INTRODUCTION
The combination of experiences at Jacobi and Montefiore provides our
residents with an incredibly diverse and rewarding education in Emergency
Medicine. Our residents learn compassionate and socially sensitive care of
patients from all walks of life and all parts of the world. At the same time,
the combined Jacobi-Montefiore experience provides our residents with the tools
they will need to be successful practitioners and leaders in the field.
Residents are equipped with the latest in diagnostic and therapeutic equipment
at both sites including new ultrasound machines (now 6 in total) capable of
pelvic, abdominal, trauma and cardiovascular sonography, fiberoptic
laryngoscopes for upper airway evaluation and management, state of the art
electronic patient records and digitalized radiology as well as 24 hour access
to hundreds of online medical journals and references.
The Pediatric Emergency Departments at both training sites are home to
Pediatric Emergency Medicine fellowships and Pediatric Emergency Medicine
faculty.
The Department offers fellowships in Clinical Research, Ultrasound and Pediatric
Emergency Medicine.
BACK TO TOP
STAFFING
Residents work under the direct supervision of full-time residency-trained
and/or board-certified Emergency Medicine faculty at both training sites at all
times. Patient care in the Jacobi ED is provided entirely by members of the
house staff under supervision of the full-time Emergency Medicine faculty.
There is a clearly defined graded progression of resident responsibility
from direct patient care to supervisory and team leader roles in subsequent
training years. In addition to around the clock supervision by EM faculty,
a dedicated “teaching” attending provides supplemental bedside teaching to EM
housestaff ninety four hours each week.
BACK TO TOP
Clinical Curriculum
·
Schedule
|
EM - 1 |
Blocks |
EM - 2 |
Blocks |
EM - 3 |
Blocks |
EM - 4 |
Blocks |
|
Orientation |
2 |
Ultrasound |
0.5 |
CCU |
1 |
PICU |
2 |
|
Jacobi ED Med |
4 |
Jacobi ED Med |
5 |
Jacobi Chief Med |
6 |
Jacobi Pre-Attending |
6 |
|
Jacobi ED Surg |
2 |
Jacobi ED
Surg |
7 |
Jacobi Chief Surg |
5 |
Urgent Care |
2 |
|
Montefiore ED |
4 |
Montefiore ED |
5 |
Montefiore ED |
3 |
Montefiore ED |
6 |
|
Pediatric ED |
2 |
Pediatric ED |
2 |
Pediatric ED |
3 |
Pediatric ED |
3 |
|
Internal Med |
4 |
EMS |
1 |
Urgent Care |
1 |
Dermatology |
1 |
|
Critical Care |
4 |
Radiology |
1 |
Fast Track |
1 |
Elective |
4 |
|
Obstetrics |
1 |
Gynecology |
2 |
Toxicology |
1 |
Vacation |
2 |
|
Anesthesia |
1 |
Research |
0.5 |
Dental |
1 |
|
|
|
Vacation |
2 |
Vacation |
2 |
Vacation |
2 |
|
|
| |
|
|
|
|
|
|
|
|
|
Each Block is 2 wks long
EM
- 1
The
EM-1 year serves as the intern year of the residency
program. The purpose of the intern year is an
introduction into emergency medicine and obtaining a
broad-based knowledge in areas essential to the practice
of Emergency Medicine. These areas include Medical and
Surgical Critical Care, Cardiology, General Medicine,
Neurology, Orthopedics, Obstetrics, and Anesthesia. The
EM-1
Orientation Program in July
consists of 4 weeks of lectures to cover core
topics in emergency medicine and workshops to introduce
interns to necessary ED skills, such as endotracheal
intubation, suturing, chest tubes, and the various uses
of the ultrasound machine. All lectures will take place
in the mornings, Monday through Friday from 8am to
12pm. Interns will attend the regular Wednesday
conferences with the rest of the residents. As an
introduction to clinical emergency medicines, all
interns will work in the emergency room every third day
(including weekends), from noon to midnight. Two
interns will be at each site (Jacobi Medical Side,
Jacobi Surgical Side, and Montefiore ED)
As an EM - 1 intern
at Jacobi ED, patients are assigned by the EM - 3
resident. Patient management and training includes
peripheral IV lines, endotracheal intubation, suturing,
chest tubes, and ultrasound.
At the Montefiore ED,
EM -1 will work on the North and South sides in an
autonomous manner with direct one to one interaction
with an Attending in patient management and clinical
decisions.
EM-1 Interns rotate
for 4 consecutive months on the Internal medicine and
CCU/MICU wards. All medicine rotations are completed at
Jacobi Hospital. During the rotations the EM - 1 is
completely integrated into the medical and critical care
teams with patient responsibility and care.
