed
32-36
99-131
33
7-10
132-166
35
41-45
167-201
35
36-45:
11-26
202-230
29
26-32;
47-49
—
23-24
727-758
31
229-239
630638
159-163
219-256
26
49-55
725728;
482483;
15371569
32
545-555
477481;
483486;
504506;
508509
1-5;2022;5-6
15691613
44
556-571
487497
6-14;
411-414
226
Rivers
AAEM
Board
Review
56-68
10
11
12
13
14
15
16
thoracic)
256-259
Trauma (Abdominal,
flank, GU, Extremity,
Ballistics, foresnics)
260-266
Injuries to the Bones,
Joints and Soft
Tissue (Initial
approach, Hand,&
Wrist)
267-269
Injuries to the Bones,
Joints & Soft
Tissue(Elbow,
Forearm, Shoulder,
Spine)
270-272
Injuries to the Bones,
Joints & Soft Tissues
(Pelvis, hip, femur,
Knee, Leg, ankle,
foot)
273-277
Injuries to the Bones,
Joints & Soft Tissues
(Compartment
Syndrome,
Rhabdomyolysis,
Devices, and
Reconstructions)
278-280
Nontraumatic
Musculoskeletal
Disorders (Neck
pain, thoracic &
lumbar pain, shoulder
pain, rheumatic
emergencies, hand,
joints and bursea,
foot)
281-287
Cardiology (chest
pain, ACS,
Interventional
strategies, Syncope,
16131650
37
571-583
16511683
32
583-588
399-406
16841711
28
581-593
406-414
17121741
31
594-603
415-425
17421768
26
604-609
393
17691806
37
609-622
381-391;
394-397
333-373
40
91-101
227
497501;
506508
61-85
14-20;
22-24
32-40;
54-55;
40-42
17
18
19
20
21
22
23
24
CHF/APE)
49-53
Cardiology
373-409
(Valvular,
Cardiomyopathy, PE,
HTN, aortic disease)
54-58
Cardiology(Arterial 409-436;
disease, transplant,
758-760;
noninvasive imaging, 838-843
pediatric cardiology)
59-61, 120, 131
Prehospital Care
1-26
1-5
Disaster
27-60
Preparedness
6-10
Heme Onc
1319Emergencies
1348
(Anemia, Acquired
Bleeding disorders,
Hemophila,
Hereditary Hemolytic
Anemias)
218-222
Heme Onc
1348Emergencies
1368
(Transfusion therapy,
anticoagulants,
complications of
malignancy)
223-225
Toxicology
1088(Salicylates,
1098;
acetaminophen,
1102Digitalis, gylcosides,
1117
beta-blocker toxicity,
Calcium channel
blockers, antihypertensives)
170-171; 174-177
Toxicology
1117(Phenytoin, Iron,
1145
hydrocarbons,
caustics,
inseceticides,
228
38
101-121
85-113;
128154
42-44;
48-54;
25-31
45
121-125;
239-242;
268-270
638641;
137-139
26
641-645
34
338-341
29
455-467
305-310;
314-315
20
468-483
301-305;
313
317-320
25
380-386;
373-379;
341;349350
344;
345-346
28
386-397
342-343;
345;
347
348
477-485
25
26
27
28
29
30
anticholinergics,)
178-183
Toxicology (Metals,
Hazardous
chemicals, vitamins
and herbals,
antimicrobials,
cyanide,
dyshemoglobinemias,
hypoglycemic
agents)
184-190
Pediatrics (otitis,
pharyngitis, skin and
soft tissue infections,
pneumonia, asthma
and bronchiolitis)
121-124
Pediatrics (seizures,
vomting and
diarrhea, abdominal
emergencies, DKA,
hypoglycemia, AMS
and headache)
125-130
Pediatrics (fluids,
