Curriculum and Rotations

Clinical Experience
The required rotations are organized as follows:

EM1		EM2		EM3
York Hospital		York Hospital		York Hospital
ED Orientation	1 month	ED	24 weeks	ED	40 weeks
ED	5 months	Trauma/SICU	8 weeks	Administrative	4 weeks
Trauma/General Surgery	1 month	EMS/Research*	4 weeks	Elective**	4 weeks
Pediatrics	1 month	Ortho	4 weeks
		Ultrasound	4 weeks
Obstetrics	1 month	Harrisburg  Hospital		Chambersburg Hospital
MICU	2 months	Toxicology	4 weeks	Rural ED	4 weeks
Anesthesia	2 weeks	Children's Hospital of Pennsylvania		** Established Electives: Plastics, Occupational Medicine, Research, Imaging, etc.
		Pediatric ED	4 weeks
Gettysburg Hospital		* Aeromedical experience available
Anesthesia	1-2 weeks

A Well-Rounded Curriculum

Our program emphasizes the development of well-rounded emergency physicians. Residents are actively involved in planning and delivery of the didactic curriculum. Tuesday morning academic conferences can include any combination of the following:

• Grand Rounds with topic-related Morbidity and Mortality Case Conferences (pediatric, trauma, and/or medicine themes)
• Pediatrics Conference (featuring speakers from CHOP as well as local speakers)
• Trauma Conference
• EKG and Cardiology Conferences
• Toxicology Presentations and Discussions
• Emergency Medicine Text Review and Board Preparation Conference
• Oral Board simulations
• Documentation and Coding conference
• Minor Emergency conference

Didactic skills sessions are complemented by hands-on procedure training including:

• Ultrasound workshop:  cardiac, biliary, vascular, renal, and FAST examinations
• Central line mannequin:  subclavian and internal jugular approaches
• Airway, suturing, dental, and splinting/casting workshops
• Biannual cadaver lab

York Hospital opened a new Medical Simulation Center in May 2008. The state-of-the-art 4500 square foot center contains two full-scenario simulation rooms housing high-fidelity human patient simulators (adult, child, neonate), a control room, task-training room, and a debriefing room. Competency days are held twice yearly to test our residents’ ability to handle the management of critically ill patients and their skill in performing year-specific procedures (i.e. FAST exam, central line placement, endotracheal intubation).

An innovative Longitudinal Medical Simulation Curriculum has also been integrated into our simulation offerings.  Developed and coordinated by Andrew Kepner, M.D. (Medical Director of the multidisciplinary York Hospital Medical Simulation Center) and Jerome Bacasnot, M.D. (Director, Section of Procedural Education, Competency, and Simluation - SPECS), this curriculum features core elements of resuscitation training from all major resuscitation areas: adult cardiac (ACLS), pediatric (PALS/APLS), traumatic (ATLS) and other areas (e.g., upcoming addition of toxicology resuscitations.  This longitudinal series involves rotating weekly sessions by EM residents in the Medical Simulation Center.  This program is designed to complement our Skills Day and other procedural sessions, and to enhance our didactic teaching sessions.

We continue to integrate current techniques and trends in medical education.  In addition to the state-of-the-art simulation technology noted above, we have embraced the emerging concept of self-reflective learning as a key tool in resident education.  Discussions, evaluations, and opportunities for self-reflective learning will allow our residents to enhance their critical thinking and medical knowledge.  These improvements will allow a smooth transition to the life-long learning techniques of self-reflection critical for successful emergency medicine practice on graduation.

Medical students from our university affiliations and other universities routinely fulfill elective rotations in the Emergency Department. We also sponsor rotations for the PGY-1 residents from other York Hospital and Penn State programs. In addition, York Hospital serves as a clinical education site for nursing, paramedic, EMT, and allied health training programs.

Clinical Rotations

The York Hospital Emergency Department (ED)

Our busy Emergency Department (ED) features patient volumes of nearly 79,000 visits per year.  This allows a wide variety of patient evaluation and management experiences and ensures an excellent case mix for developing core emergency medicine practice skills.

ED Orientation

The first month of the residency is dedicated to a comprehensive orientation, mixing didactic sessions, clinical shifts in the Emergency Department, EMS Skills Day, and introductions to evidence-based medicine/research, and emergency ultrasound. All residents are assigned to the emergency department during this rotation, maximizing their exposure to each other, to upper level residents, and to emergency medicine faculty.

Emergency Department

There are five months of emergency department rotations in the first year curriculum.  Shifts are ten hours with an average of 20 shifts/month.  Shifts are balanced between day and night shifts.  The majority of shifts (approximately 2/3) are in the intermediate care setting with the remainder on the critical care side of the ED.

During the EM-2 and EM-3 years, there are a total of 64 weeks of training in the emergency department.  Senior residents act as charge residents providing leadership and mentoring for EM-1 residents and medical students. Our community academic hospital setting allows residents to develop communication skills by discussing cases with consulting/admitting residents, fellows, and attending physicians - a unique learning opportunity.   Shifts provide experience in both the intermediate and critical care settings.  A wide array of clinical scenarios are seen in one of the busiest Emergency Departments in Pennsylvania, allowing our residents to be well-rounded clinicians when they graduate from our program.

