Clinical Curriculum

EM3 Overview

The EM3 year is a year for further expansion of emergency medical knowledge with the addition of primary management of critically ill trauma patients at Denver Health and The Children's Hospital. In addition, this year initiates teaching the art of running and managing the flow of the department at University of Colorado Hospital. This includes a supervisory role in the Emergency Department, with oversight of patient care in the department as performed by emergency medicine interns and EM2 residents, as well as internal medicine and general surgery interns. By the end of this year, the resident is ready to assume senior resident supervisory control of the Emergency Department at Denver Health Medical Center. In addition, their year includes rotations in Toxicology and a month of EMS (Emergency Medical Services) in which residents act as a third rider on a paramedic staffed ambulance, assisting in field resuscitations and critical care transfers. The specific schedule for the EM3 year is as follows:

EM3 Schedule

Rotation Descriptions

Emergency Medicine – Denver Health There is responsibility for individual patient care of all categories of patients seen in the department with an emphasis placed on resuscitation of critically ill medical and trauma patients. Senior Emergency Medicine residents and attending staff physicians are always available to the junior residents for consultation and supervision. In the final two weeks of this rotation, the EM3 resident takes on the role of "acting senior" with a seasoned EM4 resident working under them.

Emergency Medicine – University The EM3 resident functions as the supervising resident for junior Emergency Medicine residents, interns, and students assigned to this department. This is the resident's first experience directing and coordinating a medical team and experiencing all the challenges involved in managing a busy academic emergency department.

Emergency Medicine – Privates A large, combined emergency department is the setting for both the Exempla Saint Joseph Hospital and Kaiser emergency medicine experiences. The resident will care for HMO and non-HMO patients. The resident will be exposed to a patient population similar to those found in the majority of emergency department private practices. An emphasis is placed on teaching the administrative necessities of managing a private emergency department, the emergency case management (ECM) of HMO patients, outcome-based emergency medicine research, ultrasonography in the emergency department, and the utilization of Physician Assistants as physician extenders.

Teaching & Evidence Based Medicine This rotation is a unique experience in emergency medicine. EM3 residents are members on an Evidence Based Medicine (EBM) Teach team made up of an Emergency Medicine Attending, EM residents and medical students. This team meticulously dissects cases they see in the UCDHSC ED, taking time to answer all EBM questions. Multiple pearls are given in addition to a lecture hour every day. One day of the week is dedicated to simulation time. Organized curriculums are covered on EBM principles, how to teach, and simulation.

Pediatric EM - TCH Emergency Department This is a high volume pediatric emergency department in which the resident directs resuscitations and gains experience in managing acutely ill children and children with exacerbations of chronic illnesses.

Prehospital / Emergency Medical Services Residents act as a third rider on a Denver Health paramedic-staffed ambulance and assist in field resuscitations and critical care transfers in the progressive DHMC-EMS system. The resident also learns about the EMS systems with which emergency physicians work intimately for their entire career. Additional, residents spend one week engaging in Critical Care EMS through Flight For Life Colorado. This entails ground and air transport. This rotation promotes a familiarity with the Denver Health Paramedic system, which facilitates resident to paramedic interactions when the EM4 resident directs major resuscitations by paramedics in the field via radio.

Toxicology The resident works under the supervision of the toxicology staff and clinical fellows at the Rocky Mountain Regional Poison and Drug Center, one of the best toxicology centers in the country. The goal is to gain experience in diagnosis and treatment of a wide variety of toxic exposures via participation in conferences and consultations.

Elective During these weeks the resident may select from various clinical and administrative experiences relevant to Emergency Medicine. Some may be taken outside of Denver. All electives are subject to prior approval of the Program Director.

CME / Reading Residents are provided one week in each of their upper level years for independent reading. The only clinical obligation during this week is covering sick call for their respective EM class.