upper respiratory
emergencies, acute
pain management,
PSA, Exanthems)
132-135
Pediatrics (MSK
pain, sickle cell,
special health needs,
GU and GYN, peds
UTI)
136-140
Infectious Disease
(reportable Infectious
Dx, Infection control
and standard
precautions,
pharmacology of
antimicrobials,
antifungals and
antivirals)
11461171
25
398-413
347-349
344-345
769-798
29
243-255
145;
143-144
148-151
798-837
39
255-270
129-136;
139-142
138-139
843-876
33
273-286
145-148;
154-157
876-908
32
286-299
136-137
9871014
28
N/A
n/A
229
31
32
33
34
35
36
37
153-155
Neurology (Exam,
Seizures, acute
pheripheral
neurological lesions,
chronic neurologic
disorders)
232-234
Neurology (Vertigo,
CNS infections,
complications of
CND devices,
approach to imaging)
231; 235-237
Eye & ENT (Ocular
emergencies,
External, Middle and
Inner Ear)
238-239
Principles of Imaging
& Special Situations
(Contrast Studies,
Sono, CT, MRI,
Injection drug users,
Patient safety) 302305; 306; 312
Special Situations
(Elderly patient,
disabled, mentally
retarded adult,
homeless, morbidly
obese, violence in the
ED)
307-311; 301
Pulmonary
(respiratory distress,
bronchitis,
pneumonia,
empyema, aspiration
pneumonia, lung
abscess, TB)
62-65
Pulmonary
(Spontaneous
pneumothorax,
hemoptysis, acute
13691374;
14091431
27
496-509
247-251;
245-256;
259-262
264-266
14001409;
14311449
27
496-499;
509-515
251-254
14491470
21
515519;522526
181-197
18651882;
18911895
19121917
27
635-641;
N/A
18961912;
18601865
21
N/A
N/A
437-462
24
125-133
91-99;
104-106;
215-217
462-487
25
133-143
99-101
102-104
106-108
230
38
asthma, COPD,
transplant, imaging)
63-71
Emergency
Medicine in Unique
Environments
(World travelers,
High altitude,
Antarctic medicine,
space medicine)
206-209
12511283
231
32
N/A
374376
TOPIC REVIEW SCHEDULE
July
7- Goldenberg
August
4- Tsang
September
1- Laoteppitkas
8- Rubano
15- Bowen-Spinelli
October
6- Martin
13- Johnson
November
10- Naik
December
1- Natal
8- Suess
15- Cobb
January
5- Edelstein
19 - Schechter
February
2- Estephan
9March
29- Patel
1623- Yee
April
6-Jackson
1320May
411June
1815-
232
Presenter Schedule 2010-2011
Month
Coordinators
/Faculty
JULY
Adult
Journal Club
Backster/Scheer
SInert
7-Jul
Semenovskaya
Maurelus
18-Aug
Aherne
Guy
AUGUST
SEPTEMBER
3-Sept
Cioe
Tan
20-Oct
Melendez
Maurelus
OCTOBER
NOVEMBER
10-Nov
Joshi
Adeleke
15-Dec
Harriot
Scheer
DECEMBER
JANUARY
5-Jan
Harriot
Timberger
3-Mar
Kazzi
Nadir
21-Apr
Regan
Chapman
APRIL
MAY
JUNE
28-Jul
Willis
Scheer
18-Aug
Auerbach
Timberger
29-Sept
Meister
Backster
28-Oct
Ritchie
Mathieu
24-Nov
Yeo
Brothers
29-Dec
Semenovskaya
Valesky
26-Jan
Christopher
Guy
17-Feb
Auerbach
Valesky
FEBRUARY
MARCH
Peds
M&M
Journal
Timberger/Mathieu Nadir/Pearsall
Tejani
Rios
5-May
White
Mathieu
16-Jun
Lau