EM
- 2
As a second year
junior resident, the EM - 2 residents continue to learn
and develop skills within all core areas of Emergency
Medicine. In addition, EM-2 residents are assigned
patients of highest acuity level by the EM - 3 resident
while at Jacobi ED. During all medical notifications EM
- 2 is first attempt at intubations. Added training
during the EM-2 year include dedicated Ultrasound, EMS
and Radiology blocks. EM-2 residents have increased
autonomy with dedicated management of GYN area of the
adult ED.
At the Montefiore ED,
EM - 2 will work shifts with more autonomy in the higher
acuity West side.
EM - 3
The
EM-3 year focuses on developing leadership skills in
managing the Emergency Department, while also
solidifying core Emergency Medicine priniciples.
As a senior
resident, the EM - 3 is acting "chief" resident while
rotating through Jacobi ED. Responsibilities include
initial assessment of all new patients and delegating
patients to the junior residents on the team. During all
medical and surgical notifications, EM - 3 will delegate
patient responsibility, junior resident resuscitation
areas, and is first attempt at all Trauma/Surgical
intubations. In addition the EM - 3 will see, manage,
present and discharge their own lower acuity patients.
EM-3 residents also
rotate through lower acuity Urgent Care and Fast Track
area in the Jacobi and Montefiore Emergency Departments.
EM
- 4
The EM-4
year in Emergency Medicine is designed to raise the
knowledge and skills developed in the first three years
of postgraduate training to a consultant or
"Pre-attending" level in the specialty. Residents spend
all of their clinical time at Jacobi ED in a leadership
role with an emphasis on the supervision and teaching of
junior residents and medical students in the department.
EM-4
residents have very significant authority and the
responsibility to make decisions that have far-reaching
implications, both within the department and throughout
the Medical Center. All junior residents and medical
students present only to the EM-4, who has all decision
making capability with consultation from the Attending
as needed. EM-4 residents run all medical and surgical
notifications, and assume primary responsibility for
overseeing critical patient care.
This
unique clinical experience produces some of the most
prepared and capable Emergency Medicine residents.
Typically graduates of the Jacobi/Montefiore program are
ready to assume any attending role and adapt deftly to
the dynamic environment which is Emergency Medicine.
Pediatrics
Every year EM
residents complete 4-6 weeks of dedicated Pediatric
Emergency Medicine rotations. Residents alternate
between the Jacobi Pediatric ED, an independent level I
pediatric trauma center and the Montefiore Children's
Hospital, one of the nation's top pediatric specialty
center. With exposure to dedicated Pediatric residents,
fellows and attendings, the Pediatric rotation allows
specialized training and pathology throughout all years
of residency.
Internal
Medicine
As an EM-1 two months
are spent at Jacobi Hospital on an Internal Medicine
team with primary patient responsibility. As part of the
inpatient medical team residents have the same q3 call
schedule and present to the Medical Attending. The
experience of inpatient medicine allows the EM resident
to broaden their general medicine knowledge and allows
for a more complete medical experience as the resident
is responsible for every aspect of his/her patient care.
Responsibilities include admission, inpatient therapy,
discharge and follow-up. Residents find themselves with
stronger bonds between the Emergency and Inpatient
service from the diversity of interaction and
participation between services. EM residents are exempt
from attending Medical Clinic during the rotation.
Critical Care
To provide EM residents exposure to
current cardiologic thinking regarding Acute Ischemic
Syndromes. To provide EM residents exposure to a variety
of arrhythmias and their management. To provide EM
residents exposure to different cardiologic testing and
treatment modalities to better understand their role in
the diagnosis and management of heart disease. To
provide residents with the opportunity to improve ECC
reading skills through daily ECG reading sessions.
Obstetrics & Gynecology
During the EM-1 year,
two weeks are spent OB service exclusively on the Labor
and Delivery floor. EM residents participate in triage,
assessment and delivery of prenatal patients. With a
thriving delivery service, residents typically
participate and assist in more than the minimum of 20
live births.
As an EM-2, residents
have 4 weeks of working daily in the Jacobi ER dedicated
GYN area. With more autonomy, residents are able to
evaluate and treat patients with gynecological
complaints and presents directly to an attending.
Integral to the rotation is the utility of transvaginal
ultrasonography, which residents will continue to
sharpen throughout their residency.
Radiology
EM-2 residents have a
two week intensive dedicated radiology rotation.
Residents report to the plain film radiology attending
daily during the block. From 9am-3pm residents review
all ER plain films, ICU plain films on a 1 on 1 basis
with the attending with instantaneous critique and
evaluation.
