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
EMS & Radiology
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.
Elective time allows you to tailor your learning during training. Our residents have ample elective time in PGY2, 3 and 4 to explore their passions or develop a niche. We believe in liberal arts emergency medicine, and you can choose your own adventure when it comes to your elective time. Through our division of Global Health, we have ample funding to support International Electives, and residents have chosen to pursue electives in every medical and surgical speciality, as well as medical humanities, sex and gender, ultrasound, wilderness medicine, research, public health, and much more. You are only limited by your imagination!