The DHREM is a unique Emergency Medicine Residency Training Program in many ways. One of the important aspects of the program is support from the hospitals in the Denver community. By affiliating with four institutions, the DHREM can offer superior rotations in specialized areas of instruction, an exposure to the breadth of patient diversity (including socioeconomic status) and pathology, and an exposure to the breadth of practice styles of a large faculty. The emergency medicine experiences at the participating institutions are not redundant, but rather complementary. >>(back to questions)

2. Is this program accredited?

Yes. This program is fully accredited by the ACGME.>>

3. Is this a 3 or 4 year program?

The residency is a four year program (EM 1-4). >>

4. What is the emergency department like at Denver Health Medical Center?

The emergency department at Denver Health Medical Center is a very busy urban emergency department and Level 1 trauma center. There is a high volume of sick trauma patients, as well as unstable medical patients seen in the department. The department is physically divided into a medicine and a trauma side. Our residents are expected to work on both sides of the department during each shift and are responsible for taking care or the sickest patients in the department. All pediatric trauma patients presenting to DHMC are seen and treated in the ED. For 12 hours a day, the Pediatric Urgent Care Center sees and treats the medical pediatric cases. Similarly, for 12 hours a day, minor medical complaints in adult patients are evaluated and treated in the Adult Walk-In Clinic. In the "off hours" both medical pediatric patients and adults with minor medical problems are treated in the emergency department. There are a variable number of medical students and interns working in the emergency department, all supervised by the emergency medicine senior residents and emergency medicine attending staff.>>

5. What kind of attending coverage can be expected at Denver Health Medical Center?

There is 24 hour attending coverage in our ED. In addition, there is double coverage for 81 hours a week during the busiest hours. The attendings primarily assist in the flow of the department, supervising patient care and procedures. They are readily available for resident questions, but do not necessarily staff all the patients seen by the residents.>>

6. What is the ED at University like?

The University ED is a very busy level 2 trauma center, which sees a large volume of very sick medical patients. The department has 25 beds, plus a fast-track zone where patients with minor medical complaints and minor trauma are treated 12 hours a day. There is 24 hour attending coverage in the ED and attendings staff all patients with the residents. Along with the attendings, EM3 residents manage department flow and supervise EM2 residents, interns, and medical students. Although the University Hospital is in the process of relocating to a new main campus (University Hospital at Fitzsimmons), the current ED is less than five years old and continues to see a high volume of patients. The current hospital has a state of the art cath lab facilities and remains a major regional tertiary referral center. >>

7. How many hospitals are staffed by the residents?

There are five emergency departments that are covered by our emergency medicine residents. These include Denver Health Medical Center, University Hospital at 9th Avenue, University Hospital at Fitzsimmons, Exempla St. Joseph Hospital, and The Children's Hospital. At each hospital, our resdients are supervised by board-certified emergency physicians. >>

8. What do the different hospitals have to offer?

DENVER HEALTH MEDICAL CENTER
- 349 bed, acute care, city-county Level I trauma center
- A commitment to pediatric trauma
- 54,000 selected annual patient visits
- Fully renovated ED opened in 1994
EXEMPLA ST. JOSEPH HOSPITAL
- 550 bed, acute care, private hospital
- Completely renovated ED opened in 1997
- Annual census of 67,000 visits
- Colorado's oldest and largest group practice HMO, caring for more than 321,602 members
- Significant educational opportunities in managed care medicine, emergency case management (ECM), and observational medicine
- A single physician group provides care for both the St. Joseph patients and the Kaiser patients
UNIVERSITY OF COLORADO HOSPITAL / Anschutz Medical Center
- 350 bed primary teaching hospital for the University of Colorado
- A major referral and tertiary care center for the Rocky Mountain region.
- Level II Trauma Center with 38,000 unselected annual visits to the emergency department.
- Regional burn center for the Rocky Mountain region
- Home and primary training site of the University of Colorado School of Medicine
- Significant educational opportunities in academic emergency medicine, emergency medicine research, adult burn care, and trauma care support from the Office of Graduate Medical Education with ACGME endorsed residency programs in all of the major medical and surgical specialties and subspecialties
THE CHILDREN'S HOSPITAL
- 224 bed children's hospital
- A regional pediatric tertiary care center
- Home and primary training site of the Department of Pediatrics of the University of Colorado School of Medicine
- Regional Pediatric Trauma Center
- Regional Pediatric Burn Center
- Tertiary care referral center
- the region's largest Pediatric Intensive Care Unit

By rotating through these institutions, EM Residents are exposed to the full gamut of patient pathology, insurance status, and socioeconomic status. Further, EM Residents work with a large number of Emergency Medicine Attendings with varying styles of practice.>>

9. How much time in the residency is devoted to the emergency department?

Approximately 55% of the residents' time is spent on ED rotations. The rest of the time is spent on our off-service rotations such as MICU, CCU, SICU, medicine, surgery, orthopedics, toxicology, labor and delivery, and prehospital EMS services.>>

