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Orientation / Introduction to Acute Care
This four-week rotation bridges medical school to residency and allows new interns to hit the ground running. Workshops include cadaver procedure lab, ultrasound, suturing, splinting, and obstetrics/gynecology. There is one week of EMS as well as interspersed shadow shifts at the Anderson Emergency Center. Seminars review the approaches to core chief complaints in emergency medicine. Interns will become certified in ACLS, ATLS, and PALS. Various social and team-building activities are arranged throughout the month for interns to enjoy summer in Rhode Island and to bond with their new colleagues.
PGY-1 Emergency Department Rotation
Interns are encouraged to focus on learning, working primarily in the dedicated teaching side of the Anderson Emergency Department, staffed with an extra resident to allow for instruction. Interns will establish a foundational fund of knowledge in managing common chief complaints and proficiency in common ED procedures.
The Emergency Medicine Follow-up Month (EMFU) provides interns with an opportunity to work one-on-one with an EM faculty member to round on select admitted patients and discover what happens after the acute ED workup.
Pediatric Emergency Department
Interns spend one month working directly with the pediatric EM fellows at the Hasbro ED, a busy pediatric Level I trauma center that cares for over 50,000 children visits annually. Over the following three years, Hasbro shifts are interspersed throughout ED rotations for residents to maintain proficiency in pediatrics and to account for the seasonal variability of childhood illness.
This rotation is a highly-regarded month at the Miriam, where interns work one-on-one with attendings to treat lower acuity cases, including many orthopedic and ophthalmologic conditions, and become proficient in common emergency medicine procedures.
Obstetrics and Gynecology
Interns spend one month at Women and Infants Hospital, a busy specialty hospital adjacent to Rhode Island Hospital. The first week is spent on the Labor and Delivery floor and remaining three weeks in the Triage unit. Interns will work with OB/GYN-trained attendings and learn how to manage obstetric and gynecologic emergencies as well as become proficient in OB/GYN ultrasounds. Residents have the option to continue dedicated OB/GYN shifts throughout the rest of their training for more focused OB/GYN training.
During this rotation, the intern takes call for emergency department consultations with the orthopedic team. Anderson Emergency Center is one of the busiest trauma centers in the country with no shortage of orthopedic trauma. Interns will learn techniques for reductions, splinting, and casting of upper and lower extremity fractures, basic extremity x-ray interpretation, and spinal pathology evaluation. Interns also have the option to work at our Sports Medicine Clinic with sports medicine trained emergency medicine faculty.
Medical Intensive Care Unit
One of the highest-rated off-service rotations intern year, residents work at the Miriam in a 15-bed MICU managing critically ill patients. Residents become proficient in management of ventilators, emergent dialysis and a variety of other therapies and have extensive opportunities for procedures, such as central lines, arterial lines, and intubations. Interns also see consults on the floor and in the emergency department under supervision of a senior emergency medicine resident.
Pediatric Intensive Care Unit
Interns rotate through the 16-bed PICU at Hasbro Children's Hospital and manage critically ill children. Because Hasbro Children's Hospital is the only major tertiary care referral center for children in southern New England, interns are exposed to a variety of critically ill patients. The PICU is also where newborns are placed on extracorporeal membrane oxygenation (ECMO), and interns will learn how to manage ECMO. The PICU is combined medical and surgical and as a result, interns become familiar with not only pediatric critical care but also pediatric surgical critical care. Interns have the opportunity in the PICU to do procedures, including intubation, central lines and arterial lines.
Trauma Intensive Care Unit
Interns are part of the trauma team and manage critically ill trauma patients in a busy 10-bed TICU at Rhode Island Hospital. Interns are supervised by a second-year surgical resident in the TICU. Here, interns grow into physicians—they have the chance to independently manage multiple trauma patients with backup from the surgical service. During this month, interns also attend trauma rounds every morning to learn about management of trauma patients that were admitted the night before. In the TICU, interns have the opportunity to perform chest tubes, central lines, and intubations and learn surgical critical care. The TICU also doubles as the Burn Unit, and interns will manage critically ill victims of chemical and environmental disasters.
Anesthesia / Ultrasound
During this hands-on rotation, interns spend the morning in the operating rooms intubating and learning alternative airway techniques. In the afternoon, interns are scheduled scanning shifts with dedicated EM ultrasound faculty and perform a high volume of EM ultrasounds.
PGY-2 Emergency Department Rotation
Brown EM PGY-2's spend five months in the Anderson Emergency Department continuing to strengthen their patient care skills learned intern year while improving flow and efficiency. As second-years, residents are expected to run a sixteen-bed unit of the ED, working with a dedicated attending physician.
Miriam Emergency Department
This highly regarded month during second year exposes residents to our busy community hospital ED, gaining the skills to co-manage patients with private consultants and primary care physicians. Patients at the Miriam tend to have better access to primary care and present to the emergency department in a more decompensated state, offering second-year residents opportunities to manage multiple critically ill patients at a time.
While training at the only Level 1 Trauma Center in Rhode Island, southern Massachusetts and eastern Connecticut, residents spend 2 months during PGY-2 and 1 month during PGY-3 in our Anderson ED Critical Care bays managing our trauma patients in collaboration with our surgical colleagues. During these months, residents will have the opportunity to further refine their procedural skills, including chest tube placement, arterial lines, central lines, fracture reductions, lateral canthotomies, and complex laceration repairs.
