Frequently Asked Questions
Is KMC a trauma center?
KMC is a Level II Trauma Center and the only trauma center for all of Kern County. KMC cares for a large volume of both blunt and penetrating trauma. The Emergency Medicine department works hand in hand with the trauma service to critically assess, resuscitate, diagnose, and treat trauma patients. The traumas run the gamut from minor injuries to open thoracotomies. We are on extremely collegial terms with our surgical colleagues, which is a major strength of our department as well as our residency.
What? Only Level II?
The only features that KMC does not have that are required of a Level I trauma center are a burn unit and cardiopulmonary bypass capability. However, from the training standpoint of a Emergency Medicine resident, it does not change much. If a trauma patient requires a burn unit or cardiopulmonary bypass, they will always first come to KMC for stabilization, prior to transfer, as we are the only trauma center for 100 miles in any direction. As Emergency Physicians, we see plenty of burns, major and minor. We direct the initial assessment and management of emergent burns.
Who runs the trauma at KMC?
The ED has a healthy relationship with the surgery service. All trauma activations are run by the Emergency Medicine residents. The surgical team is present during the resuscitations, providing manpower assistance and consultation in the decision making process. The ED attending is also present in the room for consultation. The EM resident in charge assigns all duties prior to the arrival of the patient and coordinates all efforts during the resuscitation. Orders are given by only one person - the EM resident in charge of the resuscitation.
What is the interaction like between your residents and attendings?
Our residency program is acutely aware that being a physician, especially in a busy county Emergency Department, is a demanding job. Part of the strength of our program is the supportive environment in which we work and learn. The faculty is committed to training our residents and to helping them learn how to integrate life and work. To this end, the program sponsors a variety of social events outside the confines of the hospital. There are backyard barbeques, movie nights, tennis matches, holiday parties, graduation parties, and a yearly resident retreat on the lake. These events allow residents and faculty the opportunity to get to know each other on a more personal level.
What is the attending coverage like in the ED?
At least one attending is available in the ED 24 hours a day, seven days a week. They are always easily accessible for questions or problems. Every case is discussed with the attending at some point prior to discharge or admission, and the attending physically sees every patient. For junior residents, cases are presented early, and the attending takes a more active role in the work-up, treatment, and disposition decisions. Senior residents are given more independence and may have disposition already arranged prior to discussing the case.
Do your residents have enough autonomy?
We believe that we have struck an excellent balance between guiding our residents and yet not being too overbearing. Since our attendings see every patient, usually separate from the resident, they can make an independent assessment and provide feedback regarding important history or physical exam findings that might have been missed. Procedures are supervised by attendings until documented competency has been established. Residents progressively take over more of the decision making process until, by the senior year, they are functioning independently and basically managing the entire department.
How many shifts per month are you expected to work?
Our residents thrive in an environment which is committed to their education and not their exhaustion. Our residents work seven, eight, and nine hour shifts, and are scheduled for 20 shifts in 28 days. Typically, a resident will work 4 to 5 night shifts in a 28-day block. Some overlap is provided in the schedule in order to allow those residents coming toward the end of their shift to finish working on old patients without having to pick up new ones. Conference time, every Tuesday and Thursday morning, is protected time. Residents are required to leave the department or their off-service rotation to attend conference. The shifts are scheduled as follows: Morning (7:30am-3:30pm), "Nooner" (12pm-8pm), Evening (3:30pm-10:30pm), "Sixer" (6pm-2am), Night (10:30pm-7:30am).
Do you have ultrasound in the ED?
Ultrasound is an extensively used resource in our department. We have three ultrasound machines that are in nearly constant use. There are few patient encounters or exams, in our opinion, that can not be facilitated in some way by the accomplished use of ultrasonography. We perform hundreds of FAST exams on trauma patients. In addition, we perform transabdominal and transvaginal ultrasound exams on our Ob/Gyn patients. We regularly perform bedside ultrasounds to evaluate for viable intrauterine pregnancy, fetal age, ectopic pregnancy, gallstones, kidney stones, hydronephrosis, abscess depth, aortic aneurysm, cardiac wall motion, and pericardial effusion.
Are there plenty of procedures?
This is an absolute and resounding yes. Training in a county Emergency Department necessitates that faculty and residents have the ability to perform almost any procedure under even the most dire of circumstances. Our program places emphasis on our residents' ability to perform difficult procedures with equanimity and excellence. Anesthesiology does not intubate in our ED. In fact, they are not present in our department, only in the operating rooms. The Emergency Medicine physicians perform all Emergency Department intubations. In addition, the ED responds to all code blues in the hospital, 24 hours a day. The program director is careful to track the residents' procedures and review their progress every six months. By the end of your residency here, there is no doubt that you will be comfortable performing any of the myriad of procedures required of an Emergency Physician.
Are residents expected to teach?
Residents are actively involved in the teaching process. At the PGY-1 level, they take turns directing a weekly review of the Tintinalli's Study Guide. The PGY-2 residents are expected to direct journal club. The PGY-3 residents organize and present a lecture on a particular ED procedure. At the PGY-4 level, residents prepare and present lectures on a topic of their choice for emergency and trauma conferences. Senior residents also supervise and teach medical students and residents from other services when they rotate through our emergency department.
What is your accreditation status?
Our last RRC review occurred in 2010, and we were awarded full accreditation for five years.
What about research at KMC?
The primary focus of the residency program has traditionally been to produce strong clinical Emergency Physicians. Residents can join faculty in an existing research project, but are highly encouraged to produce their own unique research project from inception of a clinical question, through IRB approval, to analysis, and completion. We require all residents to complete a scholarly project, and encourage research publication and abstract presentation as a goal. KMC holds an annual research forum in order to provide a setting for the presentation of locally produced research.