10. Are there teaching opportunities for the residents?

The residents continually serve as teachers for the rotating students and interns on clinical shifts, as well as for fellow EM residents. Each resident is also responsible for a formal didactic presentation to the other residents. There is a monthly lecture series provided to rotating students and interns that is taught by residents and attendings. EM Residents have the opportunity to teach in the Denver Health Paramedic School. EM faculty and residents assist in teaching an elective course in the University of Colorado School of Medicine: Introduction to Emergency Medicine and Traumatic Emergencies (a second year elective). In addition, EM Residents are each assigned a fire station in the Denver metro area in order to serve as their physician advisor and to provide teaching for their CME.>>

11. How much responsibility do residents have?

The residents in our program have a lot of responsibility everywhere they rotate. At the private hospitals, patients are staffed with an emergency medicine attending but residents have primary responsibility for their patients. At the University, EM3 residents serve as the seniors in the department, supervising an EM2 resident, interns and students. As EM4s, residents supervise the entire emergency department at Denver Health Medical Center, which entails staffing all patients with the students and interns, calling consultants, running resuscitations, answering the paramedic biophone for the city of Denver, and assuming primary care of the patients in our observation unit.>>

12. What are the specific roles of the different classes of residents?

EM1 - Residents acquire the technical skills and theoretical knowledge required as a foundation for a career in emergency medicine.

EM2 - Residents build on patient care skills and practical knowledge of emergency medicine.

EM3 - Residents refine clinical and technical skills, expanding their efficiency and multitasking abilities. They begin to assume supervisory roles, educating other residents and students.

EM4 - Residents have supervisory control of the entire ED at DHMC, perfecting their efficiency and multitasking abilities. They have more autonomous role in the private ED and further develop specific areas of their knowledge base with electives. >>

13. What are the relations like with the other clinical services in the hospitals?

Superior. The Emergency Medicine Residency prides itself on strong relations with other services. This residency has been in place since 1973 and has graduated over 300 emergency physicians. Other specialties are not threatened by the presence of emergency medicine. In fact, the residency and the residents are highly respected within the "House of Medicine". >>

14. What formal didactics are offered?

The core didactic curriculum is presented Wednesday mornings. All of our residents have protected time to attend weekly teaching conference including those rotating on non EM services. Residents are freed from clinical responsibilities to attend a 5 ½ hour teaching conference.The current didactic schedule can be found on this site. In general, the weekly offerings consist of a Mortality and Morbidity Conference, a lecture by an Emergency Medicine Resident, a faculty lecture, and a review of the week's modular reading curriculum. Reading Review has been a valuable addition to the curriculum and covers the Clinical Model of Emergency Medicine in two years. In addition, there is a monthly research conference, Grand Rounds, radiology conferences, EKG conferences, and Journal Clubs. In total 80% of the Educational Conferences are departmental conferences, 10% are journal clubs, 5% are seminars and discussion groups, 3% are laboratories, and 2% are joint conferences sponsored with other disciplines. >>

15. Are the residents relieved of their clinical duties to attend the didactic conferences?

All of the residents are freed from their clinical duties in the emergency department to attend the Wednesday morning didactic conferences. Residents rotating on non-emergency medicine rotations are relieved based on clinical duties and are able to attend about 70% of conferences.>>

16. What research opportunities are available?

There are a wide variety of opportunities at Denver Health and at the University.Basic science lab facilities are available at the University of Colorado; Multiple large databases for retrospective studies (including the Colorado trauma database and the Kaiser outcome database) are available; there are also numerous clinical study possibilities with an annual combined census of over 250,000 in the participating institutions. The DHREM staff and residents are prolific researchers. >>

17. How are the residents evaluated? How often?

Residents receive written evaluations from faculty at the end of each month of clinical rotation. These evaluations are generally completed by the attending staff who worked most closely with the residents and include the resident's performance in specific areas, such as ACGME core competencies, technical skills, clinical knowledge, responsibility and interpersonal relations. There is also a space provided for individual comments and suggestions by the evaluator. Evaluations are accessible on a secured website that is also used to log procedures. Twice a year, the Program Advisory Committee meets to create a formal evaluation letter for each resident, which the resident then reviews with a member of the faculty.>>

18. Do the residents get to evaluate the faculty and rotations?

Yes, the residents annually evaluate each attending and each rotation. These comments are consolidated into a letter format and given to the individual attendings and the directors of the services where the residents rotate. These evaluations are anonymous and are taken very seriously by the faculty. >>

19. What does Denver have to offer?

Denver is a fabulous place to live! There are great restaurants, museums, theaters, parks, art galleries, nightclubs, music, and sporting teams. Denver has the nation's second largest performing arts center with a Performing Arts Complex that has eight theaters and is capable of seating over 9,000 people. Recent renovations include a brand new state of the art Opera and Ballet House. Denver's citizens contribute more public funding for the arts per capita than any other U.S. city. The city is an affordable place to live. The population of the Denver Metropolitan area is over 2 million. The City of Denver occupies 155 sq mi/401 sq km; the metropolitan area occupies 5,075 sq mi/13,144 sq km. The weather is very temperate with cool summers, sunny and relatively mild winters, and wet and windy springs. Clear skies prevail 32% of the time; partly cloudy 35%; cloudy skies 33%. Denver receives 300 days of sunshine a year -- more annual hours of sun than San Diego or Miami Beach. The average annual rainfall is 16 inches and the annual snowfall is 60 inches. Denver is the nation's most highly educated city with the highest percentage of high school and college graduates. Denver has the largest city park system in the nation with 205 parks in city limits and 20,000 acres of parks in the nearby mountains.>>