Pediatric Emergency Medicine Follow Up
This month is another dedicated month in the Pediatric ED where residents work one-on-one with pediatric EM attendings to build upon their foundational experience intern year. Residents spend dedicated time with pediatric EM attendings rounding on select admitted patients to learn about pediatric care following the acute ED work-up.
Our second-year residents spend a valuable 3 weeks working with our experienced plastic surgery colleagues, gaining practical suturing skills and learning to manage complex wounds, facial and hand injuries. During this rotation, residents are responsible for ED consults and take primary call for injuries involving the hand and face. Residents also have the opportunity to participate in the operating room.
Cardiac Care Unit
Residents will spend a dedicated month in the Rhode Island Hospital Cardiac Critical Care Unit. As one of the busiest cardiac services in the country, residents will gain an invaluable experience caring for critically ill cardiac patients. They will learn the basics of EKG interpretation, cardiac catheterization findings, management of acute decompensated heart failure, and post-MI care. There are ample opportunities for procedures including intravenous pacer placement, central line placement, intubation, and ventilator management.
Toxicology / Elective
Building on their foundation of knowledge from intern year, our PGY-2's spend 2 weeks learning the intricacies of emergency toxicology with our experienced faculty. While on toxicology, residents will hold an educational consult pager and are notified about toxicological emergencies that present to Rhode Island Hospital, Miriam Hospital and Hasbro Children's Hospital. Elective experience varies, and more information can be found here.
PGY-3 Emergency Department Rotation
The third year is the clinical highlight. Residents are expected to become competent in managing critically ill and injured patients in the ED’s twelve-bed Critical Care alley. Residents are responsible for the sickest of the sick patients that present to the emergency department. From severe traumatic injuries to sepsis, STEMIs, and anaphylactic shock, residents will learn to manage multiple critically ill patients at once while triaging them to the correct inpatient setting—a daunting task that is the highlight of our residency. As the critical care resident, you are responsible for all of the trauma airways and help supervise the second-year resident on Trauma. Residents also start to learn about the flow in the ED, managing throughput via ambulance and public triage. Critical Care residents provide medical control to local EMS with backup from the Critical Care ED attending. As the area's only Comprehensive Stroke Center residents also gain extensive experience evaluating acute stroke patients and providing cutting edge stroke care. Because we are the major referral center for critically ill patients, there will be no shortage of conditions to see.
PGY-3 residents spend one week in the pediatric operating room with nurse anesthesists and anesthesiologists to gain more experience in pediatric airway management. This is a great opportunity to learn about new advanced airway equipment and learn about induction medications in the pediatric setting.
Medical Intensive Care Unit
PGY-3 residents act as the MICU senior at the Miriam Intensive Care Unit. This open ICU provides the opportunity to manage critically ill patients in a different setting from the ED critical care bays. In addition to managing the ICU, the 3rd year resident is paired with an emergency medicine intern and will be responsible for teaching aspects of critical care and procedures to the EM intern. Residents are responsible for ED and floor consults.
While training at the only Level 1 Trauma Center in Rhode Island, southern Massachusetts and eastern Connecticut, residents spend two months in our Anderson ED Critical Care bays managing our trauma patients in collaboration with our surgical colleagues. During these months, residents will have the opportunity to further refine their procedural skills, including chest tube placement, arterial lines, central lines, fracture reductions, lateral canthotomies, and complex laceration repairs.
Emergency Medical Services / Elective
Two weeks of 3rd year are dedicated to EMS. The other two weeks of the EMS month are available for an elective. Building on topics covered during 1st year Intro to Acute Care EMS orientation, this 3rd year EMS rotation includes field experience as the transport physician staffing LifePACT, our ground critical care transport program. Supervised by EMS Faculty, this is an exciting opportunity to manage critically ill patients during transport with the LifePACT team (Paramedics and Transport Nurses). LifePACT responds to hospitals and incident scenes throughout the Rhode Island region in our custom ambulances, with most patients delivered directly to intensive care units at Rhode Island Hospital, Hasbro Children's Hospital, or Miriam Hospital. Other topics covered during sessions with the EMS Division Faculty and Fellows include administrative aspects of EMS at the Rhode Island Department of Health, EMS Quality Assurance, training of EMTs including a short project presentation to Paramedics, and focused review of other EMS topics tailored to the resident's interests. Residents may also join EMS Fellows during didactic and field rotations -- see EMS Fellowship link for a description of options.
The second two weeks focus on providing residents with a solid foundation in emergency radiology. In this innovative program residents will be taught in 8-10 one-on-one sessions with an emergency medicine faculty member who is a national expert in emergency radiology. Residents will learn the basics of plain film and CT interpretation as well as clinical management in a systematic fashion.
PGY-4 Emergency Department Rotation
Senior residents are required to demonstrate excellence in teaching, proficiency in functioning autonomously and efficiency in improving patient flow. As a four-year residency, Brown offers an enhanced clinical and academic experience with opportunities for research, electives and individual career development. The PGY-4 experience in the ED prepares the soon-to-graduate resident to become an attending. Residents work in all parts of the adult ED as well as Hasbro and are responsible for a 16-bed unit of the ED supervising junior residents and medical students. PGY-4 residents are responsible for daily morning teaching rounds for all residents in the ED. In addition to their teaching role, residents also return to the critical care bays to keep up their critical care skills and work overnight at the Miriam Hospital managing a community ED in conjunction with an ED attending.
PGY4 residents spend 2 weeks in the ED of Newport Hospital, a true community hospital. This rotation in beautiful Newport RI only occurs during warm months, and is an hour from Providence. Residents are provided a newly renovated and furnished house in Newport to stay in for free.
Intro to Acute Care