FAQs
Is KMC a trauma center?
KMC is a Level II Trauma Center and the only trauma center for all of Kern County. KMC is fortunate to care 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 who run the gamut from minor injury to open thoracotomy. We are on extremely collegial terms with our surgical colleagues, it is a major strength of our department as well as our residency.
What? Only Level 2?
The only features that KMC does not have that are required of a Level 1 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. Whether a trauma patient requires a burn unit or cardiopulmonary bypass, they will, of necessity, first come to KMC for stabilization 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 have intensive involvement in the initial assessment and decision making regarding emergent burns, and this is where the strength of a qualified emergency medicine physician lies.
Who runs the trauma at KMC?
We are fortunate at KMC to have a healthy relationship with the surgery service. All trauma codes 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 ever aware that being a physician, especially in a busy emergency department, is a demanding job. Part of the strength of our program is the collegial 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 opportunities outside the bounds of the hospital. There are backyard barbeques, movie nights, tennis matches, holiday parties, graduation parties and a yearly resident retreat on the coast that all allow residents and faculty the opportunity to get to know each other as human beings, not simply as physicians.
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 roll in the work-up, treatment and disposition decisions. Senior residents are given more liberty and may have disposition already arranged prior to discussing the case.
Do your residents have enough autonomy?
We actually believe that we have struck an excellent balance between guiding our residents and yet not being too overbearing. Because our attendings see every patient, usually separate from the resident, they can make an independent assessment and provide feedback regarding important history or physical findings that might have been missed. Procedures are proctored by attendings until documented competency is established. Residents progressively take over more of the decision making progress until, by the senior year, they are functioning independently and basically managing the entire ED.
How many shifts per month are you expected to work?
Our residents are fortunate to thrive in an environment which is committed to their education and not their exhaustion. Our residents work 8 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 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 to attend conference. The shifts are scheduled as follows: Morning (7:30am-4:00pm), "Nooner" (12pm-8pm), Evening(3:30pm-11pm), "Casino" (6pm-2am), Night(10:30pm-8:00am).
Do you have ultrasound in the ED?
Ultrasound is an extensively used resource in our department. We have two ultrasound machines that are in nearly constant employ. There are few patient encounters or exams, in our opinion, that can not be facilitated in some way by the accomplished use of an ultrasound machine. We perform hundreds of FAST exams on trauma patients, day in and day out. In addition, we perform transabdominal and transvaginal ultrasound exams on our ob/gyn patients. We regularly perform bedside ultrasound exams to evaluate for viable intrauterine pregnancy, fetal age, , abscess depth, aortic aneurysm, ectopic pregnancy, gallstones, kidney stones, hydronephrosis, cardiac wall motion, and pericardial effusion.
What is your accreditation status?
Our last RRC review occurred in 2006, and we were awarded full accreditation for three years.
Are there plenty of procedures?
This is an absolute and resounding, yes. It is one of the odd quirks of training in emergency medicine that the county hospitals necessitate that its faculty and residents can perform almost any procedure under even the most dire of circumstances. Our program places emphasis on our resident's ability to perform difficult procedures with equanimity and excellence. Anesthesiology does not intubate in our department, 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 ER runs all trauma resuscitations and answers to all code blues in the hospital, 24/7. Our program director is careful to track our procedures, and every six months we review our progress. 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.
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 question: seeing through a project from inception, 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.
Are residents expected to teach? Residents are actively involved in the teaching process. At the EM-1 level, they take turns directing a weekly review of the Harwood-Nuss Study Guide. At the EM-2 level, they are expected to organize and present a lecture on a particular ED procedure. At the EM-3 level, residents prepare and present lectures on a topic of their choice, to be presented to the emergency and trauma conferences. Senior residents also supervise and teach medical students and residents from other services when they rotate through our emergency department.