Urgent
Care/Fast Track
From 8am through 9pm, patients who
present at the Jacobi ED with relatively minor
complaints will be seen in the Urgent Care / Fast Track
area, which is adjacent to the main ED. EM-3 and EM-4
residents work there under the direct supervision of an
attending, alongside other attendings and a nurse
practitioner. This is a Monday-Friday rotation, with no
weekend responsibilities. EM-3 residents will work from
1pm to 9pm on Mondays, Thursdays and Fridays, and from
8am-4pm on Wednesdays and Thursdays (although you do
attend Wednesday conference as per usual). EM-4
residents will have the opposite schedule. Until 4pm,
there are dedicated nurses and PCAs in the urgent care
area. From 4pm to 9pm, the resident will work alone
with one nurse, and will present cases to the teaching
attending in the main ED.
Fast track shifts at Montefiore are
from noon to 10pm, Monday through Thursday. There are
no holidays. Similar to the Jacobi urgent care, the
Montefiore fast track is adjacent to the ED, and
low-acuity cases are triaged there. Fast track is open
24 hours at Montefiore, and you will work directly under
the supervision of an attending, and alongside
experienced physician’s assistants.
Toxicology
The rotation is at the New York
Poison Control Center. Meet in the ED at Bellevue for
Morning Rounds at 8am on the first day of the rotation,
and ask for any of the Toxicology fellows. Each
Resident will be expected to give one presentation at
the Poison Center, the subject of which is at the
discretion of the Toxicology Fellows. 8am morning
lecture is conducted in the conference room adjacent to
the main adult ED, the lectures tend to be very
informative.
PICU
As an EM-4, residents
rotate through the North Central Bronx Hospital PICU
service over a course of 2 block rotations. Residents
work directly with PICU attendings, fellows and
Pediatric residents.
Dermatology
During the EM-4 year,
residents spend two weeks at the Jacobi Dermatology
Clinic working with dermatology residents and attendings
in both common and uncommon dermatological
presentations. In addition, dermatology residents hold
bi-weekly hours in the Jacobi Urgent Care clinic for
follow-up and evaluation of dermatologic cases.
Elective
All EM-4 residents
will have four elective blocks, All away electives will
require the approval of the Program Director on a
case-by-case basis.
Formal electives
are available at Montefiore in Neurology, Endocrine,
Rheumatology, Pulmonary Medicine, Plastics,
Ophthalmology, Forensics Medicine, and a Teaching
Elective in the Adult ED.
BACK TO TOP
Didactic
Curriculum
Conferences are held at both the
Jacobi and the Montefiore sites. The Emergency Medicine
Core Curriculum is covered during Wednesday conferences
at Jacobi and schedules have been designed to optimize
attendance. Each topic covered in the core curriculum
is given a priority. Priority 1 lectures are repeated
each year, priority 2 lectures are repeated every 2
years and priority 3 every 3 years. In addition to the
core curriculum, there are multiple site-specific
lectures available throughout the week.
|
Conference |
Format |
Director |
Frequency |
|
Core Curriculum |
Lecture |
Faculty, Chief
Residents, Visitors |
Weekly |
|
Oral Board Review |
Group Discussion |
Faculty, Chief
Residents |
Weekly |
|
Follow-up Rounds |
Case Review, Group
Discussion |
Residents, Faculty |
Bi-Monthly |
|
Trauma Conference |
Case Review, Group
Discussion |
Trauma Faculty,
Chief Residents, Nursing |
Monthly |
|
Morbidity &
Mortality |
Case Review, Group
Discussion |
Faculty, Chief
Residents |
Monthly |
|
Evidence Based
Medicine |
Lecture |
Residents |
Monthly |
|
Anatomy/Procedure
Lab |
Cadaver Procedures |
Residents, Faculty |
Monthly |
|
Mock Code |
Simulation Lab |
Residents, Faculty |
Monthly |
|
Pediatric Mock Code |
Mock Code |
Residents, Faculty |
Monthly |
|
Journal Club |
Group Discussion |
Residents |
Monthly |
|
Firm Meetings |
Discussion |
Faculty, Resident |
Monthly |
|
Toxicology |
Group Discussion |
Faculty, Residents,
Fellows |
During Rotation |
|
Ultrasound |
Group Discussion |
Residents, Fellows |
During Rotation |
Core Curriculum
Oral Board Review
Follow-up Rounds
These conferences happen every
Friday and are usually organized by the EM-3 on an
elective rotation with a faculty member according to a
schedule of assignments. This is a case-based,
interactive conference which will be done in oral-boards
format. Ideal cases should be challenging and
interesting and it is the resident's responsibility to
ensure that interesting cases are available. The first
case is presented in 20 minutes to an assigned EM-4 who
has to figure out the case by asking the EM-3 pertinent
questions. Another resident will be assigned as
scribe. The second case will be presented for 40
minutes to the entire audience again in oral boards
format, where the onus is on the audience to get
information from the presenter. For both cases, the
presenting resident should make every effort to provide
any related imaging studies/EKG, history and physical,
differential diagnosis, management issues, any
interesting educational points or information about the
patient’s outcome. The attending will direct the
discussion around the cases.
