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Shifts in the ED each month for residents are divided   approximately 40% trauma   shifts, 40% general medicine   shifts, and 20% pediatric shifts. These are   approximate   estimates, as traumatic vs. medical vs. pediatric patient   presentations may be seen in any part of the ED. 

• Orientation month- This first month of residency incorporates many high-yield experiences to orient the EM1 resident for his or her emergency medicine residency. Included are lectures, procedure and cadaver labs, an ACLS instructor course, ATLS, APLS, and supervised shifts in the ED.
  
• Pediatric ED- This is one month of shifts solely in our Level I Pediatrics ED working under EM, Pediatric, and Pediatric EM faculty. The focus is on recognition and management of pediatric emergent and ambulatory patient presentations.

• OB/Anesthesia- This month incorporates two weeks each of OB/Gyn and Anesthesia. The OB rotation is at LBJ hospital, which has over 6000 deliveries per year. On the Anesthesia rotation, the EM resident will gain experience with intubations and airway techniques in the OR setting with direct faculty supervision.

• CCU- The resident is an integral part of the cardiology ward and ICU team for patient care. The resident will be supervised by Cardiology faculty involved with cutting edge research and national trials. Currently construction of a new MHH Cardiovascular Institute is underway.

• Trauma- The EM1 resident is the intern on this busy service. The resident covers ED consultations, trauma wards, participates in the OR and ICU as indicated, and gains valuable experience with procedures and patient management under the direction of our trauma colleagues.

• Radiology- The resident spends two weeks with the Emergency Radiology team reviewing plain films with ED Radiology fellowship trained faculty and Radiology fellows. The additional two weeks are spent learning fundamental principles of radiology with experience in the CT neuro and body rooms, the pediatric radiology suite, and the interventional radiology suite. Residents have no night or weekend call but work two shifts in the ED during the course of the month.

• Orthopedics- The EM resident participates in ED call, ward coverage, overnight call, clinic, and gains extensive experience with the acute diagnosis and management of orthopedic and spine injuries, splinting, fracture reduction, Steinman pin placement, and other procedures. Supervision is via dedicated ED Orthopedic faculty for consults and upper level Orthopedic residents. Orthopedic faculty also provide care for the different Houston sports teams, and residents will see these patients in clinic with faculty.

• MICU- This rotation involves four weeks gaining experience and knowledge of all aspects of care of critically ill medical patients.

• 4 ED months for EM1s at MHH.

• Resident teaching requirements during the EM1 year include presenting two 30 minute case presentations during conference, one adult and one pediatric based on cases in which the resident was involved, during the spring of the PGY1 year. Additionally, the resident will participate as an ACLS instructor. Return to Top

EM II Rotations

• Hand/Plastic Surgery- The EMII resident is on-call with the Hand/Plastic Surgery attending during the month and covers ED consultations. This rotation involves extensive 1:1 time with faculty as the resident is first assist in the OR and sees patients in the clinic and wards with the faculty member.

• EMS/ED- The resident gains experience with Houston Fire Department (HFD) and the principles of EMS. One day is spent in the 911 city call center, one day with the heavy rescue team, two shifts of ride-alongs with the HFD medical directors participating as physician command on-scene, attends training programs, and participates in scene calls with HFD crews for two weeks. The additional two weeks is spent in the ED.

• Pediatric ED at Texas Children’s Hospital- The resident participates as an EMII in the largest children’s hospital in the world with the busiest Pediatric ED in the country with >75,000 patient visits per year. Direct supervision is by Pediatric EM faculty and fellows.

• Elective (see below)

• 8 ED months at MHH involving progressive responsibility, resuscitation management, and introduction to the supervision of medical students.

• Resident teaching requirements involve two 30 minute focused topic presentations and one 60 minute core lecture presentation during the course of the EMII year. The resident will also participate as an ACLS instructor. The resident may supervise medical students during their EM rotation and participate in medical student focused teaching sessions. Return to top
  

EM III Rotations

• Stroke service and Administrative rotation- The senior resident spends two weeks on our busy stroke service, gaining experience with management of acute stroke diagnosis, resuscitation and management. This rotation has no call. The additional two weeks of the month incorporate extensive administrative experience in EM for the resident with discussions about billing and coding, budget, quality assurance, and the general business of EM. The EMIII also participates as junior faculty on 6 supervisory shifts, intended to allow the resident to function in the attending role with direct attending supervision.

• Shock Trauma ICU- The EMIII  resident is the senior resident in the STICU, affording extensive experience managing critically ill trauma patients.

• NeuroTrauma ICU or Pediatric ICU- The senior resident may choose either the NeuroTrauma ICU or Pediatric ICU experience depending on his or her educational goals. The NeuroTrauma ICU allows the resident to manage critically ill neurosurgical patients 1:1 with critical care faculty. The PICU allows the resident to manage critically ill pediatric patients, both traumatic and medical, with direct supervision by PICU faculty and fellows.

