Rotations
This rotation occurs at Cedars Sinai Hospital in Los Angeles during the PGY-2 year. For 4 weeks the resident functions as a member of the CCU team. Call is every fourth night. Residents gain invaluable experience dealing with myocardial infarction, cardiogenic shock, the entire gamut of arrythmias, 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 everyday. 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.
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. The resident functions as the senior resident on a team consisting of one resident and one intern. Call is every third night. 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 is a weekly ethics session in which pertinent cases or controversial issues regarding end-of-life decisions are discussed.
Trauma Surgery
There are two 4 week rotations done during the PGY-2 year (total of 8 weeks). As a PGY-2, the EM resident responds to all trauma activations with a senior surgeon. The PGY-2 is responsible for all procedures to be done 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
Internal Medicine
The medicine service admits patients to the direct observation unit, med/surg, and telemetry floors. Each team consists of a senior medicine resident and two interns. Medicine lectures are given daily at noon.
Orthopedic Surgery
The resident spends 4 weeks during the PGY-2 year on the Orthopedic Surgery service caring for patients in the clinic, on the inpatient wards and in the operating room. Call is every other to every third night and is taken from home. 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.
Pediatrics
The pediatric experience at KMC is considered one of the stronger points of the program. Between the 8 weeks of dedicated pediatrics during the PGY-2 year 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. Call duty starts at 5 pm, ends at 8 am, and is taken every fourth night. Two of the eight weeks is spent in the NICU where the resident works side by side with the 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.
Neurosurgery
Neurosurgery is done during the PGY-3 year. Call occurs every other night and is taken from home. 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 a 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.