Trauma/ICU

This is a one-month rotation at York Hospital on the Trauma service in our Level 1 Trauma Center.  As a first-year resident, you will be an integral part of a resident team including a mix of several upper level surgery and emergency medicine residents.  Patient care begins in a state-of-the-art trauma bays and continues on the surgical floors, Surgical Transitional Care Unit,  and a dedicated Trauma/Surgical ICU.  Emergency medicine residents participate on the daytime trauma team with occasional weekend call

During the EM-2 year, there are two months as an upper level resident on the Trauma service. As a senior resident, you are one of the leaders of the trauma team.  You will gain valuable experience in managing both blunt and penetrating trauma, and develop essential critical care skills.

Pediatrics

This is a one-month rotation at York Hospital with a mixture of inpatient pediatrics, newborn nursery, outpatient clinic, and daily didactic lectures.  Residents become proficient in performing well-child examinations and learn the skills in communicating with parents and families.  The various private pediatric groups help facilitate your clinical experience with lectures.

Obstetrics

 This is a three week rotation at York Hospital.  On this rotation, the resident works directly with a group of private attending obstetricians.  Duties include aiding in the delivery of all patients for that day.  The schedule is Monday-Friday with no call.

Ultrasound

This is a four-week experience focusing on ultrasound basics and additional clinical exposure to various emergency ultrasound scanning techniques. In addition, regular ultrasound QA sessions have been added recently to further enhance our residents' learning

MICU

This two-month rotation at York Hospital involves managing critically ill patients in the CCU, Medical/Surgical ICU, and Medical/Transitional ICU.  You will work as part of the resident ICU team including four interns and two senior Internal Medicine residents.  Duties include admitting patients every fourth night on-call, daily rounds, and responding to hospital codes. EM-1 residents complete two separate one-month ICU rotations.

Anesthesia

This is a three-week rotation at York Hospital and Gettysburg Hospital that includes learning the basics of airway management in a controlled operating room environment.  Residents become proficient at induction, bag-valve mask ventilation, endotracheal intubation, laryngeal mask airways, and other alternative airways.  The schedule is Monday-Friday with no overnight call.

EMS/Research

This is a four-week rotation where residents learn more about pre-hospital care.  You will participate in EMS scene calls with paramedics, and also become involved in EMS administration and QA activities.  The research portion of the rotation focuses on developing skills in research methodology and evidence-based medicine.  You will participate in a variety of learning activities, as well as planning a specific EM research project.

Toxicology

This is a four-week rotation at Harrisburg Hospital/Pinnacle Health Toxicology Center where residents learn general management of the poisoned patient.  Staffed by board-certified toxicologists and toxicology fellows, this Center provides exceptional learning experiences in one of the few dedicated inpatient toxicology units in the country.

Children’s Hospital of Pennsylvania (CHOP) Emergency Department

This four-week rotation at the world-renowned Children’s Hospital of Philadelphia exposes residents to the unpredictable world of pediatric emergency medicine.  Residents learn clinically and through didactics from leaders in pediatric emergency medicine.  Housing is provided in Philadelphia during the month, and clinical schedules are arranged to allow residents to return to York for Tuesday morning conference sessions.

Administrative

The Administration portion of the rotation consists of a four weeks of combined didactic and practical experience at York Hospital focusing on non-clinical aspects of Emergency Medicine. Residents have the opportunity to tailor certain parts of the curriculum based on their career goals.  Throughout the rotation, the senior resident works closely with Emergency Department and Residency Leadership, attends departmental and hospital-wide meetings with the Department Chairman, Program Director, and other staff members.  Supplemental lectures and learning modules enhance this experience and provide additional information about reimbursement issues, business strategies, management styles, patient safety, performance improvement, and legal issues in Emergency Medicine.  In addition, focused experiences in neonatal emergency care have been added to enhance clinical comfort with our youngest patients.  Residents participate in the Neonatal Resuscitation Program course and neonatal resuscitation cases in the Medical Simulation Center.

Elective

 The Elective Rotation four weeks allows residents to expand their knowledge and skills in their areas of interest.  The scheduling during this month is very flexible and residents have the option to pursue additional clinical experience, skills-based activities, or additional research or administrative time.   Elective rotations include: plastic surgery, trauma/critical care experience, additional ultrasound training, focused research time, radiology, and more.

Orthopedics

This four-week rotation in orthopaedics allows EM-2 residents to sharpen their skills in the initial evaluation, diagnosis, and treatment of a wide variety of fractures and dislocations.  Residents assist the orthopaedic team in closed fracture reductions, splinting, and casting.  We look forward to further enhancements in this rotation over the next few years with the expansion of WellSpan Orthopaedics, and the addition of subspecialists in orthopaedic trauma, hand surgery, and other areas.

