Ask Chief Residents: Questions & Answers

What is the Orientation Block for First Year Residents?

At the beginning of their 1st year, the interns complete a six week long orientation rotation. They get a chance to spend a good deal of time together, both at work and outside work. This is a great way for the new class to get to know each other and become a very cohesive group. During this month, interns do several "mini-shifts" that introduce them to the department. They are given multiple faculty lectures, complete all prerequisite employment-related coursework, and participate in procedure and medical simulation labs to gain hands on experience.

Where do Residents Live?

About one third of the residents live in Manhattan (midtown east, upper east side, east village, lower east side), another third in western Queens or Brooklyn, and the last third on or around campus. Residents are a very tight knit group and tend to spend their time together doing a variety of activities a city of 12 million has to offer.

How Many Shifts do you Work and What are the Hours?

Throughout residency EM residents work 12 hour shifts. Tuesdays & Wednesdays shifts are shorter because our Wednesday conference time is protected.

Average # of shifts per month:

PGY1 work 18-19 shifts / month
PGY2 work 17-18 shifts / month
PGY3 work 16-17 shifts / month

What are Off-Service Rotations Like?

We do not work any floor months in Medicine, Surgery, or Pediatrics.

Our outside rotations include 5 months of ICU (SICU, MICU, CCU, & Maryland Shock Trauma). These are intense months and are great experiences for training in critical care. As first years, rotations are very procedure-heavy - you are responsible for central lines, transvenous pacemakers, chest tubes, arterial lines, and intubations. As second years we are seniors in the ICU and are responsible for running the unit, doing consults, teaching procedures & supervising junior residents.

During our residency we also complete 2 months of Anesthesia (1 month for each Adult & Pediatric) with the express purpose of learning airway management including mask ventilation, oro/nasotracheal intubations, LMAs, and fiberoptic intubations. Most PGY1 residents finish their first year with over 100 adult intubations and 30-40 pediatric intubations. In addition, we have two week rotations in Plastic Surgery / Hand, Labor & Delivery, and FDNY EMS. 

As senior residents, we have one month where we can choose among several selective rotations.  Most of these provide additional experience with penetrating and multi-trauma cases, and may be done at several institutions or at Shock Trauma in Maryland.

How is your Experience in Ultrasound?

Amazing! Among our faculty there are 7 ultrasound fellowship-trained attendings who routinely utilize ultrasound to answer key clinical questions. Our department also has an ultrasound fellowship with up to 4 fellows each year. As a first and second year resident, you are scheduled for a 2 week rotation each year to work exclusively with the ultrasound team, during which all you do is scan. On Fridays, the ultrasound faculty hosts a live tape review of all the scans conducted in the department the previous week. Tape review is a great opportunity to learn from your mistakes and to become a better ultrasonographer. In addition to the ultrasound elective residents use ultrasound routinely during their clinical shifts.

What Fellowships Does your Department Offer?

Our department offers a one-year ultrasound fellowship, a two-year medical toxicology fellowship, a two-year critical care fellowship, a one-or two-year basic research fellowship, and a one-year sports medicine fellowship. In conjunction with our sister hospital, LIJ, we also offer a co-sponsored fellowship in international emergency medicine.

Who Gets the Most Procedural Experience?

Universally the first-year residents get preference for any and all procedures. As second-and third-years, we routinely pull interns to do chest tubes, intubations, central lines placements, do lumbar punctures, and most other procedures. This is a reflection of the high comfort level of the senior resident, having done so many and being able to ultimately teach the procedures. 

How are Shifts Structured?

The ED is divided into 5 areas (Adult Red, Adult Midway, Adult Gold, Pediatrics, and Fast Track). Most shifts in the department consist of one resident and one attending, with the exception of the Adult Red side where the intern and a senior resident work together. The purpose of this is for senior resident to teach and guide the first year resident. However, starting second year, the resident is expected (and thus prepared) to manage an entire Adult ED side by themselves.

How is your Support Staff?

Our support staff and ancillary services are designed so that the residents and attendings can spend more time seeing patients. Although residents are expected to place most if not all pediatric IVs and other pediatric procedures (which are invaluable skills), you will rarely be asked to place an IV into an adult patient.

Do you have your Own Department?

We are our own department.  We are not a division of surgery or medicine.

Who Handles Trauma?

As a Level 1 Adult and Pediatric Trauma Center, we have a cachement area of 6 million people (we are the trauma receiving hospital in a network of 15 hospitals). We are also a Stroke Center, 24/7 Cardiac Catheterization Center, and a Magnet Hospital for Neurosurgery. In regards to Trauma, we reserve the right to notify trauma surgeons if we feel that to be the appropriate course of action. This is usually done after our ED physicians secure the airway and make appropriate primary interventions.

Do Residents Have a Voice in Curriculum Design?

Every year the residents spend a day at Dr. LaMantia's house, where everyone has a voice regarding which rotations we found most beneficial and which ones we feel could use a little work or need to be removed entirely. Thus, every year our residency is a little different, and we think, a little better than the previous year.

What do Graduates Typically Do?

Traditionally about 60% of graduates pursue highly successful careers nationwide as community ER physicians. The other 30%-40% enter fellowships and/or pursue academic careers.

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