• Elective (see below)

• Community ED month - This rotation allows the senior resident experience in a true community ED setting with a different patient population than MHH, allowing the resident to gain additional experience with efficiency and patient care in a setting different from the primary residency training site.

• 7 ED months at MHH involving principles of ED management as a whole, progressive responsibility in supervising medical students and junior residents, and a focus on advanced principles of patient management.
  
• Resident teaching requirements involve two 30 minute focused topic presentations and one 60 minute grand rounds presentation during the course of the EMIII year. The resident will also participate as an ACLS instructor. The resident may supervise medical students during their EM rotation and participate in medical student focused teaching sessions. Return to top

Sample Resident Block Schedules

Chief residents- Two incoming EMIII residents are chosen in the late PGYII year by the faculty based of many factors: patient care, didactic and academic standing, patient and resident advocacy, leadership and communication skills. The position includes a stipend, attendance at the SAEM chief’s conference, and responsibilities for resident scheduling, mediation, participation in Education Committee monthly meetings and faculty monthly meetings, and other administrative tasks and involvement with the residency. Return to top

Resident Electives

EMS/Lifeflight
Toxicology
Ultrasound
PICU, NTICU, STICU
ENT/Ophthalmology/Dental combined rotation
Other rotations considered upon request, planning, and funding. 

Trauma experience:

We have very close working relationships with our trauma colleagues. EM residents develop extensive experience managing multiple critically injured trauma patients. Upper level EM residents manage the trauma airways in the ED. EMIs rotate on the trauma and orthopedics services, and EMIIIs are the upper level resident for the Shock Trauma ICU rotation.  

Pediatric experience:

Our residents gain extensive pediatric experience. Each ED month throughout the residency involves specific pediatric shifts. Pediatric patients also may be seen in the main ED. The EMI year dedicates one full month to the Pedi ED, and the EMII year has a full month at Texas Children’s hospital ED. The EMIII year has the option of PICU for those residents who elect for additional critical care experience.Return to top

Didactic Curriculum

We are dedicated to our residents’ education, learning and individual progress as they progress towards becoming successful practicing emergency physicians. Our didactics follow the core curriculum from the Model of Emergency Medicine. We have conference with didactic lectures, demonstrations, journal clubs, and labs on Wednesdays from 7am to noon in one hour time slots. During this time we incorporate morbidity and mortality conference, ultrasound curriculum, airway in-services, EKG courses, follow-up and case conferences, monthly reading exams and test-taking skills sessions, review sessions, oral board preparation experience, and many other educational offerings. Residents are relieved of all clinical duties in order to attend conference on Wednesday mornings except on some ICU rotations in which direct patient care takes precedence. All residents are expected to maintain a minimum of >70% conference attendance throughout the year. 
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Research and Scholarly Project Requirements

Each EM resident will complete a scholarly project under the supervision of an EM faculty member as per RRC guidelines. This project may be original research or other scholarly project as approved by the program director on an individual basis. The residents are exposed to principles of research project design and implementation throughout the residency and are afforded many opportunities to participate in departmental projects. Return to top

Medical Student Rotation Elective

This very popular rotation is coordinated by our medical student clerkship director, Dr. Katrin (Kay) Takenaka, and our residency coordinator, Amy Dietrich. Interested students must contact Amy first to determine space availability (see contact information above). Amy will then refer interested students to the Student Affairs Office to request an application for rotation. 

The rotation begins on the 1^st of each month and ends the last day of the month. Visiting students must be in good standing at their medical school and have completed all core third year rotations. Students receive faculty and senior resident supervision on 15 8-hour shifts during the course of the month, dedicated medical student teaching sessions (lectures, suture lab, airway lab), copies of references to use during their rotation, and gain valuable experience in the management of EM patients.

LifeFlight-

LifeFlight is Memorial Hermann’s air ambulance service which serves a 150 mile radius surrounding Houston, traveling across southeast Texas and into western Louisiana, one of the oldest and busiest aeromedical ambulance services in the country. Emergency Medicine residents may fly with LifeFlight as an elective in the PGY2 or PGY3 years. For additional information, please see the LifeFlight website at ww.memorialhermann.org/services/lifeflight.html. Return to top 

Emergency Medicine Fellowships available

Houston Fire Department EMS fellowship- This is a two year fellowship directed by David E. Persse, MD, Medical Director, City of Houston EMS. Interested parties should contact diana.rodriguez@cityofhouston.net.

Ultrasound Fellowship- Interested parties should contact Dr. Greg Press for more information at gregory.m.press@uth.tmc.edu.