20. Do you get a chance to see the rest of Colorado?

Yes. It is only a short drive away to magnificent hiking, mountain biking, rock climbing, camping and, of course, spectacular skiing. As a resident, you will have ample opportunity to pursue the activities you enjoy.>>

21. How is the Residency Program governed?

The DHREM is a single integrated program directed by a program director who is responsible to the Denver Health Graduate Medical Education Committee. The program director chairs the Program Advisory Committee, which is very active in forging the overall direction of the residency. The DHREM Program Advisory Committee is composed of representatives from Denver Health Medical Center (the base institution and primary clinical site), the University Hospital, Exempla Saint Joseph Hospital, the Children's Hospital, Kaiser Permanente, and one resident representative elected by a majority vote of the DHMCREM residents.>>

22. What does the Program Steering Committee do?

The Program Advisory Committee nominates the Program Director, assists in the selection and evaluation of the residents, reviews faculty development, teaching privileges, indirect costs, expansion of the residency program, and elimination of rotations. It also reviews the nominations for associate program director and the residency research director put forth by the program director, and acts on disciplinary actions of a resident in accordance with the policies and procedures of the DHREM. The Committee typically meets three times a year, in the fall, winter and spring quarter.>>

23. Who would do well at the DHREM?

This is a residency program that demands much of the residents, including self-reliance, independence, responsibility, and hard work. Residents are not led by the hand, nor are they held back. They are encouraged, supported, and guided. All of the tools are available in the residency to allow residents to mature into superior practitioners and leaders of emergency medicine in any arena. In order to make the most of this experience, a resident should be highly motivated, focused, energetic, enthusiastic and willing to get involved in everything that is offered.>>

24. How are applicants selected?

Only ERAS applications are accepted. Each application is reviewed by several of the staff and "scored" in seven specific areas: the medical school attended, the Dean's Letter, the letters of recommendation, the USMLE Step 1 Score, the personal statement, research experience, and outside activities. On the basis of this score, some applicants are invited to interview. Each applicant will interview with at least three of the staff. The final rank order list is created based on the application score, the interviews, and input from the Program Advisory Committee. All of the positions in the residency are offered through the NRMP.>>

25. Does the date that I interview affect my position on the residency's Rank Order List? Should I plan to interview only in January, for example?

Absolutely not. There is NO CORRELATION between the date that an applicant interviews in our program and their position on the rank order list. The importance of interviewing in January is a myth. See Martin-Lee LA, Park HW, Overton DL: Does Interview Date Affect Match List Position in the Emergency Medicine National Residency Matching Program Match? Acad Emerg Med 2000; 7:1022-26. >>

26. Are there fellowships available in Denver?

Yes. Denver Health Medical Center offers fellowships in EMS and Ultrasound. A clinical research fellowship is anticipated to start in 2007-08. Additionally, The Children's Hospital of Denver offers a Fellowship in Pediatric Emergency Medicine and the Rocky Mountain Poison Control Center offers a Toxicology Fellowship. Information on these fellowships can be found on this web site.>>

27. Have there been any recent changes in the program?

Yes. This residency has never rested on reputation. We are constantly improving the program wherever we can. In 2003, we became an EM1-4 program, adding an EM1 year with excellent rotations at the Children's Hospital and the University of Colorado Hospital in addition to rotations at Denver Health Medical Center. Additionally, we recently named a new program director who, like directors in the past, will lead this program through continuous improvement. >>

28. Do you accept applications from International Medical Graduates? What VISAS do you sponsor?

Although we are pleased to accept applications from qualified International Medical Graduates, we do not sponsor any visas. >>

29. What is the future of the Denver Health Medical Center Residency in Emergency Medicine?

This residency program has been in existence since 1973 and has earned a reputation as being one of the best training programs in any specialty. The future of this residency program is brighter than ever. We have some of the most talented emergency medicine residents, very dedicated faculty, and an unmatched breadth of training environments within a single program.>>

30. Where should I write to request a brochure or additional information?

All of the information that is available is posted on the pages of this web site. We do not publish a written brochure. Requests for information will be referred back to the web site. >>

31. What is the minimum score on the USMLE Step 1 that is required of applicants?

We do not set a minimum score. This is one piece of data that is considered in sum with the entire application. >>

32. Do you have a resident mentoring program?

Yes. Each EM Resident is assigned to a faculty member for formal mentoring sessions. These assignments are made randomly and change every year so that the resident receives the benefit of counsel from several members of the faculty. >>