Rotations
PGY -1
Emergency Department 12 weeks
Internal Medicine 8 weeks
Cardiac Care Unit 4 weeks
Trauma Surgery 4 weeks
General Surgery 4 weeks
Pediatrics 4 weeks
Orthopedic/Psychiatry 4 weeks
Ob/Gyn 4 weeks
Anesthesia/Radiology 4 weeks
Vacation 4 weeks
PGY-2
Emergency Department 24 weeks
Intensive Care Unit 4 weeks
Trauma Surgery 4 weeks
Pediatrics 4 weeks
Neurosurgery 4 weeks
EMS/Administration 4 weeks
Elective 4 weeks
Vacation 4 weeks
PGY-3
Emergency Department 40 weeks
Intensive Care Unit 4 weeks
Elective (PICU) 4 weeks
Vacation 4 weeks
PGY-4
Emergency Department 40 weeks
Electives 8 weeks
Vacation 4 weeks
Cardiac Care Unit
The CCU rotation occurs at Cedars Sinai Hospital in Los Angeles during the PGY-1 year. For 4 weeks the resident functions as a member of the CCU team. Residents gain invaluable experience managing acute myocardial infarction, cardiogenic shock, arrythmias, congestive heart failure, and the cardiac transplant patient. The service is busy and most patients have multiple medical problems. Our residents often find themselves running the multiple code blue resuscitations that occur daily. There is more than ample opportunity to place central lines, PA catheters, and to intubate patients. The CCU often takes overflow from the MICU, so the experience here is not limited to just the cardiac patient. Didactic sessions occur at least twice a day, in addition to the teaching that occurs during work rounds. While in Los Angeles, the resident can stay in a private Westwood apartment that is maintained by the KMC residency program. Meals and parking are paid for at the hospital. Call is every third night.
Intensive Care Unit
There are two 4-week rotations on the MICU service, one during the PGY-2 year and the second during the PGY-3 year. During both rotations, the resident functions as the senior resident on a team consisting of one resident and one intern. During this rotation the resident manages critically ill patients on a closed MICU. This is a prime opportunity for the resident to fine tune the subtleties of ventilator management. Like the CCU rotation, opportunities for critical care procedures are abundant during these 8 weeks. Teaching rounds occur on a daily basis. In addition, there are weekly ethics sessions in which pertinent cases or controversial issues regarding end-of-life decisions are discussed. Call is every fourth night.
Trauma Surgery
There are two 4-week rotations on Trauma Surgery, one during the PGY-1 year and the second during the PGY-2 year. During the 8 weeks, the EM resident responds to all trauma activations with a senior surgeon. The EM resident is responsible for all procedures during the resuscitation such as chest tubes, diagnostic peritoneal lavages, central lines, etc. The EM resident also works as an integral member of the team by caring for inpatients (both in the SICU and on the floor), seeing clinic patients, and answering consults from the Emergency Department. EM residents are not expected to scrub-in for operating room cases, but are welcome to do so if they desire. There is no overnight call.
Orthopedic Surgery
The EM resident spends 4 weeks during the PGY-1 year on the Orthopedic Surgery service caring for patients in the clinic, on the inpatient wards, and in the operating room. There is no orthopedic surgery residency program at KMC, so our residents are at liberty to gain experience with fracture reduction, casting, splinting, traction devices, tendon repair, and operative fixation directly under the guidance of the orthopedic attendings. There is no overnight call.
Pediatrics
The pediatric experience at KMC is considered one of the stronger points of the program. There are two 4-week rotations on the Pediatric Service, one during the PGY-1 year and the second during the PGY-2 year. Between the 8 weeks of dedicated pediatrics and the mix of pediatrics seen in the main ED, our residents see far more children than is required by the RRC for an EM training program. Two of the eight weeks are spent in the NICU, where the resident works side by side with neonatologists learning neonatal resuscitation and intravenous access. The pediatric attendings in general are eager to teach. Didactic sessions occur daily from 8 to 9 am. Call is, on average, every third night, starting at 5 pm until 8 am the next morning.
Neurosurgery
The Neurosurgery rotation is during the PGY-2 year. Residents work very closely with the neurosurgical attendings during this month, caring for patients on both an inpatient and outpatient basis. The attendings are notoriously hard working and encourage residents to contact them at any hour of the day to answer questions. Inquisitive and dedicated residents have found that the teaching occurs literally 24 hours per day. Vital emergency skills learned on this rotation include interpretation of CT scans, management of subarachnoid hemorrhage, acute stabilization of the spinal injury patient, and skull trephination for epidural bleeds. There is no overnight call.