Trauma Conference
Trauma rounds are held every other
week at core conference in Building #1, 4th Floor
Auditorium. This is an interdepartmental conference
provided jointly by the ED staff and the Dept. of
Surgery. Challenging trauma cases are selected and
presented by the ED staff with follow-up operative and
post-op course provided by the surgical service. One
EM-4 Resident, with the help of Dr. Gruber, will be
responsible for choosing interesting cases in
conjunction with the Trauma Service and for collecting
relevant materials for presentation of the case. The
Super Senior may ask another resident who was involved
in the case to be present at rounds if their schedule
permits or present the cases themselves. Selected cases
should be forwarded to the conference chief at least 1
week in advance to the lecture. The Super Senior will
prepare a 1-2 page summary of the cases discussed and
the main teaching points made and submit it to Dr.
Gruber within 1 week of the conference. Slides need to
be in PowerPoint(.ppt) format.
Morbidity and
Mortality
M&M will be held every month. A
Super Senior and Attending will be assigned to choose
cases and provide a presentation and discussion of
relevant quality improvement issues. Cases may be drawn
from Jacobi, Montefiore, or North Central Bronx. Good
sources of cases for this conference are the attendings
involved with quality improvement (Dr. Elsner or Dr.
Schechter). Any cases encountered in clinical practice
at either site may be used in which a patient’s adverse
outcome may have been related to emergency department
management (triage, diagnosis, therapy and
disposition). The resident will prepare a one page
summary of the issues and recommendations that were
discussed and submit this to Dr. Elsner.
Evidence
Based Medicine/Journal Club
EBM / Journal Watch
will be held one per month during conference. One EM-2
resident will work with an Attending to present recently
published articles. EBM is an evidenced based approach
to answer specific questions relevant to clinical
practice. Residents should make arrangements to meet
with their preceptor at least one month in advance of
their presentation to select a question for research and
to develop a strategy. The resident will present 1-2
articles relevant to the clinical question and the
attending will direct discussion concerning the
article’s pertinence to EM.
Anatomy, Procedure&Simulation Lab
Pediatric Mock Code
Journal Club
Firm Meetings
Toxicology
Ultrasound
The Jacobi Fellowship in Emergency Medicine
Ultrasound is a one year program designed to
develop expertise in all areas of emergency
medicine ultrasound applications. Jacobi
Medical Center is a busy Level 1 trauma
center with 3 ultrasound machines based in
the emergency department. The fellow works
20 hours per week in the didactic of
ultrasound skills and interpretation at
Jacobi Medical Center and 20 hours
clinically split between Jacobi Medical
Center and North Center Bronx Hospital. In
addition to the didactic curriculum, fellows
will assist in education, research into new
applications and quality assurance for the
department. At the end of one year, the
fellow will be eligible for RDMS
accreditation. The goal is to produce
experts and leaders in the field of
emergency medicine ultrasound. Physicians
who will not only have the skills in
ultrasonography and image interpretation,
but who can ultimately develop and maintain
an emergency department division of
ultrasound and/or emergency medicine
ultrasound fellowship themselves.
RDMS Certified Faculty
Jill Corbo, MD, RDMS
Jessica Wang, MD, RDMS
Sonali Ruder, DO, RDMS
Tesfa Young, MD, RDMS
Other resources include scanning with
ultrasonographers and echocardiographer to
gain in-depth exposure in those disciplines.
These opportunities to learn advance
echocardiography with the Division of
Cardiology is available, as well as advance
OB with the Department of Gyn.
At Jacobi Medical Center, the main site,
there are 3 new ED ultrasound machines: 1
Philips and 2 Seimen Sonoline. At North
Central Bronx Hospital, there is one brand
new Seimen Sonoline.
For more information, please contact:
Jill Corbo MD, RDMS at
jillcorbo@aol.com
Jessica Wang MD at
wangjessica@yahoo.com
Research
The Department of Emergency Medicine is dedicated to an
active and productive research program. Research
projects are a collaborative effort between faculty and
residents working in small groups to design and
implement projects and analyze results. The academic and
scholarly environment has grown to include a significant
subset of faculty members with formal clinical research
training, interest, ability, and devoted time to secure
funding and perform research. Medical students employed
throughout the summer months and data collectors
supported by departmental and grant funding facilitate
collection of data. The research program has been highly
successful to date, with numerous publications in
emergency medicine journals and abstracts presented at
scientific assemblies. The department sponsors an
Emergency Medicine research fellowship
Lecture Library
- pending
Fellowships