Nadir
233
Peds Case
ICU
Conference
Maurelus/Adeke Chase/Brothers
Shah
DeSouza/Rios
28-Jul
Melendez
18-Aug
Joshi
22-Sept
Harriot
20-Oct
Kazzi
24-Nov
Caputo
15-Dec
White
19-Jan
Lau
28-Jul
Fan
Meister
18-Aug
Kong
Julie
29-Sept
Desmond
Aherne
28-Oct
Bradby
Semenovskaya
24-Nov
Melton
Lau
29-Dec
Bon
Joshi
26-Jan
Al-Zahrani
Cioe
16-Feb
Meister
30-Mar
Melendez
Tan
16-Mar
Cioe
30-Mar
Paulson
Harriot
27-Apr
Julie
Cheng
25-May
Adeleke
Chase
22-Jun
White
Benson
20-Apr
Willis
27-Apr
Basilla
Kazzi
25-May
Louis
Caputo
22-Jun
McMillin
Willis
18-May
Aherne
15-Jun
Julie
MONTH
EBM
Coordinators/
Faculty
JULY
Valesky
Benson/Tan
Lanigan/Paladino Baron/Stavile
14-Jul
Coie
Mathieu
4-Aug
AUGUST
Nadir
Suess
8-Sept
SEPTEMBER
Adeleke
Chase
OCTOBER
Trauma
29-Sept
Benson
Tan
13-Oct
Timberger
Nata
11-Nov
Valesky
Lira
11-Nov
Benson
Tan
DECEMBER
8-Dec
Benson
Martin
26-Jan
Pearsall
Goldenberg
22-Dec
Benson
Tan
9-Feb
Maruelus
Daphnis
9-Mar
Scheer
Bowen-Spinelli
13-Apr
Guy
Cobb
2-Feb
Benson
Tan
23-Mar
Benson
Tan
27-Apr
Benson
Tan
FEBRUARY
MARCH
APRIL
Junior
14-Jul
Benson
Tan
NOVEMBER
JANUARY
Senior
234
8-Sept
Yee
15-Sept
Tsang
6-Oct
Schechter
13-Oct
Goldenberg
28-Oct
Suess
24-Nov
Patel
22-Dec
BowenSpinelli
19-Jan
Estephan
26-Jan
Natal
9-Mar
Laoteppitkas
6-Apr
Martin
13-Apr
Naik
20-Apr
Johnson
27-Apr
Core
Content
Bang
Rios
15-Sept
Backster
Guy
7-Jul
Thompson
Yeo
4-Aug
Chase
Daphnis
1-Sept
Regan
Auerbach
13-Oct
Cobb
Edelstein
6-Oct
Brown
Jackson
10-Nov
Nordstrom
Chapman
8-Dec
1-Dec
Goldenberg Coquillon
Estephan
Cheng
6-Jan
DiMare
Yeo
9-Mar
Valesky
Adeleke
3-Feb
Berzon
Yee
2-Mar
Thompson
Schechter
7-Apr
Hussain
Christopher
MAY
JUNE
18-May
Backster
Johnson
8-Jun
Brothers
Backster
Edelstein
18-May
Cobb
15-May
Jackson
8-Jun
Benson
Tan
235
22-Jun
Rubano
8-Jun
Timberger
Mathieu
4-May
Jegede
Bang
1-Jun
Lira
Naik
Chief On Call Schedule 2010-2011
Block 13 5/31 - 6/27
Block 1 6/28 - 7/25
Block 2 7/26 - 8/22
Block 3 8/23 - 9/19
Block 4 9/20 - 10/17
Block 5 10/18 - 11/14
Block 6A 11/15 - 11/28
Block 6B 11/29 - 12/12
Block 7 12/13 - 1/9
Block 8 1/10 - 2/6
Block 9 2/7 - 3/6
Block 10 3/7 - 4/3
Block 11 4/4 - 5/1
Block 12A 5/2 - 5/15
Jenn
Jenn
Teresa
Chaiya
Chaiya
Kaedrea
Trushar
Kaedrea
Trushar
Chaiya
Kaedrea
Teresa
Trushar
Jenn
Chief Residents
Teresa Bowen-Spinelli
Jen Martin
Chaiya Laoteppitaks
Kaedrea Jackson
Trushar Naik
Email
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Chief-on-call pager
Residency-director on call pager
917-761-1405
917-219-0650
Residency Director Cell Phone numbers
Doty
917-597-0466
Rios
917-693-4429
Silverberg
917-822-4510
Quinn
718-938-4841
Gore
312-399-3451
236
Cell
917-902-0577
917-723-2669
267-253-3188
917-971-3972
734-730-8980
Pager
917-219-6350
917-219-6277
917-219-6354
917-219-6300
917-219-6367