Chambersburg Hospital Emergency Department

This four-week rotation at Chambersburg Hospital allows residents to experience emergency medicine in a rural setting.  Residents learn independence via a role as junior attending physicians during this rotation.  Documentation, coding, and clinical efficiency are key areas of focus.  Housing is provided during this month.

International Medicine Elective

A one-week elective in Honduras is available to second and third year EM residents. The elective involves providing medical care to the local population in several remote villages in Honduras and touring local medical facilities. A scholarship is available to defray costs.Further information can be obtained from Dr. Marc Pollack, Department of Emergency Medicine, York Hospital, mpollack@yorkhospital.edu

Outstanding Support for Your Residency Journey

Residency is difficult - no matter where you train.  We are fortunate to have a friendly and supportive residency administrative staff, led by our Program Coordinators: Becky Bluett and Wende Tucker.  They are experienced coordinators and help guide our residents through the sometimes complicated and stressful journey that is residency training. 

Conference Series In-Depth

We strive to provide a variety of interactive, small group, and skills-based sessions to enhance our residents’ learning.   We value the experiences and input of our residents in all activities and review the conference series offerings regularly to maximize their educational impact.   Five hours of protected conference time are offered each week.  Here is a sampling of our conference sessions:

Grand Rounds

• Weekly series featuring faculty, EM-3 residents, and guest speakers/visiting professors from around the country

Morbidity & Mortality (M&M) / Interesting Case Conference

• Review of critical cases as part of overall quality assurance and performance improvement training
• Monthly toxicology M&M sessions, using cases from Pinnacle Health Toxicology Center
• Team-Based ECG / Cardiology Conference
• Monthly small group sessions highlighting key ECG features

Pediatric M&M/Interesting Case Conference

• Quarterly, focused sessions, with faculty from CHOP
• Mix of cases with M&M/patient safety issues and interesting cases

Evidence-Based Medicine (EBM)/ Research

• Monthly session featuring integration of research methodology and statistics as well as core EBM concepts

Emergency Ultrasound Conferences / Workshops

• Quarterly sessions with our ultrasound faculty, with didactic and workshop components, focusing on core emergency ultrasound skills
• Recent sessions include: cardiac, FAST, hepatobiliary, aortic, ultrasound-guided peripheral and central venous line placement, foreign body localization,and other ultrasound techniques

Skills Day Sessions / Medical Simulation

• Cover a wide variety of procedures, including: central line placement, chest tube placement, intubation/difficult airway equipment, LP, suturing, cardiac pacing, T-Pod pelvic fracture stabilization device, wilderness medicine skills/techniques, cricothyrotomy, slit lamp techniques, corneal foreign body removal, dental blocks, splinting/casting, nasopharyngolaryngoscopy, and more!
• Also include components of residency's resuscitation competency program featuring ACLS, ATLS, and PALS skills
• Utilize York Hospital's state-of-the-art Medical Simulation Center

Longitudinal Medical Simulation Sessions - Resuscitation

• Each week, several residents undergo focused training for resuscitaton emergencies in the Medical Simulation Center.  These training sessions are led by Dr. Kepner (Medical Director, York Hospital Medical Simulation Center) or Dr. Bacasnot (Director, Section of Procedural Educaton and Competency)

Minor Emergencies Conference

• Brief weekly session in conjunction with weekly readings
• Discussion of common/important minor emergency topics

Resident Self-Reflection Conference

• Monthly informal session allowing self-reflective learning and sharing of important issues from a variety of clinical cases

Orthopaedics

• Monthly sessions – cover entire spectrum of orthopaedic injuries and conditions

EM / IM Patient Safety

• Quarterly sessions with our internal medicine colleagues focusing on interactive learning and systems issues which impact ED and hospital care and communication

Core Content / EM Review Sessions

• Monthly sessions in a variety of formats designed to cover the entire curriculum of the Model of the Clinical Practice of Emergency Medicine

Performance Improvement (PI) Conference

• Informal quarterly session, allowing discussion and implementation of resident-driven ideas and suggestions for improving efficiency and coordination of care in the ED

Trauma

• Monthly session with discussion of key issues in the diagnosis and management of patients with trauma-related illnesses

Oral Board Simulations

• Quarterly practice sessions using cases to simulate the experience of the ABEM Oral Examinaton 
• Feature wide variety of cases and 1:1 resident/faculty teaching sessions
• Our residency expectation is a 100% first-time pass rate for the ABEM Oral Board Examination

Board Exam

• Special emphasis placed on the mechanics of the ABEM Qualifying (written) Exam process as well as medical knowledge and patient care issues
• Our residency expectation is a 100% first-time pass rate for the ABEM Qualifying (written) Exam

Administrative/Legal

• Covers key topics such as wellness, sleep/fatigue issues, legal and malpractice issues, documentation/coding, EMTALA, performance improvement, EMS, and other areas

Core Competency Series

• Hospital-wide monthly series focusing on a variety of issues related to communication, ethics, professionalism, palliative care, administrative issues in medicine, job searching/career planning, and systems-based practice